Form Rd 442 2 PDF Details

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QuestionAnswer
Form NameForm Rd 442 2
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesform statement equity sample, zero income statement form usda, usda form rd 442 2, form statement budget blank

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Form RD 442-2

Position 3

FORM APPROVED

 

 

(Rev. 9-97)

UNITED STATES DEPARTMENT OF AGRICULTURE

OMB NO. 0575-0015

 

 

 

STATEMENT OF BUDGET, INCOME AND EQUITY

Schedule 1

Name

Address

 

 

ANNUAL BUDGET

For the

 

 

 

Months Ended

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BEG

 

 

 

 

 

CURRENT YEAR

 

 

 

 

(1)

PRIOR YEAR

 

 

 

 

Actual Data

 

 

Actual YTD

 

 

 

 

 

 

 

 

 

(Over) Under Budget

OPERATING INCOME

Actual

END

 

 

Current Quarter

Year To Date

 

 

Col. 3 - 5 = 6

 

 

(2)

(3)

 

(4)

(5)

(6)

 

1.

2.

3.

4.

5.Miscellaneous

6.Less: Allowances and Deductions

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

OPERATING EXPENSES

8.

 

 

 

 

 

 

 

 

 

 

 

 

 

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)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NONOPERATING INCOME

 

 

 

 

 

 

 

 

 

19.

 

 

 

 

 

 

 

 

 

 

 

 

 

20.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21. Total Nonoperating

 

 

 

 

 

 

 

 

 

 

 

 

 

Income (Add 19 and 20)

 

 

 

 

 

 

 

 

 

 

22. NET INCOME (LOSS)

 

 

 

 

 

 

 

 

 

 

 

 

 

(Add lines 18 and 21)

 

 

 

 

 

 

 

 

 

 

23. Equity Beginning of

 

 

 

 

 

 

 

 

 

 

 

 

 

Period

 

 

 

 

 

 

 

 

 

24.

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

 

 

 

 

 

 

 

 

 

 

 

 

 

26. Equity End of Period

 

 

 

 

 

 

 

 

 

 

 

 

(Add lines 22 through 25)

 

 

 

 

 

 

 

 

 

 

Budget and Annual Report Approved by Governing Body

Quarterly Reports Certified Correct

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Secretary

 

 

Date

 

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. 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

 

 

 

 

 

 

 

 

SUPPLEMENTAL DATA

 

 

 

 

 

 

 

 

 

Page 2

 

 

 

 

 

 

The Following Data Should Be Supplied Where Applicable

 

Circle One

 

1. ALL BORROWERS

- -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

a. Are deposited funds in institutions insured by the Federal Government?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. Are you exempt from Federal Income Tax?

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

c. Are Local, State and Federal Taxes paid current?

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. Is corporate status in good standing with State?

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e. List kinds and amounts of insurance and fidelity bond: Complete Only when submitting annual budget information:

 

 

Insurance Coverage

Insurance Company

 

 

 

Amount of

 

Expiration

 

and Policy Number

and Address

 

 

 

Coverage

 

Date of Policy

 

Property Insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Policy #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Liability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Policy #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fidelity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Policy #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year to Date

 

2. RECREATION AND GRAZING ASSOCIATION BORROWERS ONLY

Current Quarter

 

 

a. Number of Members

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.WATER AND/OR SEWER UTILITY BORROWERS ONLY

a. Water purchased or produced (CU FT - GAL)

 

gal.

 

 

 

gal.

 

 

gal.

 

 

 

gal.

 

b. Water sold (CU FT - GAL)

 

 

 

 

 

gal.

 

 

 

gal.

c. Treated waste (CU FT - GAL)

 

 

 

 

 

 

 

 

 

 

 

 

 

d. Number of users - water

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e. Number of users - sewer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Operation &

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Construction

 

Revenue

 

 

Debt Service

 

 

Maintenance

 

 

Reserve

 

 

 

All Others

 

 

Grand Total

Cash

 

$

 

 

 

$

 

 

$

 

$

 

 

 

$

 

 

$

 

$

 

 

 

Savings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and

 

$

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Invest-

 

 

 

 

 

 

 

$

 

 

 

$

 

 

$

 

$

 

 

 

ments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

$

 

 

 

$

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.AGE ACCOUNTS RECEIVABLE AS FOLLOWS:

 

 

 

 

 

 

 

Days

 

 

 

 

 

 

 

 

 

 

0-30

31-60

61-90

 

91 and Older

*Total

Dollar Values

$

 

$

 

 

$

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

Number of Accounts

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Totals must agree with those on Balance Sheet.

PROJECTED CASH FLOW

 

For the Year BEG.

 

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

$

Add

 

B. Items in Operations not Requiring Cash:

 

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.

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:

6.Total E 1 through 5

Add

 

F. Beginning Cash Balances

 

G. Ending Cash Balances (Total of D Minus E 6 Plus F)

$

Item G Cash Balances Composed of:

 

Construction Account

$

Revenue Account

 

Debt Payment Account

 

O&M Account

 

Reserve Account

 

Funded Depreciation Account

 

Others:

 

 

 

 

 

 

 

 

Schedule 2

END.

(same as schedule 1 column 3)

Total - Agrees with Item G

$

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2. Your next stage is usually to fill out these blank fields: Interest Depreciation, Total Operating Expense Add Lines, NET OPERATING, INCOME LOSS Line less, NONOPERATING INCOME, Total Nonoperating Income Add, NET INCOME LOSS, Add lines and, Equity Beginning of, Period, Equity End of Period, Add lines through, Budget and Annual Report Approved, and Quarterly Reports Certified Correct.

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4. This next section requires some additional information. Ensure you complete all the necessary fields - ALL BORROWERS, The Following Data Should Be, a Are deposited funds in, Circle One Yes No, Yes, Yes, Yes, e List kinds and amounts of, Amount of Coverage, Insurance Company, and Address, Expiration, Date of Policy, Property Insurance, and Policy - to proceed further in your process!

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5. Now, the following last segment is what you'll have to wrap up before using the document. The blank fields here are the following: a Water purchased or produced CU, OTHER UTILITIES, a Number of users b Product, HEALTH CARE BORROWERS ONLY, a Number of beds b Patient days of, gal gal, gal gal, DISTRIBUTION OF ALL CASH AND, Indicate balances in the following, Construction, Revenue, Debt Service, Operation Maintenance, Reserve, and All Others.

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