The University of the State of New York - NYSED
The University of the State of New York ANALYSIS OF CASH RESOURCES REPORT Form SA-603F
THE STATE EDUCATION DEPARTMENT
Child Nutrition Program Administration Sponsoring Agency Name: _______________________________________________
LEA Code: ___ ___ ___ ___-___ ___ ___ ___-___ ___ ___ ___
For Non-Public Schools Only Report Period: ________________________________________
National School Lunch/School Breakfast Cash Resources Report
| | | | | | |
|Beginning Cash Resources |1.___________ | |Expenses | | |
| | | |a. Food Purchased _____________ | | |
|Prior Year Adjustments (specify) |2.___________ | |Rebates Received ____________ | | |
|_________________________________ | | |TOTAL (a - b) |11.________ | |
|_________________________________ | | | | | |
| | | |Labor Costs | | |
|Adjusted Beginning Cash Resources | |3.__________ |Salaries | | |
| | | |Fringe Benefits | | |
|REVENUES | | |TOTAL |12.________ | |
|Sale of Reimbursable Meals | | | | | |
|Breakfast ______________ | | |Materials/Supplies Purchased |13.________ | |
|Lunch _________________ | | | | | |
|Milk ___________________ | | |Interfund Transfers Paid (Identify) ___________ |14.________ | |
|TOTAL |4.__________ | | | | |
| | | |Other Expenses | | |
|5. Reimbursement (Accrued) State Federal | | |Warehousing ________________ | | |
|a. Breakfast ________ _________ | | |All Other ____________________ | | |
|b. Lunch ________ _________ | | |TOTAL |15.________ | |
|c. Milk ________ _________ | | | | | |
|d. Snack ________ _________ | | |Contractual Expenses | | |
|Subtotal ________ _________ | | |Administrative service fee (to be completed by | | |
|TOTAL (State + Federal) |5.__________ | |both Type I and II schools) _____________ | | |
| | | |All other Mgt. Co. Expenses _____________ | | |
|6. Other Sales |6.__________ | |TOTAL |16.________ | |
| | | | | | |
|Other Income |7.__________ | |Total Years Expenses (11+12+13+14+15+16) |17.________ |17.__________ |
| | | | | | |
|Interfund Transfers Received |8.__________ | |Ending Cash Resources (10 – 17) | |18.________ |
| | | |- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -|- - - - - - - - - |- - - - - - - - - |
|Total Years Revenue (4+5+6+7+8) | |9.__________ |- - | |19a._________ |
| | | |19. a. Value of Donated Food Received | |19b._________ |
|Total – All Revenues (3+9) | |10._________ |b. Value of Donated Food Used | | |
| | | | | |20.__________ |
| | | |Outstanding Loans Owed | | |
Certification: I certify to the best of my knowledge and belief that this ANALYSIS OF CASH RESOURCES REPORT is true and correct in all respects; that the operation of the program(s) was in accordance with the terms of the existing agreement(s) as amended; and that invoices and other pertinent records as required by the agreement(s) are on file to substantiate this report.
AUTHORIZED REPRESENTATIVE OF SPONSOR:
SIGNATURE:_________________________________________ Title:________________________________________ Date Submitted: _________________
Submit one copy to BARBARA ST. LOUIS, Child Nutrition Program Administration, Room 55, Albany, NY 12234-0055. Keep one copy for school’s file.
Be sure to include your agency information at the top of this page.
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