|
-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$
<br />445,241$ -$ 16,148$ 279,263$ 149,830$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />(470,407)$ (277,270)$ (8,979)$ 23,181$ (129,046)$ (55,556)$ (22,738)$ -$ -$ -$ -$ -$ -$ -$ -$
<br />915,648$ 293,417$ 288,242$ 126,649$ 129,046$ 55,556$ 22,738$ -$ -$ -$ -$ -$ -$ -$ -$
<br />Service Service Service Service Service Service Service Service Service Service Service Service Service Service
<br />Grand Congregate Nutrition Information & Case Assistance Senior Center Operation In-Home Aide-Level II - Personal Care Adult Day Health Adult Day Care 0 0 0 0 0 0 0 0
<br />Total 180 040 170 042 155 030 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A
<br />915,648$ 293,417$ 288,242$ 126,649$ 129,046$ 55,556$ 22,738$ -$ -$ -$ -$ -$ -$ -$ -$
<br />16,000 4,107 684 374
<br />18.3386$ -$ -$ 31.4210$ 81.2222$ 60.7968$ -$ -$ -$ -$ -$ -$ -$ -$
<br />915,648$ 293,417$ 288,242$ 126,649$ 129,046$ 55,556$ 22,738$ -$ -$ -$ -$ -$ -$ -$ -$
<br />12,800$ 12,800$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />902,848$ 280,617$ 288,242$ 126,649$ 129,046$ 55,556$ 22,738$ -$ -$ -$ -$ -$ -$ -$ -$
<br />16,000 - - 4,107 684 374 - - - - - - - -
<br />17.5386$ -$ -$ 31.4210$ 81.2222$ 60.7968$ -$ -$ -$ -$ -$ -$ -$ -$
<br />16,000 - - 4,107 684 374 - - - - - - - -
<br />- - - - - - - - - - - - - -
<br />- - - - - - - - - - - - - -
<br />16,000 - - 4,107 684 374 - - - - - - - -
<br />Certification:
<br />Authorized Signature Title Date
<br />DAAS-732A DAAS-732
<br />Line I.A Col. A
<br />Line I.B Col. B
<br />Line I.C Col. C
<br />Line I.D Col. D
<br />L. I.C+I.D Col. E
<br />Line III.C Col. F
<br />Line III.B.5 Col. G
<br />Line III.F Col. I
<br />NSIP Subsidy
<br />Total Funding
<br />Projected HCCBG Reimbursed Units
<br />Total Reimbursement Rate
<br />Projected Total Service Units
<br />Information on this form (DAAS-732A) corresponds with
<br />information stated on the Provider Services Summary
<br />(DAAS-732) as follows:
<br />Block Grant Funding
<br />Required Local Match-Cash & In-Kind
<br />Net Service Cost
<br /> F. Total Units Reimbursed/Total Projected Units
<br />* The Division of Aging ARMS deducts reported program income from reimbursement paid to providers. Line III.D indicates the number of units that will have to be produced in addition to those stated on line III.C in order to earn the net revenues stated on line I.C.
<br />I certify to the best of my knowledge and belief that the information included in the cost computation above is accurate and complies with all laws and regulations. I also understand that material
<br />deviations in reported cost information could limit funding, and also result in return of funds if the error or omission results in a higher than actual reported cost.
<br /> 3. Revenues Subject to Unit Reimbursement
<br /> 4. Total Projected Units (equals line III.A.2)
<br /> 5. Total Reimbursement Rate
<br /> C. Units Reimbursed Through HCCBG
<br /> D. Units Reimbursed Through Program Income*
<br /> E. Units Reimbursed Through Remaining Revenues
<br /> 3. Total Unit Cost Rate
<br /> B. Computation of Reimbursement Rate:
<br /> 1. Total Revenues (equals line I.J)
<br /> 2. Less: NSIP (equals line I.D)
<br /> Title V (equals line I.E less II.D)
<br /> Non Match In-Kind (equals line I.H less II.C)
<br />III. Computation of Rates
<br /> A. Computation of Unit Cost Rate:
<br /> 1. Total Expenses (equals line II.J)
<br /> 2. Total Projected Units
<br />H. Total Proj. Expenses Prior to Admin. Distribution
<br />I. Distribution of Admininistrative Cost
<br />J. Total Proj. Expenses After Admin. Distribution
<br />F. Subtotal, General Operating Expenses
<br />G. Subtotal, Other Administrative Cost Not Allocated in
<br />Lines II.A through E
<br />Docusign Envelope ID: 33187FF3-2913-4BF6-A737-FFB28C0A4B95
<br />7/18/2025Director
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