Expense Report - Excel

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					DANE COUNTY DEPARTMENT OF HUMAN SERVICES                               PROVIDER AGENCY EXPENSE REPORT THROUGH:

Provider Name:                                                                     Contract #:                                  *Provider Certified By:
Program Name:                                                                Program Group #:                                                                                                   Date

                                                         1                       2                           3                                4                           5                       6
                                                     Approved                  YTD                          YTD                             YTD                         YTD                     YTD
                                                   County-Funded           County-Funded               County-Funded              County-Funded Expense             County-Funded            % Variance
                                                      Budget               Admin Expense              Program Expense               Total ( = Col. 2 + 3)              Budget                from Budget
A.PERSONNEL
  Salaries                                                                                                                                                0
  Taxes                                                                                                                                                   0
  Benefits                                                                                                                                                0
                        Subtotal A                                 0                         0                              0                             0                              0                  #DIV/0!
B.OPERATING
  Insurance                                                                                                                                               0
  Professional Fees                                                                                                                                       0
  Audit                                                                                                                                                   0
  Data Processing Fees                                                                                                                                    0
  Postage, Office, and Program Supplies                                                                                                                   0
  Equipment/Furnishings                                                                                                                                   0
  Depreciation                                                                                                                                            0
  Telephone                                                                                                                                               0
  Training/Conference                                                                                                                                     0
  Food/Household Supplies                                                                                                                                 0
  Auto Allowance                                                                                                                                          0
  Vehicle Costs                                                                                                                                           0
  Other1:                                                                                                                                                 0
  Other2:                                                                                                                                                 0
                        Subtotal B                                 0                         0                              0                             0                              0                  #DIV/0!
C.SPACE
  Rent                                                                                                                                                    0
  Utilities                                                                                                                                               0
  Maintenance                                                                                                                                             0
  Mortgage Interest, Depreciation,                                                                                                                        0
  Property Taxes                                                                                                                                          0
                        Subtotal C                                 0                         0                              0                             0                              0                  #DIV/0!
D.SPECIAL COSTS
  Assistance to Individuals                                                                                                                               0
                        Subtotal D                                 0                         0                              0                             0                              0                  #DIV/0!
E.OTHER
  Other3:                                                                                                                                                 0
  Other4:                                                                                                                                                 0
                        Subtotal E                                 0                         0                              0                             0                              0                  #DIV/0!
This section for Adult - DD only.
F. OFF-SETTING REVENUE
  Show as negative numbers:
  Government Benefits (SSI, SSDI, etc.)                                                                                                                    0
  Private Pay (Trust Funds, etc.)                                                                                                                          0
  Cost Share                                                                                                                                               0
  Other                                                                                                                                                    0
                        Subtotal F                       0                               0                                 0                               0                             0                  #DIV/0!
        TOTAL A THROUGH F                                0                               0                                 0                               0                             0                  #DIV/0!
                                   *CERTIFICATION: I certify the expenses listed above are true, correct, and allowable, in the amount stated and have not been reimbursed heretofore.
          775cbe2e-18de-49a8-a964-390e6ee7fefa.xls - Exp Report                                                                                                                               Page 1 of 2
                                                          DANE COUNTY DEPARTMENT OF HUMAN SERVICES
                                                 EXPENSE REPORTS MUST BE PRESENTED USING THE ATTACHED FORMAT

                                                                                    Expense Report Instructions

                                      Provider
                                      Name            Enter legal name per current Dane County Contract Agreement.

                                      Program
                                      Name            Enter name of the program identified in your current Dane County Contract Agreement.

                                      Contract # Enter the current contract number.

                                      Program         Enter the current Program Group number provided by Dane County staff. It can be found on the
                                      Group #         Program Summary Form of the contract.

                                      Column 1        Approved County-Funded Budget. Use amounts from the County-funded column of the
                                                      approved (i.e., signed by both parties to the contract) program budget.

                                      Column 2        Year-to-Date County-Funded Admin Expense. Using the County’s definition of Admin, report
                                                      year-to-date County-funded Admin expenses in this column.

                                      Column 3        Year-to-Date County-Funded Program Expense. Using the County’s definition of Program,
                                                      report year-to-date County-funded Program expenses in this column.

                                      Column 4        Year-to-Date County-Funded Expense Total. This column is the sum of the expenses reported
                                                      in columns 2 and 3.

                                      Column 5        Year-to-Date County-Funded Budget. Assuming this is a 12-month program, divide column 1 by
                                                      12; then, multiply the result by the number of months that have elapsed in the contract period. For
                                                      example: If this is the expense report for May, the YTD budget column is determined by dividing
                                                      column 1 by 12 and multiplying by 5.

                                      Column 6        Year-to-Date % Variance from Budget. For each of the account categories (Personnel,
                                                      Operating, Space, Special Costs, Other, Off-setting Revenue), compute the percentage that year-to-
                                                      date expenses (Column 4) vary from the year-to-date budget (Column 5). Use one of the two
                                                      methods described below to find the percent. (Please round to two decimal places.) The Excel
                                                      Spreadsheet has this formula built in.

                                      Method I
                                      A.              Subtract year-to-date total expenses (Column 4) from year-to date budget (Column 5).

                                      B.              Divide this difference by the year-to-date budget (Column 5).

                                      C.              Multiply the result of Step B by 100 to give the percent variance from budget.

                                      Method II
                                      A.              Divide the year-to-date total expense (Column 4) by the year-to-date budget (Column 5).

                                      B.              Multiply the result by 100.

                                      C.              Subtract this result from 100. This is the percent variance from budget.




775cbe2e-18de-49a8-a964-390e6ee7fefa.xls - Exp Report Instructions                                                                                          Page 2 of 2

				
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