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<br />_ _ . _
<br />�'
<br />jeontEongrQgaie
<br />•iogn
<br />3Er? st+treE
<br />M
<br />...................................................
<br />....
<br />_
<br />IVJKu
<br />........-......-..
<br />. ........
<br />....A%A..._...............................
<br />1. Cc" regate Kitcnen and
<br />.............._...
<br />Dining
<br />SPONSOR
<br />A8G
<br />2. Lo ies
<br />3. Como;.nity Room
<br />-------------- -:..............
<br />1. Nursing Payroll
<br />.................
<br />................
<br />-
<br />4. Hobor Shoo
<br />No, of Nurses
<br />0
<br />S. infirmary/health faility
<br />6, Other
<br />x salaryy (Ptr hour)
<br />2. Equipment Expenses
<br />0
<br />0
<br />;
<br />7. Other
<br />a. R,R: IOs:Equip.
<br />8. TOTAL SQUARE FEET
<br />Cost
<br />......,.,....,..................................
<br />S. PROJECT COMPOSITION
<br />..............a,..
<br />b. Int on Inv
<br />Rate
<br />.............. .--......................
<br />..................
<br />- ..........
<br />Cost
<br />NO OF
<br />NO. OF
<br />NO OF
<br />NO OF
<br />c. Maint/Re airs
<br />BEDROOMS
<br />UNITS
<br />UNiTS WITH
<br />UNITS WITH
<br />3. Medical Supplits
<br />KITCHENS
<br />KITCHENETTES
<br />4. Utilities
<br />0
<br />..............
<br />...........
<br />- ......_-__,•_-
<br />..................
<br />5. Laundry Service
<br />0-BEDROOMS
<br />1-BEDROOMS
<br />64
<br />4
<br />64
<br />4
<br />0
<br />0
<br />6. Other
<br />7. Total Health S,rrvica
<br />0
<br />2-BEDRDOMS
<br />0
<br />D
<br />0
<br />Ba,No, Assisted Living
<br />TOTAL
<br />68
<br />68
<br />0
<br />Units
<br />0
<br />..............
<br />...................................................
<br />Who. of People
<br />C. -f00D SERVICE
<br />ANNUAL EXPENSES
<br />Served
<br />0
<br />.................
<br />.....
<br />9. Proposed Charge
<br />_
<br />SPONSOR
<br />ABG
<br />Per Person Per Mo.
<br />ERR
<br />..........................
<br />......................
<br />.................•
<br />...... 0.................,...,.
<br />,.,, t.,a t.,,,....
<br />................
<br />1. PAYROLL
<br />F. FURNISHINGS
<br />No. of cooks 0
<br />x salary SO.00
<br />1 0
<br />------------------------------
<br />1. Furniture -Leased
<br />---•---•---------
<br />0
<br />----------------
<br />No, of wail. 0
<br />2. Furniture -Not leased
<br />0
<br />x salary S0100
<br />0
<br />3, Total Furn. Expense
<br />0
<br />No.of helper 0
<br />4. No, of Units
<br />68
<br />. salaryr SO.00
<br />0
<br />Furnished
<br />2, food Costs
<br />55,046
<br />5, Proposed Charge
<br />3.Supplies
<br />Per Unit Per Month
<br />0
<br />4.' Dinin39roan Furniture
<br />a.- Re pi,Res:IOXxEquip.
<br />...................,......
<br />G. OTHER NON -SHELTER SERVICES
<br />.......,.............�...........,,,,.
<br />` '
<br />Cost0
<br />b,: Mains/Repairs
<br />................................................
<br />1. Program/Activities
<br />7,280
<br />................
<br />5.-
<br />2. Communications
<br />0
<br />.Utilities ,
<br />6a. Diet Contract'
<br />68,640
<br />3. Transportation
<br />12,000
<br />0
<br />G; Ma1nf, Payroil
<br />7; Laundr /Uniforms
<br />4. Management fee
<br />S. Administration
<br />0
<br />8. Total ood Expense
<br />123,686
<br />so
<br />6. Security
<br />9, Avg, No, of People
<br />7. Chg per unit for 1,
<br />9
<br />0
<br />Served
<br />68
<br />8. Chg per unit for 2,
<br />15
<br />10. Proposed Charge
<br />9, Chg per unit for 3.
<br />Per Per Mo.
<br />1S2
<br />1O.Chg per unit for A.
<br />0
<br />No oPerson
<br />I1. f Meals'
<br />24820
<br />11,Chq per unit for S.
<br />0+
<br />Per Person Per Day
<br />1.00
<br />12.Chg per unit for 6.
<br />0
<br />, ., ... uasa,.,. ua,a. a., .,
<br />„ae, ■.n.aaauna.a,,.
<br />., .,,..,, uu.....
<br />........ a....su. a...........
<br />uu................ .............
<br />D;: `MAID SERVICE
<br />OFFICIAL USE
<br />......._................
<br />-- -- .
<br />..........................
<br />1. Payroll
<br />......................
<br />..................
<br />Food Service
<br />S123,686
<br />No, of Maids I
<br />Maid Service
<br />$25:614
<br />x salary MOO
<br />10,400
<br />Health Service
<br />SO
<br />2; Supplies
<br />0
<br />Furniture
<br />SO
<br />3. Equipment -
<br />0
<br />Activities
<br />S7,280
<br />4. LaundryY ,Contract
<br />15,214
<br />Communications
<br />Transportation
<br />s0
<br />S12.000
<br />S. Total FfaId Service
<br />25,614
<br />6,: Avg. No. Units Using
<br />Management Fee
<br />s0
<br />ServiCt
<br />68
<br />Administration
<br />SO
<br />7. Proposed Charge
<br />Security
<br />IO
<br />Per Unit Per Month
<br />S31
<br />uses.. ....... ......................
<br />.4 REMARKS AND SIGNATURES
<br />...........au....
<br />GRAND TOTAL
<br />$168,580 .............................
<br />.
<br />The above estimates column_ for.Sections
<br />C.inat f� cohe.end.expense.in nona heltPr_budgets
<br />.in _'Sponsor'
<br />Signed IXISponsor
<br />.through .G.represent.e
<br />-I
<br />I8orro
<br />Orner
<br />Date
<br />........... � --�f-
<br />.Date:
<br />...
<br />Valuation Processor:.
<br />.............
<br />._.
<br />Date:
<br />-Mortgagor...
<br />�Revie er: t
<br />f00D "SERVICE
<br />LUhUM' �
<br />MEALS
<br />TOTAL
<br />TOTAL COST
<br />COST PER P R N PER
<br />Y,QNTH
<br />PER DAY
<br />HEALS
<br />0 PAL RESIDENTS
<br />0
<br />0
<br />0
<br />ERR
<br />68 REGULAR RESIDENTS
<br />1.00
<br />24,820
<br />123686
<br />152
<br />24,820
<br />123:686
<br />MAID SERVICE
<br />SERVICE
<br />TOTAL
<br />TOTAL
<br />COST PER PERSON PER
<br />MONTH
<br />_
<br />PER WEEK
<br />SERVICE
<br />COST
<br />O PAL UNIiS
<br />0
<br />0
<br />0
<br />ERR
<br />68"REGULAR UNITS
<br />1
<br />3,536
<br />25.614
<br />31
<br />3.536
<br />25,614
<br />NURSING CARE
<br />SERVICE
<br />TOTAL
<br />TOTAL
<br />COST PER PERSON PER
<br />MONTH
<br />PER WEEK
<br />SERVICE
<br />COST
<br />`
<br />0 PAC UNITS
<br />1
<br />0
<br />kRR
<br />ERR
<br />68 REGULAR UNITS
<br />0
<br />0
<br />ERR
<br />0
<br />RR
<br />ACijvlTIES
<br />SERVICE
<br />TOTAL
<br />TOTAL
<br />COST PER PERSON PER
<br />MONTH
<br />PER WEEK
<br />SERVICE
<br />COST
<br />0 PAL UNITS
<br />l
<br />0
<br />0
<br />ERR
<br />66 REGULAR UNITS
<br />1
<br />7,280
<br />9
<br />3,536
<br />COMMUH I CATI ONS
<br />SERVICE
<br />TOTAL
<br />TOTAL
<br />COST PER PERSON PER
<br />MONTH
<br />PER WEEK
<br />SERVICE
<br />COST
<br />0 PAL UNITS
<br />1
<br />0
<br />0
<br />ERR
<br />68 REGULAR UNITS
<br />1
<br />3,53
<br />0
<br />6
<br />0
<br />iRANSPORTAiIOH
<br />SERVICE
<br />TOTAL
<br />TOTAL
<br />COST P L A PERSON PER
<br />MONTH
<br />PER WEEK
<br />SFIVICE
<br />COST
<br />0 PAL UNITS
<br />l
<br />0
<br />0
<br />ERR
<br />68 REGULAR UNITS
<br />1
<br />3,636
<br />12,000
<br />15
<br />J,536
<br />12,000
<br />MANAGEMENT FEE
<br />SERVICE
<br />TOTAL
<br />TOTAL
<br />COST PER PERSON PER
<br />MONTH
<br />PER WEEK
<br />SERVICE
<br />COST
<br />U PAL UNITS
<br />1
<br />0
<br />0
<br />ERR
<br />68 REGULAR, UNITS
<br />1
<br />3,536
<br />0
<br />0
<br />ADHINISTRAIIOH
<br />SERVICE
<br />TOTAL
<br />701AL
<br />COST PER PERSON PER
<br />MONTH
<br />t^ '
<br />I'M WEEK
<br />SERVICE
<br />COST
<br />-
<br />0 PAL -UNITS
<br />}
<br />0
<br />0
<br />ERR
<br />'
<br />68 REGULAR UNITS
<br />3
<br />0
<br />O
<br />n�
<br />;536
<br />,;,
<br />SECURITY
<br />SERVICE
<br />TOTAL
<br />TOTAL
<br />COST PER PERSON PER
<br />MONTH
<br />PER WEEK
<br />SERVICE
<br />COST
<br />O PAL UNITS
<br />1 -
<br />0
<br />0
<br />ERR
<br />60 REGULAR UNITS
<br />1
<br />3,536
<br />0
<br />0
<br />0
<br />K.
<br />3,$36
<br />INCUiE;PROFORH
<br />ERR 207
<br />Unit TYPPe Units
<br />/
<br />SQ fT SppenFT
<br />Rent
<br />Service
<br />Shelter
<br />1,233 $2.37
<br />i
<br />EFFICIERCY 64
<br />520 S1.77
<br />1440
<br />207
<br />SE 57
<br />`1BR 4
<br />, 700 S2.87 ,
<br />- 2009
<br />207
<br />1,802
<br />68
<br />36080
<br />"
<br />TOidAVERAGE: 0
<br />0
<br />r
<br />68
<br />36080
<br />al
<br />4
<br />t
<br />..54A
<br />k.,r. ;t. ., u,. .......
<br />.. ...
<br />-
<br />..•rl., .. L r±u-«.. ....V h4.• S., r - 'b t
<br />
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