RD 442-2 Statement of Budget, Income, and Equity

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

Position 3

UNITED STATES DEPARTMENT OF AGRICULTURE

STATEMENT OF BUDGET, INCOME AND EQUITY

Schedule 1

Address

Name

ANNUAL BUDGET
(1)
OPERATING INCOME

FORM APPROVED
OMB NO. 0575-0015
OMB NO. 0572-0137
Exp. Date: MM/DD/YY

BEG

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

OPERATING EXPENSES

0

0

0
0
0
0
0
0
0
0
0
0

8.
9.
1
0.
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)
NONOPERATING INCOME

0

0

0

0

0

0

0

0

0

0
0
0

19.
2
0.
21. Total Nonoperating
Income (Add 19 and 20)
2
2. NET INCOME (LOSS)
(Add lines 18 and 21)
2
3. Equity Beginning of
Period

0

0

0

0

0
0

0

0

0

0
0
0
0

24.
25.
2
6. 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

Schedule l
Page 2

SUPPLEMENTAL DATA
The Following Data Should Be Sup-p-lied Where Applicable

1. ALL BORROWERS

Circle One
Yes
No

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

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

%

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

$

$

$0

$0

7. AGE ACCOUNTS RECEIVABLE AS FOLLOWS:
31-60

0-30
Dollar Values

$

$

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

Reserve
$

$
$

$

Operation &
Maintenance

Debt Service

Revenue

All Others
$

$

$

$

$0

$0

$0

Days
$

61-90

%

91 and Older
$

Grand Total
$ 0
0
$
$0

*Total
$0
0

Schedule 2

PROJECTED CASH FLOW
For the Year BEG.
A. Line 22 from Schedule 1, Column 3 NET INCOME (LOSS)

END.

(same as schedule 1 column 3)

$

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

$

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to
the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is
0575-0015 and 0572-0137. Public reporting for this collection of information is estimated to be approximately 2-1/2 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are voluntary. However,
in order to obtain or retain a benefit, the information in this form is required by 7 CFR 1942-A, Community Facility Loans and 7 CFR 1782, Servicing of Water Programs Loans and Grants. Rural
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