Statement of Budget, Income and Equity

FORM APPROVED
OMB NO. 0575-0015
OMB NO. 0572-0137

Position 3

Form RD 442-2
(Rev. 9-97)

UNITED STATES DEPARTMENT OF AGRICULTURE

STATEMENT OF BUDGET, INCOME AND EQUITY
Address

Name

ANNUAL BUDGET
BEG
(1)
OPERATING INCOME

Schedule 1

PRIOR YEAR
Actual
(2)

END

For the

Months Ended
CURRENT YEAR
Actual Data

Current Quarter
(4)

(3)

Year To Date
(5)

Actual YTD
(Over) Under Budget
Col. 3 - 5 = 6
(6)

0
0
0
0
0

1.
2.
3.
4.
5. Miscellaneous
6. Less: Allowances and
Deductions

0

7. Total Operating Income
(Add lines 1 through 6)

0

0

0

0

0

OPERATING EXPENSES

8.

0
0
0
0
0
0
0
0
0

9.
10.
11.
12.
13.
14.
15. Interest
16. Depreciation
17. Total Operating Expense
(Add Lines 8 through 16)
18. NET OPERATING
INCOME (LOSS)
(Line 7 less 17)

0

0

0

0

0

0

0

0

0

0

NONOPERATING INCOME

0
0

19.
20.
21. Total Nonoperating
Income (Add 19 and 20)

0

0

0

0

0

22. NET INCOME (LOSS)
(Add lines 18 and 21)

0

0

0

0

0

23. Equity Beginning of
Period

0
0
0

24.
25.
26. Equity End of Period
(Add lines 22 through 25)

0

0

Budget and Annual Report Approved by Governing Body

Secretary

Date

0

0

0

Quarterly Reports Certified Correct

Appropriate Official

Date

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0575-0015 and 0572-0137 . The time required to complete this information collection is estimated to average 2-1/2 hours per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Schedule l
Page 2

SUPPLEMENTAL DATA
The Following Data Should Be Supplied
Where Applicable
--

Circle One
Yes
No

1. ALL BORROWERS
a. Are deposited funds in institutions insured by the Federal Government?
b. Are you exempt from Federal Income Tax?
c. Are Local, State and Federal Taxes paid current?
d. Is corporate status in good standing with State?

Yes

No

Yes

No

No
Yes
e. List kinds and amounts of insurance and fidelity bond: Complete Only when submitting annual budget information:
Expiration
Insurance Company
Amount of
Insurance Coverage
and Address
and Policy Number
Coverage
Date of Policy
Property Insurance
Policy #
Liability
Policy #
Fidelity
Policy #

2. RECREATION AND GRAZING ASSOCIATION BORROWERS ONLY

Year to Date

Current Quarter

a. Number of Members
3. WATER AND/OR SEWER UTILITY BORROWERS ONLY
gal.

a. Water purchased or produced (CU FT - GAL)
b. Water sold (CU FT - GAL)
c. Treated waste (CU FT - GAL)
d. Number of users - water
e. Number of users - sewer

gal.
gal.
gal.

gal.
gal.

4. OTHER UTILITIES
a. Number of users
b. Product purchased
c. Product sold
5. HEALTH CARE BORROWERS ONLY
a. Number of beds
b. Patient days of care
c. Percentage of occupancy
d. Number of outpatient visits

NaN %

NaN %

6. DISTRIBUTION OF ALL CASH AND INVESTMENTS*
Indicate balances in the following accounts:
Construction
Cash
$
Savings
and
Invest- $
ments
$0
Total

Operation &
Maintenance

Debt Service

$

$

$

$

$

Grand Total
$ 0

$

$

$

$

$

$ 0

$0

$0

$0

$0

$0

$0

Revenue

Reserve

All Others

7. AGE ACCOUNTS RECEIVABLE AS FOLLOWS:
Days
Dollar Values

0-30

31-60

61-90

91 and Older

*Total

$

$

$

$

$0

Number of Accounts
*Totals must agree with those on Balance Sheet.

0

Schedule 2

PROJECTED CASH FLOW
END.

For the Year BEG.

(same as schedule 1 column 3)

A. Line 22 from Schedule 1, Column 3 NET INCOME (LOSS)

$ 0

Add
B. Items in Operations not Requiring Cash:
0

1. Depreciation (line 16 schedule 1)
2. Others:
C. Cash Provided From:
1. Proceeds from Agency loan/grant
2. Proceeds from others
3. Increase (Decrease) in Accounts Payable, Accruals and other Current Liabilities
4. Decrease (Increase) in Accounts Receivable, Inventories and
Other Current Assets (Exclude cash)
5. Other:
6.

$0

D. Total all A, B and C Items
E. Less: Cash Extended for:
1. All Construction, Equipment and New Capital Items (loan & grant funds)
2. Replacement and Additions to Existing Property, Plant and Equipment
3. Principal Payment Agency Loan
4. Principal Payment Other Loans
5. Other:

$0

6. Total E 1 through 5
Add
F. Beginning Cash Balances
G. Ending Cash Balances (Total of D Minus E 6 Plus F)

$ 0

Item G Cash Balances Composed of:
Construction Account

$

Revenue Account
Debt Payment Account
O&M Account
Reserve Account
Funded Depreciation Account
Others:

Total - Agrees with Item G

$