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A. Subtotal, Staff Salary <br />0 <br />0 <br />0 <br />Fringe Benefits <br />////////////1H <br />////////////1H <br />H1111///////// <br />1) FICA <br />0 <br />0 <br />0 <br />2) Health Ins. <br />0 <br />0 <br />3) Retirement <br />0 <br />0 <br />4) Unemployment Insurance <br />0 <br />0 <br />5) Worker's Compensation <br />0 <br />0 <br />6) Other (Longevity) <br />0 <br />B. Subtotal, Fringe Benefits <br />0 <br />0 <br />0 <br />Local In -Kind Resources, Non -Match <br />////////////1H <br />////////////1H <br />H1111///////// <br />1 <br />0 <br />0 <br />2 <br />0 <br />0 <br />3 <br />0 <br />C. Subtotal, Local In -Kind Resources Non-Ma <br />0 <br />0 <br />0 <br />D. OAA Title V Worker Wages, Fringe BenefitE <br />0 <br />0 <br />0 <br />Travel <br />/ / / / / / / / / / / /// <br />////////////1H <br />H1111///////// <br />1 Per Diem <br />0 <br />0 <br />2 Mileage Reimbursement <br />0 <br />0 <br />3 Other Travel Cost <br />0 <br />E. Subtotal, Travel <br />0 <br />0 <br />0 <br />General Operating Expenses <br />////////////1H <br />////////////1H <br />H1111///////// <br />1 Service Contracts <br />0 <br />2 Rent, Utilities, Supplies <br />0 <br />3 ARMS COST <br />0 <br />4 Postage, Dues, Subscriptions <br />0 <br />5 Advertising <br />0 <br />6 In Home Aide Level II and III RN assessments <br />0 <br />7 Program Supplies <br />37,830 <br />37,830 <br />8 Caterer <br />0 <br />F. Subtotal, General Operating Expenses <br />37,830 <br />0 <br />37,830 <br />G. Subtotal, Other Admin. Cost Not Allocated/////////////// <br />in Lines ILA .A t h ro u g h F <br />H. Total Proj. Expenses Prior to Admin. Distri <br />37,830 <br />0 <br />37,830 <br />I. Distribution of Admininistrative Cost <br />/ / / / / / / / / / / / /// <br />0 <br />0 <br />J. Total Proj. Expenses After Admin. Distribu <br />37,830 <br />////////////1H <br />37,830 <br />HCCBG Budget <br />Service Cost Computation Worksheet <br />Division of Aging <br />III. Computation of Rates <br />Grand Total <br />Home Delivered 02C <br />A. Computation of Unit Cost Rate: <br />/ / / / / / / / / / / / / /// <br />////////////1H <br />H1111///////// <br />1. Total Expenses (equals line II.J) <br />37,830 <br />////////////1H <br />37,830 <br />2. Total Projected Units <br />/ / / / / / / / / / / / / /// <br />/ / / / / /// <br />10,353 <br />3. Total Unit Cost Rate <br />/ / / / / / / / / / / / / /// <br />/ / / / / / / /// <br />3.6540 <br />B. Computation of Reimbursement Rate: <br />1. Total Revenues (equals line I.J) <br />37,830 <br />////////////1H <br />37,830 <br />2. Less: USDA (equals line I.D) <br />3,1100 <br />////////////1H <br />3,100 <br />Title V (equals line LE and II.D) <br />0 <br />////////////1H <br />0 <br />Non Match In -Kind (equals line I. <br />0 <br />////////////1H <br />0 <br />3. Revenues Subject to Unit Reimbursemen <br />34,730 <br />////////////1H <br />34,730 <br />4. Total Projected Units (equals line III.A.2) <br />1 1111111111111H <br />11111111111111H <br />1 10,353 <br />5. Total Reimbursement Rate <br />11111111111111H <br />1 3.3546 <br />Attachment number 1 <br />F -3 Page 94 <br />