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DAAS-732A
<br />Provider:
<br />County:
<br />Budget Period:July 2020 through June 2021
<br />Other Other Access In-Home In-Home In-Home 0 0 0 0 0 0 0 0
<br />Service Service Service Service Service Service Service Service Service Service Service Service Service Service
<br />Senior Center Operation Congregate Nutrition Information & Case Assistance
<br />In-Home Aide-Level II - Personal
<br />Care Adult Day Care Adult Day Health 0 0 0 0 0 0 0 0
<br />Grand Total 170 180 040 042 030 155 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A
<br />659,702$ 76,494$ 147,369$ 259,514$ 116,141$ 10,000$ 50,184$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) 53,921$ 8,499$ 16,587$ 28,835$
<br /> 2) -$
<br />3) -$
<br />53,921$ 8,499$ 16,587$ 28,835$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br /> Total Required Minimum Match - In-Kind -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />53,921$ 8,499$ 16,374$ 28,835$ 12,905$ 1,111$ 5,576$ -$ -$ -$ -$ -$ -$ -$ -$
<br />713,623$ 84,993$ 163,743$ 288,349$ 129,046$ 11,111$ 55,760$ -$ -$ -$ -$ -$ -$ -$ -$
<br />15,750$ -$ 15,750$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />4) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$
<br />729,373$ 84,993$ 179,493$ 288,349$ 129,046$ 11,111$ 55,760$ -$ -$ -$ -$ -$ -$ -$ -$
<br />Service Service Service Service Service Service Service Service Service Service Service Service Service Service
<br />Grand Admin.Senior Center Operation Congregate Nutrition Information & Case Assistance In-Home Aide-Level II - Personal Care Adult Day Care Adult Day Health 0 0 0 0 0 0 0 0
<br />Total Cost 170 180 040 042 030 155 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A
<br />22,422$ -$ -$ 22,422$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />349,624$ -$ 92,058$ 44,504$ 213,062$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />372,046$ -$ 92,058$ 66,926$ 213,062$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) FICA @ 7.65 28,462$ -$ 7,042$ 5,120$ 16,299$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />49,847$ 8,711$ 41,136$
<br />12,878$ -$ 2,225$ 10,653$
<br />-$
<br />-$
<br />-$
<br />91,187$ -$ 7,042$ 16,056$ 68,088$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$
<br />-$
<br />-$
<br />-$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) 82,889$ 82,889$
<br /> 2) 200,194$ 131,184$ 11,112$ 57,898$
<br />3) -$
<br /> 4) -$
<br /> 5) -$
<br /> 6) -$
<br /> 7) -$
<br />8) -$
<br /> C. Subtotal, Fed/State/Required Match Revenues
<br /> F. Subtotal, Local Cash, Non-Match
<br /> Other Revenues, Non-Match
<br /> D. NSIP Cash Subsidy/Commodity Valuation
<br /> E. OAA Title V Worker Wages, Fringe Benefits and Costs
<br /> Local Cash, Non-Match
<br />Caterer Contract
<br />DSS
<br /> 1) Per Diem
<br /> 2) Mileage Reimbursement
<br /> 3) Other Travel Cost
<br />E. Subtotal, Travel
<br /> General Operating Expenses
<br />Local In-Kind Resources Non-Match
<br />C. Subtotal, Local In-Kind Resources Non-Match
<br />D. OAA Title V Worker Wages, Fringe Benefits and Costs
<br /> 6) Other
<br />B. Subtotal, Fringe Benefits
<br /> Staff Salary From Labor Distribution Schedule
<br /> 1) Full-time Staff (do not include Title V workers)
<br /> 2) Part-time staff (do not include Title V workers)
<br />A. Subtotal, Staff Salary
<br /> Fringe Benefits
<br />%
<br /> Travel
<br /> 2) Health Insurance
<br /> 3) Retirement
<br /> 4) Unemployment Insurance
<br /> 5) Worker's Compensation
<br />Division of Aging and Adult Services
<br />Service Cost Computation Worksheet
<br />II. Line Item Expenses
<br /> G. Subtotal, Other Revenues, Non-Match
<br /> Local In-Kind Resources (Includes Volunteer Resources)
<br /> H. Subtotal, Local In-kind Resources, Non-Match
<br /> I. Client Cost Sharing
<br /> J. Total Projected Revenues (Sum I.C,D,E,F,G,H, & I)
<br />Orange County
<br />Orange
<br />North Carolina Division of Aging and Adult Services
<br />Service Cost Computation Worksheet
<br /> Required Minimum Match - In-Kind
<br /> B. Total Required Minimum Match (cash + in-kind)
<br />I. Projected Revenues
<br /> A. Fed/State Funding From the Div. of Aging & Adult Svcs.
<br /> Required Minimum Match - Cash
<br /> Total Required Minimum Match - Cash
<br />Orange County Government
<br />DocuSign Envelope ID: 876C92A1-FFCC-4CCE-9133-469A78CE1DCA
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