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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