Form Sr 3 - Group Home Program Costs Report Page 3

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COST REPORT (SR 3) (Continued)

9c. Administrator Salary: Report annual salary for person(s) approved by Community Care Licensing as the Administrator. Include payroll, payroll taxes, and benefits (if applicable).

9d. All Other Administrative Salaries: Report annual payroll-related expenses for staff primarily responsible for the ongoing administration and support functions of the organization,

including salaries and wages, overtime, payroll taxes and employee benefits which include vacation, sick leave, contributions to an employee pension plan, and dental and health

insurance.

9e. Financial Audit Costs: Report any costs incurred in obtaining an independent audit of the organization’s financial statements on line 9e, Column A. If the organization has received

reimbursement of financial audit costs as previously allowed by Welfare and Institutions Code Section 11466.21(c) prior to this statute being eliminated, report the amount of the

reimbursement as an offset of total costs on Line 9e, Column B of the SR 3.

9f. Administration: (Minus Administrative Salaries and Financial Audit Costs). All costs necessary for the ongoing administration and support functions of the Program. This includes

contracts, telephone, postage, freight, office supplies, administrative travel, conferences, meetings, in-service training, memberships, subscriptions, dues, printing and publications,

bonding, general insurance, advertising, recruiting and other miscellaneous administrative costs.

TOTAL: For Total Program Costs add lines 1 through 9f under column A and enter the amount. For total Offsets add lines 1 through 9f under column B and enter the amount. For total

Reasonable Adjustments add lines 1 through 9f under column C and enter the amount. For total Final Costs add lines 1 through 9f under column D and enter the amount.