Form 442-2

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

FORM APPROVED
OMB NO. 0575-0015

Position 3
UNITED STATES DEPARTMENT OF AGRICULTURE

STATEMENT OF BUDGET, INCOME AND EQUITY

Name

Schedule 1

Address

(1)
OPERATING INCOME

PRIOR YEAR
Actual
(2)

ANNUAL BUDGET For the ______________ Months Ended ______________
CURRENT YEAR
Actual Data
BEG ___________
Actual YTD
END ___________
(3)

Current Quarter

Year To Date

(4)

(5)

(Over) Under Budget
Col. 3 – 5 = 6

(6)

1.
2.
3.
4.
5.
6.

______________________
______________________
______________________
______________________
Miscellaneous
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

____________________________________
Secretary

_______________
Date

Quarterly Reports Certified Correct

____________________________
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 1
Page 2

SUPPLEMENTAL DATA
The Following Data Should Be Supplied Where Applicable

1. ALL BORROWERS
Circle One
a. Are deposited funds in institutions insured by the Federal Government?
Yes
No
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 # ________________
________________________________________ _______________
_______________
2. RECREATION AND GRAZING ASSOCIATION BORROWERS ONLY
a. Number of Members

Current Quarter
Year to Date
______________________ ____________________

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

______________________
______________________
______________________
______________________
______________________

4. OTHER UTILITIES
a. Number of users
b. Product purchased
c. Product sold

______________________ ____________________
______________________ ____________________
______________________ ____________________

____________________
____________________
____________________
____________________
____________________

5. HEALTH CARE BORROWERS ONLY
a.
b.
c.
d.

Number of beds
Patient days of care
Percentage of occupancy
Number of outpatient visits

______________________
______________________
____________________ %
______________________

6. DISTRIBUTION OF ALL CASH AND INVESTMENTS*
Indicate balances in the following accounts:
Construction

Revenue

Cash
$ ___________ $ ___________
Savings
and
Invest- $ ___________ $ ___________
ments
$ ___________ $ ___________
Total

Debt Service

All Others

Grand Total

$ ___________ $ ____________

$ ___________ $ ___________ $ __________

$ ___________ $ ____________

$ ___________ $ ___________ $ __________

$ ___________ $ ____________

0–30

Number of Accounts

Reserve

$ ___________ $ ___________ $ __________

7. AGE ACCOUNTS RECEIVABLE AS FOLLOWS:

Dollar Values

Operation &
Maintenance

____________________
____________________
___________________ %
____________________

31–60

Days

$ _____________ $ ____________
______________

*Totals must agree with those on Balance Sheet.

_____________

61–90

91 and Older

*Total

$ _____________ $ _____________ $ ________________
______________

______________

_________________

Schedule 2

PROJECTED CASH FLOW

For the Year BEG. ________________ END. _________________
(same as schedule 1 column 3)

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 Expended 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: _______________________________________________..................................... ________________________________
_____________________________________________________ .................................... ________________________________
Total - Agrees with Item G ......................................................................................................... $ _______________________________

STATEMENT OF BUDGET, INCOME AND EQUITY
INSTRUCTIONS

Schedule 1

Community Program Borrowers
Frequency and Preparation:
1.

When used as Management Report.
(a) Prior to the beginning of each fiscal year, complete only column three, “Annual Budget,” for the next fiscal year on page 1
and forward two copies to the County Supervisor. All data should be entered on the same basis as your accounting records, i.e., cash,
accrual, etc. The budget must be approved by the governing body. Schedule 2, Projected Cash Flow will also be prepared and submitted at the same time.
(b) Twenty (20) days after the end of each of the 1st 3 quarters of each year, complete all data on pages one and two and
forward two copies to the County Supervisor. For 4th quarter Management Report, see (2) and (3) below.
2.
When used as a year end Statement of Income. For borrowers not required to have an independent audit, and who are required to
furnish Management Reports, complete all information on both pages of Schedule 1. This will serve as the 4th quarter Management
Report and year end financial Statement of Income. This Annual Report will be approved by the governing body, with two copies
submitted within 60 days of year end to the County Supervisor.
For borrowers who are not required to furnish Management Reports, page 1 of schedule 1 may be used for the Annual Statement
of Income if an annual audit is not required. In this case, complete only columns 1, 2 and 5.
Note:

Year End Balance Sheet is also required in either of the aforementioned situations.

3.
An independently audited Statement of Income containing budget and actual data will substitute for page 1 of this form as the
4th quarter Management Report, when required, and the year end Statement of Income. However, page 2 must be completed for all
borrowers required to submit Management Reports.
Group Farmer Program Borrowers

1949-B (442.9)

Frequency and Preparation:
1.
When used as Management Report submit Budget Data Only. Complete column three, “Annual Budget,” for the next fiscal year
on page 1, Schedule 1 and forward two copies to the County Supervisor. All data should be entered on the same basis as your accounting records, i.e., cash, accrual, etc. The budget must be approved by the governing body. When submitting along with Statement of
Income, (item 2 below) include this budget data at the same time. Schedule 2, Projected Cash Flow is not required.
2.
When used as year end Statement of Income. For borrowers not required to have independent audits, page 1 of Schedule 1 may
be used for the Annual Statement of Income. Complete columns 1, 2 and 5. Also complete items 1, 6 and 7 on page 2. This form must
be approved by the governing body, with two copies submitted within 60 days of year end to the County Supervisor. An independently
audited Statement of Income will substitute for page 1, Schedule 1.
Column and Line Item Preparation
Column 1
Income and Expense Items:
All data entered should be on the same basis as your Accounting Record, i.e., Cash Basis, Accrual Basis, etc.
Operating Income
Lines 1 – 5
List types of income as appropriate.
Line 6
Allowances and Deductions
(Pertains Generally to Health Care Institutions, and represents the difference between Gross Income and
Amounts Received or to be Received from Patient and third party payors)
Operating Expenses
Lines 8 – 14
List types of expenses as appropriate
Line 15
Interest Agency
(Interest expense incurred on Agency note(s).)
Line 16
Depreciation
(Total depreciation expense for the year)
Line 18
Net Operating Income (Loss)
(This amount represents the net operating income or loss before adding income not related to operations below)

INSTRUCTIONS - Column and Line Item Preparation Cont’d
Non Operating Income
Line 19 – 20
(Indicate items of income derived from sources other than regular activities, EX: interest, earned)
Line 22
Net Income (Loss)
(This amount is also transferred to item A of the Projected Cash Flow statement Schedule 2 when Management
Reports are required for Community Program borrowers only.
Line 23
Equity, Beginning of Period
(Enter the Equity at the beginning of Reporting Period. The term Equity is used interchangeably with Net Worth and
Fund Balance.)
Lines 24 – 25
Enter items which cause changes in the Current Year’s Equity other than line 22 amount.
Lines 26
Equity End of Period
(This balance will be the same amount that appears on the Balance Sheet.)
Column 2 -

Prior Year Actual
Enter the actual income, expense and equity amounts of the prior year.
Community Program Borrowers: Use this column for all management report requirements except when submitting
the proposed budget prior to the beginning of each fiscal year. Also fill in when using this Schedule as the year-end
Statement of Income.
Group Farmer Programs: Complete only when also using this form as annual Statement of Income.

Column 3 -

Annual Budget
This will be the budget for the current year when actual data is presented in columns four and/or five. When
submitting only budget data on this form, the amounts will be for the next year. Enter the beginning and ending
dates of the budget year at the top of this column.

Column 4 -

Actual Data, Current Quarter
Only used by Community Program borrowers required to submit Management Reports and contains information
for the current three months being reported.

Column 5 -

Actual Data, Year to Date
For borrowers submitting Management Reports, enter cumulative data from the beginning of the Accounting Year
through the Current Quarter. When used as Fourth Quarter Management Report and/or year end Statement of
Income, enter data for the entire year.

Column 6 -

Actual Year to Date (over) Under Budget
Only used by borrowers required to submit Management Reports and is determined by subtracting column 5 from
column 3 for each line item.

SCHEDULE 1, PAGE 2, SUPPLEMENTAL DATA
This information is required of all borrowers submitting Management Reports. Fill in as indicated.
Community Program Borrowers complete as appropriate.
Group Farmer Program Borrowers complete only items 1, 6 and 7.

PROJECTED CASH FLOW
INSTRUCTIONS

Schedule 2

The completion of this form is required of all Community Program borrowers submitting Management Reports, and will
accompany Schedule 1 when the Annual Budget is transmitted, to the County Supervisor. See Instruction No. 1 on Schedule 1.
This form is used to Project the Flow of cash for the budget year in order to determine the adequacy of cash to cover Operating
Expenses, Transfer to Reserves, Debt Payment, Capital Outlays, etc.
Cash Basis Account - Systems
Borrowers who maintain their records strictly on the cash basis of accounting and have no Accounts Receivable and Accounts
Payable, will probably only need to complete the following line items:
A, B-1, C-1, E-1 and E-3, F and G.
Line Item Instructions
Line A - Bring forward the income or loss as entered on line 22, schedule 1, column 3.
Line B - Add back any depreciation or other non cash items included on schedule 1, column 3.
Line C - Complete items C-1 through C-6 as appropriate, for item changes which provide for increase in cash balances.
Note: Do not include changes in Cash Accounts, in Current Assets of item C-4. Lines C-3 and C-4 will indicate
the changes in Working Capital (Current Assets and Current Liabilities, Exclusive of Cash.)
Line D - Enter the net total of all A, B and C items.
Line E - Complete items E-1 through E-6 as appropriate for items for which cash was expended.
Line F - Enter the Beginning Cash Balance(s) for the Period.
Line G - The total of item D less E-6 plus F will be the Ending Cash Balance(s). This total will be reconciled by balances
in the Various Accounts, i.e., Construction, Revenue, Debt, etc.