Schedule Dmh-2 - Consolidated Quarterly Report - Office Of Mental Health Of New York State Page 2
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2NEW YORK STATE
Funding State Agency:
SCHEDULE DMH-2
OMH
CONSOLIDATED FISCAL REPORT
AID TO LOCALITIES/
OMRDD
For the Period: July 1, 2009 to June 30, 2010
DIRECT CONTRACT
OASAS
SUMMARY
Page _____
AGENCY NAME:____________________________________
PREPARED BY: _____________________________________________
TELEPHONE: (____) _________________
Please check the box if the preparer changed from the previous submission.
AGENCY CODE:____________________________________
COUNTY NAME & CODE: _______________________(____)
PLEASE CHECK:
ESTIMATED CLAIM ____
FINAL CLAIM _____
COLUMN NUMBER
Cost
Line
ITEM DESCRIPTION
Codes
No. Program Type
00072
Program Code (Program Code Index)
00012
(
)
(
)
(
)
(
)
(
)
25 State Grants (Detail Required)
46190
26 LTSE Income Total (OMH and OMRDD Only)
46220
27 Food Stamps (OASAS and OMRDD Only)
46240
28 Net Deficit Funding (State & LGU Funding Only)*
46110
29 Other (Detail Required)
46230
30 Total Gross Revenue (Sum Lines 14-29)
46999
GAAP ADJUSTMENTS TO REVENUE
31 Participant Allowance
47010
32 Uncollectible Accounts Receivable
47040
33 Other (Detail Required)
47045
34 Total GAAP Adjustments (Sum Lines 31-33)
47049
35 Net GAAP Revenues (Line 30 minus 34)
47025
NON-GAAP ADJUSTMENTS TO REVENUE
36 Exempt Contract Income
47050
37 Exempt LTSE Income
47060
38 Net Deficit Funding**
47070
39 Other (Detail Required)
47080
40 Total NON-GAAP Adjustments (Sum Lines 36-39)
47998
41 Subtotal Adj. to Revenue (Sum Lines 34 & 40)
47999
42 Total Net Revenues (Line 30 minus 41)
48999
43 Net Operating Costs (Line 13 minus 42)
49999
DEFICIT FUNDING
44 State Share
60010
45 Local Government Share
60020
46 Service Provider Share (Voluntary Contributions)
60030
47 Total Approved Deficit Funding (Sum lines 44 - 46)
60039
48 Non-Funded
60040
49 Total Net Deficit (Sum Lines 47-48)
60999
* Do not include non-funded or voluntary contributions.
DMH-2.2
** Amounts should equal the corresponding amounts reported as revenue on line 28 above.
Rev.
May 2010
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