Cash Disbursement Worksheet

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Cash Disbursement Worksheet Powered By Docstoc
					MENTAL HEALTH CASH TRANSACTIONS ONLY                                                        BOARD NAME:
Prepared by:                                                                                Cash Receipt/Disbursement Model
Date:                                                                                       PERIOD COVERED:            July - Sept SFY 2010
FUND WORKSHEET

                                                                                            Community      Beh'l Hlth                                                Child Care
                                     MEDICAID    ARRA               Levy (MH   Forensic        Flex        Children        SE Ohio        ECMH           TSIG         Quality      Block Grant    Title XX        Block Grant
                                       FFP      (eFMAP)    Other MH  share)      401            408           404            505              505        Fed            Fed           Base                         (Forensic)   TOTAL
ENTER: Beginning Available Funds >                                                                                                                                                                                                      $0

RECEIPTS:
     PERIOD        DESCRIPTION
July               Receipts                                                                                                                                                                                                             $0

August             Receipts                                                                                                                                                                                                              0

September          Receipts                                                                                                                                                                                                              0

Total Receipts Available                   $0         $0        $0       $0            $0             $0            $0               $0             $0          $0            $0             $0              $0            $0           $0

DISBURSEMENTS:
     PERIOD    DESCRIPTION
July          Administration                                                                                                                                                                                                            $0
July          Medicaid                                                                                                                                                                                                                   0
July          Non-Medicaid                                                                                                                                                                                                               0
July          Other                                                                                                                                                                                                                      0

August             Administration                                                                                                                                                                                                        0
August             Medicaid                                                                                                                                                                                                              0
August             Non-Medicaid                                                                                                                                                                                                          0
August             Other                                                                                                                                                                                                                 0

September          Administration                                                                                                                                                                                                        0
September          Medicaid                                                                                                                                                                                                              0
September          Non-Medicaid                                                                                                                                                                                                          0
September          Other                                                                                                                                                                                                                 0

Total Disbursements                        $0         $0        $0       $0            $0             $0            $0               $0             $0          $0            $0             $0              $0            $0           $0

Ending Fund Balance                        $0         $0        $0       $0            $0             $0            $0               $0             $0          $0            $0             $0              $0            $0           $0
MENTAL HEALTH CASH TRANSACTIONS ONLY                                                                       BOARD NAME:
Prepared by:                                                                                               Cash Receipt/Disbursement Model
Date:                                                                                                      PERIOD COVERED:            July - Sept SFY 2010



Cash Worksheet                                                               DATE:               AMOUNT:
BEGINNING MENTAL HEALTH CASH BALANCE                                        06/30/09                  $0
Total Mental Health Receipts                                                                           0
Total Mental Health Disbursement                                                                       0
ENDING MENTAL HEALTH CASH BALANCE                                                                     $0
ENDING AOD CASH BALANCE                                                                                0
COUNTY AUDITOR CASH REPORT                                                                            $0


NOTES:
1) The beginning cash balance is made up of fund balances and should equal the cash account.
2) Cash balances are the actual number from a reconciled cash account to the County Auditor
Cash Report and/or the bank account(s).
3) Insert AOD ending cash balance (for Joint boards) to determine your Total Cash Balance.
This number should reconcile to County Auditor Cash Report and/or the bank account(s).
4) Do not include any non-cash transactions (i.e. hospital bed days, medication credit, etc.)
5) Submit your County Auditor's Cash Report(s) or Bank Account(s) to ODMH with this worksheet.
6) Any other mental Health related transactions which do not have a caregory, enter them in
them under the "other MH"
7) This is a spreadsheet always check formulas and math before sending to ODMH.
MENTAL HEALTH CASH TRANSACTIONS ONLY
Prepared by:
Date:
FUND WORKSHEET



                                     MEDICAID     ARRA             Levy (MH   Forensic
                                       FFP      (eFMAP)    Other MH share)      401
ENTER: Beginning Available Funds >         $0         $0        $0      $0            $0

RECEIPTS:
    PERIOD         DESCRIPTION
October            Receipts

November           Receipts

December           Receipts

Total Receipts Available                   $0         $0        $0       $0           $0

DISBURSEMENTS:
    PERIOD     DESCRIPTION
October       Administration
October       Medicaid
October       Non-Medicaid
October       Other

November           Administration
November           Medicaid
November           Non-Medicaid
November           Other

December           Administration
December           Medicaid
December           Non-Medicaid
December           Other

Total Disbursements                        $0         $0        $0       $0           $0

Ending Fund Balance                        $0         $0        $0      $0            $0


Cash Worksheet                                              DATE:             AMOUNT:
BEGINNING MENTAL HEALTH CASH BALANCE                                                  $0
Total Mental Health Receipts                                                             0
Total Mental Health Disbursement                                                         0
ENDING MENTAL HEALTH CASH BALANCE                                                     $0
ENDING AOD CASH BALANCE                                                                  0
COUNTY AUDITOR CASH REPORT                                                                         $0


NOTES:
1) The beginning cash balance is made up of fund balances and should equal the cash account.
2) Cash balances are the actual number from a reconciled cash account to the County Auditor
Cash Report and/or the bank account(s).
3) Insert AOD ending cash balance (for Joint boards) to determine your Total Cash Balance. This
number should reconcile to County Auditor Cash Report and/or the bank account(s).
4) Do not include any non-cash transactions (i.e. hospital bed days, medication credit, etc.)
5) Submit your County Auditor's Cash Report(s) or Bank Account(s) to ODMH with this worksheet.
6) Any other mental Health related transactions which do not have a caregory, enter them in them
under the "other MH"
7) This is a spreadsheet always check formulas and math before sending to ODMH.
BOARD NAME:
Cash Receipt/Disbursement Model
PERIOD COVERED:            Oct - Dec SFY 2010


Community      Beh'l Hlth                                               Child Care
   Flex        Children       SE Ohio           ECMH        TSIG         Quality
    408           404            505             505        Fed            Fed
          $0            $0              $0             $0          $0            $0




          $0            $0              $0             $0          $0            $0




          $0            $0              $0             $0          $0            $0

          $0            $0              $0             $0          $0            $0
Block Grant    Title XX        Block Grant
   Base                        (Forensic)    TOTAL
          $0              $0           $0        $0



                                                 $0

                                                     0

                                                     0

          $0              $0           $0        $0




                                                 $0
                                                  0
                                                  0
                                                  0

                                                     0
                                                     0
                                                     0
                                                     0

                                                     0
                                                     0
                                                     0
                                                     0

          $0              $0           $0        $0

          $0              $0           $0        $0
MENTAL HEALTH CASH TRANSACTIONS ONLY                                                          BOARD NAME:
Prepared by:                                                                                  Cash Receipt/Disbursement Model
Date:                                                                                         PERIOD COVERED:            Jan - Mar SFY 2010
FUND WORKSHEET

                                                                                              Community      Beh'l Hlth                                               Child Care
                                     MEDICAID    ARRA               Levy (MH   Forensic          Flex        Children       SE Ohio           ECMH        TSIG         Quality      Block Grant    Title XX        Block Grant
                                       FFP      (eFMAP)    Other MH  share)      401              408           404           505              505        Fed            Fed           Base                         (Forensic)   TOTAL
ENTER: Beginning Available Funds >         $0         $0        $0       $0            $0               $0            $0              $0             $0          $0            $0             $0              $0            $0       $0

RECEIPTS:
    PERIOD         DESCRIPTION
January            Receipts                                                                                                                                                                                                          $0

February           Receipts                                                                                                                                                                                                              0

March              Receipts                                                                                                                                                                                                              0

Total Receipts Available                   $0         $0        $0       $0            $0               $0            $0              $0             $0          $0            $0             $0              $0            $0       $0

DISBURSEMENTS:
    PERIOD     DESCRIPTION
January      Administration                                                                                                                                                                                                          $0
January      Medicaid                                                                                                                                                                                                                 0
January      Non-Medicaid                                                                                                                                                                                                             0
January      Other                                                                                                                                                                                                                    0

February           Administration                                                                                                                                                                                                        0
February           Medicaid                                                                                                                                                                                                              0
February           Non-Medicaid                                                                                                                                                                                                          0
February           Other                                                                                                                                                                                                                 0

March              Administration                                                                                                                                                                                                        0
March              Medicaid                                                                                                                                                                                                              0
March              Non-Medicaid                                                                                                                                                                                                          0
March              Other                                                                                                                                                                                                                 0

Total Disbursements                        $0         $0        $0       $0            $0               $0            $0              $0             $0          $0            $0             $0              $0            $0       $0

Ending Fund Balance                        $0         $0        $0       $0            $0               $0            $0              $0             $0          $0            $0             $0              $0            $0       $0


Cash Worksheet                                              DATE:              AMOUNT:
BEGINNING MENTAL HEALTH CASH BALANCE                                                   $0
Total Mental Health Receipts                                                              0
Total Mental Health Disbursement                                                                 0
ENDING MENTAL HEALTH CASH BALANCE                                                                $0
ENDING AOD CASH BALANCE                                                                          0
COUNTY AUDITOR CASH REPORT                                                                       $0


NOTES:
1) The beginning cash balance is made up of fund balances and should equal the cash account.
2) Cash balances are the actual number from a reconciled cash account to the County Auditor
Cash Report and/or the bank account(s).
3) Insert AOD ending cash balance (for Joint boards) to determine your Total Cash Balance.
This number should reconcile to County Auditor Cash Report and/or the bank account(s).
4) Do not include any non-cash transactions (i.e. hospital bed days, medication credit, etc.)
5) Submit your County Auditor's Cash Report(s) or Bank Account(s) to ODMH with this worksheet.
6) Any other mental Health related transactions which do not have a caregory, enter them in
them under the "other MH"
7) This is a spreadsheet always check formulas and math before sending to ODMH.
MENTAL HEALTH CASH TRANSACTIONS ONLY
Prepared by:
Date:
FUND WORKSHEET



                                     MEDICAID     ARRA             Levy (MH   Forensic
                                       FFP      (eFMAP)    Other MH share)      401
ENTER: Beginning Available Funds >         $0         $0        $0      $0            $0

RECEIPTS:
      PERIOD       DESCRIPTION
April              Receipts

May                Receipts

June               Receipts

Total Receipts Available                   $0         $0        $0       $0           $0

DISBURSEMENTS:
      PERIOD   DESCRIPTION
April         Administration
April         Medicaid
April         Non-Medicaid
April         Other

May                Administration
May                Medicaid
May                Non-Medicaid
May                Other

June               Administration
June               Medicaid
June               Non-Medicaid
June               Other

Total Disbursements                        $0         $0        $0       $0           $0

Ending Fund Balance                        $0         $0        $0      $0            $0


Cash Worksheet                                              DATE:             AMOUNT:
BEGINNING MENTAL HEALTH CASH BALANCE                                                  $0
Total Mental Health Receipts                                                             0
Total Mental Health Disbursement                                                         0
ENDING MENTAL HEALTH CASH BALANCE                                                     $0
ENDING AOD CASH BALANCE                                                                  0
COUNTY AUDITOR CASH REPORT                                                                         $0


NOTES:
1) The beginning cash balance is made up of fund balances and should equal the cash account.
2) Cash balances are the actual number from a reconciled cash account to the County Auditor
Cash Report and/or the bank account(s).
3) Insert AOD ending cash balance (for Joint boards) to determine your Total Cash Balance. This
number should reconcile to County Auditor Cash Report and/or the bank account(s).
4) Do not include any non-cash transactions (i.e. hospital bed days, medication credit, etc.)
5) Submit your County Auditor's Cash Report(s) or Bank Account(s) to ODMH with this worksheet.
6) Any other mental Health related transactions which do not have a caregory, enter them in them
under the "other MH"
7) This is a spreadsheet always check formulas and math before sending to ODMH.
BOARD NAME:
Cash Receipt/Disbursement Model
PERIOD COVERED:            Apr - Jun SFY 2010


Community      Beh'l Hlth                                               Child Care
   Flex        Children       SE Ohio           ECMH        TSIG         Quality
    408           404            505             505        Fed            Fed
          $0            $0              $0             $0          $0            $0




          $0            $0              $0             $0          $0            $0




          $0            $0              $0             $0          $0            $0

          $0            $0              $0             $0          $0            $0
Block Grant    Title XX        Block Grant
   Base                        (Forensic)    TOTAL
          $0              $0           $0        $0



                                                 $0

                                                     0

                                                     0

          $0              $0           $0        $0




                                                 $0
                                                  0
                                                  0
                                                  0

                                                     0
                                                     0
                                                     0
                                                     0

                                                     0
                                                     0
                                                     0
                                                     0

          $0              $0           $0        $0

          $0              $0           $0        $0

				
DOCUMENT INFO
Description: Cash Disbursement Worksheet document sample