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Division of A_g~n_g ! I I I :
<br /> Service Cost Computation Worksheet 1/98 ' J
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<br /> . Service Service ---Se~rv~ce Service ~ervlce ~ Service ~ Service
<br /> Grand r Trans. cong. ---s-~pp In-Home -H:H I Adult * Infori
<br /> A Com_J)utatlon of Unit Cost Rate: flllllllllllllll IIII/11/1111111 III//llflll/lll II/111111111111 Iflllll/llfllll llfllllllllllll ~11111111111111' IIIIIIIIIIIIIII IIIIIIIIIIIIIII
<br /> 1 Total E~equals tine II.J) '~ 876,15"'-~IIIIIIIIIIIIIl'-T 201,883~ 323,2 24,425 92,367 47,287 140,446 46,467
<br /> 2 Total Pro__.~ted Units flllllllllllllll~llllllllll'---'~llll~- 2'~,1'-~ ~ 8,140 4,085 N/A 6,806 N/A
<br /> 3. Total Unit Cost Rate :111111111111111'~-'~IIIIIIIIIIIII1'~' 9.1350 4.4590 3.~ 22.6113 N/A 206356 N/A
<br /> B. Com~utation of Reimbursement Rate: ~1111 IIIIIIIIIIIIIIII IIIIIIIIIIIIIIII ~111111111111111 IIIIIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIIIIIIIII
<br /> 1. Total Revenues~ 899,60~11111111111111'~- 203,883 323,2 24,42'"--~ 92,36'--------~ 47,28-'"'--'---~ 161,8'~ 46,467
<br /> 2. Less: USDA .~uaJslineJ.D) ~ 44, 66.~~11/1111/1111111 0 40,158 4,509 0 _C C 0
<br /> Title V ~ I.E and II.D...~~ IIIIIIIIIIIIII'-T o o o o o c o
<br /> ~Match In-Kind ~ line I.H and il.C) ~ ~111111111111~ 0 ~--'---~ ~--'--~-----"~ 0 0
<br /> 3. Revenues Subject to Unit Reimbursement ~436,14~"~ flllllll/lllll'-T 93,~ 113,70-'-~-~ ~ 10,885 34,328 24,518 121,978 37,221
<br /> 4. Total Projected Units(equals line III.A2) IIIIIIIIIIIIlfl ~11/1111/1111111 22,100 72,500 8,140 4,085 N/A 6,806 NIA
<br /> 5. Total Reimbursement Rate IIIIIIlflllllfl/ IIII/11/111//11 4.6500 3.6000 1.6700 10.6600 NIA 23.0000 N/A
<br /> C. Units Reimbursed Through HCCBG flllllllllllllll III/11111111111 21,422 36,097 7,242 3,57~ NIA 5,893 N/A
<br /> D. Units Reimbursed Throu h P..~_~.~m Income* IIIIIIIIIIIIIIII I/il/I/I///ifil 412 8,143 898 607 NIA 91;3 N/A
<br /> E Units Reimbursed Through Remaining Revenues ;IIIIIIIIIIIIII-T~ IIIIIIIIIII1~-~ 2~,20'~' 36,65-"~"'"-~ 3,689 4,580 NIA 233 NIA
<br /> F. Total Units Reimbu/sedn'otal Projected Units ~111111/111111/I __ III//I//1111111 42,037 80,892 ~ 11,82.~9 8,66.5 NIA 7,030 NIA _
<br /> T_h~e Division of Aging ARMS deducts reported pro~ram -~ -
<br /> inc_ome from reimbursement paid to providers. Line II1. E~ ........... - ............
<br /> indicates the number of units that Wiil have to be produced ..... - .....
<br /> in addition to those stated o~ line III.C in order to earn the ......
<br /> net revenues stated o~ line I.C. --
<br /> Inforrnatlon on thins f_o_rm (DOA-732A) corresponds with
<br /> information stated on the Provider Services Summary
<br /> (DOA-732) as follows: ......... ___
<br /> - DOA-732A DOA-732 T -
<br /> Block Grant F~nding Line I.A Co/. A ........ -- ~ - ~ -- --
<br /> _. Required Local Match-Cash & In-Kind --- Line I.B Col. B
<br />, Net Service Cost Line LC Col. C ....... -- - ~ - -
<br /> - -_ USDA Subsidy Line I.D Col. D
<br /> . - Total Funding L.I.C+I.D Col. E ....... - ........ ! -- --
<br /> Proiec_ted H__C_CBG.R_e!m_b_u_r~Unit~ Line IIl. C -- Col. F
<br /> Total Reimbursement Rate ~ne lii?~i~ ' d~7."G-~
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