California Department of Education
January 2008
MEAL WAIVER CONDITION TWO
School Meal Profit/Loss Worksheet
This form is an Excel Spreadsheet. If you are completing this form online, the fields below self-calculate as you enter information. Please Fill in the blanks under "# Students," "Op Days," and "Student Pay." Please fill out a separate spreadsheet for breakfast and lunch. Attach these spreadsheets to the application (waiver request). You may obtain an electronic version of this form by e-mailing jsheldon@cde.ca.gov .
Summer This worksheet applies to (Check One): Check which meal program will be offered: Lunch Specify time of meal service: Begins at: Enter the district enrollment: Enter the "anticipated" total summer/Saturday school enrollment: Enter the prior year summer/Saturday school enrollment: Participation Percent #DIV/0! Expected ADP
Saturday Breakfast and ends at:
Enter the total regular school year average daily participation of free, reduced-price, and paid: #DIV/0!
PROGRAM INCOME Based on your current level of reimbursement, complete one section below for each of the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) to estimate income from offering either. Please Enter this information based on the number of summer or Saturday meals you anticipate will be served during the school Under "Op Days," enter the total number of days that summer/Saturday School will operate. Under "# Students," enter the projected number of students that will be attending summer/Saturday School. Under "Student Pay," enter the price students will pay for meals (including reduced, if different). NSLP = Less than 60% needy # Students Category Free Reduced-Price Paid Total 0 NSLP = More than 60% needy # Students Category Free Reduced-Price Paid Total 0 SBP - Basic Category Free Reduced-Price Paid Total SBP - Especially Needy Category Free Reduced-Price Paid Total # Students Op Days Meals Served 0 0 0 0 # Students Op Days Meals Served 0 0 0 0 Reimbursement Op Days Meals Served 0 0 0 0 Federal $2.47 $2.07 $0.23 Student Pay Total Income State $0.2195 $0.00 $0.00 $0.2195 $0.40 $0.00 $0.00 $0.00 $0.00
Reimbursement Op Days Meals Served 0 0 0 0 Federal $2.49 $2.09 $0.25 State $0.2195 $0.2195 $0.00 Student Pay Total Income $0.00 $0.00 $0.40 $0.00 $0.00 $0.00
Reimbursement Federal $1.35 $1.05 $0.24 State $0.2195 $0.2195 $0.00 Student Pay Total Income $0.00 $0.00 $0.30 $0.00 $0.00 $0.00
0
Reimbursement Federal $1.61 $1.31 $0.24 State $0.2195 $0.2195 $0.00 Student Pay Total Income $0.00 $0.00 $0.30 $0.00 $0.00 $0.00
0
California Department of Education
January 2008
MEAL WAIVER CONDITION TWO
School Meal Profit/Loss Worksheet PROGRAM EXPENSES The calculations below determine the amount that would be spent in salaries if a meal were to be offered during the summer or Saturday school session. Total # of Hours Needed
# of Staff Needed Cook Cook Cook Nutritionist Food Service Director Janitor Other Staff: (Helper) Total Salaries Indirect Costs Food & Supplies Other Costs TOTAL PROGRAM EXPENSES
Hourly Wage $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Total Wages $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 EXPLAIN:
$0.00 $0.00 $0.00 $0.00 EXPLAIN: $0.00 FINANCIAL LOSS STATEMENT
Will providing meals during the summer/Saturday school session result in a financial loss? (check one below): NO YES If "Yes," check "Option One" or "Option Two" below: OPTION ONE: Check if the loss is equal to 1/3 of the Net Cash Resources Net cash resources means all monies as determined in accordance with the State agency's established accounting system at any given time, less cash payable [Cafeteria Fund]. (Title 7 Code of Federal Regulations, Part 210.2) Program Income: Program Expenses: Program Income/Loss Net Cash Resources Financial Loss (if any): $0.00 $0.00 $0.00 $0.00 1/3 = $0.00 $0.00
OPTION TWO: Check if the loss is equal to one month's operating costs Program Income: $0.00 Program Expenses: $0.00 Program Income/Loss $0.00 Following is the calculation for one months operating costs (as averaged over the summer) Operating Costs (same as Expenses above): $0.00 *Dividing the Operating Costs by Enter the total number of Operating Days: Total Operating Days gives the Cost COST PER DAY* #DIV/0! Per Day Enter the highest number of operating days for either one month of the summer or for the year if this calculation is for a Saturday school waiver. Multiply the Cost Per Day above by the highest number of operating days. (e.g., if the cost per day is $900 and the operating days are 21 then $900 x 21 = $18,900) One Months Operating Costs is:
#DIV/0!
California Department of Education
January 2008
MEAL WAIVER CONDITION TWO
School Meal Profit/Loss Worksheet The Program Loss from above is: $0.00
PROGRAM INCOME Based on your current level of reimbursement, complete one section below for each of the National School Lunch NSLP = Less than 60% needy # Students Op Days Category Free Reduced-Price Paid Total 0 NSLP = More than 60% needy # Students Op Days Category Free 37 18 Reduced-Price 3 18 Paid 10 18 Total 50 SBP - Basic Category Free Reduced-Price Paid Total # Students Op Days Meals Served Reimbursement Meals Served Federal 0 $2.32 0 $1.92 0 $0.22 0 State $0.1413 $0.1413 $0.00 Student Total Pay Income $0.00 $0.00 $0.40 $0.00 $0.00 $0.00 $0.00
Reimbursement Meals Served Federal State 666 $2.34 $0.1413 54 $1.94 $0.1413 180 $0.24 $0.00 900 Reimbursement Federal 0 $1.27 0 $0.97 0 $0.23 0 State $0.1413 $0.1413 $0.00 CFSP $0.1000 $0.1000 $0.1000
Student Total Pay Income $0.00 $1,652.55 $0.40 $133.99 $2.50 $493.20 $2,279.74
0
Student Total Pay Income $0.00 $0.00 $0.30 $0.00 $0.00 $0.00 $0.00
SBP - Especially Needy Category Free Reduced-Price Paid Total # Students Op Days 37 18 3 18 10 18 50
Reimbursement Meals Served Federal State 666 $1.51 $0.1413 54 $1.21 $0.1413 180 $0.23 $0.00 900
CFSP $0.1000 $0.1000 $0.1000
Student Total Pay Income $0.00 $1,166.37 $0.30 $94.57 $1.50 $329.40 $1,590.34
SUMMER SCHOOL MEAL WAIVER SUPPLEMENTAL INFORMATION SHEET DISTRICT NAME: SITE NAME: