2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
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2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
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AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 11
17223333
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost 1 2 3 4 5 6 7
No. ITEM DESCRIPTION Codes
1 Program Type 00070
ADMINISTRATIVE
OVERSIGHT (#300)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Long Island - ICF
(#426)
2 Program Code (Program Code Index) 00010 1090 1090 1090 1090 1090 0090
3 Program/Site Identification Number 00050 227838
4 Program/Site Name 00020 Sunmount (225) B. Fineson (230) Broome (233) Brooklyn (235) Capital District (260) House A
5 Program/Site Address (Line One) 0003064 Ridge Road
6 Program/Site Address (Line Two) 00040
7 Medicaid Provider Agreement Number (DMH only) 00060
8 County Code (See Appendix C) 00080
9 Date Site Opened 00090
10 Certified Capacity (OASAS, OMRDD and SED only) 00100 0 350 346 540 192 70 16
11 Actual Capacity (OMH, OMRDD and SED only) 00110 0 175 118 127 48 0 12
12 Actual Days Program/Site Open 00160 N/A 365 365 365 365 N/A 365
13 Units of Service 00120 0 64410 46,771 49,890 44,271 6,741 4,569
13b Units of Service Monthly IRA Supervised
14 Respite or TUBS Units of Service (OMRDD only) 00130 0 0
15 Program/Site Square Footage (OASAS, OMRDD and SED Only) 00150 0
0
SECTION B: EXPENSES
PERSONAL SERVICES
16 Personal Services - Program/Site & Program Admin 11999 57,302,275 36,982,289 25,934,969 31,370,071 32,205,186 7,614,902 1,462,106
17 Vacation Accruals - Program/Site & Program Admin 12999 -309,431 -199,704 -140,049 -169,398 -173,908 -41,120 -7,895
FRINGE BENEFITS
18 Mandated Fringe Benefits 13200 30,645,256 19,778,128 13,870,021 16,776,714 17,223,333 4,072,450 781,934
19 Non-Mandated Fringe Benefits 13300 0
20 Total Fringe Benefits (Sum Lines 18 & 19) 13999 30,645,256 19,778,128 13,870,021 16,776,714 17,223,333 4,072,450 781,934
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 12
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost 1 2 3 4 5 6 7
No. ITEM DESCRIPTION Codes
1 Program Type 00070
ADMINISTRATIVE
OVERSIGHT (#300)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Long Island - ICF
(#426)
2 Program Code (Program Code Index) 00010 1090 1090 1090 1090 1090 0090
3 Program/Site Identification Number 00050 227838
4 Program/Site Name 00020 Sunmount (225) B. Fineson (230) Broome (233) Brooklyn (235) Capital District (260) House A
5 Program/Site Address (Line One) 0003064 Ridge Road
OTHER THAN PERSONAL SERVICES (OTPS)
21 Food 14010 0 566,277 49,197 309,790 1,172 788 44,664
22 Repairs and Maintenance 14020 0 162,714 1,023,896 142,920 94,194 1,708 64,653
23 Utilities 14030 0 25,547 402 29,763
24 Transportation Related-Participant 14040 0 1,155 20 71 100 75
25 Staff Travel 14250 0 22,220 2,243 698 10,202 11,659
26 Participant Incidentals 14050 0 58,022 100,045 13,438 27,343 7,762 10,189
27 Expensed Adaptive Equipment (OMRDD and SED only) 14070 0
28 Expensed Equipment 14080 0 14,864 11,684 12,792 75 1,536
29 Sub-Contract Raw Materials 14090 0
30 Participant Wages-Non-Contract 14100 031 Participant Wages-Contract 14110 032 Participant Fringe Benefits 14120 033 Section 43.04 Services Assessment (OMRDD only) 14130 0 5,595,203 4,027,014 4,518,398 4,007,784 607,601 213,13034 Staff Development 14140 0 1,844 40 1,90035 Contracted Direct Care and Clinical Personal Svs. (from CFR-4A) 14150 0 5,197 39,502 49,650 15,998 38236 Supplies and Materials - Non-Household 14160 0 100,380 45,983 53,340 17,182 5,915 59,52337 Household Supplies 14170 0 229 20,864 2,803 62238 Telephone 14190 0 3,017 11 2,56439 Insurance - General 14260 040 Other (Detail Required) 14998 3,953,777 3,777,266 2,714,494 3,290,867 5,455,012 1,018,990 126,16541 Total Other Than Personal Services (Sum Lines 21-40) 14999 3,953,777 10,333,936 8,035,384 8,380,374 9,635,089 1,654,045 563,921
EQUIPMENT-PROVIDER PAID
42 Lease/Rental Vehicle 15010 0 317 33443 Lease/Rental Equipment 15020 0 1,116 2344 Depreciation-Vehicle 15040 045 Depreciation-Equipment 15050 0 6,058 59,617 7,132 7,850 11,115 3,10946 Interest-Vehicle 15070 047 Other (Detail Required) 15998 11,116 160,783 149,233 159,669 151,018 38,965 9,555
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 13
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost 1 2 3 4 5 6 7
No. ITEM DESCRIPTION Codes
1 Program Type 00070
ADMINISTRATIVE
OVERSIGHT (#300)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Long Island - ICF
(#426)
2 Program Code (Program Code Index) 00010 1090 1090 1090 1090 1090 0090
3 Program/Site Identification Number 00050 227838
4 Program/Site Name 00020 Sunmount (225) B. Fineson (230) Broome (233) Brooklyn (235) Capital District (260) House A
5 Program/Site Address (Line One) 0003064 Ridge Road
48 Total Equipment (Sum of Lines 42-47) 15999 11,116 167,957 208,873 167,118 158,868 50,414 12,664
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 14
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost 1 2 3 4 5 6 7
No. ITEM DESCRIPTION Codes
1 Program Type 00070
ADMINISTRATIVE
OVERSIGHT (#300)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Long Island - ICF
(#426)
2 Program Code (Program Code Index) 00010 1090 1090 1090 1090 1090 0090
3 Program/Site Identification Number 00050 227838
4 Program/Site Name 00020 Sunmount (225) B. Fineson (230) Broome (233) Brooklyn (235) Capital District (260) House A
5 Program/Site Address (Line One) 0003064 Ridge Road
PROPERTY-PROVIDER PAID
49 Lease/Rental-Real Property 16010 050 Leasehold/Leasehold Improvements 16020 051 Depreciation-Building 16030 0 90,99652 Depreciation Building/Land Improvements 16040 0 88,286 4,785 327,512 7,731 18,674 23,96053 Mortgage/Capital Improvements Interest (Report MCFFA/DASNY Bond Int. on Line 59) 16060 0
54 Mortgage Expenses 16070 0
55 Insurance-Property & Casualty 16080 0
56 Real Estate Taxes 16090 0
57 Interest on Capital Indebtedness 16100 0
58 Start-up Expenses 16110 0
59 MCFFA/DASNY Interest Expense 16120 0 30,971 571,753 1,232 8,597
60 MCFFA/DASNY Administration Fees 16130 0 0 0 0 0
61 Maintenance in Lieu of Rent (LGU only) 16140 0
62 Other (Detail Required) 16998 1,410,297 1,453,335 4,482,727 1,174,892 1,710,565 464,211 29,948
63 Total Property-Provider Paid (Sum of Lines 49-62) 16999 1,410,297 1,572,592 4,578,509 2,074,157 1,719,528 482,885 62,506TOTALS
64 Total Operating Costs (Sum lines 16, 17, 20, 41 minus 29) 19010 91,591,877 66,894,649 47,700,325 56,357,761 58,889,700 13,300,277 2,800,066
65 Agency Administrative Allocation 19050 2,928,560 2,138,891 1,525,171 1,801,984 1,882,940 425,263 89,529
66 Adjustments/Non-Allowable Costs (Detail Required) 19030 -138,211 -100,943 -71,979 -85,043 -88,864 -20,070 -4,227
67 Total Prog/Site Costs (Sum lines 29, 48, 63-65 plus/minus 66) 19060 95,803,638 70,673,145 53,940,898 60,315,976 62,562,173 14,238,769 2,960,537
OMRDD Only - Informational
68a Other Than To/From Transportation Allocation 19101 0 0 0 0 0 0 0
68b To/From Transportation Allocation 19102 0 0 0 0 0 0 0
68c ICF/DD SED Contract Liability 19103 0 0 0 0 0 0 0
68d ICF/DD Day Services Liability 19104 0 0 0 0 0 0 0
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 15
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost 1 2 3 4 5 6 7
No. ITEM DESCRIPTION Codes
1 Program Type 00070
ADMINISTRATIVE
OVERSIGHT (#300)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Long Island - ICF
(#426)
2 Program Code (Program Code Index) 00010 1090 1090 1090 1090 1090 0090
3 Program/Site Identification Number 00050 227838
4 Program/Site Name 00020 Sunmount (225) B. Fineson (230) Broome (233) Brooklyn (235) Capital District (260) House A
5 Program/Site Address (Line One) 0003064 Ridge Road
SECTION C: REVENUES
69 Participant Fee (less SSI & SSA) 20010 0 15,845 61,284 46,876 24,819 21,378
70 SSI & SSA 20020 0 555,894 768,354 601,010 398,441 92,243 113,632
71 Home Relief/Public Assistance 20030 0
72 Medicaid 20040 0 71,147,038 51,206,382 57,454,687 50,961,855 7,726,085 2,959,081
73 Medicare 20060 0
74 Other Third Parties (Detail Required) 20070 0
75 OMRDD Residential Room and Board/NYS OPTS 20080 0
76 Transportation, Medicaid 20090 0
77 Transportation, Other (Detail Required) 20100 0
78 Sales: Contract Total 21070 0
79 Federal Grants (Detail Required) 22040 0
80 State Grants (Detail Required) 22030 0
81 LTSE Income Total (OMH and OMRDD only) 22080 0
82 Food Stamps (OASAS and OPWDD Only)/Food Revenue (SED Only) 22160 0
83 Gifts, Legacies, Bequests, Restricted Donations 22010 0
84 Section 202/8/811 HUD Funds* 22020 0
85 Interest/Dividend Income 22050 0
86 Prior Period Rate Adjustments** 22090 0
87 Excessive Teacher Turnover Prevention Grant (SED only) 22100 0
88 LDSS County Revenue (SED only) 22110 0
89 4402 Revenue (School District In-State) (SED only) 22120 0
90 Department of Health Chapter 428 Revenue (SED only) 22130 0
91 4408 Revenue (School District) (SED only) 22140 0
92 4410 Revenue (Preschool) (SED only) 22150 0
93 Net Deficit Funding (State & LGU Funding only)* 20110 0
94 Other (Detail Required) (County Payment for Services) 22998 0 4,137,653 0 838,851 253,950 0
95 Gross Revenues (Sum Lines 69-94) 23999 0 75,856,430 52,036,021 58,941,424 51,639,065 7,839,706 3,072,713
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 16
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost 1 2 3 4 5 6 7
No. ITEM DESCRIPTION Codes
1 Program Type 00070
ADMINISTRATIVE
OVERSIGHT (#300)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Developmental Center
(#310)
Long Island - ICF
(#426)
2 Program Code (Program Code Index) 00010 1090 1090 1090 1090 1090 0090
3 Program/Site Identification Number 00050 227838
4 Program/Site Name 00020 Sunmount (225) B. Fineson (230) Broome (233) Brooklyn (235) Capital District (260) House A
5 Program/Site Address (Line One) 0003064 Ridge Road
GAAP ADJUSTMENTS TO REVENUE
96 Participant Allowance 24010 0
97 Uncollectible Accounts Receivable 24040 0
98 Other (Detail Required) 24996 0
99 Total GAAP Adjustments (Sum Lines 96-98) 24997 0 0 0 0 0 0 0
100 Net GAAP Revenues (Line 95 minus 99) 24998 0 75,856,430 52,036,021 58,941,424 51,639,065 7,839,706 3,072,713
NON-GAAP ADJUSTMENTS TO REVENUE
101 Exempt Contract Income 24050 0
102 Exempt LTSE Income 24060 0
103 Net Deficit Funding** 24070 0
104 Other (Detail Required) 24080 0
105 Total NON-GAAP Adjustments (Sum Lines 101-104) 24097 0 0 0 0 0 0 0
106 TOTAL ADJ. TO REVENUE (Sum Lines 99 & 105) 24999 0 0 0 0 0 0 0
107 TOTAL NET REVENUES (Line 95 minus 106) 25999 0 75,856,430 52,036,021 58,941,424 51,639,065 7,839,706 3,072,713
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 17
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040
7 Medicaid Provider Agreement Number (DMH only) 00060
8 County Code (See Appendix C) 00080
9 Date Site Opened 00090
10 Certified Capacity (OASAS, OMRDD and SED only) 00100
11 Actual Capacity (OMH, OMRDD and SED only) 00110
12 Actual Days Program/Site Open 00160
13 Units of Service 00120
13b Units of Service Monthly IRA Supervised
14 Respite or TUBS Units of Service (OMRDD only) 00130
15 Program/Site Square Footage (OASAS, OMRDD and SED Only) 00150
SECTION B: EXPENSES
PERSONAL SERVICES
16 Personal Services - Program/Site & Program Admin 11999
17 Vacation Accruals - Program/Site & Program Admin 12999
FRINGE BENEFITS
18 Mandated Fringe Benefits 13200
19 Non-Mandated Fringe Benefits 13300
20 Total Fringe Benefits (Sum Lines 18 & 19) 13999
8 9 10 11 12 13 14 15 16
Long Island - ICF
(#427)
Long Island - ICF
(#428)
Long Island - ICF
(#429)
Long Island - ICF
(#430)
Long Island - ICF
(#431)
Long Island - ICF
(#459)
Long Island - ICF
(#461)
Long Island - ICF
(#462)
Long Island - ICF
(#463)
0090 0090 0090 0090 0090 0090 0090 0090 0090
227844 227839 227845 227840 227847 227848 227890 227891 227892
House A House B House B House C House A House B 901-903 904-906 907-909
85 West Yaphank
Road64 Ridge Road
85 West Yaphank
Road64 Ridge Road 206 Oxhead Rd 206 Oxhead Rd 36 Melville Estates 39 Melville Estates 42 Melville Estates
16 16 16 16 16 16 36 36 36
13 14 11 14 13 13 25 26 21
365 365 365 365 365 365 365 365 365
5,077 5,487 4,284 5,071 5,224 5,105 9,524 10,427 9,847
0 0 0 0 0 0 0 0 0
1518172.177
1,518,172 1,368,229 1,448,311 1,444,464 1,210,334 1,356,138 3,863,479 4,184,810 2,679,030
-8,198 -7,388 -7,821 -7,800 -6,536 -7,323 -20,863 -22,598 -14,467
811,918 731,729 774,557 772,499 647,287 725,263 2,066,189 2,238,036 1,432,745
811,918 731,729 774,557 772,499 647,287 725,263 2,066,189 2,238,036 1,432,745
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 18
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040OTHER THAN PERSONAL SERVICES (OTPS)
21 Food 14010
22 Repairs and Maintenance 14020
23 Utilities 14030
24 Transportation Related-Participant 14040
25 Staff Travel 14250
26 Participant Incidentals 14050
27 Expensed Adaptive Equipment (OMRDD and SED only) 14070
28 Expensed Equipment 14080
29 Sub-Contract Raw Materials 14090
30 Participant Wages-Non-Contract 14100
31 Participant Wages-Contract 14110
32 Participant Fringe Benefits 14120
33 Section 43.04 Services Assessment (OMRDD only) 14130
34 Staff Development 14140
35 Contracted Direct Care and Clinical Personal Svs. (from CFR-4A) 14150
36 Supplies and Materials - Non-Household 14160
37 Household Supplies 14170
38 Telephone 14190
39 Insurance - General 14260
40 Other (Detail Required) 14998
41 Total Other Than Personal Services (Sum Lines 21-40) 14999
EQUIPMENT-PROVIDER PAID
42 Lease/Rental Vehicle 15010
43 Lease/Rental Equipment 15020
44 Depreciation-Vehicle 15040
45 Depreciation-Equipment 15050
46 Interest-Vehicle 15070
47 Other (Detail Required) 15998
8 9 10 11 12 13 14 15 16
Long Island - ICF
(#427)
Long Island - ICF
(#428)
Long Island - ICF
(#429)
Long Island - ICF
(#430)
Long Island - ICF
(#431)
Long Island - ICF
(#459)
Long Island - ICF
(#461)
Long Island - ICF
(#462)
Long Island - ICF
(#463)
0090 0090 0090 0090 0090 0090 0090 0090 0090
227844 227839 227845 227840 227847 227848 227890 227891 227892
House A House B House B House C House A House B 901-903 904-906 907-909
85 West Yaphank
Road64 Ridge Road
85 West Yaphank
Road64 Ridge Road 206 Oxhead Rd 206 Oxhead Rd 36 Melville Estates 39 Melville Estates 42 Melville Estates
66,666 49,357 59,905 43,549 66,431 42,541 97,899 115,390 96,854
4,287 5,360 2,033 4,912 2,804 8,475 78,679 74 1,630
29,100 29,995 26,091 27,701 38,089 32,794 33,270 2,118 10,640
140 10 4,946
2,210 265 9,107 567 3,340 2,060 1,348
8,227 1,066 7,829 1,271 11,238 925 13,921 10,109 16,799
7,276 877 564 300 5,955 252 1,200 3,723 1,289
116
232,238 232,710 190,101 246,488 234,891 230,420 445,318 483,569 446,464
166 48,020 106 5,294 39,728 20,148 1058,006 43,914 54,578 60,596 71,598 63,413 113,211 101,599 120,055
408 34 48 1815,740 3,256 4,843 2,380 5,442 5,946 20,530 12,344 25,912
126,592 111,845 123,002 118,013 105,802 112,890 317,919 331,468 219,902541,056 478,645 516,965 505,220 551,497 503,517 1,170,125 1,082,602 941,084
465
4,321 2,640 4,453 2,248 717 1,605 1,470 1,363 2,465
9,629 8,507 9,356 8,977 8,048 8,587 24,182 25,213 16,727
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 19
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 0004048 Total Equipment (Sum of Lines 42-47) 15999
8 9 10 11 12 13 14 15 16
Long Island - ICF
(#427)
Long Island - ICF
(#428)
Long Island - ICF
(#429)
Long Island - ICF
(#430)
Long Island - ICF
(#431)
Long Island - ICF
(#459)
Long Island - ICF
(#461)
Long Island - ICF
(#462)
Long Island - ICF
(#463)
0090 0090 0090 0090 0090 0090 0090 0090 0090
227844 227839 227845 227840 227847 227848 227890 227891 227892
House A House B House B House C House A House B 901-903 904-906 907-909
85 West Yaphank
Road64 Ridge Road
85 West Yaphank
Road64 Ridge Road 206 Oxhead Rd 206 Oxhead Rd 36 Melville Estates 39 Melville Estates 42 Melville Estates
14,415 11,147 13,809 11,224 8,765 10,192 25,652 26,576 19,192
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 20
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040PROPERTY-PROVIDER PAID
49 Lease/Rental-Real Property 16010
50 Leasehold/Leasehold Improvements 16020
51 Depreciation-Building 16030
52 Depreciation Building/Land Improvements 16040
53 Mortgage/Capital Improvements Interest (Report MCFFA/DASNY Bond Int. on Line 59) 16060
54 Mortgage Expenses 16070
55 Insurance-Property & Casualty 16080
56 Real Estate Taxes 16090
57 Interest on Capital Indebtedness 16100
58 Start-up Expenses 16110
59 MCFFA/DASNY Interest Expense 16120
60 MCFFA/DASNY Administration Fees 16130
61 Maintenance in Lieu of Rent (LGU only) 16140
62 Other (Detail Required) 16998
63 Total Property-Provider Paid (Sum of Lines 49-62) 16999
TOTALS
64 Total Operating Costs (Sum lines 16, 17, 20, 41 minus 29) 19010
65 Agency Administrative Allocation 19050
66 Adjustments/Non-Allowable Costs (Detail Required) 19030
67 Total Prog/Site Costs (Sum lines 29, 48, 63-65 plus/minus 66) 19060
OMRDD Only - Informational
68a Other Than To/From Transportation Allocation 19101
68b To/From Transportation Allocation 19102
68c ICF/DD SED Contract Liability 19103
68d ICF/DD Day Services Liability 19104
8 9 10 11 12 13 14 15 16
Long Island - ICF
(#427)
Long Island - ICF
(#428)
Long Island - ICF
(#429)
Long Island - ICF
(#430)
Long Island - ICF
(#431)
Long Island - ICF
(#459)
Long Island - ICF
(#461)
Long Island - ICF
(#462)
Long Island - ICF
(#463)
0090 0090 0090 0090 0090 0090 0090 0090 0090
227844 227839 227845 227840 227847 227848 227890 227891 227892
House A House B House B House C House A House B 901-903 904-906 907-909
85 West Yaphank
Road64 Ridge Road
85 West Yaphank
Road64 Ridge Road 206 Oxhead Rd 206 Oxhead Rd 36 Melville Estates 39 Melville Estates 42 Melville Estates
47948,965 16,822 3,894 17,977 7,081 7,893 89,070 127,714 18,999
116,042 6,436 316 5,851 486 486 93,853 304,301 14,528
0 0 0 0 0 0 0 0 0
45,993 26,486 28,132 27,808 24,230 25,848 86,413 120,497 52,350
211,000 49,744 32,342 51,637 31,797 34,227 269,336 552,992 85,877
2,862,948 2,571,215 2,732,012 2,714,383 2,402,582 2,577,595 7,078,814 7,482,849 5,038,392
91,540 82,212 87,353 86,790 76,820 82,416 226,338 239,257 161,098
-4,322 -3,882 -4,125 -4,097 -3,627 -3,892 -10,685 -11,294 -7,607
3,175,580 2,710,436 2,861,392 2,859,937 2,516,337 2,700,539 7,589,572 8,290,381 5,296,951
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 21
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040SECTION C: REVENUES
69 Participant Fee (less SSI & SSA) 20010
70 SSI & SSA 20020
71 Home Relief/Public Assistance 20030
72 Medicaid 20040
73 Medicare 20060
74 Other Third Parties (Detail Required) 20070
75 OMRDD Residential Room and Board/NYS OPTS 20080
76 Transportation, Medicaid 20090
77 Transportation, Other (Detail Required) 20100
78 Sales: Contract Total 21070
79 Federal Grants (Detail Required) 22040
80 State Grants (Detail Required) 22030
81 LTSE Income Total (OMH and OMRDD only) 22080
82 Food Stamps (OASAS and OPWDD Only)/Food Revenue (SED Only) 22160
83 Gifts, Legacies, Bequests, Restricted Donations 22010
84 Section 202/8/811 HUD Funds* 22020
85 Interest/Dividend Income 22050
86 Prior Period Rate Adjustments** 22090
87 Excessive Teacher Turnover Prevention Grant (SED only) 22100
88 LDSS County Revenue (SED only) 22110
89 4402 Revenue (School District In-State) (SED only) 22120
90 Department of Health Chapter 428 Revenue (SED only) 22130
91 4408 Revenue (School District) (SED only) 22140
92 4410 Revenue (Preschool) (SED only) 22150
93 Net Deficit Funding (State & LGU Funding only)* 20110
94 Other (Detail Required) (County Payment for Services) 22998
95 Gross Revenues (Sum Lines 69-94) 23999
8 9 10 11 12 13 14 15 16
Long Island - ICF
(#427)
Long Island - ICF
(#428)
Long Island - ICF
(#429)
Long Island - ICF
(#430)
Long Island - ICF
(#431)
Long Island - ICF
(#459)
Long Island - ICF
(#461)
Long Island - ICF
(#462)
Long Island - ICF
(#463)
0090 0090 0090 0090 0090 0090 0090 0090 0090
227844 227839 227845 227840 227847 227848 227890 227891 227892
House A House B House B House C House A House B 901-903 904-906 907-909
85 West Yaphank
Road64 Ridge Road
85 West Yaphank
Road64 Ridge Road 206 Oxhead Rd 206 Oxhead Rd 36 Melville Estates 39 Melville Estates 42 Melville Estates
13,983 100,422 13,050 17,893 9,912 25,551
119,946 138,282 137,367 129,938 144,897 134,418 178,362 235,303 256,536
3,310,807 3,221,004 2,710,095 3,423,253 3,348,630 3,284,898 6,348,499 6,893,805 6,364,832
3,430,754 3,373,269 2,847,462 3,653,613 3,506,577 3,419,316 6,544,754 7,139,020 6,646,919
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 22
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040GAAP ADJUSTMENTS TO REVENUE
96 Participant Allowance 24010
97 Uncollectible Accounts Receivable 24040
98 Other (Detail Required) 24996
99 Total GAAP Adjustments (Sum Lines 96-98) 24997
100 Net GAAP Revenues (Line 95 minus 99) 24998
NON-GAAP ADJUSTMENTS TO REVENUE
101 Exempt Contract Income 24050
102 Exempt LTSE Income 24060
103 Net Deficit Funding** 24070
104 Other (Detail Required) 24080
105 Total NON-GAAP Adjustments (Sum Lines 101-104) 24097
106 TOTAL ADJ. TO REVENUE (Sum Lines 99 & 105) 24999
107 TOTAL NET REVENUES (Line 95 minus 106) 25999
8 9 10 11 12 13 14 15 16
Long Island - ICF
(#427)
Long Island - ICF
(#428)
Long Island - ICF
(#429)
Long Island - ICF
(#430)
Long Island - ICF
(#431)
Long Island - ICF
(#459)
Long Island - ICF
(#461)
Long Island - ICF
(#462)
Long Island - ICF
(#463)
0090 0090 0090 0090 0090 0090 0090 0090 0090
227844 227839 227845 227840 227847 227848 227890 227891 227892
House A House B House B House C House A House B 901-903 904-906 907-909
85 West Yaphank
Road64 Ridge Road
85 West Yaphank
Road64 Ridge Road 206 Oxhead Rd 206 Oxhead Rd 36 Melville Estates 39 Melville Estates 42 Melville Estates
0 0 0 0 0 0 0 0 0
3,430,754 3,373,269 2,847,462 3,653,613 3,506,577 3,419,316 6,544,754 7,139,020 6,646,919
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
3,430,754 3,373,269 2,847,462 3,653,613 3,506,577 3,419,316 6,544,754 7,139,020 6,646,919
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 23
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040
7 Medicaid Provider Agreement Number (DMH only) 00060
8 County Code (See Appendix C) 00080
9 Date Site Opened 00090
10 Certified Capacity (OASAS, OMRDD and SED only) 00100
11 Actual Capacity (OMH, OMRDD and SED only) 00110
12 Actual Days Program/Site Open 00160
13 Units of Service 00120
13b Units of Service Monthly IRA Supervised
14 Respite or TUBS Units of Service (OMRDD only) 00130
15 Program/Site Square Footage (OASAS, OMRDD and SED Only) 00150
SECTION B: EXPENSES
PERSONAL SERVICES
16 Personal Services - Program/Site & Program Admin 11999
17 Vacation Accruals - Program/Site & Program Admin 12999
FRINGE BENEFITS
18 Mandated Fringe Benefits 13200
19 Non-Mandated Fringe Benefits 13300
20 Total Fringe Benefits (Sum Lines 18 & 19) 13999
17 18 19 20 21 22 23 24 25 26
Long Island - ICF
(#464)
Long Island - ICF
(#465)
Long Island - ICF
(#466)
Long Island - ICF
(#467)
Long Island - ICF
(#468)
Broome - ICF
(#413)
Brooklyn - ICF
(#415)
Brooklyn - ICF
(#420)
Brooklyn - ICF
(#421)
Central NY - ICF
(#432)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0090
227893 227894 227895 227896 227897 233441 235629 235626 235631 273960
910-912 913-915 916-918 919-921 922-924 Glenwood ICF Thomas Shirtz #1 Thomas Shirtz #2 Walsh Complex
45 Melville Estates48 Rainbow
Commons
51 Rainbow
Commons
54 Rainbow
Commons
57 Rainbow
Commons
241 Glenwood
Road960 Elton Street 980 Elton Street
888 Fountain
Avenue
801 Cypress
Street
36 36 36 36 36 8 22 22 8 Closed 11-7-2013
34 34 19 32 27 4 22 21 8
365 365 365 365 365 365 365 365 365
10,724 12,056 10,229 9,129 9,688 1,460 7,519 7,756 2,487
0 0 0 0 0 0 0 0 0
4,224,734 3,781,906 3,393,921 2,027,722 4,163,534 696,208 3,334,926 2,855,737 803,760
-22,814 -20,422 -18,327 -10,950 -22,483 -3,760 -18,009 -15,421 -4,340
2,259,388 2,022,563 1,815,069 1,084,426 2,226,658 372,332 1,783,519 1,527,248 429,851
2,259,388 2,022,563 1,815,069 1,084,426 2,226,658 372,332 1,783,519 1,527,248 429,851
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 24
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040OTHER THAN PERSONAL SERVICES (OTPS)
21 Food 14010
22 Repairs and Maintenance 14020
23 Utilities 14030
24 Transportation Related-Participant 14040
25 Staff Travel 14250
26 Participant Incidentals 14050
27 Expensed Adaptive Equipment (OMRDD and SED only) 14070
28 Expensed Equipment 14080
29 Sub-Contract Raw Materials 14090
30 Participant Wages-Non-Contract 14100
31 Participant Wages-Contract 14110
32 Participant Fringe Benefits 14120
33 Section 43.04 Services Assessment (OMRDD only) 14130
34 Staff Development 14140
35 Contracted Direct Care and Clinical Personal Svs. (from CFR-4A) 14150
36 Supplies and Materials - Non-Household 14160
37 Household Supplies 14170
38 Telephone 14190
39 Insurance - General 14260
40 Other (Detail Required) 14998
41 Total Other Than Personal Services (Sum Lines 21-40) 14999
EQUIPMENT-PROVIDER PAID
42 Lease/Rental Vehicle 15010
43 Lease/Rental Equipment 15020
44 Depreciation-Vehicle 15040
45 Depreciation-Equipment 15050
46 Interest-Vehicle 15070
47 Other (Detail Required) 15998
17 18 19 20 21 22 23 24 25 26
Long Island - ICF
(#464)
Long Island - ICF
(#465)
Long Island - ICF
(#466)
Long Island - ICF
(#467)
Long Island - ICF
(#468)
Broome - ICF
(#413)
Brooklyn - ICF
(#415)
Brooklyn - ICF
(#420)
Brooklyn - ICF
(#421)
Central NY - ICF
(#432)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0090
227893 227894 227895 227896 227897 233441 235629 235626 235631 273960
910-912 913-915 916-918 919-921 922-924 Glenwood ICF Thomas Shirtz #1 Thomas Shirtz #2 Walsh Complex
45 Melville Estates48 Rainbow
Commons
51 Rainbow
Commons
54 Rainbow
Commons
57 Rainbow
Commons
241 Glenwood
Road960 Elton Street 980 Elton Street
888 Fountain
Avenue
801 Cypress
Street
95,076 35,643 81,591 86,647 109,671 20,580 51,044 40,620 26,204
71,774 104,723 47,850 2,030 5,498 5,109 276,291 70,484 8,243
941 54,944 1,141 7,578 1,256 8,527 38,220 33,016 1,566
10
10,424 3,843 1,558 870 28 293 32
23,697 28,099 18,407 26,057 3,907 7,678 8,268 2,259
1,486 5,590 4,061 2,422 1,818 599 678 6,215 145
490,941 552,983 468,661 406,782 454,415 69,516 350,079 369,645 111,679
40,598 609 151 145,474 245 14,301 14,100 52689,032 191,196 196,015 102,337 111,186 1,890 52,672 48,839 1,168
18 273 7099,590 19,886 9,459 25,806 15,730 659 2,330 2,927
340,098 315,424 279,477 169,864 339,341 66,279 470,853 385,246 105,0691,173,656 1,312,958 1,108,231 830,544 1,188,324 173,404 1,264,146 979,926 257,600
9
2,318 6,866 6,378 2,515 2,041 551 1,795 2,825
25,865 23,938 21,258 12,920 25,812 4,363 19,273 15,722 4,308
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 25
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 0004048 Total Equipment (Sum of Lines 42-47) 15999
17 18 19 20 21 22 23 24 25 26
Long Island - ICF
(#464)
Long Island - ICF
(#465)
Long Island - ICF
(#466)
Long Island - ICF
(#467)
Long Island - ICF
(#468)
Broome - ICF
(#413)
Brooklyn - ICF
(#415)
Brooklyn - ICF
(#420)
Brooklyn - ICF
(#421)
Central NY - ICF
(#432)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0090
227893 227894 227895 227896 227897 233441 235629 235626 235631 273960
910-912 913-915 916-918 919-921 922-924 Glenwood ICF Thomas Shirtz #1 Thomas Shirtz #2 Walsh Complex
45 Melville Estates48 Rainbow
Commons
51 Rainbow
Commons
54 Rainbow
Commons
57 Rainbow
Commons
241 Glenwood
Road960 Elton Street 980 Elton Street
888 Fountain
Avenue
801 Cypress
Street
28,182 30,804 27,636 15,445 27,853 4,915 21,068 18,546 4,308
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 26
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040PROPERTY-PROVIDER PAID
49 Lease/Rental-Real Property 16010
50 Leasehold/Leasehold Improvements 16020
51 Depreciation-Building 16030
52 Depreciation Building/Land Improvements 16040
53 Mortgage/Capital Improvements Interest (Report MCFFA/DASNY Bond Int. on Line 59) 16060
54 Mortgage Expenses 16070
55 Insurance-Property & Casualty 16080
56 Real Estate Taxes 16090
57 Interest on Capital Indebtedness 16100
58 Start-up Expenses 16110
59 MCFFA/DASNY Interest Expense 16120
60 MCFFA/DASNY Administration Fees 16130
61 Maintenance in Lieu of Rent (LGU only) 16140
62 Other (Detail Required) 16998
63 Total Property-Provider Paid (Sum of Lines 49-62) 16999
TOTALS
64 Total Operating Costs (Sum lines 16, 17, 20, 41 minus 29) 19010
65 Agency Administrative Allocation 19050
66 Adjustments/Non-Allowable Costs (Detail Required) 19030
67 Total Prog/Site Costs (Sum lines 29, 48, 63-65 plus/minus 66) 19060
OMRDD Only - Informational
68a Other Than To/From Transportation Allocation 19101
68b To/From Transportation Allocation 19102
68c ICF/DD SED Contract Liability 19103
68d ICF/DD Day Services Liability 19104
17 18 19 20 21 22 23 24 25 26
Long Island - ICF
(#464)
Long Island - ICF
(#465)
Long Island - ICF
(#466)
Long Island - ICF
(#467)
Long Island - ICF
(#468)
Broome - ICF
(#413)
Brooklyn - ICF
(#415)
Brooklyn - ICF
(#420)
Brooklyn - ICF
(#421)
Central NY - ICF
(#432)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0090
227893 227894 227895 227896 227897 233441 235629 235626 235631 273960
910-912 913-915 916-918 919-921 922-924 Glenwood ICF Thomas Shirtz #1 Thomas Shirtz #2 Walsh Complex
45 Melville Estates48 Rainbow
Commons
51 Rainbow
Commons
54 Rainbow
Commons
57 Rainbow
Commons
241 Glenwood
Road960 Elton Street 980 Elton Street
888 Fountain
Avenue
801 Cypress
Street
17,485 18,756 65,909 6,393 19,260 1,476 28,630 5,430 1,817
11,580 13,881 102,314 7,145 7,145 19,077
0 0 0 0 0 0
79,347 73,902 78,881 39,838 78,535 28,311 245,768 196,497 53,840
108,412 106,539 247,104 53,376 104,940 29,787 293,475 201,926 55,657
7,634,964 7,097,005 6,298,894 3,931,742 7,556,033 1,238,184 6,364,582 5,347,490 1,486,871
244,120 226,920 201,401 125,714 241,597 39,590 203,501 170,981 47,541
-11,523 -10,712 -9,507 -5,937 -11,406 -1,868 -9,618 -8,069 -2,244 0
8,004,155 7,450,556 6,765,528 4,120,339 7,919,016 1,310,607 6,873,009 5,730,874 1,592,133 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 27
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040SECTION C: REVENUES
69 Participant Fee (less SSI & SSA) 20010
70 SSI & SSA 20020
71 Home Relief/Public Assistance 20030
72 Medicaid 20040
73 Medicare 20060
74 Other Third Parties (Detail Required) 20070
75 OMRDD Residential Room and Board/NYS OPTS 20080
76 Transportation, Medicaid 20090
77 Transportation, Other (Detail Required) 20100
78 Sales: Contract Total 21070
79 Federal Grants (Detail Required) 22040
80 State Grants (Detail Required) 22030
81 LTSE Income Total (OMH and OMRDD only) 22080
82 Food Stamps (OASAS and OPWDD Only)/Food Revenue (SED Only) 22160
83 Gifts, Legacies, Bequests, Restricted Donations 22010
84 Section 202/8/811 HUD Funds* 22020
85 Interest/Dividend Income 22050
86 Prior Period Rate Adjustments** 22090
87 Excessive Teacher Turnover Prevention Grant (SED only) 22100
88 LDSS County Revenue (SED only) 22110
89 4402 Revenue (School District In-State) (SED only) 22120
90 Department of Health Chapter 428 Revenue (SED only) 22130
91 4408 Revenue (School District) (SED only) 22140
92 4410 Revenue (Preschool) (SED only) 22150
93 Net Deficit Funding (State & LGU Funding only)* 20110
94 Other (Detail Required) (County Payment for Services) 22998
95 Gross Revenues (Sum Lines 69-94) 23999
17 18 19 20 21 22 23 24 25 26
Long Island - ICF
(#464)
Long Island - ICF
(#465)
Long Island - ICF
(#466)
Long Island - ICF
(#467)
Long Island - ICF
(#468)
Broome - ICF
(#413)
Brooklyn - ICF
(#415)
Brooklyn - ICF
(#420)
Brooklyn - ICF
(#421)
Central NY - ICF
(#432)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0090
227893 227894 227895 227896 227897 233441 235629 235626 235631 273960
910-912 913-915 916-918 919-921 922-924 Glenwood ICF Thomas Shirtz #1 Thomas Shirtz #2 Walsh Complex
45 Melville Estates48 Rainbow
Commons
51 Rainbow
Commons
54 Rainbow
Commons
57 Rainbow
Commons
241 Glenwood
Road960 Elton Street 980 Elton Street
888 Fountain
Avenue
801 Cypress
Street
9,426 17,346 15,610 7,713 0 3,600 6,005 3,167
280,997 316,805 248,607 290,943 192,765 23,519 157,553 119,603 17,324
6,998,902 7,883,387 6,681,288 5,799,123 6,478,184 991,023 4,990,763 5,269,698 1,592,114
7,279,899 8,209,618 6,947,241 6,105,676 6,678,662 1,014,542 5,151,916 5,395,306 1,612,606
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 28
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040GAAP ADJUSTMENTS TO REVENUE
96 Participant Allowance 24010
97 Uncollectible Accounts Receivable 24040
98 Other (Detail Required) 24996
99 Total GAAP Adjustments (Sum Lines 96-98) 24997
100 Net GAAP Revenues (Line 95 minus 99) 24998
NON-GAAP ADJUSTMENTS TO REVENUE
101 Exempt Contract Income 24050
102 Exempt LTSE Income 24060
103 Net Deficit Funding** 24070
104 Other (Detail Required) 24080
105 Total NON-GAAP Adjustments (Sum Lines 101-104) 24097
106 TOTAL ADJ. TO REVENUE (Sum Lines 99 & 105) 24999
107 TOTAL NET REVENUES (Line 95 minus 106) 25999
17 18 19 20 21 22 23 24 25 26
Long Island - ICF
(#464)
Long Island - ICF
(#465)
Long Island - ICF
(#466)
Long Island - ICF
(#467)
Long Island - ICF
(#468)
Broome - ICF
(#413)
Brooklyn - ICF
(#415)
Brooklyn - ICF
(#420)
Brooklyn - ICF
(#421)
Central NY - ICF
(#432)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0090
227893 227894 227895 227896 227897 233441 235629 235626 235631 273960
910-912 913-915 916-918 919-921 922-924 Glenwood ICF Thomas Shirtz #1 Thomas Shirtz #2 Walsh Complex
45 Melville Estates48 Rainbow
Commons
51 Rainbow
Commons
54 Rainbow
Commons
57 Rainbow
Commons
241 Glenwood
Road960 Elton Street 980 Elton Street
888 Fountain
Avenue
801 Cypress
Street
0 0 0 0 0 0 0 0 0
7,279,899 8,209,618 6,947,241 6,105,676 6,678,662 1,014,542 5,151,916 5,395,306 1,612,606
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
7,279,899 8,209,618 6,947,241 6,105,676 6,678,662 1,014,542 5,151,916 5,395,306 1,612,606
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 29
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040
7 Medicaid Provider Agreement Number (DMH only) 00060
8 County Code (See Appendix C) 00080
9 Date Site Opened 00090
10 Certified Capacity (OASAS, OMRDD and SED only) 00100
11 Actual Capacity (OMH, OMRDD and SED only) 00110
12 Actual Days Program/Site Open 00160
13 Units of Service 00120
13b Units of Service Monthly IRA Supervised
14 Respite or TUBS Units of Service (OMRDD only) 00130
15 Program/Site Square Footage (OASAS, OMRDD and SED Only) 00150
SECTION B: EXPENSES
PERSONAL SERVICES
16 Personal Services - Program/Site & Program Admin 11999
17 Vacation Accruals - Program/Site & Program Admin 12999
FRINGE BENEFITS
18 Mandated Fringe Benefits 13200
19 Non-Mandated Fringe Benefits 13300
20 Total Fringe Benefits (Sum Lines 18 & 19) 13999
27 28 29 30 31 32 33 34 35
Hudson Valley - ICF
(#422)
Finger Lakes - ICF
(#411)
Finger Lakes - ICF
(#429)
Western - ICF
(#413)
Western - ICF
(#414)
Western - ICF
(#415)
Western - ICF
(#416)
Western - ICF
(#421)
Western - ICF
(#429)
0090 0090 0090 0090 0090 0090 0090 0090 0090
271974 277643 277642 229612 229615 229649 229613 229656 264079
Harriman ICF Perry ICF Nunda ICF Parker ICF Ridgewood ICF
23 Resident Road344 South Main
Street
35 SouthState
Street
1278 East &
West Road
1478 East & West
Road
854 Leydecker
Rd
880 Leydecker
Rd540 Leydecker Rd 648 Leydecker Rd
24 24 24 0 4 4 4 5 7
21 20 18 0 2 4 3 5 7
365 365 365 210 365 365 365 365 365
7,945 7,718 7,262 1,001 730 1,460 1,456 1,813 2,465
0 0 0 0 0 0 0 0 0
2,324,630 1,580,966 1,587,209 446,663 542,180 785,209 638,048 890,260 1,033,576
-12,553 -8,537 -8,571 -2,412 -2,928 -4,240 -3,445 -4,807 -5,581
1,243,212 845,501 848,839 238,875 289,958 419,930 341,228 476,111 552,757
1,243,212 845,501 848,839 238,875 289,958 419,930 341,228 476,111 552,757
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 30
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040OTHER THAN PERSONAL SERVICES (OTPS)
21 Food 14010
22 Repairs and Maintenance 14020
23 Utilities 14030
24 Transportation Related-Participant 14040
25 Staff Travel 14250
26 Participant Incidentals 14050
27 Expensed Adaptive Equipment (OMRDD and SED only) 14070
28 Expensed Equipment 14080
29 Sub-Contract Raw Materials 14090
30 Participant Wages-Non-Contract 14100
31 Participant Wages-Contract 14110
32 Participant Fringe Benefits 14120
33 Section 43.04 Services Assessment (OMRDD only) 14130
34 Staff Development 14140
35 Contracted Direct Care and Clinical Personal Svs. (from CFR-4A) 14150
36 Supplies and Materials - Non-Household 14160
37 Household Supplies 14170
38 Telephone 14190
39 Insurance - General 14260
40 Other (Detail Required) 14998
41 Total Other Than Personal Services (Sum Lines 21-40) 14999
EQUIPMENT-PROVIDER PAID
42 Lease/Rental Vehicle 15010
43 Lease/Rental Equipment 15020
44 Depreciation-Vehicle 15040
45 Depreciation-Equipment 15050
46 Interest-Vehicle 15070
47 Other (Detail Required) 15998
27 28 29 30 31 32 33 34 35
Hudson Valley - ICF
(#422)
Finger Lakes - ICF
(#411)
Finger Lakes - ICF
(#429)
Western - ICF
(#413)
Western - ICF
(#414)
Western - ICF
(#415)
Western - ICF
(#416)
Western - ICF
(#421)
Western - ICF
(#429)
0090 0090 0090 0090 0090 0090 0090 0090 0090
271974 277643 277642 229612 229615 229649 229613 229656 264079
Harriman ICF Perry ICF Nunda ICF Parker ICF Ridgewood ICF
23 Resident Road344 South Main
Street
35 SouthState
Street
1278 East &
West Road
1478 East & West
Road
854 Leydecker
Rd
880 Leydecker
Rd540 Leydecker Rd 648 Leydecker Rd
19,756 49,687 35,443 10,082 11,533 21,067 25,300 36,642 26,235
89,506 29,948 34,422 3,901 6,396 12,721 11,378 13,587 7,952
66,181 26,886 24,463 4,257 2,696 4,371 4,028 5,910 5,511
43 18
5,465 1,950 3,091 1,500 784
14,780 4,224 4,451 1,647 2,058 2,252 1,908 2,879 2,699
783 7,476 2,252 78 255 4,350 1,425 44
342,784 345,955 326,596 45,487 34,855 65,923 71,301 87,716 114,26218,144 12,699 20 234 234 277 108
11,744 2,184 682 3,401 2,925 5,348 2,624 4,561 4,556115,391 57,892 44,220 1,942 941 1,760 3,993 2,395 9,070
909 1579,363 1,481 1,226 136
182,331 135,478 129,667 22,030 26,622 38,933 32,325 44,722 51,106858,993 681,305 619,211 92,825 89,588 153,666 157,577 200,114 221,700
27 15
5,104 2,668 1,228 672
19,837 9,429 9,250 2,570 3,105 4,541 3,768 5,216 5,935
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 31
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 0004048 Total Equipment (Sum of Lines 42-47) 15999
27 28 29 30 31 32 33 34 35
Hudson Valley - ICF
(#422)
Finger Lakes - ICF
(#411)
Finger Lakes - ICF
(#429)
Western - ICF
(#413)
Western - ICF
(#414)
Western - ICF
(#415)
Western - ICF
(#416)
Western - ICF
(#421)
Western - ICF
(#429)
0090 0090 0090 0090 0090 0090 0090 0090 0090
271974 277643 277642 229612 229615 229649 229613 229656 264079
Harriman ICF Perry ICF Nunda ICF Parker ICF Ridgewood ICF
23 Resident Road344 South Main
Street
35 SouthState
Street
1278 East &
West Road
1478 East & West
Road
854 Leydecker
Rd
880 Leydecker
Rd540 Leydecker Rd 648 Leydecker Rd
24,941 12,124 10,493 2,570 3,105 4,541 3,768 5,216 6,607
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 32
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040PROPERTY-PROVIDER PAID
49 Lease/Rental-Real Property 16010
50 Leasehold/Leasehold Improvements 16020
51 Depreciation-Building 16030
52 Depreciation Building/Land Improvements 16040
53 Mortgage/Capital Improvements Interest (Report MCFFA/DASNY Bond Int. on Line 59) 16060
54 Mortgage Expenses 16070
55 Insurance-Property & Casualty 16080
56 Real Estate Taxes 16090
57 Interest on Capital Indebtedness 16100
58 Start-up Expenses 16110
59 MCFFA/DASNY Interest Expense 16120
60 MCFFA/DASNY Administration Fees 16130
61 Maintenance in Lieu of Rent (LGU only) 16140
62 Other (Detail Required) 16998
63 Total Property-Provider Paid (Sum of Lines 49-62) 16999
TOTALS
64 Total Operating Costs (Sum lines 16, 17, 20, 41 minus 29) 19010
65 Agency Administrative Allocation 19050
66 Adjustments/Non-Allowable Costs (Detail Required) 19030
67 Total Prog/Site Costs (Sum lines 29, 48, 63-65 plus/minus 66) 19060
OMRDD Only - Informational
68a Other Than To/From Transportation Allocation 19101
68b To/From Transportation Allocation 19102
68c ICF/DD SED Contract Liability 19103
68d ICF/DD Day Services Liability 19104
27 28 29 30 31 32 33 34 35
Hudson Valley - ICF
(#422)
Finger Lakes - ICF
(#411)
Finger Lakes - ICF
(#429)
Western - ICF
(#413)
Western - ICF
(#414)
Western - ICF
(#415)
Western - ICF
(#416)
Western - ICF
(#421)
Western - ICF
(#429)
0090 0090 0090 0090 0090 0090 0090 0090 0090
271974 277643 277642 229612 229615 229649 229613 229656 264079
Harriman ICF Perry ICF Nunda ICF Parker ICF Ridgewood ICF
23 Resident Road344 South Main
Street
35 SouthState
Street
1278 East &
West Road
1478 East & West
Road
854 Leydecker
Rd
880 Leydecker
Rd540 Leydecker Rd 648 Leydecker Rd
2,04389,980 11,128
300,408 21,521 5,449 582 502 4,786 1,222 636 9,577
335,152 8,120 595 12,690
0 0 0 0
125,363 53,350 50,980 6,138 7,417 11,052 9,000 12,459 18,538
852,947 82,991 56,429 6,721 7,919 16,433 10,222 13,095 51,933
4,414,283 3,099,235 3,046,688 775,951 918,798 1,354,565 1,133,407 1,561,678 1,802,452
141,142 99,095 97,415 24,810 29,378 43,311 36,240 49,933 57,632
-6,667 -4,677 -4,597 -1,171 -1,388 -2,047 -1,714 -2,365 -2,725
5,426,647 3,288,768 3,206,427 808,881 957,811 1,416,802 1,181,922 1,627,558 1,915,899
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 33
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040SECTION C: REVENUES
69 Participant Fee (less SSI & SSA) 20010
70 SSI & SSA 20020
71 Home Relief/Public Assistance 20030
72 Medicaid 20040
73 Medicare 20060
74 Other Third Parties (Detail Required) 20070
75 OMRDD Residential Room and Board/NYS OPTS 20080
76 Transportation, Medicaid 20090
77 Transportation, Other (Detail Required) 20100
78 Sales: Contract Total 21070
79 Federal Grants (Detail Required) 22040
80 State Grants (Detail Required) 22030
81 LTSE Income Total (OMH and OMRDD only) 22080
82 Food Stamps (OASAS and OPWDD Only)/Food Revenue (SED Only) 22160
83 Gifts, Legacies, Bequests, Restricted Donations 22010
84 Section 202/8/811 HUD Funds* 22020
85 Interest/Dividend Income 22050
86 Prior Period Rate Adjustments** 22090
87 Excessive Teacher Turnover Prevention Grant (SED only) 22100
88 LDSS County Revenue (SED only) 22110
89 4402 Revenue (School District In-State) (SED only) 22120
90 Department of Health Chapter 428 Revenue (SED only) 22130
91 4408 Revenue (School District) (SED only) 22140
92 4410 Revenue (Preschool) (SED only) 22150
93 Net Deficit Funding (State & LGU Funding only)* 20110
94 Other (Detail Required) (County Payment for Services) 22998
95 Gross Revenues (Sum Lines 69-94) 23999
27 28 29 30 31 32 33 34 35
Hudson Valley - ICF
(#422)
Finger Lakes - ICF
(#411)
Finger Lakes - ICF
(#429)
Western - ICF
(#413)
Western - ICF
(#414)
Western - ICF
(#415)
Western - ICF
(#416)
Western - ICF
(#421)
Western - ICF
(#429)
0090 0090 0090 0090 0090 0090 0090 0090 0090
271974 277643 277642 229612 229615 229649 229613 229656 264079
Harriman ICF Perry ICF Nunda ICF Parker ICF Ridgewood ICF
23 Resident Road344 South Main
Street
35 SouthState
Street
1278 East &
West Road
1478 East & West
Road
854 Leydecker
Rd
880 Leydecker
Rd540 Leydecker Rd 648 Leydecker Rd
35,502 5,844 11,220
254,171 206,280 180,209 24,671 46,075 2,240 21,568 47,957
4,886,768 4,931,971 4,655,981 648,468 496,890 939,809 1,016,473 1,250,492 1,628,929
5,176,442 5,138,252 4,836,190 678,983 496,890 985,883 1,029,933 1,272,060 1,676,886
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 34
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040GAAP ADJUSTMENTS TO REVENUE
96 Participant Allowance 24010
97 Uncollectible Accounts Receivable 24040
98 Other (Detail Required) 24996
99 Total GAAP Adjustments (Sum Lines 96-98) 24997
100 Net GAAP Revenues (Line 95 minus 99) 24998
NON-GAAP ADJUSTMENTS TO REVENUE
101 Exempt Contract Income 24050
102 Exempt LTSE Income 24060
103 Net Deficit Funding** 24070
104 Other (Detail Required) 24080
105 Total NON-GAAP Adjustments (Sum Lines 101-104) 24097
106 TOTAL ADJ. TO REVENUE (Sum Lines 99 & 105) 24999
107 TOTAL NET REVENUES (Line 95 minus 106) 25999
27 28 29 30 31 32 33 34 35
Hudson Valley - ICF
(#422)
Finger Lakes - ICF
(#411)
Finger Lakes - ICF
(#429)
Western - ICF
(#413)
Western - ICF
(#414)
Western - ICF
(#415)
Western - ICF
(#416)
Western - ICF
(#421)
Western - ICF
(#429)
0090 0090 0090 0090 0090 0090 0090 0090 0090
271974 277643 277642 229612 229615 229649 229613 229656 264079
Harriman ICF Perry ICF Nunda ICF Parker ICF Ridgewood ICF
23 Resident Road344 South Main
Street
35 SouthState
Street
1278 East &
West Road
1478 East & West
Road
854 Leydecker
Rd
880 Leydecker
Rd540 Leydecker Rd 648 Leydecker Rd
0 0 0 0 0 0 0 0 0
5,176,442 5,138,252 4,836,190 678,983 496,890 985,883 1,029,933 1,272,060 1,676,886
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
5,176,442 5,138,252 4,836,190 678,983 496,890 985,883 1,029,933 1,272,060 1,676,886
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 35
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040
7 Medicaid Provider Agreement Number (DMH only) 00060
8 County Code (See Appendix C) 00080
9 Date Site Opened 00090
10 Certified Capacity (OASAS, OMRDD and SED only) 00100
11 Actual Capacity (OMH, OMRDD and SED only) 00110
12 Actual Days Program/Site Open 00160
13 Units of Service 00120
13b Units of Service Monthly IRA Supervised
14 Respite or TUBS Units of Service (OMRDD only) 00130
15 Program/Site Square Footage (OASAS, OMRDD and SED Only) 00150
SECTION B: EXPENSES
PERSONAL SERVICES
16 Personal Services - Program/Site & Program Admin 11999
17 Vacation Accruals - Program/Site & Program Admin 12999
FRINGE BENEFITS
18 Mandated Fringe Benefits 13200
19 Non-Mandated Fringe Benefits 13300
20 Total Fringe Benefits (Sum Lines 18 & 19) 13999
36 37 38 39 40 41 42 43 44 45
Western - ICF
(#430)
Taconic - ICF
(#430)
Taconic - ICF
(#431)
Taconic - ICF
(#433)
Taconic - ICF
(#434)
Taconic - ICF
(#435)
Taconic - ICF
(#436)
Taconic - ICF
(#437)
Staten Island - ICF
(#422)
DAY HABILITATION
(#675)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0223
264080 275671 275676 275786 275787 275788 275789 275791 276639
Maple House Pryor House ICF Riverview ICF Cedar Knolls ICF Mistler ICF
650 Leydecker Rd42 Sinpatch
Road
19 Sinpatch
Road
55 Sinpatch
Road50 Cedar Lane
18 Sinpatch
Road
51 Sinpatch
Road22 Sinpatch Road
24 "O" Executive
Way
7 9 4 6 4 7 24 4,785
7 6 3 0 0 5 4 6 20 3,735
365 365 365 83 265 365 365 365 365 256
2,555 2,832 1,025 179 1094 1,750 1,460 2,280 7,050 699,212
0 1 0 0 1 0 0 0 0 0
0
959,374 1,302,391 562,624 125,531 408,293 646,692 604,808 872,522 3,543,271 70,347,985
-5,181 -7,033 -3,038 -678 -2,205 -3,492 -3,266 -4,712 -19,134 -379,879
513,073 696,519 300,891 67,134 218,355 345,851 323,452 466,625 1,894,941 37,622,101
0
513,073 696,519 300,891 67,134 218,355 345,851 323,452 466,625 1,894,941 37,622,101
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 36
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040OTHER THAN PERSONAL SERVICES (OTPS)
21 Food 14010
22 Repairs and Maintenance 14020
23 Utilities 14030
24 Transportation Related-Participant 14040
25 Staff Travel 14250
26 Participant Incidentals 14050
27 Expensed Adaptive Equipment (OMRDD and SED only) 14070
28 Expensed Equipment 14080
29 Sub-Contract Raw Materials 14090
30 Participant Wages-Non-Contract 14100
31 Participant Wages-Contract 14110
32 Participant Fringe Benefits 14120
33 Section 43.04 Services Assessment (OMRDD only) 14130
34 Staff Development 14140
35 Contracted Direct Care and Clinical Personal Svs. (from CFR-4A) 14150
36 Supplies and Materials - Non-Household 14160
37 Household Supplies 14170
38 Telephone 14190
39 Insurance - General 14260
40 Other (Detail Required) 14998
41 Total Other Than Personal Services (Sum Lines 21-40) 14999
EQUIPMENT-PROVIDER PAID
42 Lease/Rental Vehicle 15010
43 Lease/Rental Equipment 15020
44 Depreciation-Vehicle 15040
45 Depreciation-Equipment 15050
46 Interest-Vehicle 15070
47 Other (Detail Required) 15998
36 37 38 39 40 41 42 43 44 45
Western - ICF
(#430)
Taconic - ICF
(#430)
Taconic - ICF
(#431)
Taconic - ICF
(#433)
Taconic - ICF
(#434)
Taconic - ICF
(#435)
Taconic - ICF
(#436)
Taconic - ICF
(#437)
Staten Island - ICF
(#422)
DAY HABILITATION
(#675)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0223
264080 275671 275676 275786 275787 275788 275789 275791 276639
Maple House Pryor House ICF Riverview ICF Cedar Knolls ICF Mistler ICF
650 Leydecker Rd42 Sinpatch
Road
19 Sinpatch
Road
55 Sinpatch
Road50 Cedar Lane
18 Sinpatch
Road
51 Sinpatch
Road22 Sinpatch Road
24 "O" Executive
Way
34,548 32,982 13,325 15,757 19,101 14,073 22,676 55,243 344,358
11,496 2,325 1,779 1,219 5,535 781 4,019 55,611 1,696,164
5,460 12,876 5,438 12,545 7,698 2,680 9,073 17,713 1,273,919
5,185 1,118 15 825 1,043 122 243 16,227,150
727 275 330 . 72 163,643
4,210 2,127 832 877 945 1,240 3,467 17,698 36,552
0
9 262 5,661 117,905
4 0
27500
124,201 129,399 47,627 7,545 52,714 79,575 66,600 107,290 319,143 0282 724 8,068
2,231 423 5,620 165 150 71 9,170 385,0555,020 2,667 801 986 1,887 827 2,432 28,053 576,971
66 5,562 4,306 4,400 6,021 4,319 8,121 4,551 37,096200 200 1,125 1,201 187,816
047,742 123,636 53,405 11,350 41,042 62,312 56,953 83,412 175,166 6,757,694
235,265 318,109 129,093 18,895 136,576 184,394 148,666 240,756 690,181 27,812,666
1,6845,654
0672 428 507 2,696 47,129
05,568 8,916 3,851 818 2,943 4,493 4,107 6,015 19,634 543,469
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 37
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 0004048 Total Equipment (Sum of Lines 42-47) 15999
36 37 38 39 40 41 42 43 44 45
Western - ICF
(#430)
Taconic - ICF
(#430)
Taconic - ICF
(#431)
Taconic - ICF
(#433)
Taconic - ICF
(#434)
Taconic - ICF
(#435)
Taconic - ICF
(#436)
Taconic - ICF
(#437)
Staten Island - ICF
(#422)
DAY HABILITATION
(#675)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0223
264080 275671 275676 275786 275787 275788 275789 275791 276639
Maple House Pryor House ICF Riverview ICF Cedar Knolls ICF Mistler ICF
650 Leydecker Rd42 Sinpatch
Road
19 Sinpatch
Road
55 Sinpatch
Road50 Cedar Lane
18 Sinpatch
Road
51 Sinpatch
Road22 Sinpatch Road
24 "O" Executive
Way
6,240 9,344 3,851 818 2,943 4,493 4,107 6,522 22,330 597,936
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 38
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040PROPERTY-PROVIDER PAID
49 Lease/Rental-Real Property 16010
50 Leasehold/Leasehold Improvements 16020
51 Depreciation-Building 16030
52 Depreciation Building/Land Improvements 16040
53 Mortgage/Capital Improvements Interest (Report MCFFA/DASNY Bond Int. on Line 59) 16060
54 Mortgage Expenses 16070
55 Insurance-Property & Casualty 16080
56 Real Estate Taxes 16090
57 Interest on Capital Indebtedness 16100
58 Start-up Expenses 16110
59 MCFFA/DASNY Interest Expense 16120
60 MCFFA/DASNY Administration Fees 16130
61 Maintenance in Lieu of Rent (LGU only) 16140
62 Other (Detail Required) 16998
63 Total Property-Provider Paid (Sum of Lines 49-62) 16999
TOTALS
64 Total Operating Costs (Sum lines 16, 17, 20, 41 minus 29) 19010
65 Agency Administrative Allocation 19050
66 Adjustments/Non-Allowable Costs (Detail Required) 19030
67 Total Prog/Site Costs (Sum lines 29, 48, 63-65 plus/minus 66) 19060
OMRDD Only - Informational
68a Other Than To/From Transportation Allocation 19101
68b To/From Transportation Allocation 19102
68c ICF/DD SED Contract Liability 19103
68d ICF/DD Day Services Liability 19104
36 37 38 39 40 41 42 43 44 45
Western - ICF
(#430)
Taconic - ICF
(#430)
Taconic - ICF
(#431)
Taconic - ICF
(#433)
Taconic - ICF
(#434)
Taconic - ICF
(#435)
Taconic - ICF
(#436)
Taconic - ICF
(#437)
Staten Island - ICF
(#422)
DAY HABILITATION
(#675)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0223
264080 275671 275676 275786 275787 275788 275789 275791 276639
Maple House Pryor House ICF Riverview ICF Cedar Knolls ICF Mistler ICF
650 Leydecker Rd42 Sinpatch
Road
19 Sinpatch
Road
55 Sinpatch
Road50 Cedar Lane
18 Sinpatch
Road
51 Sinpatch
Road22 Sinpatch Road
24 "O" Executive
Way
1,767,4351,168 43,416
38,355 09,341 9,979 2,138 456 20,232 24,759 878,567
0
0
0
0
0
0
12,690 1,019 669,907
0 0 0
0
17,661 100,317 43,332 9,209 33,111 50,559 46,211 68,031 314,806 3,211,910
39,691 110,296 45,470 9,209 33,111 51,015 67,611 107,405 339,566 6,571,235
1,702,530 2,309,985 989,570 210,882 761,019 1,173,445 1,073,661 1,575,191 6,109,255 135,402,873
54,437 73,860 31,641 6,743 24,333 37,520 34,329 50,365 195,337 4,329,374
-2,574 -3,486 -1,493 -318 -1,148 -1,771 -1,620 -2,377 -9,219 -204,717
1,800,324 2,499,999 1,069,039 227,334 820,257 1,264,703 1,178,087 1,737,106 6,657,274 146,696,701
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 39
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040SECTION C: REVENUES
69 Participant Fee (less SSI & SSA) 20010
70 SSI & SSA 20020
71 Home Relief/Public Assistance 20030
72 Medicaid 20040
73 Medicare 20060
74 Other Third Parties (Detail Required) 20070
75 OMRDD Residential Room and Board/NYS OPTS 20080
76 Transportation, Medicaid 20090
77 Transportation, Other (Detail Required) 20100
78 Sales: Contract Total 21070
79 Federal Grants (Detail Required) 22040
80 State Grants (Detail Required) 22030
81 LTSE Income Total (OMH and OMRDD only) 22080
82 Food Stamps (OASAS and OPWDD Only)/Food Revenue (SED Only) 22160
83 Gifts, Legacies, Bequests, Restricted Donations 22010
84 Section 202/8/811 HUD Funds* 22020
85 Interest/Dividend Income 22050
86 Prior Period Rate Adjustments** 22090
87 Excessive Teacher Turnover Prevention Grant (SED only) 22100
88 LDSS County Revenue (SED only) 22110
89 4402 Revenue (School District In-State) (SED only) 22120
90 Department of Health Chapter 428 Revenue (SED only) 22130
91 4408 Revenue (School District) (SED only) 22140
92 4410 Revenue (Preschool) (SED only) 22150
93 Net Deficit Funding (State & LGU Funding only)* 20110
94 Other (Detail Required) (County Payment for Services) 22998
95 Gross Revenues (Sum Lines 69-94) 23999
36 37 38 39 40 41 42 43 44 45
Western - ICF
(#430)
Taconic - ICF
(#430)
Taconic - ICF
(#431)
Taconic - ICF
(#433)
Taconic - ICF
(#434)
Taconic - ICF
(#435)
Taconic - ICF
(#436)
Taconic - ICF
(#437)
Staten Island - ICF
(#422)
DAY HABILITATION
(#675)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0223
264080 275671 275676 275786 275787 275788 275789 275791 276639
Maple House Pryor House ICF Riverview ICF Cedar Knolls ICF Mistler ICF
650 Leydecker Rd42 Sinpatch
Road
19 Sinpatch
Road
55 Sinpatch
Road50 Cedar Lane
18 Sinpatch
Road
51 Sinpatch
Road22 Sinpatch Road
24 "O" Executive
Way
4,424 1,474 27,275 5,424 0
22,947 69,169 25,906 2,337 16,602 29,631 40,416 52,112 199,876 0
0
1,770,619 1,844,721 678,971 107,569 751,498 1,134,427 949,460 1,529,543 4,549,739 144,208,138
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1,793,567 1,918,314 704,877 111,380 768,101 1,191,333 989,876 1,581,656 4,755,039 144,208,138
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 40
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040GAAP ADJUSTMENTS TO REVENUE
96 Participant Allowance 24010
97 Uncollectible Accounts Receivable 24040
98 Other (Detail Required) 24996
99 Total GAAP Adjustments (Sum Lines 96-98) 24997
100 Net GAAP Revenues (Line 95 minus 99) 24998
NON-GAAP ADJUSTMENTS TO REVENUE
101 Exempt Contract Income 24050
102 Exempt LTSE Income 24060
103 Net Deficit Funding** 24070
104 Other (Detail Required) 24080
105 Total NON-GAAP Adjustments (Sum Lines 101-104) 24097
106 TOTAL ADJ. TO REVENUE (Sum Lines 99 & 105) 24999
107 TOTAL NET REVENUES (Line 95 minus 106) 25999
36 37 38 39 40 41 42 43 44 45
Western - ICF
(#430)
Taconic - ICF
(#430)
Taconic - ICF
(#431)
Taconic - ICF
(#433)
Taconic - ICF
(#434)
Taconic - ICF
(#435)
Taconic - ICF
(#436)
Taconic - ICF
(#437)
Staten Island - ICF
(#422)
DAY HABILITATION
(#675)
0090 0090 0090 0090 0090 0090 0090 0090 0090 0223
264080 275671 275676 275786 275787 275788 275789 275791 276639
Maple House Pryor House ICF Riverview ICF Cedar Knolls ICF Mistler ICF
650 Leydecker Rd42 Sinpatch
Road
19 Sinpatch
Road
55 Sinpatch
Road50 Cedar Lane
18 Sinpatch
Road
51 Sinpatch
Road22 Sinpatch Road
24 "O" Executive
Way
0
0
0
0 0 0 0 0 0 0 0 0 0
1,793,567 1,918,314 704,877 111,380 768,101 1,191,333 989,876 1,581,656 4,755,039 144,208,138
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
1,793,567 1,918,314 704,877 111,380 768,101 1,191,333 989,876 1,581,656 4,755,039 144,208,138
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 41
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040
7 Medicaid Provider Agreement Number (DMH only) 00060
8 County Code (See Appendix C) 00080
9 Date Site Opened 00090
10 Certified Capacity (OASAS, OMRDD and SED only) 00100
11 Actual Capacity (OMH, OMRDD and SED only) 00110
12 Actual Days Program/Site Open 00160
13 Units of Service 00120
13b Units of Service Monthly IRA Supervised
14 Respite or TUBS Units of Service (OMRDD only) 00130
15 Program/Site Square Footage (OASAS, OMRDD and SED Only) 00150
SECTION B: EXPENSES
PERSONAL SERVICES
16 Personal Services - Program/Site & Program Admin 11999
17 Vacation Accruals - Program/Site & Program Admin 12999
FRINGE BENEFITS
18 Mandated Fringe Benefits 13200
19 Non-Mandated Fringe Benefits 13300
20 Total Fringe Benefits (Sum Lines 18 & 19) 13999
46 47 48 49 50 51 52 53
PRE-VOCATIONAL
SERVICES (#676)
SUPPORTED WORK
(#677)
COMMUNITY
HABILITATION (#708) FAMILY CARE
RES HAB (#710)
WAIVER RESPITE
(#712)
CERTIFIED CLINIC
(#729)
CERTIFIED CLINIC
(#730) CERTIFIED CLINIC (#730)
0227 0214 0237 0220 0233 0100 0100 0100
233170 233142 270155
BROOME (233) BROOME (233) CAPITAL DISTRICT (260)
249 GLENWOOD RD 305 MAIN ST 200 SMITH DR
ADIRONDACK CLINIC
0 0 0 0 55
236 124 4 1415 373
260 260 360 365 365 260 260 260
40,716 1,258 16,572 17,764 482,704
0 0 0 0 55
0 0 0 0 0
2,672,525 1,074,746 402,166 13,103,188 2,169,664 198,091 696,918 917,562
-14,432 -5,803 -2,172 -70,757 -11,715 -1,070 -3,763 -4,955
1,429,266 574,774 215,078 7,007,585 1,160,336 105,939 372,712 490,712
0 0 0 0 0
1,429,266 574,774 215,078 7,007,585 1,160,336 105,939 372,712 490,712
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
SCHEDULE CFR-1
PROGRAM/SITE DATA
Page 42
SECTION A: GENERAL INFORMATION
Line COLUMN NUMBER Cost
No. ITEM DESCRIPTION Codes
1 Program Type 00070
2 Program Code (Program Code Index) 00010
3 Program/Site Identification Number 00050
4 Program/Site Name 00020
5 Program/Site Address (Line One) 00030
6 Program/Site Address (Line Two) 00040OTHER THAN PERSONAL SERVICES (OTPS)
21 Food 14010
22 Repairs and Maintenance 14020
23 Utilities 14030
24 Transportation Related-Participant 14040
25 Staff Travel 14250
26 Participant Incidentals 14050
27 Expensed Adaptive Equipment (OMRDD and SED only) 14070
28 Expensed Equipment 14080
29 Sub-Contract Raw Materials 14090
30 Participant Wages-Non-Contract 14100
31 Participant Wages-Contract 14110
32 Participant Fringe Benefits 14120
33 Section 43.04 Services Assessment (OMRDD only) 14130
34 Staff Development 14140
35 Contracted Direct Care and Clinical Personal Svs. (from CFR-4A) 14150
36 Supplies and Materials - Non-Household 14160
37 Household Supplies 14170
38 Telephone 14190
39 Insurance - General 14260
40 Other (Detail Required) 14998
41 Total Other Than Personal Services (Sum Lines 21-40) 14999
EQUIPMENT-PROVIDER PAID
42 Lease/Rental Vehicle 15010
43 Lease/Rental Equipment 15020
44 Depreciation-Vehicle 15040
45 Depreciation-Equipment 15050
46 Interest-Vehicle 15070
47 Other (Detail Required) 15998
46 47 48 49 50 51 52 53
PRE-VOCATIONAL
SERVICES (#676)
SUPPORTED WORK
(#677)
COMMUNITY
HABILITATION (#708) FAMILY CARE
RES HAB (#710)
WAIVER RESPITE
(#712)
CERTIFIED CLINIC
(#729)
CERTIFIED CLINIC
(#730) CERTIFIED CLINIC (#730)
0227 0214 0237 0220 0233 0100 0100 0100
233170 233142 270155
BROOME (233) BROOME (233) CAPITAL DISTRICT (260)
249 GLENWOOD RD 305 MAIN ST 200 SMITH DR
4,494 4,564 0 2,040 117,735
5,747 21,068 0 19,322 21,572 7,574 48,692
0 6,560 11,949 0 32,012 35,762
35 329 24 648,907 0
0 15,390 0 38,202 637 10,331
5,926 156 0 1,023 6,703
0 0 0 0 0
4,500 2,315 0 450 2,065 2,462
0 82 0 0 0
0 0 0 0 00 0 0 0 00 0 0 0 00 0 0 0 00 49 0 49 282 3710 210,136 0 1,231 5,863 334 86,130
26,765 34,820 0 11,221 -36,813 2,088 12,2451,567 0 10 113 1,997 132
0 1,172 0 0 4,990 3,114 12,4920 0 0 0 0
178,651 77,094 37,444 19,025,825 191,017 18,606 63,416 103,304227,685 373,735 49,427 19,748,383 348,060 26,514 68,618 311,921
0 0 0 686 00 7 0 0 0 3000 0 0 0 00 2,822 0 0 1,5320 0 0 0 0
17,418 8,694 2,700 185,965 14,112 1,225 4,175 7,340
2014-15 CFR_7-23-16_FINAL_PROTECTED.xlsx
-
AGENCY NAME: Office for People With Dev Disabilities
AGENCY CODE: 51000
NEW YORK STATE
CONSOLIDATED FISCAL REPORT
For the Period: April 1, 2014 to March 31, 2015
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