ANNUAL REPORT QUESTIONNAIRE
2009-2010
COUNTY NAME
PHONE
ADDRESS
FOOD SERVICE DIRECTOR
TREASURER
Complete 4th Quarter Financial Report (C-Master) before submitting the questionnaire to WVDE-OCN.
1.
Opening Inventory (food)
(supplies)
2.
Closing Inventory (food)
(supplies)
3.
Rebates (food)
Rebates (supplies)
4.
Equipment Value
5.
Depreciation Expense if using less than a 12 year useful life
6.
Other Federal/State Money not Reported
7.
Adjustment for Labor Cost *
8.
Reimbursement not Received (breakfast)
9.
Reimbursement not Received (lunch)
10.
Reimbursement not Received (snack)
11.
a. Accounts Receivable *(children payments, teachers, etc.)
(a)
b. Other Receivables *(i.e. catered, interest)
(b)
c.
(c)
Allowance for Doubtful Accounts *
Net Realizable Value of receivables [11(a)+11(b)-11(c)]
12.
Age of oldest individual account included in the Net Receivables amount above
13.
Cook Positions:
14.
hours worked per day
Half Time
hours worked per day
Charge Per Meal:
Child Bk.
15.
Full Time
Child Lunch
Number of Schools _____________
Adult BK.
Adult Lunch
Operating CNP Programs _______________
Confirming Signatures:
Food Service Representatives:
School Business Official:
*OBTAIN INFORMATION FROM THE CSBO (Chief School Business Official)
RG131b
Date