3707 Meals on Wheels Spreadsheet 2012 by T29G78H

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									               9/28/2012 11:24 PM                                                                             Submission #   7/27/2012   101ƒ
                                             Department of Aging and Disability Serv ices
                                                       Uniform Rate Negotiation Workbook/Budget
                                                Federal Contract Period:               10-01-12 / 09-30-13
                                                               Common Provider
1                             Nutrition Providers Legal Business Name:       Nueces County
2                                                         Street Address:    4540 FM 892
3                                                       Mailing Address:     4540 FM 892
4                                                                    City:   Robstown
5                                                              Zip Code:     78380
6                                                         Phone Number:      361-387-5445
7                                                        E-mail Address:     edward.herrera@co.nueces.tx.us
8                                                         Contact Name:      Edward Herrera
9                                    Nutrition Providers website address:


# Did this Nutrition provider complete a rate setting workbook last year?               Yes
# If Yes what was the provider name listed on the workbook?               Nueces County Community Servives

# Is the Provider a AAA Provider?                  Yes
# If Yes, select the AAA Name:                              Area Agency on Aging of the Coastal Bend
# If Yes, contact name at AAA:                     Betty Lamb
# If Yes, is it a contract or vendor relationship?            Vendor
# Is the Provider a DADS Community Services Provider?                     Yes
# If Yes, Contract Manager name at DADS Community Services:               Arnulfo Marquez
# If Yes, select the DADS Region Number:                             Region 11
# If Yes, enter the DADS contract number:                                         167600

  Service Delivery Information
  Home Delivered Meals
# Does this Nutrition provider serve home delivered meals paid for by DADS or the AAA?                           Yes
# Does this Nutrition provider have an approved Home Delivered Nutrition Waiver for 2012?                        Yes
# Is this Nutrition provider requesting a Home Delivered Nutrition Waiver for 2013?                   Yes
# Total number of home delivered meal routes for this provider:                           5
# Total number of meal preparation sites used by this provider:                           1

  Congregate Meals
# Does this Nutrition provider serve congregate meals paid for by the AAA?                            Yes
# Does this Nutrition provider have an approved Congregate Nutrition Waiver for 2012?                 No
# Is this Nutrition provider requesting a Congregate Waiver for 2013?                                 No
# Total number of meal preparation sites used by this provider:                              1
# Total number of meal sites used by this provider:                                          5




                                                               Area
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Alamo
    Yes                                                        Area
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of Ark-
    No                                                         Tex                      Region 1/10
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of Bexar
                                                               County                   Region 2/9
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of Brazos
    Contract                                                   Valley                   Region 3
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Capital
    Vendor                                                     Area                     Region 4
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of Central
                                                               Texas                    Region 5
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Coastal
                                                               Bend
                                                               Area                     Region 6
                                                               Agency
                                                               on Aging
                                                               of
                                                               Concho
                                                               Valley                   Region 7
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of Dallas
                                                               County
                                                               Area                     Region 8
                                                               Agency
                                                               on Aging
                                                               of Deep
                                                               East
                                                               Texas                    Region 11
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of East
                                                               Texas
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Golden
                                                               Crescent
                                                               Region
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of Harris
                                                               County
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Heart of
                                                               Texas
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of
                                                               Houston-
                                                               Galvesto
                                                               n
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Lower Rio
                                                               Grande
                                                               Valley
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Middle
                                                               Rio
                                                               Grande
                                                               Area
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of North
                                                               Central
                                                               Texas
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of North
                                                               Texas
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Panhandl
                                                               e Area
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of the
                                                               Permian
                                                               Basin
                                                               Agency
                                                               on Aging
                                                               of the Rio
                                                               Grande
                                                               Area
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of
                                                               Southeas
                                                               t Texas
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of South
                                                               Plains
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of South
                                                               Texas
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of Tarrant
                                                               County
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of
                                                               Texoma
                                                               Area
                                                               Agency
                                                               on Aging
                                                               of West
                                                               Central
                                                               Texas
                                                  Provider Total Budget by Service
                                                       Provider Name:                                      Nueces County                                                    AAA Name: Area Agency on Aging of the Coastal Bend
                                                   9/28/2012 11:24 PM                                                                                                   Region Number: Region 11
                                                                                                                                                                                                                                                                      If applicable
                                                                                               Home         Nutrition        Nutrition                 Other Meal        Agency Budget                                                                             replace with title
                                                                            Total Agency     Delivered    Education -       Education   Congregate     Programs         not Applicable to    Participant                         Center          Other Local        of other agency     Balance not
                               Cost Area                                       Budget       Meal Program AAA Clients       RLS Clients Meal Program   (non-DADS)            Programs        Assessment         Transportation   Operations        Projects               program         budgeted
                                                                                                  Personnel
Salaries (Identified by Job Title)
                                                                Director        72,114.00                                                                                                                                          36,057.00        36,057.00                                     -
                                                      Assistant Director        38,685.92       2,410.20         483.58                    7,230.60         723.06                                1,831.75                         25,903.39           103.34                                     -
                                        Community Services Specialist           29,724.00       1,814.80                                                  1,814.80                                                                 10,815.08        15,279.32                                     -
                                        Meal Site Manager Agua Dulce            31,280.34       1,903.20         391.01                    7,612.80         418.70                                1,484.50           3,425.76      10,828.50         5,215.87                                     -
                                         Meal Site Manager Banquete             31,040.36       1,903.20         387.26                    5,709.60         418.70                                1,484.50           3,045.12      11,311.05         6,780.93                                     -
                                            Meal Site Manager Bishop            30,381.00       1,903.20         379.77                    7,612.80         418.70                                1,446.43           3,806.40      10,244.81         4,568.89                                     -
                                           Meal Site Manager Driscoll           31,040.36       1,903.20         388.01                    5,709.60         418.70                                1,484.50           1,903.20      12,639.11         6,594.04                                     -
                                                          Menu Planner          23,229.18                                                                                                                                          23,229.18                                                      -
                                                                   Cook         25,626.04      13,649.61                                   9,980.36       1,996.07                                                                                                                                -
                                                           Cook Helper          22,361.30      12,452.70                                   8,569.60       1,339.00                                                                         -                                                      -
                                                  Van Driver Robstown           24,346.50      12,303.20                                          -       2,306.85                                                   6,151.00       1,379.24         2,206.21                                     -
                                                  Van Driver Robstown           24,346.50      12,303.20                                          -       2,306.85                                                   6,151.00       1,379.24         2,206.21                                     -
                                                     Intermediate Clerk         21,924.00                                                                                                                                          21,924.00                                                      -
                                                 Activities Coordinator         29,030.00                                                                                                                                          29,030.00                                                      -
                                                       Custodian/Driver         24,260.60       6,021.60                                         -        1,204.32                                                                  9,097.74         7,936.94                                     -
                                     Temporaries (2) Van Driver/Elderly         23,200.82      13,722.80                                                    640.90                                                                  8,837.12                                                      -
                                        Temporaries (2) Cook Helpers               301.60         113.10                                    113.10           75.40                                                                                                                                -
                                                                                                                                                                                                                                                                                                  -
                                                       Total Salaries          482,892.52      82,404.01        2,029.63            -     52,538.46      14,082.05                     -          7,731.68          24,482.48     212,675.46        86,948.75                      -              -
Payroll Taxes & Benefits (Employer Paid)
                           Federal Insurance compensation Act (FICA)            24,584.94       4,916.98         105.71                    3,454.18         646.58                                  400.73           2,060.21       9,049.71         3,950.84                                     -
                     Texas Unemployment Compensation Act (TUCA)                                                                                                                                                                                                                                   -
                              Federal Unemployment Tax Act (FUTA)                1,060.14         212.12           4.55                      148.94          27.88                                   17.28              88.83         390.23           170.31                                     -
                                              Workers Compensation               1,979.44         395.88           8.51                      278.11          52.05                                   32.26             165.87         728.63           318.13                                     -
                                                   Health Insurance             61,787.39      12,357.47         265.68                    8,681.12       1,625.00                                1,007.13           5,177.78      22,743.93         9,929.28                                     -
                                                         Retirement             39,534.17       7,906.83         169.99                    5,554.55       1,039.74                                  644.40           3,312.96      14,552.52         6,353.18                                     -
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                          Total Payroll Taxes & Benefits (Employer Paid)       128,946.08      25,789.28         554.44             -     18,116.90       3,391.25                     -          2,101.80          10,805.65      47,465.02        20,721.74                      -              -
Contract staff (Identify by Position)
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                     Total Contract staff               -              -            -               -             -              -                     -                 -                  -              -                -                      -              -
Total Personnel                                                                611,838.60     108,193.29     2,584.07               -     70,655.36      17,473.30                     -          9,833.48          35,288.13     260,140.48       107,670.49                      -              -
                                                                                          Professional Development
Conference (list Conference & Attendees)
                                 CB Hurricane (At least one key staff)              45.00          22.50                                      22.50                                                                                                                                               -
                                                                                                                                                                                                                                                                                                  -
                                                     Total Conferences              45.00          22.50              -             -         22.50                 -                  -                   -                -                -                 -                   -              -
Dues (list Organization Name)
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                             Total Dues                -               -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Materials (list Items)
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                         Total Materials                -              -              -             -             -                 -                  -                   -                -                -                 -                   -              -
Total Professional Development                                                      45.00          22.50              -             -         22.50                 -                  -                   -                -                -                 -                   -              -
                                                     Provider Total Budget by Service
                                                          Provider Name:                                   Nueces County                                                    AAA Name: Area Agency on Aging of the Coastal Bend
                                                      9/28/2012 11:24 PM                                                                                                Region Number: Region 11
                                                                                                                                                                                                                                                                      If applicable
                                                                                               Home        Nutrition         Nutrition                 Other Meal        Agency Budget                                                                             replace with title
                                                                            Total Agency     Delivered    Education -       Education   Congregate     Programs         not Applicable to    Participant                         Center          Other Local        of other agency     Balance not
                               Cost Area                                       Budget       Meal Program AAA Clients       RLS Clients Meal Program   (non-DADS)            Programs        Assessment         Transportation   Operations        Projects               program         budgeted
                                                                                                 Meals/Food
Raw Food
                                                                               112,300.99      65,337.52                                  35,847.63      11,115.84                                                                                             -                                  -
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                     Total Raw Food            112,300.99      65,337.52              -             -     35,847.63      11,115.84                     -                   -                -                -                 -                   -              -
Purchased Meals
      Hot Prepared Meals Purchased from a Supplier or Central Kitchen           16,285.39       4,076.12                                         -          862.24                                                                                  11,347.03                                     -
                                                       Frozen Meals                                                                                                                                                                                                                               -
                                                       Chilled Meals                                                                                                                                                                                                                              -
                                                  Shelf Stable Meals             4,938.36       2,873.17                                   1,576.38         488.81                                                                                                                                -
                                             Total Purchased Meals              21,223.75       6,949.29              -             -      1,576.38       1,351.05                     -                   -                -                -      11,347.03                      -              -
Freight
                                                                                  350.00          198.80                                    117.77           33.43                                                                                                                                -
                                                                                                                                                                                                                                                                                                  -
                                                            Total Freight         350.00          198.80              -             -       117.77           33.43                     -                   -                -                -                 -                   -              -
Storage Cost (Food or Supply)
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                   Total Storage Cost                  -               -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Consumables (identify by type)
                    Non-Capital Equipment (less that $5,000 per item)                                                                                                                                                                                                                             -
                    Paper/plastic goods (napkins, plates, utensils, etc)         3,397.02       1,976.41                                   1,084.36         336.25                                                                                                                                -
                                  Meal Delivery Consumable Supplies              7,023.85       6,040.51                                                    983.34                                                                                                                                -
                                          Pots/Pans/Cooking Utensils                                                                                                                                                                                                                              -
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                      Total Consumables         10,420.87       8,016.92              -             -      1,084.36       1,319.59                     -                   -                -                -                 -                   -              -
Other (Identify Individually all items over $100.)
                                                                                                                                                                                                                                                                                                  -
                                                                                                                                                                                                                                                                                                  -
                                                              Total Other               -              -              -             -             -              -                     -                   -                -                -              -                      -              -
Total Meals/Food                                                               144,295.61      80,502.53              -             -     38,626.14      13,819.91                     -                   -                -                -      11,347.03                      -              -
                                                    Provider Total Budget by Service
                                                         Provider Name:                                      Nueces County                                                    AAA Name: Area Agency on Aging of the Coastal Bend
                                                     9/28/2012 11:24 PM                                                                                                   Region Number: Region 11
                                                                                                                                                                                                                                                                        If applicable
                                                                                                  Home        Nutrition        Nutrition                 Other Meal        Agency Budget                                                                             replace with title
                                                                               Total Agency     Delivered   Education -       Education   Congregate     Programs         not Applicable to    Participant                         Center          Other Local        of other agency     Balance not
                              Cost Area                                           Budget       Meal Program AAA Clients      RLS Clients Meal Program   (non-DADS)            Programs        Assessment         Transportation   Operations        Projects               program         budgeted
                                                                                                     Equipment
Depreciation (identify item, year purchased, cost)
                                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                                    -
                                                       Total Depreciation                 -              -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Interest (Identify Item, year purchased, cost)
                                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                                    -
                                                             Total Interest               -              -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Leasing (identify Item, year leased)
                                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                                    -
                                                            Total Leasing                 -              -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Maintenance (Identify Item, year purchased, cost)
                                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                                    -
                                                       Total Maintenance                  -             -               -             -            -                  -                  -                   -                -                -                 -                   -              -
Total Equipment                                                                           -             -               -             -            -                  -                  -                   -                -                -                 -                   -              -
                                                                                                Occupancy/Building
Rent
                                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                                    -
                                                                Total Rent                -              -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Utilities
                                                                                   98,042.25       8,807.60                                  7,527.74       2,410.93                                                                 79,295.98                                                      -
                                                                                                                                                                                                                                                                                                    -
                                                             Total Utilities       98,042.25       8,807.60             -             -      7,527.74       2,410.93                     -                   -                -      79,295.98                   -                   -              -
Depreciation (identify item, year purchased, cost)
                                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                                    -
                                                       Total Depreciation                 -              -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Mortgage Interest
                                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                                    -
                                                   Total Mortgage Interest                -              -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Insurance (identify type of insurance)
                                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                                    -
                                                          Total Insurance                 -              -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Security
                                                            ADT Security            1,373.76         159.85                                     87.70          27.20               137.38                                               961.63                -                                     -
                                                 Koetter Fire Proctection           2,067.50                                                                                                                                                           2,067.50                                     -
                                                      Firetrol Protection             233.95                                                                                                                                                             233.95                                     -
                                                                                                                                                                                                                                                                                                    -
                                                            Total Security          3,675.21         159.85             -             -         87.70          27.20               137.38                    -                -         961.63         2,301.45                      -              -
Janitorial
                                                           Admiral Linen            9,364.23         544.82                                   298.92           92.69                                                                                   8,427.80                                     -
                                                                                                                                                                                                                                                                                                    -
                                                            Total Security          9,364.23         544.82             -             -       298.92           92.69                     -                   -                -                -       8,427.80                      -              -
Repair (Identify all items over $100.)
                                                     Jean's Restaurant                393.13          45.75                                    25.10            7.78                                                                                     314.50                                     -
                                                   Jones Refrigeration              8,358.95         972.66                                   533.65          165.48                                                                                   6,687.16                                     -
                                                      Pokie's Plumbing              2,560.00         297.89                                   163.44           50.68                                                                                   2,047.99                                     -
                                                          A & M Electric            1,498.85         174.41                                    95.69           29.67                                                                                   1,199.08                                     -
                                                      ABC Keys & Safe                 485.00          56.44                                    30.96            9.60                                                                                     388.00                                     -
                                                 Annaville Air Condition            1,776.00         206.66                                   113.38           35.16                                                                                   1,420.80                                     -
                                                            Home Depot                558.03          64.93                                    35.63           11.05                                                                                     446.42                                     -
                                                                  Butler              533.08          62.03                                    34.03           10.55                                                                                     426.47                                     -
                                                             Division 16              335.00          38.98                                    21.39            6.63                                                                                     268.00                                     -
                                               Provider Total Budget by Service
                                                     Provider Name:                                Nueces County                                                  AAA Name: Area Agency on Aging of the Coastal Bend
                                                 9/28/2012 11:24 PM                                                                                           Region Number: Region 11
                                                                                                                                                                                                                                                        If applicable
                                                                                           Home       Nutrition      Nutrition                 Other Meal    Agency Budget                                                                           replace with title
                                                                       Total Agency      Delivered   Education -    Education   Congregate     Programs     not Applicable to    Participant                         Center          Other Local      of other agency     Balance not
                               Cost Area                                  Budget        Meal Program AAA Clients   RLS Clients Meal Program   (non-DADS)        Programs        Assessment         Transportation   Operations        Projects             program         budgeted
                                                 Paredez Plumbing              650.00          75.63                                  41.50           12.87                                                                                 520.00                                  -
                                                        JC Tronics             157.50          18.33                                  10.06            3.12                                                                                 125.99                                  -
                                     Dependable Home Replacement             5,957.76         693.25                                 380.36          117.94                                                                              4,766.21                                   -
                                                  Stallion Builders          1,475.00         171.63                                  94.17           29.20                                                                              1,180.00                                   -
                                                                                                                                                                                                                                                                                    -
                                                        Total Repair       24,738.30        2,878.59           -            -      1,579.36         489.73                 -                   -                -                -      19,790.62                    -              -
Taxes (Identify Type of Tax)
                                                                                                                                                                                                                                                                                    -
                                                                                                                                                                                                                                                                                    -
                                                        Total Taxes                -               -           -            -             -               -                -                   -                -              -                -                    -              -
Total Occupancy/Building                                                  135,819.99       12,390.86           -            -      9,493.72        3,020.55           137.38                   -                -      80,257.61        30,519.87                    -              -
                                                 Provider Total Budget by Service
                                                      Provider Name:                                     Nueces County                                                    AAA Name: Area Agency on Aging of the Coastal Bend
                                                  9/28/2012 11:24 PM                                                                                                  Region Number: Region 11
                                                                                                                                                                                                                                                                    If applicable
                                                                                             Home         Nutrition        Nutrition                 Other Meal        Agency Budget                                                                             replace with title
                                                                          Total Agency     Delivered    Education -       Education   Congregate     Programs         not Applicable to    Participant                         Center          Other Local        of other agency     Balance not
                              Cost Area                                      Budget       Meal Program AAA Clients       RLS Clients Meal Program   (non-DADS)            Programs        Assessment         Transportation   Operations        Projects               program         budgeted
                                                                                          Transportation/Travel
Mileage Reimbursement
                                                                                                                                                                                                                                                                                                -
                                                                                                                                                                                                                                                                                                -
                                          Total Mileage Reimbursement                -               -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Delivery
                                                                                                                                                                                                                                                                                                -
                                                                                                                                                                                                                                                                                                -
                                                        Total Delivery               -               -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Gas & Oil
                                                                              33,606.11      15,266.69                                   2,881.55       2,774.88                                                   5,620.16       7,062.83                                                      -
                                                                                                                                                                                                                                                                                                -
                                                       Total Gas & Oil        33,606.11      15,266.69              -             -      2,881.55       2,774.88                     -                   -         5,620.16       7,062.83                   -                   -              -
Repairs (Identify Item & year purchased)


                                            Ford Van - Unit 68 - 2001          1,041.45         473.11                                     89.30           85.99                                                     177.27         215.78                                                      -
                                            Ford Van - Unit 73 - 1995            540.59         245.58                                     46.35           44.64                                                      92.01         112.01                                                      -
                                            Ford Van - Unit 74 - 2005          2,409.86       1,094.76                                    206.63          198.98                                                     410.19         499.30                                                      -
                                            Ford Van - Unit 76 - 2006            488.76         222.04                                     41.91           40.36                                                      83.19         101.26                                                      -
                                            Ford Van - Unit 77 - 2006          1,733.70         787.59                                    148.66          143.15                                                     295.10         359.20                   -                                  -
                                            Ford Van - Unit 78 - 2008            723.19         328.53                                     62.01           59.71                                                     123.10         149.84                                                      -
                                           Chevy Van - Unit 79 - 2009            181.60          82.50                                     15.57           14.99                                                      30.91          37.63                                                      -
                                                                                                                                                                                                                                                                                                -
                                                         Total Repair          7,119.15       3,234.11              -             -       610.43          587.82                     -                   -         1,211.77       1,475.02                   -                   -              -
Insurance (identify type of insurance)
                    Texas Association of Counties County Gov. Risk             4,618.00                                                                                                                                           2,323.31         2,294.69                                     -
                                                   Management Pool                                                                                                                                                                                                                              -
                                                     Total Insurance           4,618.00              -              -             -            -                  -                  -                   -                -       2,323.31         2,294.69                      -              -
Depreciation/Lease (identify item, year purchased, cost)
                                                                                                                                                                                                                                                                                                -
                                                                                                                                                                                                                                                                                                -
                                                    Total Depreciation               -               -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Interest
                                                                                                                                                                                                                                                                                                -
                                                                                                                                                                                                                                                                                                -
                                                         Total Interest              -               -              -             -            -                  -                  -                   -                -                -                 -                   -              -
Tags & Licenses
                                                                                                                                                                                                                                                                                                -
                                                                                                                                                                                                                                                                                                -
                                                Total Tags & Licenses                 -              -              -             -             -              -                     -                   -                -              -                -                      -              -
Total Transportation/Travel                                                   45,343.26      18,500.80              -             -      3,491.98       3,362.70                     -                   -         6,831.93      10,861.16         2,294.69                      -              -
                                               Provider Total Budget by Service
                                                    Provider Name:                                     Nueces County                                                    AAA Name: Area Agency on Aging of the Coastal Bend
                                                9/28/2012 11:24 PM                                                                                                  Region Number: Region 11
                                                                                                                                                                                                                                                                   If applicable
                                                                                          Home         Nutrition         Nutrition                 Other Meal        Agency Budget                                                                              replace with title
                                                                         Total Agency   Delivered     Education -       Education   Congregate     Programs         not Applicable to    Participant                          Center          Other Local        of other agency     Balance not
                            Cost Area                                       Budget     Meal Program AAA Clients        RLS Clients Meal Program   (non-DADS)            Programs        Assessment         Transportation    Operations        Projects               program         budgeted
                                                                                      Administrative & General
Advertising
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                                    Total Advertising               -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Printing
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                                       Total Printing               -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Copying
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                                       Total Copying                -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Office Supplies
                                                                              8,878.37      1,033.10                                    566.81          175.76                                                     887.84        6,214.86                   -                                  -
                                                                                                                                                                                                                                                                                               -
                                                Total Office supplies         8,878.37      1,033.10              -             -       566.81          175.76                     -                   -           887.84        6,214.86                   -                   -              -
Contractual Agreements
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                        Total Contractual Agreements                -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Postage
                                                                                 98.66         11.48                                       6.30           1.95                                         -              9.87          69.06                   -                                  -
                                                                                                                                                                                                                                                                                               -
                                                       Total Postage             98.66         11.48              -             -          6.30           1.95                     -                   -             9.87           69.06                   -                   -              -
Telecommunications
                                                          Landlines           5,900.71        686.62                                    376.71          116.81                                                     590.07        4,130.50                   -                                  -
                                             Cell phones and pagers           2,673.77        311.12                                    170.70           52.93                                                     267.38        1,871.64                   -                                  -
                                            Total Telecommunication           8,574.48        997.74              -             -       547.41          169.74                     -                   -           857.45        6,002.14                   -                   -              -
Liability Insurance
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                             Total Liability Insurance              -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Legal Fees
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                                    Total Legal Fees                -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Accounting Fees
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                               Total Accounting Fees                -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Consulting Fees
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                               Total Consulting Fees                -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Other Fees (Explain)
                                                      Culligan Water          1,024.00        119.15                                      65.37          20.27                                                     102.40          716.81                   -                                  -
                                                                                                                                                                                                                                                                                               -
                                                    Total Other Fees          1,024.00        119.15              -             -         65.37          20.27                     -                   -           102.40          716.81                   -                   -              -
Audit
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                                          Total Audit               -              -              -             -            -                  -                  -                   -                -                 -                 -                   -              -
Other Misc. (Explain)
                                                                                                                                                                                                                                                                                               -
                                                                                                                                                                                                                                                                                               -
                                                    Total other Misc.                -             -              -             -             -              -                     -                   -                -               -                   -                   -              -
Total Administrative & General                                               18,575.51      2,161.47              -             -      1,185.89         367.72                     -                   -         1,857.56       13,002.87                   -                   -              -
                                                 Provider Total Budget by Service
                                                      Provider Name:                              Nueces County                                                      AAA Name: Area Agency on Aging of the Coastal Bend
                                                  9/28/2012 11:24 PM                                                                                             Region Number: Region 11
                                                                                                                                                                                                                                                       If applicable
                                                                                         Home         Nutrition      Nutrition                 Other Meal         Agency Budget                                                                     replace with title
                                                                        Total Agency    Delivered    Education -    Education   Congregate     Programs          not Applicable to    Participant                       Center       Other Local     of other agency     Balance not
                             Cost Area                                     Budget     Meal Program AAA Clients     RLS Clients Meal Program   (non-DADS)             Programs        Assessment       Transportation   Operations     Projects            program         budgeted
                                                                                               Total
Total of all Cost Areas                                                    955,917.97   221,771.45     2,584.07              -   123,475.59         38,044.18             137.38           9,833.48        43,977.62    364,262.12     151,832.08                   -              -
Percentage of Total Cost                                                  100.000%      23.200%       0.270%        0.000%       12.917%          3.980%             0.014%            1.029%            4.601%        38.106%        15.883%           0.000%
                                                                         Budgeted Meals
                       Provider Prepared Meals
                                                           Hot Meals           71,674        41,536                                  23,068             7,070
                                                       Frozen Meals                 -
                                                       Chilled Meals                -
                                                  Shelf Stable Meals
                                     Total Provider Prepared Meals             71,674        41,536                                  23,068             7,070
                        Purchased Meals
      Hot Prepared Meals Purchased from a Supplier or Central Kitchen             591           508                                                         83
                                                       Frozen Meals                 -
                                                       Chilled Meals                -
                                                  Shelf Stable Meals            1,940         1,129                                     619               192
                                             Total Purchased Meals              2,531         1,637                                     619               275

Total Budgeted Meals                                                           74,205        43,173                                  23,687             7,345
% of Total Meals                                                                               58%                                     32%               10%
Whole Unit Rate                                                                                5.18                                    5.25   $          5.18
AAA Contractors/Vendors may choose to provide required Nutrition Education as a separate service and
exclude costs related to Nutrition Education from the meal rate.
        If the cost of Nutrition Education is to be provided as a separate service, enter an N
to exclude Nutrition Education costs from the meal rate.

                                                                                         66,860.00
                                                                                HDM            65%
                                                                                 CM            35%
            Provider Total Budget by Service
                 Provider Name:                             Nueces County                                                AAA Name: Area Agency on Aging of the Coastal Bend
             9/28/2012 11:24 PM                                                                                      Region Number: Region 11
                                                                                                                                                                                                       If applicable
                                                    Home       Nutrition      Nutrition                 Other Meal    Agency Budget                                                                 replace with title
                                  Total Agency    Delivered   Education -    Education   Congregate     Programs     not Applicable to    Participant                     Center      Other Local    of other agency     Balance not
Cost Area                            Budget      Meal Program AAA Clients   RLS Clients Meal Program   (non-DADS)        Programs        Assessment     Transportation   Operations    Projects           program         budgeted
            Provider Total Budget by Service
                 Provider Name:                             Nueces County                                                AAA Name: Area Agency on Aging of the Coastal Bend
             9/28/2012 11:24 PM                                                                                      Region Number: Region 11
                                                                                                                                                                                                       If applicable
                                                    Home       Nutrition      Nutrition                 Other Meal    Agency Budget                                                                 replace with title
                                  Total Agency    Delivered   Education -    Education   Congregate     Programs     not Applicable to    Participant                     Center      Other Local    of other agency     Balance not
Cost Area                            Budget      Meal Program AAA Clients   RLS Clients Meal Program   (non-DADS)        Programs        Assessment     Transportation   Operations    Projects           program         budgeted
            Provider Total Budget by Service
                 Provider Name:                             Nueces County                                                AAA Name: Area Agency on Aging of the Coastal Bend
             9/28/2012 11:24 PM                                                                                      Region Number: Region 11
                                                                                                                                                                                                       If applicable
                                                    Home       Nutrition      Nutrition                 Other Meal    Agency Budget                                                                 replace with title
                                  Total Agency    Delivered   Education -    Education   Congregate     Programs     not Applicable to    Participant                     Center      Other Local    of other agency     Balance not
Cost Area                            Budget      Meal Program AAA Clients   RLS Clients Meal Program   (non-DADS)        Programs        Assessment     Transportation   Operations    Projects           program         budgeted




                                      Yes
                                      No
                                      NA
9/28/2012 11:24 PM
                                 Provider Name: Nueces County
                                     AAA Name: Area Agency on Aging of the Coastal Bend
                                 Region Number: Region 11
                                               Section 1
This section is used to compare the amounts budgeted/allocated to each program by cost area.
Example: What percent of the agencies personnel cost is budgeted/allocated to home delivered meals
versus congregate meals and other agency programs? The information should be used as a review tool to
gain an understanding of the agencies overall budget and operations.


                                                       Percentage of the Total Cost Area
                                                                Budgeted to:
                                                      Home
                                                     Delivered  Congregate         Other
                    Cost Area                         Meals         Meals        Programs
Total Personnel                                          17.68%       11.55%      70.77%
Total Professional Development                           50.00%       50.00%       0.00%
                                  Total Raw Food         58.18%       31.92%       9.90%
                          Total Purchased Meals          32.74%        7.43%      59.83%
                                     Total Freight       56.80%       33.65%       9.55%
                              Total Storage Cost          0.00%        0.00%       0.00%
                              Total Consumables          76.93%       10.41%      12.66%
                           Total Other Meal/Food          0.00%        0.00%       0.00%
Total Meals/Food                                         55.79%       26.77%      17.44%
Total Equipment                                           0.00%        0.00%       0.00%
Total Occupancy/Building                                  9.12%        6.99%      83.89%
Total Transportation/Travel                              40.80%        7.70%      51.50%
Total Administrative & General                           11.64%        6.38%      81.98%
Total of all Cost Areas                                  23.20%       12.92%      63.88%

Example of how to use this information:



Compare the percentage of total personnel budgeted to the meal programs and other programs. Based on
the percentages of total cost does the percentages appear reasonable and equitably distributed between
programs? If the percentages are not easily identified as equitable a further review of the salaries may be
necessary. There are many reasons for variances in percentage for example the agency may use volunteers
for some of the programs this may cause the overall percentages appear out of line.

REMEMBER: There are no right or wrong percentages. The reviewer through analysis of the budget and
discussions with the provider must determine if the allocation is acceptable.

The reviewers notes detailing budget review, discussions with the provider, and decisions made should be
included in the work file.
9/28/2012 11:24 PM
                                Provider Name: Nueces County
                                    AAA Name: Area Agency on Aging of the Coastal Bend
                                Region Number: Region 11
                                                            Section 2
This section is a summary of information to use to analyze the cost and how they are allocated between Congregate and Home Delivered
Meals. The information is presented in three different ways:
 Total Cost: Amount budgeted by cost area
 Percentage of total cost: Percentage of the total of cost area for the two meal programs applied to each program
 Cost per unit: How much of the unit cost is used to pay for each cost area. $X.XX of the cost of each meal is for XX cost area.

Below the cost area summary information is additional information showing:
 Percentage of the total budgeted meal cost applied to the home delivered and congregate meal programs
 Percentage of the total budgeted meals (home Delivered & congregate) applied to the home delivered and congregate programs.
 Whole Unit rate for each meal program
 Calculated meal rate based on information entered on the home delivered and congregate meal budget worksheets.



                                                         Total Cost             Percentage of Total Cost            Cost per unit
                                                    Home                           Home                         Home
                                                  Delivered    Congregate        Delivered Congregate          Delivered Congregate
                  Cost Area                         Meals         Meals            Meals       Meals            Meals         Meals
Total Personnel                                   108,193.29     70,655.36        60.49%        39.51%               2.51         2.98
Total Professional Development                         22.50         22.50        50.00%        50.00%               0.00         0.00
                Total Raw Food                     65,337.52     35,847.63        64.57%        35.43%               1.57         1.55   ?
               Purchased Meals
         Hot Prepared Meals Purchased from a
                   Supplier or Central Kitchen       4,076.12           -         100.00%         0.00%              8.02          -
                                 Frozen Meals             -             -          0.00%          0.00%               -            -
                                 Chilled Meals            -             -          0.00%          0.00%               -            -
                            Shelf Stable Meals       2,873.17      1,576.38       64.57%         35.43%              2.54         2.55

              Total Consumables                     8,016.92       1,084.36       88.09%         11.91%              0.19         0.05
             Total Other Meal/Food                       -              -          0.00%          0.00%               -            -
Total Meals/Food                                   80,502.53      38,626.14       67.58%         32.42%              1.86         1.63
Total Equipment                                          -              -          0.00%          0.00%               -            -
Total Occupancy/Building                           12,390.86       9,493.72       56.62%         43.38%              0.29         0.40
Total Transportation/Travel                        18,500.80       3,491.98       84.12%         15.88%              0.43         0.15
Total Administrative & General                      2,161.47       1,185.89       64.57%         35.43%              0.05         0.05
Subtotal                                          221,771.45     123,475.59       64.24%         35.76%              5.14         5.21
                           Nutrition Education      1,668.59         915.48                                          0.04         0.04
Total                                             223,440.04     124,391.07                                          5.18         5.25

Total Budgeted Cost                                221,771.45    123,475.59     345,247.04
Percentage of Total Budgeted Meal Cost                64.24%        35.76%       100.00%

Total Budgeted Meals                                    43,173       23,687        66,860
Percentage of Total Budgeted Meals                     64.57%       35.43%        100.00%

Whole Unit Rate (Full Cost per Meal)                     5.18          5.25

Calculated Rate                                          4.73          4.79
9/28/2012 11:24 PM
                               Provider Name: Nueces County
                                   AAA Name: Area Agency on Aging of the Coastal Bend
                               Region Number: Region 11
Example of how to use this information:
Review each of the cost areas based on the three different ways the information is presented. Determine if the dollar amount is reasonable
for each of the cost areas. Is the percentage of the cost allocation between congregate and home delivered comparable to the percentage
of total budgeted meals for each program?

Review examples:

 Occupancy/Building cost is expected to be higher for congregate than home delivered because the home delivered program should only
be charged a share of the cost for the kitchen and delivery preparation area for the time those areas are used to prepare and disburse
meals. The congregate program would be charged a share of the cost for the kitchen area for the time those areas are used to prepare
meals and include the cost associated with the area used to consume meals.

 How are Personnel costs allocated between the two meal programs? Is the allocation based on the percentage of meals, percentage of
total cost, or actual time spent between the two programs?

Review the cost per unit of raw food. Is the amount the same for both programs? If not, why are they different?

 Review the total cost per unit rates, are the rates for the programs similar? Because the program requirements are different, small
variances are expected. If the variances cannot be explained by program differences, you need to explain in your review papers why they
are different.
                                                                                                    Home Delivered Meal Budget Worksheet
                        Provider Name: Nueces County
                            AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                              Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current
                        Region Number: Region 11                                                                                                   Proposed Budget
                                                                9/28/12 11:24 PM
Most Recent Completed Budget
                                           2011                                                                                    Proposed Budget                                                    Explanation of Variances
            Year

                                                                                                                                                                                                                    Inflation Factor 2011 to 2012   1.021%
                                                                                                                                                                                                                    Inflation Factor 2012 to 2013   1.014%
                                                                                                                                                                                                                        Combined Inflation Factor   2.035%
                                                                                                                                                                             1. An explanation of varianc e must be provided for each cost area where the
                                                                                                                                                                             expenses per General Ledger varies from the approved budget for the most recent
                                                                                                                                                                             completed year by 10% or more.
                                                                     Variance                                                                                                 2. An explanation of variance must be provided for each cost area where the
                                         Expense per                 Budget                                                        Percentage Variance                       proposed budget amount exceeds the prior year actual amount by more than the
                                           General    Approved        minus        Percentage    Percentage                         - Prior Year Actual Percentage of Unit   two year combined inflation factor.
               Cost Area                   Ledger      Budget       Expenses       of Variance   of Unit Cost   Proposed Budget    to Proposed Budget         Cost
                                                Personnel
Salaries, PR Taxes & Benefits             108,200.93 117,532.86       9,332             -7.94%                         108193.29               -0.01%
Contract staff, Compensation                                            0                0.00%                              0.00                0.00%
Total                                    108,200.93 117,532.86        9,332             -7.94%       48.41%            108193.29               -0.01%              48.42%
                                           Nutrition Education
Salaries, PR Taxes & Benefits              1,657.00     1,543.52      -113              7.35%                            1668.59                0.70%
Contract staff, Compensation                                            0               0.00%                               0.00                0.00%
Materials                                                               0               0.00%                               0.00                0.00%
Conference                                                              0               0.00%                               0.00                0.00%
Total                                       1,657.00   1,543.52       -113              7.35%          0.74%             1668.59                0.70%               0.75%
                                        Professional Development
Conference                                     22.00     36.00         14             -38.89%                              22.50                2.27%                        1. Additional employee assisgned to attend but did not. 2. Cost was not
Dues                                                                   0                0.00%                               0.00                0.00%                        allocated.
Materials                                                              0                0.00%                               0.00                0.00%
Total                                         22.00     36.00          14             -38.89%          0.01%               22.50                2.27%               0.01%
                                               Meals/Food
Raw Food                                  65,290.89   54,704.96      -10,586           19.35%                           65337.52                0.07%                        1. Increased in food cost due to increase of fuel and food prices, also increased
Purchased Meals                            6,863.34     0.00          -6,863         -100.00%                            6949.29                1.25%                        meals . Freight cost had been included in shelf stable food cost. Purchased
Freight                                      200.00     0.00           -200          -100.00%                             198.80               -0.60%                        Meals were not budgeted separated in now in the GL separately. Anticipated
Storage                                                                  0              0.00%                               0.00                0.00%                        increase in consumable supplies did not manifest.
Consumables                                 7,986.45   10,910.33      2,924           -26.80%                            8016.92                0.38%
Other                                                                    0              0.00%                               0.00                0.00%
Total                                     80,340.68  65,615.29       -14,725           22.44%        35.95%             80502.53                0.20%              36.03%
                                               Equipment
Depreciation                                                           0                0.00%                               0.00                0.00%
Interest                                                               0                0.00%                               0.00                0.00%
Leasing                                                                0                0.00%                               0.00                0.00%
Maintenance                                                            0                0.00%                               0.00                0.00%
Total                                           -       0.00           0                0.00%          0.00%                0.00                0.00%               0.00%
                                           Occupancy/Building
Rent                                                                    0               0.00%                               0.00                0.00%                        1. Utilities higher than anticipated in budget. FY11 - Security, Janitorial and
Utilities                                   8,970.80   7,341.50      -1,629            22.19%                            8807.60               -1.82%                        Repair not budgeted in FY11 but expenses incurred. Similar expenses budgeted
Depreciation                                                            0               0.00%                               0.00                0.00%                        in FY13.
Mortgage Interest                                                       0               0.00%                               0.00                0.00%
Insurance                                                               0               0.00%                               0.00                0.00%
Security                                      162.34                  -162           -100.00%                             159.85               -1.53%
Janitorial                                    539.70     0.00         -540           -100.00%                             544.82                0.95%
Repair                                      3,022.04     0.00        -3,022          -100.00%                            2878.59               -4.75%
Taxes                                                                   0               0.00%                               0.00                0.00%
Total                                     12,694.88    7,341.50      -5,353            72.92%          5.68%            12390.86               -2.39%               5.55%
                                                                                                      Home Delivered Meal Budget Worksheet
                         Provider Name: Nueces County
                             AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                                Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current
                         Region Number: Region 11                                                                                                    Proposed Budget
                                                                 9/28/12 11:24 PM
Most Recent Completed Budget
                                              2011                                                                                   Proposed Budget                                                   Explanation of Variances
            Year

                                                                                                                                                                                                                      Inflation Factor 2011 to 2012   1.021%
                                                                                                                                                                                                                      Inflation Factor 2012 to 2013   1.014%
                                                                                                                                                                                                                          Combined Inflation Factor   2.035%
                                                                                                                                                                               1. An explanation of varianc e must be provided for each cost area where the
                                                                                                                                                                               expenses per General Ledger varies from the approved budget for the most recent
                                                                                                                                                                               completed year by 10% or more.
                                                                         Variance                                                                                               2. An explanation of variance must be provided for each cost area where the
                                            Expense per                  Budget                                                      Percentage Variance                       proposed budget amount exceeds the prior year actual amount by more than the
                                             General      Approved        minus      Percentage    Percentage                         - Prior Year Actual Percentage of Unit   two year combined inflation factor.
                Cost Area                     Ledger       Budget       Expenses     of Variance   of Unit Cost   Proposed Budget    to Proposed Budget         Cost
                                             Transportation/Travel
Mileage Reimbursement                                                       0             0.00%                               0.00                0.00%                        1. Fuel cost has increased; also underbudgeted. Repair expenditures incurred
Delivery                                                                    0             0.00%                               0.00                0.00%                        but not budgeted in FY11. Simular Fuel and Repairs expenses budgeted in FY13
Gas & Oil                                     15,233.89   7,964.58       -7,269          91.27%                           15266.69                0.22%                        to more accurately reflected program expenses.
Repairs                                        3,208.09     0.00         -3,208        -100.00%                            3234.11                0.81%
Insurance                                                                   0             0.00%                               0.00                0.00%
Depreciation/Lease                                                          0             0.00%                               0.00                0.00%
Interest                                                                    0             0.00%                               0.00                0.00%
Tags & Licenses                                                             0             0.00%                               0.00                0.00%
Total                                         18,441.98    7,964.58     -10,477         131.55%          8.25%            18500.80                0.32%               8.28%
                                            Administrative & General
Advertising                                                                0              0.00%                               0.00                0.00%                        1. Office Supplies did not purchase projected supplies and equipment, ie,
Printing                                                                   0              0.00%                               0.00                0.00%                        calculator. Postage did not mail material. 1. Telecommunications were allocated
Copying                                                                    0              0.00%                               0.00                0.00%                        to center operations and remainder being allocated by meal percentage. 1. Other
Office Supplies                                1,020.86   1,499.66        479           -31.93%                            1033.10                1.20%                        fees is the Culligan Water expense.
Contractual Agreements                                                     0              0.00%                               0.00                0.00%
Postage                                          11.30      17.40          6            -35.06%                              11.48                1.59%
Telecommunications                              996.81     498.36        -498           100.02%                             997.74                0.09%
Liability Insurance                                                        0              0.00%                               0.00                0.00%
Legal Fees                                                                 0              0.00%                               0.00                0.00%
Accounting Fees                                                            0              0.00%                               0.00                0.00%
Consulting Fees                                                            0              0.00%                               0.00                0.00%
Other Fees (Explain)                            119.45    2,463.20       2,344          -95.15%                             119.15               -0.25%
Audit                                                                      0              0.00%                               0.00                0.00%
Other Misc. (Explain)                                                      0              0.00%                               0.00                0.00%
Total                                         2,148.42     4,478.62      2,330          -52.03%          0.96%             2161.47                0.61%               0.97%
                                                     Total
Total of all Cost Areas                      223,505.89 204,512.37      -18,993.52        9.29%       100.00%            223440.04               -0.03%             100.00%
Total Number of Meals                           49,694        39,427
Whole Cost per Meal                                4.50          5.19
Approved Meal Rate (Title III & Title XX)         4.73           4.73
Approved Meal Rate (Title XIX)                    6.12           6.12
                                                                                                   Home Delivered Meal Budget Worksheet
                     Provider Name: Nueces County
                         AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                             Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current
                     Region Number: Region 11                                                                                                     Proposed Budget
                                                             9/28/12 11:24 PM
Most Recent Completed Budget
                                          2011                                                                                          Proposed Budget                                                    Explanation of Variances
            Year

                                                                                                                                                                                                                          Inflation Factor 2011 to 2012   1.021%
                                                                                                                                                                                                                          Inflation Factor 2012 to 2013   1.014%
                                                                                                                                                                                                                              Combined Inflation Factor   2.035%
                                                                                                                                                                                   1. An explanation of varianc e must be provided for each cost area where the
                                                                                                                                                                                   expenses per General Ledger varies from the approved budget for the most recent
                                                                                                                                                                                   completed year by 10% or more.
                                                                       Variance                                                                                                     2. An explanation of variance must be provided for each cost area where the
                                       Expense per                     Budget                                                           Percentage Variance                        proposed budget amount exceeds the prior year actual amount by more than the
                                        General       Approved          minus     Percentage    Percentage                               - Prior Year Actual Percentage of Unit    two year combined inflation factor.
            Cost Area                    Ledger        Budget         Expenses    of Variance   of Unit Cost    Proposed Budget         to Proposed Budget         Cost

                                                                                   Proposed
                                Funding Source                                      Meals                      Calculated Rate               Revenue
                                DADS A&I AAA                                          11,555                                     4.73             54,655                           Proposed Meals * Calculated Units
                               DADS - Title XX                                        21,646                                     4.73            102,386                           Proposed Meals * Calculated Units
                            DADS - Title XIX (CBA)                                       -                                       0.00                -                             Proposed Meals * Calculated Units
                               Program Income                                            588                                     5.18              3,046                           Proposed Meals * Calculated Units
                          Other Funds - Eligible Meals                                 9,384                                     5.18             48,609                           Proposed Meals * Calculated Units
                        Other Funds - Non-Eligible Meals                                                                         5.18                -                             Proposed Meals * Calculated Units
                         Local Funds - Required Match                                 NA                                         0.45             14,940          DADS A&I AAA Proposed Meals +Title XX Proposed Meals *Calculated Rate
          Local Funds - Cap Limit Exceeded DADS A&I-AAA & Title XX                    NA                                         0.00                -            DADS A&I AAA Proposed Meals +Title XX Proposed Meals *Calculated Rate
                  Local Funds - Cap Limit Exceeded Title XIX                          NA                                         0.00                -                       DADS Title XIX Proposed Meals *Calculated Rate
                        Total Meals by Funding Source                                 43,173                                                     223,636
               Provider Total Budgeted Home Delivered Meals                           43,173
  Variance (Provider Total Budgeted Home Delivered Meals - Total Meals by
                               Funding Source)                                           -

          Estimated Number of Nutrition Education Units AAA Clients                      100
                  Nutrition Education Budget - AAA Clients                          1,668.59
                           Calculated Cost per Unit                                    16.69
         9/28/12 11:24 PM
          Provider Name: Nueces County
               AAA Name: Area Agency on Aging of the Coastal Bend
          Region Number: Region 11
                                                Home Delivered Meals
                               BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE

1. Total Budgeted Expenses for Contract Year                                                                                             1.   $   223,440.04

2. Total Number of Anticipated Meals to be Provided by Funding Source




          DADS A&I AAA         11,555               Title XX        21,646            Title XIX                   0

                                                Other Funds                           Other Funds -
         Program Income          588           Eligible Meals       9,384         Non-Eligible Meals              0                      2.          43,173


3. Whole Unit Rate (Line 1 divided by Line 2)                                                                                            3.   $         5.18

Reimbursement Calculation
                                                                DADS A&I AAA
                                                                  & Title XX                                 Title XIX
4. Projected NSIP per Meal Value                                           0.69                                N/A

5. Rate Less NSIP per Meal Value                                $         4.49                                    N/A

6. Mandatory Local Match of 10%            $           0.45
 ** If Applicable, Match Reduction
    From the In-kind Match
    Certification form                     $            -

   Required Cash Match                                          $         0.45                                    N/A

7. Proposed Meal Rate (Line 3 minus Line 6)                     $         4.73                         $                 5.18

8. Rate Cap Applicable to Title XIX, Title XX
   and DADS A&I AAA Common Providers                            $         4.95                         $                 6.12

9. Excess of Cap Rate Reduction                                 $            -                         $                  -

Accepted Unit Rate for Current Year                             $         4.73                         $                 5.18


** If any portion of the required match is in-kind, you must complete an In-Kind Match Certification form.

   By signing below, the provider acknowledges that all related records are subject to audit in accordance with contract
   requirements and all applicable federal and state laws.



                     Nueces County                                                               Samuel L. Neal Jr.
             Legal Name of Contracted Provider                                             Printed/Typed Name of Signer



                          Signature                                                                        Date


         Area Agency on Aging of the Coastal Bend                                                    Region 11
              Name of Area Agency on Aging                                           Department of Aging and Disability Services




            John P. Buckner, Executive Director                                                    Paul T. Ebrom
              Printed/Typed Name of Signer                                                 Printed/Typed Name of Signer



                          Signature                                                                    Signature



                             Date                                                                          Date




                                                     Calculation of In-Kind Value
   1. Required Match Rate                                                                                                         0.45
   2. TDoA units + DHS units                                                                                                    33,201
   3. Required Match Rate (1) Multiplied by the anticipated number of TDoA units (2)                                            14,940
   4. Total Valuation from the In-Kind Certification                                                                               -
   5. Balance of Required Match (3-4)                                                                                           14,940
   6. TDoA units + DHS units                                                                                                    33,201
   7. Balance of Required Match (5) Divided by TDoA units (6)                                                                     0.45
   8. Required Match Rate                                                                                                         0.45
   9. Reduced Required Match If (8) is equal to or less than 0 this will equal (8) or else (8-7)                                   -
                     21646
          9/28/12 11:24 PM
           Provider Name: Nueces County
                AAA Name: Area Agency on Aging of the Coastal Bend
           Region Number: Region 11

                                       Home Delivered Meals
                                BUDGET WORKSHEET CERTIFICATION


  AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:


      I have read the note below and the instructions applicable to this budget worksheet.

      I have reviewed this budget worksheet after its preparation.

      To the best of my knowledge and belief, this budget worksheet is true, correct and
       complete, and was prepared in accordance with the instructions applicable to this
       budget worksheet.

      This budget worksheet was prepared from the books and records of the contracted
       provider.

      I acknowledge that all books and records related to this rate setting process are
       subject to audit in accordance with contract requirements and all applicable federal
       and state laws.




Note: The person legally responsible for the conduct of the contracted provider must
      sign this Budget Worksheet Certification. If a sole proprietor, the owner
      must sign the Budget Worksheet Certification. If a partnership, a partner must
      sign the Budget Worksheet Certification. If a corporation, the person authorized by the
      Board of Directors Resolution must sign the Budget Worksheet Certification.
      Misrepresentation of information contained in the budget worksheet may result in
      adverse action, up to and including contract termination. Furthermore, falsification of
      information in the budget worksheet may result in a referral for prosecution.


                           Nueces County                                 Samuel L. Neal, Jr.
                       Name of Contracted Provider                     Printed/Typed Name of Signer




                                  Date                                            Signature




       Signer Authority:              Sole Proprietor       Association Officer
         (check one)                  Partner               Board Member
                                      Corporate Officer     Governmental Official
     9/28/12 11:24 PM
               AAA Name: Area Agency on Aging of the Coastal Bend
          Region Number: Region 11
                                                     Home Delivered Meals
                                              IN-KIND MATCH CERTIFICATION

Provider:        Nueces County

  In-kind Contribution(s):                            $0

                              For any item identified below, you must maintain support documentation.



                                      ITEM                                       DATE OF RECEIPT                    VALUE




                                                                                                 TOTAL                 $0

Note:            All contributions must meet the requirements of IRS Publication 561
                 http://www.irs.gov/pub/irs-pdf/p561.pdf

Examples of Documentation Include:

Rent:                        1. Letter of Agreement with Owner
                             2. Adequate Valuation of Property on a Current Basis (this should be reviewed at least every two years
                                and if senior center, based on property value and center participation)

Labor:                       1. Minimum wage
                             2. Documented prevailing wage in the Area. For prevailing wage information visit the Texas Workforce
                                Commission’s website at http://www.tracer2.com/.


All in-kind labor must be required for the service to be provided. If you would not hire someone to perform the labor if it
were not in-kind then you cannot count it.

Utilities:                   1. Copy of Bill
                             2. Agreement of Amount Paid if Partial


                 Nueces County                                                                   Samuel L Neal Jr.
             Name of Contracted Provider                                                   Printed/Typed Name of Signer


                      Date                                                                            Signature
       9/28/12 11:24 PM
                                    Department of Aging and Disability Services
                                             Congregate Meals - Request for Waiver
                                             Federal Contract Period:       10-01-12 / 09-30-13
                         Provider Must be a AAA Congregate Nutrition Provider
                            Nutrition Providers Legal Business Name:
                                                       Street Address:
                                                      Mailing Address:
                                                                  City:
                                                             Zip Code:
                                                       Contact Name:
  AAA Provider:
  AAA Contact Name:
1 Does this Nutrition provider have an approved Congregate Nutrition Waiver for 2012?:

                               Waiver to Serve Congregate Meals less than five (5) days per week
2 Number of meal sites included in this waiver:
3 Percentage of total meal sites included in this waiver:                   0%
4 The circumstances necessitating this waiver request: (select "Yes" for all that apply)
                    Rural area where 5 days a week is not feasible
                    Low number of consumers at the site
                    Insufficient number of staff or volunteers
                    Insufficient funding
                    Other
5 If other, a reason for the request must be provided:

6 If the answer to question one is no, how will the consummers and the general public be notifiied of the change in the
  pattern of meal service:
                     Local newspaper
                     Flyers
                     Posting at the meal site
                     Other
7 If other is selected method used must be provided:

  Assurances
  By submitting this waiver request to the Texas Department of Aging and Disability Services (DADS, Access and Intake Division, the
  entity requesting this waiver assures adherence to all AAA contract/vendor agreement requirements and applicable Texas
  Administrative Codes.

8 Provider Signature                                                                         Date




                   Yes
                   No
                                                                                                              Congregate Meal Budget Worksheet
                        Provider Name: Nueces County
                            AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                                 Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed
                                                                                                                                                               Budget
                                                                 9/28/12 11:24 PM
Most Recent Completed Budget
                                          2011                                                                                      Proposed Budget                                                          Explanation of Variances
            Year

                                                                                                                                                                                                                                 Inflation Factor 2011 to 2012  1.021%
                                                                                                                                                                                                                                 Inflation Factor 2012 to 2013  1.014%
                                                                                                                                                                                                                                     Combined Inflation Factor  2.035%
                                                                                                                                                                             1. An explanation of variance must be provided for each cost area where the expenses per
                                                                                                                                                                             General Ledger varies from the approved budget for the most recent completed year by 10%
                                                                                                                                                                             or more.
                                                                     Variance                                                            Percentage                           2. An explanation of variance must be provided for each cost area where the proposed
                                          Expense                    Budget                                                         Variance - Prior Year                    budget amount exceeds the prior year actual amount by more than the two year combined
                                        per General  Approved         minus      Percentage    Percentage                            Actual to Proposed Percentage of Unit   inflation factor.
               Cost Area                  Ledger      Budget        Expenses     of Variance   of Unit Cost      Proposed Budget           Budget             Cost
                                               Personnel
                                                                                                                                                                             1. Activities Coordinator and Menu Planner positions were not filled.

Salaries, PR Taxes & Benefits            70,459.89   82,598.34       12,138          -14.70%                            70,655.36                0.28%
Contract staff, Compensation                                            0              0.00%                                  -                  0.00%
                                          Nutrition Education
Salaries, PR Taxes & Benefits              909.10      988.35          79             -8.02%                               915.48                0.70%
Contract staff, Compensation                                           0               0.00%                                  -                  0.00%
Materials                                                              0               0.00%                                  -                  0.00%
Conference                                                             0               0.00%                                  -                  0.00%
Total                                       909.10    988.35           79             -8.02%         0.73%                 915.48                0.70%               0.74%
                                       Professional Development
Conference                                   22.00     36.00           14            -38.89%                                22.50                2.27%                       1. Additional employees attendended. 2. Cost was not allocated.
Dues                                                                   0               0.00%                                  -                  0.00%
Materials                                                              0               0.00%                                  -                  0.00%
Total                                        22.00     36.00           14            -38.89%         0.02%                  22.50                2.27%               0.02%
                                              Meals/Food
Raw Food                                 35,843.10   35,028.82         -814            2.32%                            35,847.63                0.01%                       1. Purchase meals and freight cost were allocated in shelf stable food cost.
Purchased Meals                           1,568.90                    -1,569        -100.00%                             1,576.38                0.48%
Freight                                     116.00                     -116         -100.00%                               117.77                1.53%
Storage                                                                  0             0.00%                                  -                  0.00%
Consumables                               1,075.35    2,719.27         1,644         -60.45%                             1,084.36                0.84%
Other                                                                    0             0.00%                                  -                  0.00%
Total                                    38,603.35  37,748.09          -855            2.27%        31.11%              38,626.14                0.06%              31.05%
                                              Equipment
Depreciation                                                            0             0.00%                                   -                  0.00%
Interest                                                                0             0.00%                                   -                  0.00%
Leasing                                                                 0             0.00%                                   -                  0.00%
Maintenance                                                             0             0.00%                                   -                  0.00%
Total                                         -       0.00              0             0.00%          0.00%                    -                  0.00%               0.00%
                                          Occupancy/Building
Rent                                                                     0             0.00%                                  -                  0.00%                        1. Increase in utilities due to increase cost of utilities. Expenditures have been allocated to
Utilities                                 7,490.67    7,043.48         -447            6.35%                             7,527.74                0.49%                       reflect a more accurate meal delivery cost.
Depreciation                                                             0             0.00%                                  -                  0.00%
Mortgage Interest                                                        0             0.00%                                  -                  0.00%
Insurance                                                                0             0.00%                                  -                  0.00%
Security                                     86.23                      -86         -100.00%                                87.70                1.70%
Janitorial                                  295.99      0.00           -296         -100.00%                               298.92                0.99%
Repair                                    1,569.45      0.00          -1,569        -100.00%                             1,579.36                0.63%
Taxes                                                                    0             0.00%                                  -                  0.00%
Total                                     9,442.34    7,043.48        -2,399          34.06%         7.61%               9,493.72                0.54%               7.63%
                                                                                                                 Congregate Meal Budget Worksheet
                         Provider Name: Nueces County
                             AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                                    Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed
                                                                                                                                                                  Budget
                                                                   9/28/12 11:24 PM
Most Recent Completed Budget
                                           2011                                                                                        Proposed Budget                                                        Explanation of Variances
            Year

                                                                                                                                                                                                                                    Inflation Factor 2011 to 2012  1.021%
                                                                                                                                                                                                                                    Inflation Factor 2012 to 2013  1.014%
                                                                                                                                                                                                                                        Combined Inflation Factor  2.035%
                                                                                                                                                                                1. An explanation of variance must be provided for each cost area where the expenses per
                                                                                                                                                                                General Ledger varies from the approved budget for the most recent completed year by 10%
                                                                                                                                                                                or more.
                                                                       Variance                                                             Percentage                           2. An explanation of variance must be provided for each cost area where the proposed
                                           Expense                     Budget                                                          Variance - Prior Year                    budget amount exceeds the prior year actual amount by more than the two year combined
                                         per General   Approved         minus       Percentage    Percentage                            Actual to Proposed Percentage of Unit   inflation factor.
                Cost Area                  Ledger       Budget        Expenses      of Variance   of Unit Cost      Proposed Budget           Budget             Cost
                                           Transportation/Travel
Mileage Reimbursement                                                      0             0.00%                                   -                  0.00%                       1. Fuel cost have increased and repair expenditures have been allocated to reflect a more
Delivery                                                                   0             0.00%                                   -                  0.00%                       accurate meal delivery cost.
Gas & Oil                                  2,880.91    1,696.50         -1,184          69.81%                              2,881.55                0.02%
Repairs                                      599.10      0.00            -599         -100.00%                                610.43                1.89%
Insurance                                                                  0             0.00%                                   -                  0.00%
Depreciation/Lease                                                         0             0.00%                                   -                  0.00%
Interest                                                                   0             0.00%                                   -                  0.00%
Tags & Licenses                                                            0             0.00%                                   -                  0.00%
Total                                      3,480.01     1,696.50        -1,784         105.13%          2.80%               3,491.98                0.34%               2.81%
                                         Administrative & General
Advertising                                                               0              0.00%                                   -                  0.00%                       1. Office supplies were not purchase. 1. Postage material were not send out. 1.
Printing                                                                  0              0.00%                                   -                  0.00%                       Telecommunications were allocated to center operations and remainder being allocated by
Copying                                                                   0              0.00%                                   -                  0.00%                       meal percentage.
Office Supplies                              560.90     960.26           399           -41.59%                                566.81                1.05%
Contractual Agreements                                                    0              0.00%                                   -                  0.00%
Postage                                        6.26      11.14            5            -43.81%                                  6.30                0.64%
Telecommunications                           540.11       0.00          -540          -100.00%                                547.41                1.35%
Liability Insurance                                                       0              0.00%                                   -                  0.00%
Legal Fees                                                                0              0.00%                                   -                  0.00%
Accounting Fees                                                           0              0.00%                                   -                  0.00%
Consulting Fees                                                           0              0.00%                                   -                  0.00%
Other Fees (Explain)                          64.35    1,577.24         1,513          -95.92%                                 65.37                1.59%
Audit                                                                     0              0.00%                                   -                  0.00%
Other Misc. (Explain)                                                     0              0.00%                                   -                  0.00%
Total                                      1,171.62     2,548.64        1,377          -54.03%          0.94%               1,185.89                1.22%               0.95%
                                                   Total
Total of all Cost Areas                   124,088.31 132,659.40          8,571.09        -6.46%      100.00%              124,391.07                0.24%            100.00%
Total Number of Meals                        11,986        25,246
Whole Cost per Meal                            10.35          5.25
Approved Meal Rate Title III                   4.79           4.79
                                                                                                         Congregate Meal Budget Worksheet
                  Provider Name: Nueces County
                      AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                            Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed
                                                                                                                                                          Budget
                                                             9/28/12 11:24 PM
Most Recent Completed Budget
                                      2011                                                                                    Proposed Budget                                                              Explanation of Variances
            Year

                                                                                                                                                                                                                              Inflation Factor 2011 to 2012  1.021%
                                                                                                                                                                                                                              Inflation Factor 2012 to 2013  1.014%
                                                                                                                                                                                                                                  Combined Inflation Factor  2.035%
                                                                                                                                                                          1. An explanation of variance must be provided for each cost area where the expenses per
                                                                                                                                                                          General Ledger varies from the approved budget for the most recent completed year by 10%
                                                                                                                                                                          or more.
                                                                 Variance                                                          Percentage                              2. An explanation of variance must be provided for each cost area where the proposed
                                     Expense                     Budget                                                       Variance - Prior Year                       budget amount exceeds the prior year actual amount by more than the two year combined
                                   per General    Approved        minus     Percentage    Percentage                           Actual to Proposed Percentage of Unit      inflation factor.
          Cost Area                  Ledger        Budget       Expenses    of Variance   of Unit Cost      Proposed Budget          Budget             Cost
                                                                                           Proposed
                                  Funding Source                                             Meals                    Calculated Rate                  Revenue
                         DADS A&I AAA - Match Required                                         11563                       4.79                            55386.77    Proposed Meals * Calculated Units
                                  Program Income                                                   365                     5.25                             1916.25    Proposed Meals * Calculated Units
                            Other Funds - Eligible Meals                                       11759                       5.25                            61734.75    Proposed Meals * Calculated Units
                         Other Funds - Non-Eligible Meals                                                                  0.00                                0.00    Proposed Meals * Calculated Units
                           Local Funds - Required Match                                       NA                           0.46                             5318.98    Proposed Meals * Calculated Units
                                  Other Sources 5                                                                          5.25                                0.00    Proposed Meals * Calculated Units
                                  Other Sources 6                                                                          5.25                                0.00    Proposed Meals * Calculated Units
                         Total Meals by Funding Source                                         23687                                                      124356.75    Total Revenue
                   Provider Total Budgeted Congregate Meals                                    23687
              Variance (Provider Total Budgeted Congregate Meals -
                         Total Meals by Funding Source)                                             0

             Estimated Number of Nutrition Education Units AAA Clients                             191
                     Nutrition Education Budget - AAA Clients                                      915
                              Calculated Cost per Unit                                           4.79
         9/28/12 11:24 PM
          Provider Name: Nueces County
               AAA Name: Area Agency on Aging of the Coastal Bend
                                                  Congregate Meals
                               BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE

1. Total Budgeted Expenses for Contract Year                                                                                        1.   $   124,391.07

2. Total Number of Anticipated Meals to be Provided by Funding Source

                                                 Other Funds
           DADS A&I AAA         11,563          Eligible Meals       11,759       Other Sources 5              0

                                                Other Funds -
                                                 Non-Eligible
         Program Income           365                  Meals           0          Other Sources 6              0                    2.          23,687


3. Whole Unit Rate (Line 1 divided by Line 2)                                                                                       3.   $         5.25

Reimbursement Calculation

                                                                 DADS A&I AAA
4. Projected NSIP per Meal Value                                          0.69

5. Rate Less NSIP per Meal Value                                 $         4.56

6. Mandatory Local Match of 10%             $           0.46

 ** If Applicable, Match Reduction
    From the In-kind Match
    Certification form                      $            -

   Required Cash Match                                           $         0.46

7. Proposed Meal Rate (Line 3 minus Line 6)                      $         4.79

** If any portion of the required match is in-kind, you must complete an In-Kind Match Certification form.

   By signing below, the provider acknowledges that all related records are subject to audit in accordance with
   contract requirements and all applicable federal and state laws.

                     Nueces County
             Legal Name of Contracted Provider                                              Printed/Typed Name of Signer



                           Signature                                                                    Date


          Area Agency on Aging of the Coastal Bend
               Name of Area Agency on Aging

             John P. Buckner, Executive Director
                Printed/Typed Name of Signer



                           Signature



                             Date




                                                     Calculation of In-Kind Value
   1. Required Match Rate                                                                                                    0.46
   2. TDoA units + DHS units                                                                                               23,322
   3. Required Match Rate (1) Multiplied by the anticipated number of TDoA units (2)                                       10,728
   4. Total Valuation from the In-Kind Certification                                                                          -
   5. Balance of Required Match (3-4)                                                                                      10,728
   6. TDoA units + DHS units                                                                                               23,322
   7. Balance of Required Match (5) Divided by TDoA units (6)                                                                0.46
   8. Required Match Rate                                                                                                    0.46
   9. Reduced Required Match If (8) is equal to or less than 0 this will equal (8) or else (8-7)                              -
          9/28/12 11:24 PM
           Provider Name: Nueces County
                AAA Name: Area Agency on Aging of the Coastal Bend
                                         Congregate Meals
                                BUDGET WORKSHEET CERTIFICATION

  AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:

      I have read the note below and the instructions applicable to this budget worksheet.

      I have reviewed this budget worksheet after its preparation.

      To the best of my knowledge and belief, this budget worksheet is true, correct and
       complete, and was prepared in accordance with the instructions applicable to this
       budget worksheet.

      This budget worksheet was prepared from the books and records of the contracted
       provider.

      I acknowledge that all books and records related to this rate setting process are
       subject to audit in accordance with contract requirements and all applicable federal
       and state laws.


Note: The person legally responsible for the conduct of the contracted provider must
      sign this Budget Worksheet Certification. If a sole proprietor, the owner
      must sign the Budget Worksheet Certification. If a partnership, a partner must
      sign the Budget Worksheet Certification. If a corporation, the person authorized by the
      Board of Directors Resolution must sign the Budget Worksheet Certification.
      Misrepresentation of information contained in the budget worksheet may result in
      adverse action, up to and including contract termination. Furthermore, falsification of
      information in the budget worksheet may result in a referral for prosecution.
                           Nueces County                                 Samuel L. Neal, Jr.
                       Name of Contracted Provider                    Printed/Typed Name of Signer




                                  Date                                            Signature




       Signer Authority:              Sole Proprietor       Association Officer
         (check one)                  Partner               Board Member

                                      Corporate Officer     Governmental Official
                     9/28/12 11:24 PM
                 AAA Name: Area Agency on Aging of the Coastal Bend
                                                        Congregate Meals
                                              IN-KIND MATCH CERTIFICATION
Provider:        Nueces County

 In-kind Contribution(s):                          $0

                             For any item identified below, you must maintain support documentation.



                                    ITEM                                      DATE OF RECEIPT                    VALUE




                                                                                              TOTAL                 $0

Note:            All contributions must meet the requirements of IRS Publication 561
                 http://www.irs.gov/pub/irs-pdf/p561.pdf

Examples of Documentation Include:

Rent:                      1. Letter of Agreement with Owner
                           2. Adequate Valuation of Property on a Current Basis (this should be reviewed at least every two years
                              and if senior center, based on property value and center participation)

Labor:                     1. Minimum wage
                           2. Documented prevailing wage in the Area. For prevailing wage information visit the Texas Workforce
                              Commission’s website at http://www.tracer2.com/.


All in-kind labor must be required for the service to be provided. If you would not hire someone to perform the labor if it
were not in-kind then you cannot count it.

Utilities:                 1. Copy of Bill
                           2. Agreement of Amount Paid if Partial

                Nueces County                                                                Samuel L. Neal Jr.
             Name of Contracted Provider                                               Printed/Typed Name of Signer


                      Date                                                                         Signature
                                                                           Participant Assessment
                 Provider Name: Nueces County
                     AAA Name: Area Agency on Aging of the Coastal Bend
                                                                          Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed
                                                                                                                        Budget
                                    9/28/12 11:24 PM
Most Recent Completed Budget
                                   2011                                                     Proposed Budget                                 Explanation of Variances
            Year
                                                                                                                Participant Assessment
                        Provider Name: Nueces County
                            AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                               Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed
                                                                                                                                                             Budget
                                           9/28/12 11:24 PM
Most Recent Completed Budget
                                          2011                                                                                         Proposed Budget                                                       Explanation of Variances
            Year

                                                                                                                                                                                                                      Inflation Factor 2011 to 2012     1.021%
                                                                                                                                                                                                                       Inflation Factor 2012 to 2013    1.014%
                                                                                                                                                                                                                           Combined Inflation Factor    2.035%
                                                                                                                                                                                        1. An explanation of variance must be provided for each cost area where the
                                                                                                                                                                                        expenses per General Ledger varies from the approved budget for the most
                                                                    Variance                                                                                                            recent completed year by 10% or more.
                                         Expense                    Budget                                                            Percentage Variance -                              2. An explanation of variance must be provided for each cost area where
                                       per General Approved          minus       Percentage    Percentage of                           Prior Year Actual to                             the proposed budget amount exceeds the prior year actual amount by more
               Cost Area                 Ledger     Budget         Expenses      of Variance     Unit Cost       Proposed Budget        Proposed Budget       Percentage of Unit Cost   than the two year combined inflation factor.
                                               Personnel
Salaries, PR Taxes & Benefits                                         0               0.00%                                 9833.48                 100.00%                                                                                                        -
Contract staff, Compensation                                          0               0.00%                                    0.00                   0.00%
Total                                          -       0.00           0               0.00%              0%                 9833.48                 100.00%                      100%
                                           Nutrition Education
Salaries, PR Taxes & Benefits                                         0               0.00%                                                                                                                                                                        -
Contract staff, Compensation                                          0               0.00%
Materials                                                             0               0.00%
Conference                                                            0               0.00%
Total                                          -       0.00           0               0.00%              0%                    0.00                                                0%
                                        Professional Development
Conference                                                            0               0.00%                                    0.00                   0.00%                              1. Additional employee assisgned to attend but did not. 2. Cost was not
Dues                                                                  0               0.00%                                    0.00                   0.00%                             allocated.
Materials                                                             0               0.00%                                    0.00                   0.00%
Total                                          -       0.00           0               0.00%              0%                    0.00                   0.00%                        0%
                                               Meals/Food
Raw Food                                                              0               0.00%                                    0.00                   0.00%                             ############################################################
Purchased Meals                                                       0               0.00%                                    0.00                   0.00%
Freight                                                               0               0.00%                                    0.00                   0.00%
Storage                                                               0               0.00%                                    0.00                   0.00%
Consumables                                                           0               0.00%                                    0.00                   0.00%
Other                                                                 0               0.00%                                    0.00                   0.00%
Total                                          -     0.00             0               0.00%              0%                    0.00                   0.00%                        0%
                                               Equipment
Depreciation                                                          0               0.00%                                    0.00                   0.00%                                                                                                        -
Interest                                                              0               0.00%                                    0.00                   0.00%
Leasing                                                               0               0.00%                                    0.00                   0.00%
Maintenance                                                           0               0.00%                                    0.00                   0.00%
Total                                          -       0.00           0               0.00%              0%                    0.00                   0.00%                        0%
                                                                                                                 Participant Assessment
                         Provider Name: Nueces County
                             AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                                Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed
                                                                                                                                                              Budget
                                            9/28/12 11:24 PM
Most Recent Completed Budget
                                           2011                                                                                         Proposed Budget                                                         Explanation of Variances
            Year

                                                                                                                                                                                                                       Inflation Factor 2011 to 2012     1.021%
                                                                                                                                                                                                                        Inflation Factor 2012 to 2013    1.014%
                                                                                                                                                                                                                            Combined Inflation Factor    2.035%
                                                                                                                                                                                         1. An explanation of variance must be provided for each cost area where the
                                                                                                                                                                                         expenses per General Ledger varies from the approved budget for the most
                                                                      Variance                                                                                                           recent completed year by 10% or more.
                                          Expense                     Budget                                                           Percentage Variance -                              2. An explanation of variance must be provided for each cost area where
                                        per General Approved           minus      Percentage    Percentage of                           Prior Year Actual to                             the proposed budget amount exceeds the prior year actual amount by more
               Cost Area                  Ledger     Budget          Expenses     of Variance     Unit Cost       Proposed Budget        Proposed Budget       Percentage of Unit Cost   than the two year combined inflation factor.
                                            Occupancy/Building
Rent                                                                    0              0.00%                                    0.00                   0.00%                              1. Utilities higher than anticipated in budget. FY11 - Security, Janitorial and
Utilities                                                               0              0.00%                                    0.00                   0.00%                             Repair not budgeted in FY11 but expenses incurred. Similar expenses
Depreciation                                                            0              0.00%                                    0.00                   0.00%                             budgeted in FY13.
Mortgage Interest                                                       0              0.00%                                    0.00                   0.00%
Insurance                                                               0              0.00%                                    0.00                   0.00%
Security                                                                0              0.00%                                    0.00                   0.00%
Janitorial                                                              0              0.00%                                    0.00                   0.00%
Repair                                                                  0              0.00%                                    0.00                   0.00%
Taxes                                                                   0              0.00%                                    0.00                   0.00%
Total                                           -       0.00            0              0.00%              0%                    0.00                   0.00%                        0%
                                           Transportation/Travel
Mileage Reimbursement                                                   0              0.00%                                    0.00                   0.00%                              1. Fuel cost has increased; also underbudgeted. Repair expenditures
Delivery                                                                0              0.00%                                    0.00                   0.00%                             incurred but not budgeted in FY11. Simular Fuel and Repairs expenses
Gas & Oil                                                               0              0.00%                                    0.00                   0.00%                             budgeted in FY13 to more accurately reflected program expenses.
Repairs                                                                 0              0.00%                                    0.00                   0.00%
Insurance                                                               0              0.00%                                    0.00                   0.00%
Depreciation/Lease                                                      0              0.00%                                    0.00                   0.00%
Interest                                                                0              0.00%                                    0.00                   0.00%
Tags & Licenses                                                         0              0.00%                                    0.00                   0.00%
Total                                           -        0.00           0              0.00%              0%                    0.00                   0.00%                        0%
                                          Administrative & General
Advertising                                                             0              0.00%                                    0.00                   0.00%                             ############################################################
Printing                                                                0              0.00%                                    0.00                   0.00%
Copying                                                                 0              0.00%                                    0.00                   0.00%
Office Supplies                                                         0              0.00%                                    0.00                   0.00%
Contractual Agreements                                                  0              0.00%                                    0.00                   0.00%
Postage                                                                 0              0.00%                                    0.00                   0.00%
Telecommunications                                                      0              0.00%                                    0.00                   0.00%
Liability Insurance                                                     0              0.00%                                    0.00                   0.00%
Legal Fees                                                              0              0.00%                                    0.00                   0.00%
Accounting Fees                                                         0              0.00%                                    0.00                   0.00%
Consulting Fees                                                         0              0.00%                                    0.00                   0.00%
Other Fees (Explain)                                                    0              0.00%                                    0.00                   0.00%
Audit                                                                   0              0.00%                                    0.00                   0.00%
Other Misc. (Explain)                                                   0              0.00%                                    0.00                   0.00%
Total                                           -       0.00            0              0.00%              0%                    0.00                   0.00%                        0%
                                                                                                                      Participant Assessment
                          Provider Name: Nueces County
                              AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                                     Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed
                                                                                                                                                                   Budget
                                             9/28/12 11:24 PM
Most Recent Completed Budget
                                            2011                                                                                               Proposed Budget                                                        Explanation of Variances
            Year

                                                                                                                                                                                                                               Inflation Factor 2011 to 2012     1.021%
                                                                                                                                                                                                                                Inflation Factor 2012 to 2013    1.014%
                                                                                                                                                                                                                                    Combined Inflation Factor    2.035%
                                                                                                                                                                                                 1. An explanation of variance must be provided for each cost area where the
                                                                                                                                                                                                 expenses per General Ledger varies from the approved budget for the most
                                                                      Variance                                                                                                                   recent completed year by 10% or more.
                                           Expense                    Budget                                                                  Percentage Variance -                               2. An explanation of variance must be provided for each cost area where
                                         per General Approved          minus         Percentage    Percentage of                               Prior Year Actual to                              the proposed budget amount exceeds the prior year actual amount by more
                Cost Area                  Ledger      Budget        Expenses        of Variance     Unit Cost         Proposed Budget          Proposed Budget        Percentage of Unit Cost   than the two year combined inflation factor.
                                                    Total
Total of all Cost Areas                         0.00       0.00              -            0.00%                  -                 9,833.48                 100.00%                       100%
Total Number Units                                                               -        0.00%
Whole Cost per Unit                              0.00         0.00           -            0.00%                         Budgeted Units                                Budgeted Cost per Unit
Approved Unit Rate                                                                                                                       -




Funding Source                               Proposed Units                               Calculated Rate                Revenue
DADS A&I AAA - 10 % Match Required                                                                           -                           -
DADS A&I AAA - 25 % Match Required                                                                           -                           -
DADS A&I AAA - Full Unit Rate                                                                                -                           -
Program Income                                                                                               -                           -
Local Funds                                                                                                  -                           -
Other Funds                                                                                                  -                           -
Local Funds - Required Match 10%                   NA                                                        -                           -
Local Funds - Required Match 25%                   NA                                                        -                           -
Other Sources 6                                                                                              -                           -
Other Sources 7                                                                                              -                           -
Other Sources 8                                                                                              -                           -
Total Units by Funding Source                                 -                                                                          -




                                                                                                                                                                                                                                                                               Total
                                                                                                                                                                                                                                                                               Revenue
             9/28/12 11:24 PM
            Provider Name: Nueces County
                AAA Name: Area Agency on Aging of the Coastal Bend
                                                  Participant Assessment
                                      BUDGET WORKSHEET CALCULATION OF THE UNIT RATE

1.Total Budgeted Expenses for Contract Year                                                                                 1.    $   9,833.48

2.Total Number of Anticipated Units to be Provided
   DADS A&I AAA - 10 %                       Program
      Match Required              0           Income                 0          Other Sources 6          0
   DADS A&I AAA - 25 %
      Match Required              0         Local Funds              0          Other Sources 7          0
  DADS A&I AAA - Full Unit
           Rate                   0        Other Funds               0          Other Sources 8          0                   2.            -



3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate                                                                3.    $        -

Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction


4. Mandatory Local Match of 10%                                                                    $          -
** If Applicable, Match Reduction From the In-kind Match Certification form                        $          -
   Required Match                                                                                                           4.    $        -
5.Full Unit Rate Less Required Match (Line 3 minus Line 4)                                                                  5.    $        -



4. Mandatory Local Match of 25%                                                                    $          -
** If Applicable, Match Reduction From the In-kind Match Certification form                        $          -
   Required Match                                                                                                           4.    $        -
5.Full Unit Rate Less Required Match (Line 3 minus Line 4)                                                                  5.    $        -



**If any portion of the required match is in-kind, you must complete an In-Kind Match Certification form.




Contract Reimbursed at Full Cost Per Unit Rate. Match Requirements Will Be Met Through Provision of Additional Units

    $                    -
                                           Contractor Initial                      AAA Initial




                      Nueces County                                               Area Agency on Aging of the Coastal Bend
             Legal Name of Contracted Provider                                         Name of Area Agency on Aging



                             Signature                                                             Signature


                Printed/Typed Name of Signer                                             Printed/Typed Name of Signer



                               Date                                                                    Date




                                                 Calculation of In-Kind Value
   1. Required Match Rate                                                                                               -
   2. TDoA units                                                                                                        -
   3. Required Match Rate (1) Multiplied by the anticipated number of TDoA units (2)                                    -
   4. Total Valuation from the In-Kind Certification                                                                    -
   5. Balance of Required Match (3-4)                                                                                   -
   6. TDoA units + DHS units                                                                                            -
   7. Balance of Required Match (5) Divided by TDoA units (6)                                                           -
   8. Required Match Rate                                                                                               -
   9. Reduced Required Match If (8) is equal to or less than 0 this will equal (8) or else (8-7)                        -
           9/28/12 11:24 PM
           Provider Name: Nueces County
               AAA Name: Area Agency on Aging of the Coastal Bend
                                       Participant Assessment
                                BUDGET WORKSHEET CERTIFICATION

  AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:

      I have read the note below and the instructions applicable to this budget worksheet.

      I have reviewed this budget worksheet after its preparation.

      To the best of my knowledge and belief, this budget worksheet is true, correct and
       complete, and was prepared in accordance with the instructions applicable to this
       budget worksheet.

      This budget worksheet was prepared from the books and records of the contracted
       provider.

      I acknowledge that all books and records related to this rate setting process are
       subject to audit in accordance with contract requirements and all applicable federal
       and state laws.


Note: The person legally responsible for the conduct of the contracted provider must
      sign this Budget Worksheet Certification. If a sole proprietor, the owner
      must sign the Budget Worksheet Certification. If a partnership, a partner must
      sign the Budget Worksheet Certification. If a corporation, the person authorized by the
      Board of Directors Resolution must sign the Budget Worksheet Certification.
      Misrepresentation of information contained in the budget worksheet may result in
      adverse action, up to and including contract termination. Furthermore, falsification of
      information in the budget worksheet may result in a referral for prosecution.


                           Nueces County                                 Samuel L. Neal Jr
                       Name of Contracted Provider                   Printed/Typed Name of Signer




                                  Date                                           Signature




       Signer Authority:              Sole Proprietor      Association Officer
         (check one)                  Partner              Board Member
                                      Corporate Officer    Governmental Official
                     9/28/12 11:24 PM
                 AAA Name: Area Agency on Aging of the Coastal Bend
                                                   Participant Assessment
                                              IN-KIND MATCH CERTIFICATION
Provider:        Nueces County

 In-kind Contribution(s):                          $0

                             For any item identified below, you must maintain support documentation.



                                    ITEM                                      DATE OF RECEIPT                    VALUE




                                                                                              TOTAL                 $0

Note:            All contributions must meet the requirements of IRS Publication 561
                 http://www.irs.gov/pub/irs-pdf/p561.pdf

Examples of Documentation Include:

Rent:                      1. Letter of Agreement with Owner
                           2. Adequate Valuation of Property on a Current Basis (this should be reviewed at least every two years
                              and if senior center, based on property value and center participation)

Labor:                     1. Minimum wage
                           2. Documented prevailing wage in the Area. For prevailing wage information visit the Texas Workforce
                              Commission’s website at http://www.tracer2.com/.


All in-kind labor must be required for the service to be provided. If you would not hire someone to perform the labor if it
were not in-kind then you cannot count it.

Utilities:                 1. Copy of Bill
                           2. Agreement of Amount Paid if Partial

                Nueces County
             Name of Contracted Provider                                               Printed/Typed Name of Signer


                      Date                                                                         Signature
                                                                                                                                 Transportation
                           Provider Name: Nueces County
                               AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                                    Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed Budget
                                                            9/28/12 11:24 PM
Most Recent Completed Budget
                                             2011                                                                                              Proposed Budget                                                                Explanation of Variances
            Year

                                                                                                                                                                                                                                             Inflation Factor 2011 to 2012       1.021%
                                                                                                                                                                                                                                              Inflation Factor 2012 to 2013      1.014%
                                                                                                                                                                                                                                                  Combined Inflation Factor      2.035%
                                                                                                                                                                                                1. An explanation of variance must be provided for each cost area where the expenses per
                                                                                                                                                                                                General Ledger varies from the approved budget for the most recent completed year by 10% or
                                                                       Variance                                                                                                                 more.
                                             Expense                   Budget                                                                 Percentage Variance -                              2. An explanation of variance must be provided for each cost area where the proposed budget
                                           per General Approved         minus         Percentage    Percentage of                              Prior Year Actual to                             amount exceeds the prior year actual amount by more than the two year combined inflation
               Cost Area                     Ledger      Budget       Expenses        of Variance     Unit Cost      Proposed Budget            Proposed Budget       Percentage of Unit Cost   factor.
                                                   Personnel
Salaries, PR Taxes & Benefits                44,969.02 49,259.52         4,290.50          -8.71%                              35288.13                     -21.53%                                                                                                                         -
Contract staff, Compensation                                                    -           0.00%                                  0.00                       0.00%
Total                                        44,969.02 49,259.52         4,290.50          -8.71%            84%               35288.13                     -21.53%                       80%
                                               Nutrition Education
Salaries, PR Taxes & Benefits                                                     -         0.00%
Contract staff, Compensation                                                      -         0.00%
Materials                                                                         -         0.00%
Conference                                                                        -         0.00%
Total                                             -       0.00                    -         0.00%             0%                       0.00                                                0%
                                           Professional Development
Conference                                                                        -         0.00%                                      0.00                   0.00%
Dues                                                                              -         0.00%                                      0.00                   0.00%
Materials                                                                         -         0.00%                                      0.00                   0.00%
Total                                             -       0.00                    -         0.00%             0%                       0.00                   0.00%                        0%
                                                  Meals/Food
Raw Food                                                                          -         0.00%                                      0.00                   0.00%
Purchased Meals                                                                   -         0.00%                                      0.00                   0.00%
Freight                                                                           -         0.00%                                      0.00                   0.00%
Storage                                                                           -         0.00%                                      0.00                   0.00%
Consumables                                                                       -         0.00%                                      0.00                   0.00%
Other                                                                             -         0.00%                                      0.00                   0.00%
Total                                              -      0.00                    -         0.00%             0%                       0.00                   0.00%                        0%
                                                   Equipment
Depreciation                                                                      -         0.00%                                      0.00                   0.00%                                                                                                                         -
Interest                                                                          -         0.00%                                      0.00                   0.00%
Leasing                                                                           -         0.00%                                      0.00                   0.00%
Maintenance                                                                       -         0.00%                                      0.00                   0.00%
Total                                             -      0.00                     -         0.00%             0%                       0.00                   0.00%                        0%
                                              Occupancy/Building
Rent                                                                              -         0.00%                                      0.00                   0.00%
Utilities                                                                         -         0.00%                                      0.00                   0.00%
Depreciation                                                                      -         0.00%                                      0.00                   0.00%
Mortgage Interest                                                                 -         0.00%                                      0.00                   0.00%
Insurance                                                                         -         0.00%                                      0.00                   0.00%
Security                                                                          -         0.00%                                      0.00                   0.00%
Janitorial                                                                        -         0.00%                                      0.00                   0.00%
Repair                                                                            -         0.00%                                      0.00                   0.00%
Taxes                                                                             -         0.00%                                      0.00                   0.00%
Total                                             -       0.00                    -         0.00%             0%                       0.00                   0.00%                        0%
                                             Transportation/Travel
Mileage Reimbursement                                                           -          0.00%                                   0.00                       0.00%                             1. Repair expenditures have been allocated to reflect a more accurate meal delivery cost.
Delivery                                                                        -          0.00%                                   0.00                       0.00%
Gas & Oil                                     5,520.16   5,651.47          131.31         -2.32%                                5620.16                       1.81%
Repairs                                       1,209.70                  (1,209.70)      -100.00%                                1211.77                       0.17%
                                                                                                                                    Transportation
                            Provider Name: Nueces County
                                AAA Name: Area Agency on Aging of the Coastal Bend
                                                                                                                    Review of Most Recent Completed Year Approved Budget to Actual Year End Expense and Current Proposed Budget
                                                             9/28/12 11:24 PM
Most Recent Completed Budget
                                              2011                                                                                             Proposed Budget                                                                 Explanation of Variances
            Year

                                                                                                                                                                                                                                              Inflation Factor 2011 to 2012       1.021%
                                                                                                                                                                                                                                               Inflation Factor 2012 to 2013      1.014%
                                                                                                                                                                                                                                                   Combined Inflation Factor      2.035%
                                                                                                                                                                                                 1. An explanation of variance must be provided for each cost area where the expenses per
                                                                                                                                                                                                 General Ledger varies from the approved budget for the most recent completed year by 10% or
                                                                         Variance                                                                                                                more.
                                                                                                                                                                                                  1. Repair expenditures have been allocated to reflect a more accurate meal delivery cost.
                                              Expense                    Budget                                                               Percentage Variance -                               2. An explanation of variance must be provided for each cost area where the proposed budget
                                            per General   Approved        minus      Percentage Percentage of                                  Prior Year Actual to                              amount exceeds the prior year actual amount by more than the two year combined inflation
                Cost Area                     Ledger       Budget       Expenses     of Variance  Unit Cost          Proposed Budget            Proposed Budget        Percentage of Unit Cost   factor.
Insurance                                                                         -        0.00%                                       0.00                    0.00%
Depreciation/Lease                                                                -        0.00%                                       0.00                    0.00%
Interest                                                                          -        0.00%                                       0.00                    0.00%
Tags & Licenses                                                                   -        0.00%                                       0.00                    0.00%
Total                                          6,729.86   5,651.47        (1,078.39)      19.08%         13%                        6831.93                    1.52%                       16%
                                             Administrative & General
Advertising                                                                       -       0.00%                                        0.00                   0.00%                               1. Office supplies, did not purchase projected supplies and equipment. 1. Postage material
Printing                                                                          -       0.00%                                        0.00                   0.00%                              were not mailed. 1. Telecommunications were allocated to center operations and remainder
Copying                                                                           -       0.00%                                        0.00                   0.00%                              being allocated by meal percentage.
Office Supplies                                 885.00                      (885.00)   -100.00%                                      887.84                   0.32%
Contractual Agreements                             -                              -       0.00%                                        0.00                   0.00%
Postage                                           9.90                        (9.90)   -100.00%                                        9.87                  -0.30%
Telecommunications                              843.12     48.26            (794.86)   1647.04%                                      857.45                   1.70%
Liability Insurance                                                               -       0.00%                                        0.00                   0.00%
Legal Fees                                                                        -       0.00%                                        0.00                   0.00%
Accounting Fees                                                                   -       0.00%                                        0.00                   0.00%
Consulting Fees                                                                   -       0.00%                                        0.00                   0.00%
Other Fees (Explain)                            101.28                      (101.28)   -100.00%                                      102.40                   1.11%
Audit                                                                             -       0.00%                                        0.00                   0.00%
Other Misc. (Explain)                                                             -       0.00%                                        0.00                   0.00%
Total                                         1,839.30      48.26         (1,791.04)   3711.23%             3%                      1857.56                   0.99%                         4%
                                                       Total
Total of all Cost Areas                       53,538.18 54,959.25         1,421.07       -2.59%            1.00                   43,977.62                 -17.86%                       100%
Total Number One Way Trips                      11,936       12,500         564.00        4.73%
Whole Cost per Trip                                4.49         4.40          2.52       -1.98%                       Budgeted Units                                   Budgeted Cost per Unit
Approved One Way Trip Unit Rate                                3.96                                                           10,000.00                                                   4.40



                                                                                                  Proposed One
                                          Funding Source                                            Way Trips     Calculated Rate                   Revenue
                               DADS A&I AAA - 10 % Match Required                                        6,712                        3.96               26,579.52
                               DADS A&I AAA - 25 % Match Required                                                                      -                       -
                                    DADS A&I AAA - Full Unit Rate                                                                      -                       -
                                          Program Income                                                                               -                       -
                                     Local Funds - Eligible Trips                                        3,288                        4.40               14,467.20
                                   Other Funds - Non-Eligible Trips                                                                    -                       -
                                 Local Funds - Required Match 10%                                     NA                              0.44                2,953.28
                                 Local Funds - Required Match 25%                                     NA                              1.10                     -
                                          Other Sources 6                                                                              -                       -
                                          Other Sources 7                                                                              -                       -
                                          Other Sources 8                                                                              -                       -
                              Total One Way Trips by Funding Source                                     10,000    Total Revenue                          44,000.00
             9/28/12 11:24 PM
            Provider Name: Nueces County
                AAA Name: Area Agency on Aging of the Coastal Bend
                                                     Transportation
                                      BUDGET WORKSHEET CALCULATION OF THE UNIT RATE

1.Total Budgeted Expenses for Contract Year                                                                                     1.   $   43,977.62

2.Total Number of Anticipated Units to be Provided
   DADS A&I AAA - 10 %                        Program
      Match Required           6,712          Income                 0          Other Sources 6          0
   DADS A&I AAA - 25 %                     Local Funds -
      Match Required              0        Eligible Trips          3,288        Other Sources 7          0
                                           Other Funds -
  DADS A&I AAA - Full Unit                 Non-Eligible
           Rate                   0            Trips                 0          Other Sources 8          0                      2.         10,000



3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate                                                                    3.   $        4.40

Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction


4. Mandatory Local Match of 10%                                                                    $          0.44
** If Applicable, Match Reduction From the In-kind Match Certification form                        $           -
   Required Match                                                                                                               4.   $        0.44
5.Full Unit Rate Less Required Match (Line 3 minus Line 4)                                                                      5.   $        3.96



4. Mandatory Local Match of 25%                                                                    $          1.10
** If Applicable, Match Reduction From the In-kind Match Certification form                        $           -
   Required Match                                                                                                               4.   $        1.10
5.Full Unit Rate Less Required Match (Line 3 minus Line 4)                                                                      5.   $        3.30



**If any portion of the required match is in-kind, you must complete an In-Kind Match Certification form.




Contract Reimbursed at Full Cost Per Unit Rate. Match Requirements Will Be Met Through Provision of Additional Units

    $                   4.40
                                           Contractor Initial                      AAA Initial




                      Nueces County                                               Area Agency on Aging of the Coastal Bend
             Legal Name of Contracted Provider                                         Name of Area Agency on Aging



                           Signature                                                               Signature

                                                                                      John P. Buckner, Executive Director
                Printed/Typed Name of Signer                                            Printed/Typed Name of Signer



                               Date                                                                    Date




                                                 Calculation of In-Kind Value
   1. Required Match Rate                                                                                                0.44
   2. TDoA units                                                                                                        6,712
   3. Required Match Rate (1) Multiplied by the anticipated number of TDoA units (2)                                 2,953.28
   4. Total Valuation from the In-Kind Certification                                                                      -
   5. Balance of Required Match (3-4)                                                                                   2,953
   6. TDoA units + DHS units                                                                                            6,712
   7. Balance of Required Match (5) Divided by TDoA units (6)                                                            0.44
   8. Required Match Rate                                                                                                0.44
   9. Reduced Required Match If (8) is equal to or less than 0 this will equal (8) or else (8-7)                          -
             9/28/12 11:24 PM
            Provider Name: Nueces County
                AAA Name: Area Agency on Aging of the Coastal Bend
                                       Transportation
                              BUDGET WORKSHEET CERTIFICATION

  AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:

      I have read the note below and the instructions applicable to this budget worksheet.

      I have reviewed this budget worksheet after its preparation.

      To the best of my knowledge and belief, this budget worksheet is true, correct and
       complete, and was prepared in accordance with the instructions applicable to this
       budget worksheet.

      This budget worksheet was prepared from the books and records of the contracted
       provider.

      I acknowledge that all books and records related to this rate setting process are
       subject to audit in accordance with contract requirements and all applicable federal
       and state laws.


Note: The person legally responsible for the conduct of the contracted provider must
      sign this Budget Worksheet Certification. If a sole proprietor, the owner
      must sign the Budget Worksheet Certification. If a partnership, a partner must
      sign the Budget Worksheet Certification. If a corporation, the person authorized by the
      Board of Directors Resolution must sign the Budget Worksheet Certification.
      Misrepresentation of information contained in the budget worksheet may result in
      adverse action, up to and including contract termination. Furthermore, falsification of
      information in the budget worksheet may result in a referral for prosecution.


                           Nueces County                                    Samuel L. Neal, Jr.
                       Name of Contracted Provider                        Printed/Typed Name of Signer




                                  Date                                               Signature




       Signer Authority:                 Sole Proprietor       Association Officer
         (check one)                     Partner               Board Member
                                         Corporate Officer     Governmental Official
                     9/28/12 11:24 PM
                 AAA Name: Area Agency on Aging of the Coastal Bend
                                                        Transportation
                                              IN-KIND MATCH CERTIFICATION
Provider:        Nueces County

 In-kind Contribution(s):                          $0

                             For any item identified below, you must maintain support documentation.



                                    ITEM                                      DATE OF RECEIPT                    VALUE




                                                                                              TOTAL                 $0

Note:            All contributions must meet the requirements of IRS Publication 561
                 http://www.irs.gov/pub/irs-pdf/p561.pdf

Examples of Documentation Include:

Rent:                      1. Letter of Agreement with Owner
                           2. Adequate Valuation of Property on a Current Basis (this should be reviewed at least every two years
                              and if senior center, based on property value and center participation)

Labor:                     1. Minimum wage
                           2. Documented prevailing wage in the Area. For prevailing wage information visit the Texas Workforce
                              Commission’s website at http://www.tracer2.com/.


All in-kind labor must be required for the service to be provided. If you would not hire someone to perform the labor if it
were not in-kind then you cannot count it.

Utilities:                 1. Copy of Bill
                           2. Agreement of Amount Paid if Partial

                Nueces County
             Name of Contracted Provider                                               Printed/Typed Name of Signer


                      Date                                                                         Signature

								
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