Fitness Membership Contract Template by lbp18895

VIEWS: 0 PAGES: 13

More Info
									                                        Department of Human Services                                                                                     OLDER AMERICANS ACT, NSIP, & OPI
                                                                                                                              Cumulative Financial Report - Page 1 of 3 Prepare on a year-to -date (cumulative) basis. Round
                                                                                                                             expenditures to the nearest dollar. E-mail 148/150 report to DHS financial services by the 25th
                                        Seniors and People with Disabilities                                                                          day of the following month of expenditures.
                                        AAA District Number:                  Auto Fill from D61 (enter agency index # from column F)                  For the Month Ending:         You input                                                 Name of approver
                                                                                                                                                         Fiscal Year: You input- July - June XXXX                                           Auto Fill from Vlookup tab
                                        AAA District Name:            Auto Fill from Vlookup tab according to your input in cell D61                                                                                                                    Date:
                                                                                                                                                              Contract #: Auto Fill from Vlookup tab                                                You input
                                                                        Yes                             No
                                        Final Report?                                    Auto Fill from D63                                                                                                                                  j Name of preparer
                                        Audited?                                         Auto Fill from D65                                                                                                                                 Auto Fill from Vlookup tab
                                        Cash or Accrual?                            Auto Fill from Vlookup tab                                                                                                                                Phone # of preparer
                                                                                                                                                                                                                                            Auto Fill from Vlookup tab



                                                                                                                             III - B    III - C1   III - C2   Stimulus Stimulus        III - D     III - E    VII - B
                                                                                                                                                                                                         NSIP                                              TOTAL
                                                                                                                                                               ARRA                           Elderly Cash In         OAA State                           RESOUR
                                                                                                                       Supportiv Congrega Home-      ARRA      Home-                Family    Abuse     Lieu of       Admin - FF:                          CES &
                                                                                                                           e        te   Delivered Congregate Delivered Preventive Caregiver Preventio Commodi OPI ,  Computer,                           EXPEND
                                                                                                                        Services Meals    Meals      Meals     Meals      Health    Support      n        ties  NOC     04AD                              ITURES
                                                                      Catalog of Federal Domestic Assistance numbers #: 93.044    93.045  93.045    93.707     93.705     93.043    93.052    93.041    93.053 99.999   93.045
                                        Base Allocation/Transfer/Unspent Funds                                                 {1}        {2}        {3}        {4a}         {4b}       {6}         {7}         {8}        {9}       {10}          {11}      {12}
                                         1   Base Allocation-AAA budgeted amounts by Title for current fiscal year.        AAA Budget AAA Budget AAA Budget AAA Budget AAA Budget AAA Budget AAA Budget AAA Budget AAA BudgetAAA Budget AAA Budget        Formula
                                                                               Up to 40% of your base FY alloc. can be transferred between IIIC1 and III C2, and up to 30% may be transferred from IIIB to IIIC1 and/or IIIC2 or from
                                                                               IIIC1 and/or IIIC2 to IIIB. Transfers will net to zero. Biennial allocation amounts will be increased or reduced by transfer amounts. Carry forward funds are
                                         2 Fund Transfers                      excluded in calculation.                                                                                                                                                   Formula

                                         3 Unspent Prior Biennium Allocation Funds                                         Unspent funds of all titles may be carried forward. These funds are spent first in the first quarter of new biennium.          Formula




                                        Cash Request Work Area


                                         4 Current FY Allocation - Auto-fill formula; sum of amounts from rows 1 {Base Allocation}, 2 {Fund Transfers}, and 3 {Unspent prior biennium funds}.                                                             Formula
                                           Current Cumulative Expense: Auto-fill formula; keeping this "formula" decreases errors.YTD expenditures by fund source expended as of the end of the current month. {Linked}-
                                         5 Auto-fill formula brings totals forward from SPD 150, p2; columns 3-10, column 11 (NSIP Cash), SPD 148 {14} Total OPI Allocation Used.                                                                         Formula

                                         6 Less: Prior Cumulative Expense: You input or copy & paste (amount that was on Line (4) on the prior's month's report.)                                                                                         Formula
                                                                               Sub total =Current Cumulative expense (line 4)
                                         7               Sub-Total:            minus prior cumulative expense (line 5)        Formula Formula Formula Formula Formula Formula                    Formula Formula Formula Formula Formula                  Formula

                                         8 Adjustments:

                                                                                                                                                                                                             You input amount from the monthly HCW report..
                                         9     * Less Current Monthly HCW exp paid-SPD                                                                                                                                                                    Formula

                                                                                                                                                                                                                                                                         SPD 150 pg 1
File Name: cff88a95-32ce-4acc-aa14-d9c5ed53c82c.xls / 150 Pg1 Instructions                                                                                    Date Printed: 5/4/2011                                                                                       (7/1/2009)
                                             * Unusual Costs: Input the amount of any expenses which are payable within the next month that normal monthly reimbursements will not cover (such as annual insurance
                                           premiums or equipment purcheses, etc.) Explain the individual items & amounts in the Unusual cost section. These funds will be considered a working capital advance & must
                                        10 be deducted from the next month's expenditure report. Specify what unusual cost is.                                                                                        Formula

                                        11 *Working Capital: Input Working Capital funds issued for current months expenditures as a negative amount(s).                                                                                                          Formula

                                        12 Current Month's Requested Reimbursement: Formula The total cash requested by fund followed by the total sum of all funds requested (last cell).
                                        12                                                                                                                                                                                                                        Formula
                                                                           FY Allocation Balance = Current FY alloc
                                                                          (line 3) minus Current cumulative expense Formula Formula Formula                    Formula Formula Formula Formula Formula Formula                                                    Formula


                                                                                    Reimbursement is requested in the amount of: $               Formula                                     The total combined cash request for all funds for the current month's request.

                                        I certify that, to the best of my knowledge, the information reported above is correct .


                                        SIGNATURE: Authorized AAA signatory/Auto Fill from Vlookup tab.          TITLE: Title of authorized signatory/Auto fill                    DATE: Formula from date input above.
                                            Note: A hardcopy of the final-audited June expenditure report signed by AAA Director must be sent to DHS-Financial services by Dec 31.
                                                  A hardcopy of the fiscal year audit report must be sent to DHS-State Unit on Aging office by Dec 31.

                                        Update on final/audited report

                                                          INDEX:      You Fill - AAA 5-digit Index Code
                                                                                                                                   36140 D-2
                                                                                                                                         Community
                                                                                                                                         Action
                                                                                                                                         Team
                                                Final Yes / No: No                                   "Yes" on June Final           36730 D-7 South Coast Business Employment Corp

                                            Submit final report to DHS accounting by Sept 30.                                      37020 D-10 COCOA AAA

                                              Audited Yes / No: No                                        "Yes" if Audited         37120 D-11 Klamath Basin AAA
                                            Submit final audited signed 148/150 hardcopy to DHS by December 31.                    37340 D-13 Community Connection of NE Oregon
                                            Fiscal year end financial audit must be sent to SUA program office by December 31.     37520 D-14 Harney AAA
                                                                                                                                   37570   D-14 Malheur AAA
                                                                                                                                   37220   D-12 CAPECO AAA
                                                                                                                                   31640   D-2 Washington AAA
                                                                                                                                   32030   D-6 Douglas AAA
                                                                                                                                   32270   D-8 Rogue Valley AAA
                                                                                                                                   36920   D-9 Mid-Columbia AAA
                                                                                                                                   35720   D-2 Clackamas AAA
                                                                                                                                   34450   D-2 Multnomah AAA
                                                                                                                                   34550   D-1 Northwest Senior & Disability Services
                                                                                                                                   34660   D-4 West Cascade AAA
                                                                                                                                   34760   D-5 Lane AAA




                                                                                                                                                                                                                                                                              SPD 150 pg 1
File Name: cff88a95-32ce-4acc-aa14-d9c5ed53c82c.xls / 150 Pg1 Instructions                                                                                          Date Printed: 5/4/2011                                                                                      (7/1/2009)
Department of Human Services                                                                                OLDER AMERICANS ACT, NSIP, & OPI
Seniors and People with Disabilities                                                                      Cumulative Financial Report - Page 1 of 3
AAA District Number:                 Dist 2 Co                                                                         For the Month Ending: March 31, 2009                                                                   Approved By: Ginger Johnson
                                                                                                                      Fiscal Year: July 1, 2009 - June 30, 2010
AAA District Name:       Community Action Team                                                                                                                                                                                        Date:   4/30/2009
                                                                                                                             Contract:               128570
                           Yes               No
Final Report?                                4                                                                                                                                                                                  Prepared By: Juliann Davis
Audited?                                     4
Cash or Accrual?                       Accrual                                                                                                                                                                                      Phone: (503) 366-6584




                                                                  III - B         III - C1            III - C2         Stimulus       Stimulus               III - D            III - E         VII - B
                                                                                                                                                                                                                            OAA State
                                                                                                      Home-             ARRA         ARRA Home-                                 Family          Elderly        NSIP Cash In Admin - FF:                               TOTAL
                                                                Supportive       Congregate          Delivered        Congregate      Delivered            Preventive          Caregiver         Abuse           Lieu of    Computer,                              RESOURCES &
                                                                 Services          Meals              Meals             Meals          Meals                 Health             Support        Prevention      Commodities    04AD                 OPI            EXPENDITURES
                                                  CFDA #          93.044          93.045              93.045           93.707          93.705                93.043             93.052           93.041          93.053       93.045              99.999
Base Allocation/Transfer/Unspent Area                               {1}             {2}                 {3}              {4a}            {4b}                  {5}                {6}             {7}              {8}             {9}              {10}                {11}
 1 Base Allocation
 2 Fund Transfers
 2                                                                                                                                                                                                                                                                             $0
 3 Unspent Prior Biennium Allocation Funds                                                                                                                                                                                                                                     $0


Cash Request Work Area
 4 Current Allocation - Include Unspent & Transfers                         $0             $0                    $0             $0              $0                       $0               $0              $0             $0              $0                  $0                $0
 5 Current Cumulative Expense                                               $0             $0                    $0             $0              $0                       $0               $0              $0             $0              $0                  $0                $0
 6 Less: Prior Cumulative Expense                                           $0             $0                    $0             $0              $0                       $0               $0              $0             $0              $0                  $0                $0
 7            Sub-Total:                                                    $0             $0                    $0             $0              $0                       $0               $0              $0             $0              $0                  $0                $0
  8 Adjustments:
  9   * Less Current Month's HCW exp paid-SPD                                                                                                                                                                                                                                  $0
 10   * Unusual Costs-Specify                                                                                                                                                                                      N/A                                                         $0
 11   * Working Capital Payment                                                                                                                                                                                    N/A                                                         $0
 12 Current Month's Requested Reimbursement                                 $0             $0                    $0             $0              $0                       $0               $0              $0             $0              $0                  $0                $0
                                  FY Allocation Balance                     $0             $0                    $0             $0              $0                       $0               $0              $0             $0              $0                  $0                $0


                         Reimbursement is requested in the amount of: $                         $0

I certify that, to the best of my knowledge, the information reported above is correct .
Ginger Johnson, Fiscal Director                                                                                                                                                       April 30, 2009
SIGNATURE:                       TITLE                                                                                                                                        DATE:




                                                                                                                                                                                                                                                              SPD 150 pg 1
           File Name: cff88a95-32ce-4acc-aa14-d9c5ed53c82c.xls / SPD 150 Pg1                                                                         Date Printed: 5/4/2011                                                                                     (7/1/2009)
Department of Human Services                                                                                                                                                                                     OLDER AMERICANS ACT & NUTRITION SERVICES INCENTIVE PROGRAM
Seniors and People with Disabilities                                                                                                                                                                                          Cumulative Financial Report - Page 2 of 3                                                                                                                                                               Approved By:         Auto fill from 150, p1
                                                                 ALL INFORMATION AUTO-FILLS FROM CELLS ON 150, Pg 1
AAA District Number:              Auto filled                                                                                                                        For the Period Ending:                                Auto filled

AAA District Name:        Auto filled from 150, Pg1                                                                                                                                                                                                                                                                                                                                                                                            Date:       Auto fill from 150, p1

                           Yes         No                                                                                                                                                                                                                                                                                                                                                                                              Prepared By:        Auto fill from 150, p1

Final Report?          Auto filled                                                  Cash or Accrual?                                  Auto fill from 148

Audited?               Auto filled                                                                                                                                                                                                                                                                                                                                                                                                            Phone:       Auto fill from 150, p1

                                                                                                             OLDER AMERICAN'S ACT FUNDS                                                                                                                                     Program Income                                    OTHER CASH FUNDS                                                                IN-KIND
Matrix                                          III-B Supportive     III-C-1          III-C-2 Home-                   III-D Preventive III-E Family Caregiver              VII-B Elderly Abuse      OAA State Admin:               NSIP Cash In Lieu of                                                           Non-Federal    Cash                                                        Non-Federal-In-Kind
Number              Service Category                 Services    Congregate Meals    Delivered Meals       ARRA Meals      Health              Support                          Prevention          Computers, 04AD                   Commodities                            Program Income                              Match              Other Cash                                             Match              Other In-Kind                      TOTAL EXPENDITURES
  {A}                      {B}                         {1}              {2}                 {3}               {4}            {5}                 {6}                                {7}                   {8}                              {9}                                     {10}                                   {11)                 {12}                                                 {13}                  {14}                                   {15}
############################################ Column 2:                              Column 3:           Column 4:          Column 5:             Column 6: Report         Column 7: Report         Column 8: Report        Column 9: Report the fiscal year         Column 10: Program Income                  Column 11: Report non- Column 12: Report                                  Column 13 Report the                  Column 14: Use this       Formula
                    ####                     Report the fiscal                      Report the fiscal American             Report the fiscal     the fiscal year          the fiscal year          cumulative use of all   cumulative Nutrition Services            is a voluntary contribution                federal cash received and cash resources utilized                         value of non-cash                     column to report non-     Formula
                                             year-to-date                           year cumulative Recovery &             year cumulative       cumulative OAA Title     cumulative OAA Title     other state-provided    Incentive Program (NSIP) funds           from a service recipient or                utilized to meet required    to support the service                       resources &                           cash resources            Formula
                                             OAA Title IIIC1                        OAA Title IIIC2     Reinvestment       OAA Title IIID        IIIE funds used to       VIIB funds used in the   funds designated for    expended. Service matrix #s 4            third-party made on behalf of              administrative and program expense but not                                contributions received                utilized to support the   Formula
                                             funds used to                          funds used to pay Act funds.           funds used to pay     pay the expense per      cell of the relevant     specific use such as    and 7 only. Use of NSIP funds is         a service recipient and                    match. Examples of           reported as match in                         and employed to meet                  service expense but       Formula
                                             pay the expense                        the expense per Report on matrix       the expense per       service category it      service categories.      computer                limited to US grown raw food             described in 45CFR92.                      qualifying match - local     column 12. e.g.,                             required administrative               not reported as match     Formula
                                             per service                            service category it lines 4a, 7a and   service category it   was expended in.         Typical service matrix   replacement for AAA     products.                                Program Income is collected                businesses, city/county tax, Medicaid meal                                and program match.                    in column 13. This        Formula
                                             category it was                        was expended in. 20-1 the fiscal       was expended in.      Typical service matrix   #'s include, but may     staff performing OAA                                             directly by the AAA or their               non-client contributions,    reimbursement This                           Examples of qualifying                column is optional        Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                             expended in.                           Typical service     year cumulative    Typical service       #'s include, but may     not be limited to #'s    tasks, O4AD                                                      contractor and is to be                    State Transportation Grant - column is optional and                       match include value of                and amounts detailed
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                             Typical service                        matrix #'s include, ARRA funds         matrix #'s include,   not be limited to        13, 14, 50-2 through     membership dues.                                                 expended towards the actual                STF, rental revenue,         amounts detailed here                        volunteer hours,                      here are reported to
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                             matrix #'s                             but may not be      expended to        but may not be        matrix #'s 15, 15a,      50-5, 70-6, 70-          Reporting of these                                               cost of the service(s) received            fundraising, civic           are reported to the                          donated non-federal                   the Administration on
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                             include, but may                       limited to #4, #8, support nutrition   limited to #8, #12,   16, 16a, 20-1, 30-5,                              funds is limited to                                              prior to OAA funds. Report all             organizations, partnering Administration on Aging                         office space (state                   Aging as 'Other
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                             not be limited to                      #20-1, #30-7, #40- services.           #40-1, #40-2, #40-    30-5a, 30-6, 30-6a,                               matrix # 900, Specify                                            program income in the row                  agencies/organizations,      as 'Other Recipient                          donated is eligible),                 Recipient Outlay' (not    Formula
                                             #7, #8, #12, #20-                      1.                                     3, #40-4, #40-8,      30-7, 30-7a, 70-2a,                               use of funds.                                                    associated with the                        membership dues, etc…        Outlay' (not match).                         facility space for                    match).                   Formula
                                             1, #40-1.                                                                     #40-9, #60-1.         70-2b, 70-9, 70-9a.                                                                                                appropriate service.                       NO MEDICAID FUNDS            PLEASE NOTE:                                 training, training and                                          Formula
                                                                                                                           The Consolidated                                                                                                                                                                    are to be reported. IIIB, Federal funds reported                          meeting refreshments,                                           Formula
                                                                                                                           Appropriations                                                                                                                                                                      IIIC1/C2 and IIIE must be in this colulmn must be                         value of donated                                                Formula
                                                                                                                           Act, 2008 (P.L.                                                                                                                                                                     matched at 25% of            identified - use the insert                  instructors, supplies,                                          Formula
                                                                                                                           110-161) requires                                                                                                                                                                   administrative expense       comment function to                          food product, etc.)                                             Formula
                                                                                                                           a certain amount                                                                                                                                                                    (matrix 20-1); AAAs are      identify federal dollar                      (IIIB, IIIC1/C2 and IIIE                                        Formula
                                                                                                                           each federal fiscal                                                                                                                                                                 required to match 2/3rds of amounts (such as                              must be matched at                                              Formula
                                                                                                                           year of IIID funds                                                                                                                                                                  15% of IIIB, IIIC1/C2        Medicaid HDM                                 25% of administrative                                           Formula
                                                                                                                           to be used for                                                                                                                                                                      program expenses; IIIE       reimbursement) on                            expense (matrix 20-1);                                          Formula
                                                                                                                           purposes of                                                                                                                                                                         requires 25% match for       applicable matrix row.                       AAAs are required to                                            Formula
                                                                                                                           providing                                                                                                                                                                           program expenditures.                                                     match 2/3rds of 15% of                                          Formula
                                                                                                                           Medication                                                                                                                                                                          PLEASE NOTE: OPI                                                          IIIB, IIIC1/C2 program                                          Formula
                                                                                                                           Management                                                                                                                                                                          funds used to meet                                                        expenses; IIIE requires                                         Formula
                                                                                                                           services.                                                                                                                                                                           required match must be                                                    25% match for program                                           Formula
                                                                                                                           Distribution of                                                                                                                                                                     identified - use the insert                                               expenditures.                                                   Formula
                                                                                                                           these funds is                                                                                                                                                                      comment function to                                                                                                                       Formula
                                                                                                                           pending a                                                                                                                                                                           identify OPI dollar amounts                                                                                                               Formula
                                                                                                                           discussion on how                                                                                                                                                                   on applicable matrix row.                                                                                                                 Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                           to best allocate
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                           out to the AAAs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
                                                                                                                                                                                                                                                                                                                                                                                                                                                         Formula
PAGE GRAND TOTAL                                Formula         Formula             Formula                                Formula               Formula                  Formula                  Formula                 Formula                                  Formula                                    Formula                                                                   Formula                               Formula                   Formula



                                                                   Congregate         Home-Delivered
                     Cumulative NSIP Eligible Meal Count:                       0                      0                                                                                                                           NSIP Out of Balance

           Admin:        10% Maximum            Match:          Required:           Reported:                           Difference               Results                                                                           III-B Program:                 Minimum Required                    Reported            III-D Program           Minimum Pending      Comments
           Allowed       Formula                Adm Match       Formula             Formula                             Formula                  within compliance                                                                 Access Services                        18%                Formula                        Med Mgmt
           Actual        Formula                Prgm Match      Formula             Formula                             Formula                  within compliance                                                                In-Home Services                         3%                Formula                            III-E            Maximum Required
           within compliance                    III-E Match     Formula             Formula                             Formula                  within compliance                                                                  Legal Services                         3%                Formula                       Grandparent                   10%
                                                ARRA Match      Formula             Formula                             Formula                  within compliance                                                         The color coded matrix numbers in Column A indicate those that are eligible to meet the minimum Title IIIB, IIID expenditures & Title IIIE grandparent maxiumum expenditure requirements.
                                                Total Match :   Formula             Formula                             Formula                                                                                            Matrix 01's, 02's, 03's, 04, 05, 30-1, 30-3, 30-4, 30-5, 30-5's, 60-2, 60-3 and 70-1 may be used to meet the III-B minimum In-Home Services requirement of 3%.
                                                                                                                   Monthly Meal Counts:                                                                                    Matrix 11 maybe used to meet the legal assistance minimum expenditure of 3%.
           Note: Admin match calculation includes III-E admin.                                                                                                                                                             Matrix 06, 09, 10, 13, 14, 15's, 16's, 40-4, 60-5, 70-3, 70-5, 70-7, 70-8, and 70-10 maybe used to meet the Access Services minimum expenditures requirement of 18%
                                                                                                Monthly NSIP Eligible Meal Count:                                                                                          Matrix 40-9 maybe used to meet the III-D program medication management minimum requirement. Required percentage varies and is published via AoA Grant Award
                                                                                                                         Total Eligible                NSIP Cash                                                           Matrix 16a, 30-5a, 30-6a, 30-7a, 70-2b, 70-9a are used to track the allowable maximum 10% IIIE grandparent expenditures.
                                                                  Congregate              HDM             OPI HDM       Meals Served                 Reimbursement                                                            In-Home Services - 3%          Access Services - 18%              Legal Services 3%                  III-E -Grandparent -10%
                                                July            You Input           You Input          You Input       Formula                   Optional column for                                                       Matrix 01 & 01a - Personal Care          Matrix 06-Case Management                  Matrix 11 -Legal Assistance        Matrix 16a-Assist in Gaining Access to Caregiver Serving Children Services
                                                August          You Input           You Input          You Input       Formula                   use in calculating the                                                    Matrix 02 & 02a -Homemaker/Home Care     Matrix 09-Assisted Transportation                                             Matrix 30-5a-Caregiver Respite for Caregivers Serving Children

                                                September       You Input           You Input          You Input       Formula                   NSIP reimbursement                                                        Matrix 03 & 03a -Chore                   Matrix 10-Transportation                                                       Matrix 30-6a-Support Groups for Caregivers Serving Children

                                                October         You Input           You Input          You Input       Formula                   based on a per meal                                                       Matrix 04 - Home-delivered meals         Matrix 13-Information & Assistance                                             Matrix 30-7a-Supplemental Services to Caregivers Serving Children

                                                November        You Input           You Input          You Input       Formula                   amount. If using a                                                        Matrix 05-Adult Day Care/Adult Day Health Matrix 14-Outreach                                III-D Program               Matrix 70-2b-Individual Counseling for Caregivers Serving Children

                                                December        You Input           You Input          You Input       Formula                   per meal                                                                  Matrix 30-1-Home Repair/Modification     Matrix 15 & 15a Information for Caregivr Matrix 40-9-Medication Management Matrix 70-9a-Caregiver Training for Caregivers Serving Children
                                                                                                                                                 reimbursement                                                             Matrix 30-3-In-Home Volunteers           Matrix 16 & 16a Ass't. Gaining Crgvr Srv
                                                January         You Input           You Input          You Input       Formula
                                                                                                                                                 method, please take                                                       Matrix 30-4-Respite                      Matrix 40-4-Mental Health Services
                                                February        You Input           You Input          You Input       Formula
                                                                                                                                                 measures to ensure                                                        Matrix 30-5 & 30-5a Caregiver Respite    Matrix 60-5-Interpreting/Translation
                                                March           You Input           You Input          You Input       Formula
                                                                                                                                                 you are not
                                                April           You Input           You Input          You Input       Formula                                                                                             Matrix 60-2-Friendly Visiting            Matrix 70-3-Screening
                                                                                                                                                 requesting NSIP in
                                                May             You Input           You Input          You Input       Formula                                                                                             Matrix 60-3-Telephone Reassurance        Matrix 70-5-Newsletter
                                                                                                                                                 excess of what
                                                June            You Input           You Input          You Input       Formula                                                                                             Matrix 70-1-Case Monitoring              Matrix 70-7-Placement Services
                                                                                                                                                 you've spent on raw
                                                Total:          Formula             Formula            Formula         Formula                                      $0                                                                                              Matrix 70-8-Private Case Management
                                                                                                                                                                                                                                                                    Matrix 70-10-Public Outreach/Education




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    SPD 150 Pg2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       7/1/2009
                                                                    Department of Human Services                                                                                                                 OLDER AMERICANS ACT & NUTRITION SERVICES INCENTIVE PROGRAM
                                                                    Seniors and People with Disabilities                                                                                                                     Cumulative Financial Report - Page 2 of 3                                                                                                                              Approved By:           Ginger Johnson


                                                                    AAA District Number:                                      Dist 2 Co                                                                                                                     For the Month Ending:       March 31, 2009

                                                                    AAA District Name:                         Community Action Team                                                                                                                                                                                                                                                                            Date:          4/30/09

                                                                                                    Yes                          No                                                                                                                                                                                                                                                                 Prepared By:            Juliann Davis

                                                                    Final Report?                                                4                                                         Cash or Accrual?                                   Accrual

                                                                    Audited?                                                     4                                                                                                                                                                                                                                                                          Phone:         (503) 366-6584

                                                                                                                                                                                                                  OLDER AMERICANS ACT FUNDS                                                                                                      OTHER CASH FUNDS                             IN-KIND
                                                                                                                                                                                                                                                                                        OAA State Admin-
                                                                                                                                                                                III-C-1                                                              III-E Family    VII-B Elderly         FF Funds:       NSIP Cash In
                                                                      Matrix                                                                             III-B Supportive     Congregate        III-C-2 Home-                    III-D Preventive     Caregiver         Abuse           Computers, 04AD      Lieu of
                                                                     Number                                Service Category                                   Services          Meals          Delivered Meals     ARRA Meals         Health            Support       Prevention             Dues          Commodities      Program Income   OAA Cash Match      Other Cash     OAA Match               Other           TOTAL EXPENDITURES
                                                                        {A}                                       {B}                                           {1}                {2}                 {3}            {4}               {5}                {6}            {7}                 {8}              {9}                {10)            {11}              {12}          {13}                   {14}                   {15}
                                                                        01          Personal Care                                                                                                                                                                                                                                                                                                                                            $0
                                                                       01a          Personal Care - HCW                                                                                                                                                                                                                                                                                                                                      $0
                                                                        02          Homemaker/Home Care                                                                                                                                                                                                                                                                                                                                      $0
                                                                       02a          Homemaker/Home Care - HCW                                                                                                                                                                                                                                                                                                                                $0
                                                                        03          Chore                                                                                                                                                                                                                                                                                                                                                    $0
                                                                       03a          Chore - HCW                                                                                                                                                                                                                                                                                                                                              $0
                                                                        04          Home Del. Meals                                                                                                                                                                                                                                                                                                                                          $0
                                                                       04a          ARRA Home Del. Meals                                                                                                                                                                                                                                                                                                                                     $0
                                                                        05          Adult Day Care/AD Health                                                                                                                                                                                                                                                                                                                                 $0
                                                                        06          Case Management                                                                                                                                                                                                                                                                                                                                          $0
                                                                        07          Congregate Meals                                                                                                                                                                                                                                                                                                                                         $0
                                                                       07a          ARRA Congregate Meals                                                                                                                                                                                                                                                                                                                                    $0
                                                                        08          Nutrition Counseling                                                                                                                                                                                                                                                                                                                                     $0
                                                                        09          Assisted Transportation                                                                                                                                                                                                                                                                                                                                  $0
                                                                        10          Transportation                                                                                                                                                                                                                                                                                                                                           $0
                                                                        11          Legal Assistance                                                                                                                                                                                                                                                                                                                                         $0
                                                                        12          Nutrition Education                                                                                                                                                                                                                                                                                                                                      $0
                                                                        13          Information & Assistance                                                                                                                                                                                                                                                                                                                                 $0
                                                                        14          Outreach                                                                                                                                                                                                                                                                                                                                                 $0
                                                                        15          Info. for Caregivers                                                                                                                                                                                                                                                                                                                                     $0
                                                                       15a          Info for Crgvers srvg Children                                                                                                                                                                                                                                                                                                                           $0
                                                                        16          Assistance in Gaining Access to Caregiver Svcs                                                                                                                                                                                                                                                                                                           $0
                                                                       16a          Assistance in Gaining Access to Caregiver Serving Children Svcs                                                                                                                                                                                                                                                                                          $0
                                                                       20-1         Area Plan Administration                                                                                                                                                                                                                                                                                                                                 $0
                                                                       20-2         AAA Advocacy                                                                                                                                                                                                                                                                                                                                             $0
                                                                       20-3         AAA Program Coordination                                                                                                                                                                                                                                                                                                                                 $0
                                                                       20-4         AAA Program Planning & Development                                                                                                                                                                                                                                                                                                                       $0
                                                                       20-9         Medicaid AAA Services (non OAA funded)                                                                                                                                                                                                                                                                                                                   $0
                                                                       30-1         Home Repair/Modification                                                                                                                                                                                                                                                                                                                                 $0
                                                                       30-2         Home Health                                                                                                                                                                                                                                                                                                                                              $0
                                                                       30-3         In-Home Volunteers                                                                                                                                                                                                                                                                                                                                       $0
                                                                       30-4         Respite - IIIB                                                                                                                                                                                                                                                                                                                                           $0
                                                                       30-5         Caregiver Respite                                                                                                                                                                                                                                                                                                                                        $0
                                                                      30-5a         Caregiver Respite for Caregivers Serving Children                                                                                                                                                                                                                                                                                                        $0
                                                                       30-6         Support Groups for Caregivers                                                                                                                                                                                                                                                                                                                            $0
                                                                      30-6a         Support Groups for Caregivers Serving Children                                                                                                                                                                                                                                                                                                           $0
                                                                       30-7         Supplemental Services to Caregivers                                                                                                                                                                                                                                                                                                                      $0
                                                                      30-7a         Supplemental Services to Caregivers Serving Children                                                                                                                                                                                                                                                                                                     $0
                                                                       40-1         Health/Nutrition Screening                                                                                                                                                                                                                                                                                                                               $0
                                                                       40-2         Exercise or Physical Fitness                                                                                                                                                                                                                                                                                                                             $0
                                                                       40-3         Wellness Education                                                                                                                                                                                                                                                                                                                                       $0
                                                                       40-4         Mental Health Services                                                                                                                                                                                                                                                                                                                                   $0
                                                                       40-5         Health Equipment Loans                                                                                                                                                                                                                                                                                                                                   $0
                                                                      40-6a         Medical Alert Installation                                                                                                                                                                                                                                                                                                                               $0
                                                                      40-6b         Medical Alert Rental                                                                                                                                                                                                                                                                                                                                     $0
                                                                       40-7         Medical Equipment                                                                                                                                                                                                                                                                                                                                        $0
                                                                       40-8         Registered Nurse Services                                                                                                                                                                                                                                                                                                                                $0
                                                                       40-9         Medication Management                                                                                                                                                                                                                                                                                                                                    $0
                                                                       50-1         Guardianship/Conservatorship                                                                                                                                                                                                                                                                                                                             $0
                                                                       50-2         Protective Service                                                                                                                                                                                                                                                                                                                                       $0
                                                                       50-3         Elder Abuse Awareness                                                                                                                                                                                                                                                                                                                                    $0
                                                                       50-4         Crime Pervention/Home Safety                                                                                                                                                                                                                                                                                                                             $0
                                                                       50-5         LTC Ombudsman                                                                                                                                                                                                                                                                                                                                            $0
                                                                       60-1         Recreation                                                                                                                                                                                                                                                                                                                                               $0
                                                                       60-2         Friendly Visiting                                                                                                                                                                                                                                                                                                                                        $0
                                                                       60-3         Telephone Reassurance                                                                                                                                                                                                                                                                                                                                    $0
                                                                       60-4         Volunteer Opportunities                                                                                                                                                                                                                                                                                                                                  $0
                                                                       60-5         Interpreting/Translation                                                                                                                                                                                                                                                                                                                                 $0
                                                                       70-1         Case Monitoring                                                                                                                                                                                                                                                                                                                                          $0
                                                                       70-2         Counseling                                                                                                                                                                                                                                                                                                                                               $0
                                                                      70-2a         Individual Counseling for Caregivers                                                                                                                                                                                                                                                                                                                     $0
                                                                      70-2b         Individual Counseling for Caregivers Serving Children                                                                                                                                                                                                                                                                                                    $0
                                                                       70-3         Screening                                                                                                                                                                                                                                                                                                                                                $0
                                                                       70-4         Geriatric Assessment                                                                                                                                                                                                                                                                                                                                     $0
                                                                       70-5         Newsletter                                                                                                                                                                                                                                                                                                                                               $0
                                                                       70-6         Gatekeeper Training                                                                                                                                                                                                                                                                                                                                      $0
                                                                       70-7         Placement Services                                                                                                                                                                                                                                                                                                                                       $0
                                                                       70-8         Private Case Management                                                                                                                                                                                                                                                                                                                                  $0
                                                                       70-9         Caregiver Training                                                                                                                                                                                                                                                                                                                                       $0
                                                                      70-9a         Caregiver Training for Caregivers Serving Children                                                                                                                                                                                                                                                                                                       $0
                                                                      70-10         Public Outreach/Education                                                                                                                                                                                                                                                                                                                                $0
                                                                       80-1         Senior Center Assistance                                                                                                                                                                                                                                                                                                                                 $0
                                                                       80-2         Employment Assistance                                                                                                                                                                                                                                                                                                                                    $0
                                                                       80-3         Utility Assistance                                                                                                                                                                                                                                                                                                                                       $0
                                                                       80-4         Financial Assistance/Material Aid                                                                                                                                                                                                                                                                                                                        $0
                                                                       80-5         Money Management                                                                                                                                                                                                                                                                                                                                         $0
                                                                       80-6         Center Renovation/Acquisition                                                                                                                                                                                                                                                                                                                            $0
                                                                       80-7         Housing Assistance                                                                                                                                                                                                                                                                                                                                       $0
                                                                       90-1         Volunteer Services                                                                                                                                                                                                                                                                                                                                       $0
                                                                       900          Other (specify)                                                                                                                                                                                                                                                                                                                                          $0
                                                                                                                                        GRAND TOTAL                     $0             $0                  $0               $0                $0                $0                $0                $0                 $0              $0                  $0             $0             $0                        $0                        $0



                                                                                                                                                                              Congregate            HDM
                                                                                                                                Cumulative NSIP Eligible Meal Count:                       0                0                                                                                                NSIP OK
                                                                                                                                                                                                                                                                                                                                                                                 Minimum
                                                                                    Admin:     10% Maximum                                               Match:              Required:     Reported:     Difference              Results                                                                   III-B Program: Minimum Required      Reported        III-D Program   Expenditure         Reported                 Comments
                                                                                    Allowed              $0                                        25%   Adm Match:                  $0.00         $0.00           $0.00         within compliance                                                        Access Services       18%              #DIV/0!           Med Mgmt      (pending)             $0
                                                                                    Actual               $0                               2/3rd of 15%   Prgm Match:                 $0.00         $0.00           $0.00         within compliance                                                       In-Home Services        3%              #DIV/0!              III-E     Max Allowed         Reported
                                                                                                 pl
                                                                                    wi t hi n com i ance                                           25%   III-E Match Prg:            $0.00         $0.00           $0.00         within compliance                                                         Legal Services        3%              #DIV/0!         Grandparent     10.00%              #DIV/0!
                                                                                                                                                   15%   ARRA Match                  $0.00         $0.00           $0.00         out of compliance
                                                                                                                                                         Total Match :               $0.00         $0.00           $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                  SPD 150 pg 2
File Name: cff88a95-32ce-4acc-aa14-d9c5ed53c82c.xls / SPD 150 Pg2                                                                                                                                                                                                       Date Printed: 5/4/2011                                                                                                                                                      (7/1/2009)
                                                                                                                                                                         Monthly NSIP Eligible Meal Count:
                                                                                                                                                                                                    Total Eligible       NSIP Cash
                                                                                                                                                  Congregate            HDM          OPI HDM        Meals Served       Reimbursement
                                                                                                                                     July                                                                        0
                                                                                                                                     August                                                                      0
                                                                                                                                     September                                                                   0
                                                                                                                                     October                                                                     0
                                                                                                                                     November                                                                    0
                                                                                                                                     December                                                                    0
                                                                                                                                     January                                                                     0
                                                                                                                                     February                                                                    0
                                                                                                                                     March                                                                       0
                                                                                                                                     April                                                                       0
                                                                                                                                     May                                                                         0                          `
                                                                                                                                     June                                                                        0
                                                                                                                                     Total:                       0            0                0                  0                 $0
                                                                                                                                                                                                                                                                        ARRA                ARRA
                                                                                                 Report total MONTHLY hours                                       Monthly ARRA Eligible Meal Counts                                                                  unduplicated        unduplicated     ARRA YTD
                                                                                                 worked by staff retained or hired                NSIP Eligible                      NSIP Eligible                      Total Eligible           ARRA Cash            Congregate        Home-Delivered   Unduplicated
                                                                                                 with ARRA funds.                                 Congregate         Congregate      ARRA HDM            HDM           Meals Served             Reimbursement          patrons             patrons         Persons
                                                                                                                                      July                                                                                             0                                                                                0
                                                                                                                                      August                                                                                           0                                                                                0
                                                                                                                                      September                                                                                        0                                                                                0
                                                                    Cash or Accrual?   Accrual                                        October                                                                                          0                                                                                0
                                                                                                                                      November                                                                                         0                                                                                0
                                                                    Final Yes / No     No                                             December                                                                                         0                                                                                0
                                                                                                                                      January                                                                                          0                                                                                0
                                                                    Audited Yes / No   No                                             February                                                                                         0                                                                                0
                                                                                                                                      March                                                                                            0                                                                                0
                                                                                                                                      April                                                                                            0                                                                                0
                                                                                                                                      May                                                                                              0                                                                                0
                                                                                                                                      June                                                                                             0                                                                                0
                                                                                                                                 0.00 Total:                      0             0                0                0                     0                       0                   0                0                  0




                                                                                                                                                                                                                                                                                                                            SPD 150 pg 2
File Name: cff88a95-32ce-4acc-aa14-d9c5ed53c82c.xls / SPD 150 Pg2                                                                                                                                                                                  Date Printed: 5/4/2011                                                     (7/1/2009)
                                                                                                                                                                                                                                   YTD
     Matrix                                                                    OPI                 Program Fees            Program Fees             Program Fees            Other Funds                                           UNITS
     Number                       Service Category                        Funds Expended             Invoiced                Collected                Expended               Expended          Total Expenditures               of Service
        {1}                               {2}                                       {3}                    {4}                     {5}                     {6}                     {7}                 {8}                             {9}
        01      Columns 1 and 2                                          Column 3: Report         Column 4: Fees       Column 5: On the          Column 6: Report          Column 7:               Formula                    Column 9: This
       01-a     Column 1: This column containes the                      fiscal year-to-date      for OPI services     matrix/service category   program fees              Report                  Formula                    column will be
        02      reference number assigned by the State of                OPI funds expended       are to be charged    line applicable, report   expended on               cumulative              Formula                    mandatory only
                                                                         to provide services.     based on a sliding   the cumulative fiscal     applicable                donation/contrib        Formula                    for those AAA's
       02-a     Oregon to each applicable OPI service. The
                                                                         Record year-to-date      fee schedule and a   year-to-date program      matrix/service            utions to your                                     who are unable
        03      OPI matrix number and service category are                                                                                                                                         Formula
                                                                         amount on the            $5 annual            fee's collected .         category line. All fees   OPI program                                        to respond to
        04      the same as those assigned OAA Services                  appropriate              minimum fee will                               for service are to be     and other non-          Formula                    DHS and
        05      ----------------------------------------------------     matrix/service           be applied to all                              used to expand OPI        state awarded           Formula                    Legislative
        06      Column 2: Eligible OPI Services are outlined             category line it was     individuals                                    services noted in OAR     OPI funding, or         Formula                    requests for
                                                                         utilized in. Page 1      receiving OPI                                  411-032-0010 (1)(a).      OPI funds                                          OPI
        09      in OAR 411-032-0010. Typical service matrix                                                                                                                                        Formula
                                                                         of the Biennial          services who have                                                        allocated by                                       unduplicated
       30-1     #'s include, but may not be limited to #01,                                                                                                                                        Formula                    service units.
                                                                         Allocation Packet        adjusted income                                                          State to AAA for
       30-2     01a, 02, 02a, 03, 04, 05, 06, 09, 10-1, 30-1,                                                                                                                                      Formula                    Technical
                                                                         (page titled             levels at or below                                                       specific purpose
       30-4     30-2, 30-4, 40-8, 70-1, 70-3, 70-4, 70-7, 70-            Summary of               federal poverty                                                          (e.g., NoC).            Formula                    Assistance on
       40-8     10, 80-5.                                                Allocations notes        level. Report the                                                        Report on the           Formula                    OACCESS
                                                                         funding source at        total cumulative                                                         appropriate                                        data entry and
       70-1                                                                                                                                                                                        Formula                    utilization of
       70-3     Any matrix number/service category rows                  top of each column.      fiscal-year sum of                                                       matrix/service
                                                                                                                                                                                                   Formula
                                                                         If a special allotment   fees invoiced to                                                         category line in                                   report functions
       70-4
                identifying a service not currently provided by                                                                                                                                    Formula                    is available
                the area agency may be hidden.                           of OPI funds is          OPI clients for                                                          which it was
       70-7                                                              awarded to your          services received.                                                       expended. All           Formula                    from the State
                                                                                                                                                                                                                              Unit on Aging."
      70-10                                                              agency for another       OAR 411-032-                                                             donations for           Formula
                Other services approved by DHS/SPD may                   specific expense         0044 notes that no                                                       services (such
                                                                                                                                                                                                                               Report year-to-
       80-5                                                                                                                                                                                        Formula
                be provided as outlined in 411-032-                      (such as Network of      fees will be                                                             as home-
                                                                                                                                                                                                                              date units of
       900                                                                                                                                                                                         Formula                    service on the
                0010(1)(a)(K) and as identified in the                   Care maintenance         charged Home                                                             delivered meals)
       900a
                agency's area plan.                                      fee) record those        Delivered Meals or                                                       are to be used to       Formula                    appropriate
       900b                                                                                                                                                                                        Formula                    matrix/service
                                                                         expenditures in this     Case Management                                                          expand OPI
                                                                                                                                                                                                                              category line.
       900c     Use matrix # 900a, 900b, 900c etc., if the               column on the            services.                                                                services as             Formula
                                                                         service matrix #900                                                                               authorized in           Formula
                service has no service matrix number/service
                                                                         line and include                                                                                  OAR 411-032-
                category assigned type in the                                                                                                                                                      Formula
                                                                         explanation of                                                                                    0010(1)(a) and
                service/expense category name.                                                                                                                                                     Formula
                                                                         expenditure i.e.,                                                                                 are not exclusive
    PAGE GRAND TOTAL                                                     Formula                  Formula              Formula                   Formula                   Formula                $ Formula                   Formula

                                   '{10} Cumulative HCW Paid by SPD:   You input from HCW Report; round to nearest dollar.
                                   HCW expenditures are paid through the Housekeeper Payment System for OPI clients who "hire" a service provider to perfom OPI services. Each month DHS accounting pulls a Mobius report
                                   {SJH2520R-A} from the Housekeeper Payment system. The DHS HCW report is a summary YTD, monthly report by AAA showing the applicable charges billed to each AAA & is sent out by the 10th
                                   of the month to the AAAs. These HCW expenditures should be included in the year to date cumulative OPI expenditures reported on page 1 and will reduce the OPI fiscal year allocation.
                                   {12} Total OPI Allocation Used:       Formula                                       {11} Unduplicated YTD OPI Client Count You input YTD client count.                                     OPI Admin:
                                                                                                                                                                                                                                            SPD 148
File Name: cff88a95-32ce-4acc-aa14-d9c5ed53c82c.xls / 148 Instructions                                                                 Date Printed: 5/4/2011                                                                              (7/1/2009)
 Department of Human Services                        OREGON PROJECT INDEPENDENCE & ALZHEIMERS
 Seniors and People with Disabilities                    Cumulative Financial Report - page 3 of 3
 AAA District Number:              Dist 2 Co                              For the Month Ending: March 31, 2009             Approved By:       Ginger Johnson

 AAA District Name:            Community Action Team                                                                              Date:           4/30/09
                                                                                          Contract: 128570
                         Yes          No                                                                                   Prepared By:        Juliann Davis
 Final Report?                         4           Cash or Accrual? Accrual
 Audited?                              4                                                                                         Phone:        (503) 366-6584


                                    OPI                               Program                                                                                              YTD
  Matrix                           Funds                                Fees          Program Fees   Program Fees          Other Funds                                    UNITS
 Number        Service Category   Expended                            Invoiced          Collected      Expended             Expended         Total Expenditures         of Service
    {1}                {2}           {3}                                 {4}               {5}            {6}                  {7}                   {8}                    {9}
     01  Personal Care                                                                                                                                            $0
   01-a Personal Care - HCW                                                                                                                                       $0
     02  Homemaker/Home Care                                                                                                                                      $0
   02-a Homemaker/Home Care - HCW                                                                                                                                 $0
     03  Chore                                                                                                                                                    $0
    03a  Chore                                                                                                                                                    $0
     04  Home Del. Meals                                                                                                                                          $0
     05  Adult Day Care/AD Health                                                                                                                                 $0
     06  Case Management                                                                                                                                          $0
     09  Assisted Transportation                                                                                                                                  $0
   20-1 Area Plan Administration                                                                                                                                  $0
   30-1 Home Repair/Modification                                                                                                                                  $0
   30-2 Home Health                                                                                                                                               $0
   30-4 Respite - IIIB                                                                                                                                            $0
   40-8 Registered Nurse Services                                                                                                                                 $0
   70-1 Case Monitoring                                                                                                                                           $0
   70-3 Screening                                                                                                                                                 $0
   70-4 Geriatric Assessment                                                                                                                                      $0
   70-7 Placement Services                                                                                                                                        $0
  70-10 Public Outreach/Education                                                                                                                                 $0
   80-5 Money Management                                                                                                                                          $0
    900  Other (specify)                                                                                                                                          $0
   900a Other (specify)                                                                                                                                           $0
   900b Other (specify)                                                                                                                                           $0
   900c Other (specify)                                                                                                                                           $0
 PAGE GRAND TOTAL                          $0                                    $0             $0                    $0                $0                         $0            0

 {10} Cumulative HCW Paid by SPD:                                                                                          OPI Admin: 10% Maximum
                                                                                                                           Allowed                                $0
          {12} Total OPI Allocation Used:                       $0 {11} Unduplicated OPI Client Count                      Actual                                 $0
                                                                                                                           within compliance
                                                                                                                                                                             SPD 148
File Name: cff88a95-32ce-4acc-aa14-d9c5ed53c82c.xls / SPD 148                                         Date Printed: 5/4/2011                                                (7/1/2009)
 Matrix
Number    Service Category
   01     Personal Care
  01-a    Personal Care - HCW
   02     Homemaker/Home Care
  02-a    Homemaker/Home Care - HCW
   03     Chore
  03a     Chore - HCW
   04     Home Del. Meals
  04a     ARRA Home Del. Meals
   05     Adult Day Care/AD Health
   06     Case Management
   07     Congregate Meals
  07a     ARRA Congregate Meals
   08     Nutrition Counseling
   09     Assisted Transportation
   10     Transportation
   11     Legal Assistance
   12     Nutrition Education
   13     Information & Assistance
   14     Outreach
   15     Info. for Caregivers
  15-a    Info for Crgvers srvg Children
   16     Assistance in Gaining Access to Caregiver Svcs
  16-a    Assistance in Gaining Access to Caregiver Serving Children Svcs
  20-1    Area Plan Administration
  20-2    AAA Advocacy
  20-3    AAA Program Coordination
  20-4    AAA Program Planning & Development
  20-9    Medicaid AAA Services (non OAA funded)
  30-1    Home Repair/Modification
  30-2    Home Health
  30-3    In-Home Volunteers
  30-4    Respite - IIIB
  30-5    Caregiver Respite
 30-5a    Caregiver Respite for Caregivers Serving Children
  30-6    Support Groups for Caregivers
 30-6a    Support Groups for Caregivers Serving Children
  30-7    Supplemental Services to Caregivers
 30-7a    Supplemental Services to Caregivers Serving Children
  40-1    Health/Nutrition Screening
  40-2    Exercise or Physical Fitness
  40-3    Wellness Education
  40-4    Mental Health Services
  40-5    Health Equipment Loans
 40-6a    Medical Alert Installation
 40-6b    Medical Alert Rental
  40-7    Medical Equipment
  40-8    Registered Nurse Services
  40-9    Medication Management
  50-1    Guardianship/Conservatorship
  50-2    Protective Service
  50-3    Elder Abuse Awareness
  50-4    Crime Pervention/Home Safety
  50-5    LTC Ombudsman
  60-1    Recreation
  60-2    Friendly Visiting
  60-3    Telephone Reassurance
  60-4    Volunteer Opportunities
  60-5    Interpreting/Translation
  70-1    Case Monitoring
  70-2    Counseling
 70-2a    Individual Counseling for Caregivers
 70-2b    Individual Counseling for Caregivers Serving Children
  70-3    Screening
  70-4    Geriatric Assessment
  70-5    Newsletter
  70-6    Gatekeeper Training
  70-7    Placement Services
  70-8    Private Case Management
  70-9    Caregiver Training
 70-9A    Caregiver Training for Caregivers Serving Children
 70-10    Public Outreach/Education
  80-1    Senior Center Assistance
  80-2    Employment Assistance
  80-3    Utility Assistance
  80-4    Financial Assistance/Material Aid
  80-5    Money Management
  80-6    Center Renovation/Acquisition
  80-7    Housing Assistance
  90-1    Volunteer Services
  900     Other (specify)
   1         2          3               4                                 5                                                   6                               7          8             9                 10                  11                    12                                     13
Index     Sort Field AAA District AAA            Contract Name                                        Vendor Name                                         Vendor #    Mail Code    Accounting   Fiscal Contact        Fiscal Phone       Report Approval      Report Approver Title
                                                                                                                                                                                      Basis
  36140   D02Co    Dist 2 Co    Columbia         Community Action Team                                  D-2 Community Action Team                         1.931E+09          000   Accrual      Juliann Davis         (503) 366-6584      Ginger Johnson      Ginger Johnson, Fiscal Director
  36730   D07      Dist 7       Coos/Curry       South Coast Business Employment Corporation            D-7 South Coast Business Employment Corporation   1.931E+09          000   Accrual      Patti Landes          (541) 269-2013      Lori Austin         Lori Austin, AAA Director
  37020   D10      Dist 10      Central Oregon   Central Oregon Council on Aging                        D-10 COCOA AAA                                    1.931E+09          000   Accrual      Michelle De La Pena   (541) 548-8817      David Hamilton      David Hamilton, Executive Director
  37120   D11K     Dist 11 K    Klamath Basin    Klamath Basin Senior Citizens Council                  D-11 Klamath Basin AAA                            1.931E+09          000   Accrual      Neal Baldwin          (541) 883-7171 x16 Neal Baldwin         Neal Baldwin, Fiscal Officer
  37340   D13C     Dist 13 C    CCNO Inc.        Community Connection of Northeast Oregon, Inc.         D-13 Community Connection of NE Oregon            1.931E+09          003   Accrual      Roberta Miller        (541) 963-3186      Margaret Davidson   Margaret Davidson, Executive Director
  37520   D14H     Dist 14 H    Harney           Harney County Senior Citizens, Inc.                    D-14 Harney AAA                                   1.237E+09          000   Cash         Lynda Fine            (541) 573-6024      Ann Lessar          Ann Lessar, Director
  37570   D14M     Dist 14 M    Malheur          Malheur Council on Aging & Community Services          D-14 Malheur AAA                                  1.931E+09          001   Accrual      Gracie Green          (541) 889-7651 x234 Loni Debban         Loni Debban, Deputy Director
  37220   D12      Dist 12      CAPECO           Community Action Program E Central OR (CAPECO) D-12 CAPECO AAA                                           1.943E+09          001   Accrual      Patty Ewing-Broker    (541) 278-5690      Eva Mabbott         Eva Mabbott, Director
  31640   D02W     Dist 2 W     Washington       Washington County Disability, Aging & Veteran Services D-2 Washington AAA                                1.936E+09          001   Accrual      Connie Prentice       (503) 846-2812      Jeff Hill           Jeff Hill, Director, Department of Aging and Veterans' Services
  32030   D06      Dist 6       Douglas          Douglas County SDSD                                    D-6 Douglas AAA                                   1.936E+09          001   Cash         Catherine Patton      (541) 957-3007      Vicki Nunenkamp     Vicki Nunenkamp, Division Director
  32270   D08      Dist 8       Rogue Valley     Rogue Valley Council of Governments SDS                D-8 Rogue Valley AAA                              1.931E+09          001   Cash         Alan Hudson           (541) 423-1376      Donald O. Bruland   Donald O. Bruland, SDS Director
  36920   D09      Dist 9       Mid-Columbia     Mid-Columbia SDS                                       D-9 Mid-Columbia AAA                              1.931E+09          000   Accrual      Sarah Brumbaugh       (541) 298-4101 x213 Sue Samet           Sue Samet, Executive Director
  35720   D02Cl    Dist 2 Cl    Clackamas        Clackamas County Social Services                       D-2 Clackamas AAA                                 1.936E+09          037   Accrual      Susan Aronson         (503) 353-4356      Brenda Durbin       Brenda Durbin, SSD Interim Director
  34450   D02M     Dist 2 M     Multnomah        Multnomah Aging Services Division                      D-2 Multnomah AAA                                 1.936E+09          001   Accrual      Indirani Thirunamam   (503) 988-3620      Mary Shortall       Mary Shortall, Division Director
  34550   D03      Dist 3       NWSDS            NorthWest Senior & Disability Services                 D-1 Northwest Senior & Disability Services        1.931E+09          001   Accrual      Becky Ray             (503) 304-3427      Roger Friedman      Roger Friedman, Deputy Director
  34660   D04      Dist 4       Linn-Benton      Oregon Cascades West Council of Governments            D-4 West Cascade AAA                              1.931E+09          001   Accrual      Jeanette Denos        (541) 924-8435      Jeanette Denos      Jeanette Denos, Finance Director
  34760   D05      Dist 5       Lane             SDSD Lane County Council of Governments                D-5 Lane AAA                                      1.936E+09          000   Accrual      Jo Wright             (541) 682-4404      Jo Wright           , Financial Services Manager
Resource                                      Web address
National Value of Volunteer hours             http://www.independentsector.org/programs/research/volunteer_time.html
OAA                                           http://www.aoa.gov/AoARoot/AoA_Programs/OAA/index.aspx
SPD 411 Division 30 Rule                      http://arcweb.sos.state.or.us/rules/OARS_400/OAR_411/411_030.html
ORS                                           http://www.leg.state.or.us/ors/ors_info.html
CFR                                           http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=%2Findex.tpl
AR/IM/PTs                                     http://www.dhs.state.or.us/policy/spd/transmit/transmit.htm
OPI 411 Division 32 Rule                      http://arcweb.sos.state.or.us/rules/OARS_400/OAR_411/411_032.html
Services Definitions for OAA & OPI Services   http://www.dhs.state.or.us/policy/spd/transmit/pt/2005/pt05003.pdf
AoA Fiscal Guide                              to request e-mail rhonda.buedefeldt@state.or.us or elaine.young@state.or
Circular No. A-133                            http://www.whitehouse.gov/omb/circulars/a133/a133.html
Automatic Clearing House (ACH) payments       http://www.oregon.gov/DAS/SCD/SFMS/ach.shtml
ograms/research/volunteer_time.html
rograms/OAA/index.aspx
ARS_400/OAR_411/411_030.html

ext-idx?c=ecfr&tpl=%2Findex.tpl
d/transmit/transmit.htm
 ARS_400/OAR_411/411_032.html
d/transmit/pt/2005/pt05003.pdf
@state.or.us or elaine.young@state.or.us
ulars/a133/a133.html
 MS/ach.shtml
Eligible OAA Services for Meeting Minimum Title IIIB Expenditure Requirements

In Home – minimum expenditure is 3%
Matrix 01         Personal Care                     (OAA 102(a)(30)(F)
Matrix 01a        Personal Care - HCW               (OAA 102(a)(30)(F)
Matrix 02         Homemaker/Home Care               (OAA 102(a)(30)(A)
Matrix 02a        Homemaker/Home Care - HCW         (OAA 102(a)(30)(A)
Matrix 03         Chore                              (OAA 102(a)(30)( C )
Matrix 03a        Chore - HCW                       (OAA 102(a)(30)( C )
Matrix 05         Adult Day Care/Adult Day Health   (OAA 102(a)(30)(D)
Matrix 30-1       Home Repair/Modification          (OAA 102(a)(30)(E)
Matrix 30-3       In-Home Volunteers                (OAA 102(a)(30)(A-D)
Matrix 30-4       Respite                           (OAA 102(a)(30)(D)
Matrix 60-2       Friendly Visiting                  (OAA 102(a)(30)(B)
Matrix 60-3       Telephone Reassurance             (OAA 102(a)(30)(B)
Matrix 70-1       Case Monitoring


Legal – minimum expenditure is 3%
Matrix 11            Legal Assistance                 307(a)(11)(E)
Legal assistance related to income, health care, long-term care, nutrition, housing,
utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.


Access Services – minimum expenditure is 18%
Matrix 06         Case Management                   306(a)(2)(A)
Matrix 09         Assisted Transportation           306(a)(2)(A)
Matrix 10         Transportation                    306(a)(2)(A)
Matrix 13         Information & Assistance          306(a)(2)(A)
Matrix 14         Outreach                          306(a)(2)(A)
Matrix 40-4       Mental Health Services            306(a)(2)(A)
Matrix 60-5       Interpreting/Translation
Matrix 70-3       Screening
Matrix 70-4       Geriatrix Assessment
Matrix 70-5       Newsletter
Matrix 70-7       Placement Serices
Matrix 70-8       Private Case Management
Matrix 70-10      Public Outreach/Education         306(a)(2)(A)

								
To top