2008 Budget No Formula

BUDGET FORMAT Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2008 Actual Revenues Client Fee Contributions & Donations Insurance Payments Interest Income Licenses/Permits Medical Assistance Medicare Payments Miscellaneous Reimbursement Personal Payments Rent Revenue State Grants Payments from Other Contracts Other (specify) TOTAL REVENUE Expense/Expenditure Wages/Benefits Director Program Manager Other Administrative Wages Direct Service Staff Clerical/Support Staff Compensatory Holiday Sick Pay Vacation Fringe Benefits FICA Retirement Employee Related Insurance Dental Insurance Group Life Insurance Health Insurance Long Term Disability Unemployment Insurance Worker's Compensation TOTAL WAGES/BENEFITS EXPENSE Budget 7/1/09 - 12/31/09 Budget 01/01/10 - 12/31/10 BUDGET FORMAT Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2008 Actual Purchased Services Bed Hold Child Day Care Consulting Dietician Home Delivered Meals Interpretation Service Laboratory Membership Dues Nurses Outreach Personal Care Physician Property Taxes Psychiatrist Psychologist Recreation Respite Care Teacher Training/Education Transportation - Client Accounting Regular Audit Furniture/Equipment Furniture Under $500 Equipment Under $500 Health Care/Medical Exam Fees - Physical Drugs - Prescriptions Drugs - OTC - Adult Medical Supplies Household Expenses Food Laundry Custodial/Maintenance Clothing School Housekeeping Budget 7/1/09 - 12/31/09 Budget 01/01/10 - 12/31/10 BUDGET FORMAT Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2008 Actual Insurance Charges General Liability Insurance Property Insurance Malpractice Insurance Rental Rental of Building Rental of Equipment Travel and Meals Mileage - Employee Meals - Employee Lodging - Employee Seminars and Training Utilities Electric Natural Gas Telephone Water Other Program Expenses Advertising Printing Office Supplies Audiovisual Postage Subscriptions Books Pamphlets TOTAL PURCHASED SERVICES Budget 7/1/09 - 12/31/09 Budget 01/01/10 - 12/31/10 BUDGET FORMAT Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2008 Actual Depreciation Buildings Equipment Auto Other (specify) TOTAL DEPRECIATION Misc. Other (specify) a. b. c. d. TOTAL MISCELLANEOUS Budget 7/1/09 - 12/31/09 Budget 01/01/10 - 12/31/10 TOTAL EXPENSES COUNTY APPROPRIATION TOTAL NUMBER OF UNITS* *Please indicate your unit rate: Hours Other Days Months Client COST PER UNIT BUDGET FORMAT YEAR 2008 PERIOD 1/1/08 THROUGH 12/31/08 Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2006 Actual Revenues Client Fee Contributions & Donations Insurance Payments Interest Income Licenses/Permits Medical Assistance Medicare Payments Miscellaneous Reimbursement Personal Payments Rent Revenue State Grants Payments from Other Contracts Other (specify) TOTAL REVENUE 2007 Budget 1/1/07 - 12/31/07 2008 Proj. Rev/Exp. Budget Request % Increase/Decrease 2007 vs. 2008 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! $0 $0 $0 $0 BUDGET FORMAT YEAR 2008 PERIOD 1/1/08 THROUGH 12/31/08 Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2006 Actual Expense/Expenditure Wages/Benefits Director Program Manager Other Administrative Wages Direct Service Staff Clerical/Support Staff Compensatory Holiday Sick Pay Vacation Fringe Benefits FICA Retirement Employee Related Insurance Dental Insurance Group Life Insurance Health Insurance Long Term Disability Unemployment Insurance Worker's Compensation TOTAL WAGES/BENEFITS EXPENSE $0 $0 $0 $0 2007 Budget 1/1/07 - 12/31/07 2008 Proj. Rev/Exp. Budget Request % Increase/Decrease 2007 vs. 2008 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! BUDGET FORMAT YEAR 2008 PERIOD 1/1/08 THROUGH 12/31/08 Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2006 Actual Purchased Services Bed Hold Child Day Care Consulting Dietician Home Delivered Meals Interpretation Service Laboratory Membership Dues Nurses Outreach Personal Care Physician Property Taxes Psychiatrist Psychologist Recreation Respite Care Teacher Training/Education Transportation - Client Accounting Regular Audit 2007 Budget 1/1/07 - 12/31/07 2008 Proj. Rev/Exp. Budget Request % Increase/Decrease 2007 vs. 2008 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! BUDGET FORMAT YEAR 2008 PERIOD 1/1/08 THROUGH 12/31/08 Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2006 Actual Furniture/Equipment Furniture Under $500 Equipment Under $500 Health Care/Medical Exam Fees - Physical Drugs - Prescriptions Drugs - OTC - Adult Medical Supplies Household Expenses Food Laundry Custodial/Maintenance Clothing School Housekeeping Insurance Charges General Liability Insurance Property Insurance Malpractice Insurance Rental Rental of Building Rental of Equipment 2007 Budget 1/1/07 - 12/31/07 2008 Proj. Rev/Exp. Budget Request % Increase/Decrease 2007 vs. 2008 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! BUDGET FORMAT YEAR 2008 PERIOD 1/1/08 THROUGH 12/31/08 Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2006 Actual Travel and Meals Mileage - Employee Meals - Employee Lodging - Employee Seminars and Training Utilities Electric Natural Gas Telephone Water Other Program Expenses Advertising Printing Office Supplies Audiovisual Postage Subscriptions Books Pamphlets TOTAL PURCHASED SERVICES $0 $0 $0 $0 2007 Budget 1/1/07 - 12/31/07 2008 Proj. Rev/Exp. Budget Request % Increase/Decrease 2007 vs. 2008 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! BUDGET FORMAT YEAR 2008 PERIOD 1/1/08 THROUGH 12/31/08 Agency Name: Program Name (if different from agency): Address: Telephone Number: Contact Person Name: Telephone Number (if different from above): BUDGET SHEET 2006 Actual 2007 Budget 1/1/07 - 12/31/07 2008 Proj. Rev/Exp. Budget Request % Increase/Decrease 2007 vs. 2008 Depreciation Buildings Equipment Auto Other (specify) TOTAL DEPRECIATION Misc. Other (specify) a. b. c. d. TOTAL MISCELLANEOUS $0 $0 $0 $0 $0 $0 $0 $0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! TOTAL EXPENSES $0 $0 $0 $0 #DIV/0! COUNTY APPROPRIATION TOTAL NUMBER OF UNITS* *Please indicate your unit rate: Hours Other Days Months Client #DIV/0! #DIV/0! COST PER UNIT #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!