County of
CAMDEN
State of Missouri
SENIOR CITIZENS' SERVICES FUND BOARD
YEAR-END PERFORMANCE TO BUDGET REPORT
Organization Name:
Contact Email:
EXHIBIT D YEAR:
This Form is Due No Later than Jan 15 following the Contract Period
Actual Meals & Individuals
Total # Meals Served
Total # of Individuals Served
% Camden Co Residents
Congregate Meals
Home Bound Meals
Total Camden County Funds received:
Expense Items (match items of RFP p.2)
Camden Co. Funds Expended
Personnel Salaries(page 2)
Travel (Staff& Volunteers)
Raw Food
HB Frozen Meals
Kitchen & Dining Supplies
Bldg. Utilities
Office Expenses
Equipment
Advertising
Maintenance
Insurance
Other (specify)
Total Camden Co. Fund Expenses
Unduplicated no. of Camden County Seniors served 1/1-12/31:
Camden County Funds remaining Dec.31:
Date:
Signature:
Add Additional Expense Row
When funds remain at the end of the year the funds remaining will need reported prior to the February Disbursement for total on hand January 31 with anticipated expenditures for February projections identified.
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