Multifamily Financial Management Template

AFS Submission

Page 1 of 1

Verify AFS Submission Criteria
Organization

Wonderful Manor Associates

Tax ID

888888881

Mortgagor Type

Limited Dividend

Legal Structure

Limited Partnership

Type of Submission

Audited Submission IAW IG Handbook 2000.04

Federal Award Threshold

N/A

Property Name
WONDERFUL MANOR

FHA/Contract Number

M2M

010TC111

Date From

Date To

01/01/2004

12/31/2004

Do not continue if information is incorrect or missing from these fields.
Contact the appropriate HUD field office representative to report any discrepancies.

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Submission Criteria Verification
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Have you verified that your Type of Submission (i.e. Owner Certified, A133 or IG 2000.04) listed or selected above is the type of submission you
intend to submit?
Have you verified that the Tax ID listed above is your correct Tax ID?
Have you verified that all of the HUD related properties listed above are
correct?
Have you verified that the Federal Award Threshold is correct (if
applicable)?
Have you verified that the Mortgagor Type listed above is correct?
Have you verified that the Legal Structure listed above is correct?
Have you verified that the M2M Indicator listed for all the HUD related
properties above is correct (if applicable)?
Continue to the Statement Selection Screen
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AFS Submission

Page 1 of 5

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Balance Sheet Data

Date From

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports

Profit and Loss Data

Equity Data

Description

Account

Supplemental
Data
Cash Flow Data

Value

Details

Assets
1120

Cash - Operations

$

N/A

1121

Construction Cash Account

$

N/A

1125

Cash - Entity

$

N/A

1130

Tenant/Member Accounts Receivable (Coops)

$

N/A

1131

Allowance for Doubtful Accounts

$

N/A

1130N

Net Tenant Accounts Receivable

$

N/A

1135

Accounts Receivable - HUD

$

N/A

1137

Medicare/Medicaid/Other Insurance Receivable

$

N/A

1140

Accounts and Notes Receivable - Operations

$

[Details]

1145

Accounts and Notes Receivable - Entity

$

[Details]

1160

Accounts Receivable - Interest

$

N/A

1165

Interest Reduction Payment Receivable

$

N/A

1170

Short Term Investments - Operations

$

N/A

1175

Short Term Investments - Entity

$

N/A

1180

Inventory

$

N/A

1190

Miscellaneous Current Assets

$

[Details]

1200

Miscellaneous Prepaid Expenses

$

N/A

AFS Submission

1100T

Page 2 of 5

Total Current Assets

$

N/A

1191

Tenant/Patient Deposits Held in Trust

$

N/A

1310

Escrow Deposits

$

N/A

1320

Replacement Reserve

$

N/A

1330

Other Reserves

$

N/A

1340

Residual Receipts Reserve

$

N/A

1355

Bond Reserves

$

N/A

1367

Sinking Fund

$

N/A

1381

Management Improvement and Operating Plan

$

N/A

Total Deposits

$

N/A

1410

Land

$

N/A

1420

Buildings

$

N/A

1440

Building Equipment (Portable)

$

N/A

1450

Furniture for Project/Tenant Use

$

N/A

1460

Furnishings

$

N/A

1465

Office Furniture and Equipment

$

N/A

1470

Maintenance Equipment

$

N/A

1480

Motor Vehicles

$

N/A

1490

Miscellaneous Fixed Assets

$

N/A

Total Fixed Assets

$

N/A

Accumulated Depreciation

$

N/A

Net Fixed Assets

$

N/A

1510

Investments - Operations

$

N/A

1515

Investments - Entity

$

N/A

1520

Intangible Assets

$

N/A

1590

Miscellaneous Other Assets

$

[Details]

Total Other Assets

$

N/A

1300T

1400T
1495
1400N

1500T

AFS Submission

1000T

Page 3 of 5

Total Assets

$

N/A

2105

Bank Overdraft - Operations

$

N/A

2110

Accounts Payable - Operations

$

N/A

2111

Accounts Payable - Construction/ Development

$

N/A

2112

Accounts Payable - Project Improvement Items

$

N/A

2113

Accounts Payable - Entity

$

N/A

2115

Accounts Payable - 236 Excess Income due HUD

$

N/A

2116

Accounts Payable - Section 8 & Other

$

N/A

2120

Accrued Wages Payable

$

N/A

2121

Accrued Payroll Taxes Payable

$

N/A

2123

Accrued Management Fee Payable

$

N/A

2130

Accrued Interest Payable - Section 236

$

N/A

2131

Accrued Interest Payable - First Mortgage (or Bonds)

$

N/A

2132

Accrued Interest Payable - Other Mortgages

$

[Details]

2133

Accrued Interest Payable - Other Loans and Notes
(Surplus Cash)

$

N/A

2134

Accrued Interest Payable - Other Loans and Notes

$

N/A

2135

Accrued Interest Payable - Flexible Subsidy Loan

$

N/A

2136

Accrued Interest Payable - Capital Improvements Loan

$

N/A

2137

Accrued Interest Payable - Operating Loss Loan

$

N/A

2150

Accrued Property Taxes

$

N/A

2160

Notes Payable (Short-term)

$

N/A

2170

Mortgage (or Bonds) Payable - First Mortgage (Bonds)
(Short Term)

$

N/A

2172

Other Mortgages Payable (Short Term)

$

[Details]

2173

Other Loans and Notes Payable - Surplus Cash (Short
Term)

$

N/A

2174

Other Loans and Notes (Short Term)

$

N/A

2175

Flexible Subsidy Loan Payable (Short Term)

$

N/A

Liabilities

AFS Submission

Page 4 of 5

2176

Capital Improvement Loan Payable (Short Term)

$

N/A

2177

Operating Loss Loan Payable (Short Term)

$

N/A

2180

Utility Allowances

$

N/A

2190

Miscellaneous Current Liabilities

$

[Details]

2210

Prepaid Revenue

$

N/A

Total Current Liabilities

$

N/A

2191

Tenant/Patient Deposits Held In Trust (Contra)

$

N/A

2305

Accounts Payable - Entity (Long-Term)

$

N/A

2310

Notes Payable (Long-Term)

$

N/A

2311

Notes Payable - Surplus Cash

$

N/A

2320

Mortgage (or Bonds) Payable - First Mortgage (or Bonds)

$

N/A

2322

Other Mortgages Payable (Long Term)

$

[Details]

2323

Other Loans and Notes Payable - Surplus Cash

$

N/A

2324

Other Loans and Notes Payable

$

N/A

2325

Flexible Subsidy Loan Payable

$

N/A

2326

Capital Improvement Loan Payable

$

N/A

2327

Operating Loss Loan Payable

$

N/A

2330

Interest on Loans or Notes Payable (Long Term)

$

N/A

2390

Miscellaneous Long Term Liabilities

$

[Details]

2300T

Total Long Term Liabilities

$

N/A

2000T

Total Liabilities

$

N/A

Total Equity

$

N/A

Total Liabilities and Equity

$

N/A

2122T

Equity Data - Entities other than Corporations
3130
2033T

Equity Data - Corporations
3161

Common Stock (Corporations)

$

N/A

3162

Paid-in Surplus (Corporations)

$

N/A

3163

Retained Earnings (Corporations)

N/A

AFS Submission

Page 5 of 5

$
3164

Other Equity (Corporations)

$

N/A

3160

Total Equity (Corporations)

$

N/A

Total Liabilities and Equity/Retained Earnings
(Corporations)

$

N/A

Equity Data

Cash Flow Data

2036T

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Statement Data

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Supplemental
Data

AFS Submission

Page 1 of 5

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Balance Sheet Data

Profit and Loss Data

Date From

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports
Equity Data

Description

Account

Supplemental
Data
Cash Flow Data

Value

Details

Rent Revenue
5120

Rent Revenue - Gross Potential

$

N/A

5121

Tenant Assistance Payments

$

N/A

5140

Rent Revenue - Stores and Commercial

$

N/A

5170

Garage and Parking Spaces

$

N/A

5180

Flexible Subsidy Revenue

$

N/A

5190

Miscellaneous Rent Revenue

$

[Details]

5191

Excess Rent

$

N/A

5192

Rent Revenue/ Insurance

$

N/A

5193

Special Claims Revenue

$

N/A

5194

Retained Excess Income

$

N/A

5195

Lease Revenue (Nursing Home or Section 232 - B&C or
AL)

$

N/A

Total Rent Revenue

$

N/A

5220

Apartments

$

N/A

5240

Stores and Commercial

$

N/A

5250

Rental Concessions

$

N/A

5270

Garage and Parking Space

$

N/A

5100T
Vacancies

AFS Submission

5290

Page 2 of 5

Miscellaneous

$

[Details]

5200T

Total Vacancies

$

N/A

5152N

Net Rental Revenue (Rent Revenue Less Vacancies)

$

N/A

$

N/A

5300 Revenue
5300

Nursing Homes/ Assisted Living/Board & Care/Other
Elderly Care/Coop/ and Other Revenues

Financial Revenue
5410

Financial Revenue - Project Operations

$

N/A

5430

Revenue from Investments - Residual Receipts

$

N/A

5440

Revenue from Investments - Replacement Reserve

$

N/A

5490

Revenue from Investments - Miscellaneous

$

[Details]

Total Financial Revenue

$

N/A

5400T

Other Revenue
5910

Laundry and Vending Revenue

$

N/A

5920

Tenant Charges

$

N/A

5945

Interest Reduction Payments Revenue

$

N/A

5990

Miscellaneous Revenue

$

[Details]

5900T

Total Other Revenue

$

N/A

5000T

Total Revenue

$

N/A

Administrative Expenses
6203

Conventions and Meetings

$

N/A

6204

Management Consultants

$

N/A

6210

Advertising and Marketing

$

N/A

6250

Other Renting Expenses

$

N/A

6310

Office Salaries

$

N/A

6311

Office Expenses

$

N/A

6312

Office or Model Apartment Rent

$

N/A

6320

Management Fee

$

N/A

6330

Manager or Superintendent Salaries

$

N/A

AFS Submission

Page 3 of 5

6331

Administrative Rent Free Unit

$

N/A

6340

Legal Expense - Project

$

N/A

6350

Audit Expense

$

N/A

6351

Bookkeeping Fees/Accounting Services

$

N/A

6370

Bad Debts

$

N/A

6390

Miscellaneous Administrative Expenses

$

[Details]

Total Administrative Expenses

$

N/A

6263T

Utilities Expenses
6420

Fuel Oil/Coal

$

N/A

6450

Electricity

$

N/A

6451

Water

$

N/A

6452

Gas

$

N/A

6453

Sewer

$

N/A

Total Utilities Expense

$

N/A

6400T

Operating & Maintenance Expenses
6510

Payroll

$

N/A

6515

Supplies

$

N/A

6520

Contracts

$

N/A

6521

Operating and Maintenance Rent Free Unit

$

N/A

6525

Garbage and Trash Removal

$

N/A

6530

Security Payroll/Contract

$

N/A

6531

Security Rent Free Unit

$

N/A

6546

Heating/Cooling Repairs and Maintenance

$

N/A

6548

Snow Removal

$

N/A

6570

Vehicle and Maintenance Equipment Operation and
Repairs

$

N/A

6590

Miscellaneous Operating and Maintenance Expenses

$

[Details]

Total Operating and Maintenance Expenses

$

N/A

6500T

AFS Submission

Page 4 of 5

Taxes & Insurance
6710

Real Estate Taxes

$

N/A

6711

Payroll Taxes (Project's Share)

$

N/A

6720

Property & Liability Insurance (Hazard)

$

N/A

6721

Fidelity Bond Insurance

$

N/A

6722

Workmen's Compensation

$

N/A

6723

Health Insurance and Other Employee Benefits

$

N/A

6790

Miscellaneous Taxes, Licenses, Permits and Insurance

$

[Details]

Total Taxes and Insurance

$

N/A

6700T

Financial Expenses
6820

Interest on First Mortgage (or Bonds) Payable

$

N/A

6825

Interest on Other Mortgages

$

N/A

6830

Interest on Notes Payable (Long Term)

$

N/A

6840

Interest on Notes Payable (Short Term)

$

N/A

6850

Mortgage Insurance Premium/ Service Charge

$

N/A

6890

Miscellaneous Financial Expenses

$

[Details]

Total Financial Expenses

$

N/A

$

N/A

6800T

6900 Expenses
6900

Nursing Homes/Assisted Living/ Board & Care/Other
Elderly Care Expenses

Operating Results
6000T

Total Cost of Operations before Depreciation

$

N/A

5060T

Profit (Loss) before Depreciation

$

N/A

6600

Depreciation Expenses

$

N/A

6610

Amortization Expense

$

N/A

Operating Profit or (Loss)

$

N/A

5060N

Corporate or Mortgagor Revenue/Expenses
7105

Entity Revenue

$

N/A

7110

Officer's Salaries

$

N/A

AFS Submission

Page 5 of 5

7120

Legal Expenses

$

N/A

7130

Federal, State, and Other Income Taxes

$

N/A

7141

Interest on Notes Payable

$

N/A

7142

Interest on Mortgage Payable

$

N/A

7190

Other Expenses

$

[Details]

Net Entity Expenses

$

N/A

Profit or Loss (Net Income or Loss)

$

N/A

S1000010

Total first mortgage (or bond) principal payments required
during the audit year [12 monthly payments]. This applies
to all direct loans, amortizing HUD-helds, and fully insured
first mortgages.

$

N/A

S1000020

Total of 12 monthly deposits in the audit year into the
Replacement Reserve account, as required by the
Regulatory Agreement even if payments may be
temporarily suspended or reduced.

$

N/A

S1000030

Replacement Reserves, or Residual Receipts and
Releases which are included as expense items on this
Profit and Loss statement.

$

N/A

S1000040

Project Improvement Reserve releases under the Flexible
Subsidy Program that are included as expense items on
this Profit and Loss statement.

$

N/A

7100T

Profit or Loss
3250
Part II

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Supplemental
Data

AFS Submission

Page 1 of 2

Project Name

FHA/Contract Number

Date From

Date To

010TC111

01/01/2004

12/31/2004

WONDERFUL MANOR

Supplemental Schedules with Financial
Statement Data
Balance Sheet Data

Profit and Loss Data

Notes & Auditor
Reports
Equity Data

Description

Account

Supplemental
Data
Cash Flow Data

Value

Details

Equity Data - Entities other than Corporations
S1100010

Beginning of Year Balance

$

N/A

Net Income or Loss

$

N/A

S1200420

Distributions

$

N/A

S1200430

Contributions

$

N/A

S3100030

Prior Period Adjustment

$

N/A

S1100020

Other Changes in Equity

$

[Details]

End of Year - 3130

$

N/A

3250

3130

Equity Data - Corporations
S1100300

Beginning Balance - Common Stock (Corporations)

$

N/A

S1100310

Change in Common Stock

$

N/A

Common Stock (Corporations)

$

N/A

S1100400

Beginning Balance - Paid-in Surplus (Corporations)

$

N/A

S1100410

Change in Paid-in Surplus (Corporations)

$

N/A

Paid-in Surplus (Corporations)

$

N/A

Beginning Balance - Retained Earnings (Corporations)

$

N/A

3161

3162
S1100500

AFS Submission

S1100510

Page 2 of 2

Change in Retained Earnings (Corporations)

$

N/A

Retained Earnings (Corporations)

$

N/A

S1100600

Beginning Balance - Other Equity (Corporations)

$

N/A

S1100610

Change in Other Equity (Corporations)

$

N/A

Other Equity (Corporations)

$

N/A

S1100700

Beginning of Year Balance/Prior Year Total Equity
(Corporations)

$

N/A

S1100710

Change in Total Equity (Corporations)

$

N/A

Total Equity (Corporations)

$

N/A

Equity Data

Cash Flow Data

3163

3164

3160

Save Your Work

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Supplemental
Data

AFS Submission

Page 1 of 5

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Balance Sheet Data

Profit and Loss Data

Description

Account

Date From

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports
Equity Data

Value

Supplemental
Data
Cash Flow Data

Details

Cash Flow from Operating Activities
S1200010

Rental Receipts

$

N/A

S1200020

Interest Receipts

$

N/A

S1200030

Other Operating Receipts

$

N/A

S1200035

Entity/Construction Receipts

$

[Details]

S1200040

Total Receipts

$

N/A

S1200050

Administrative

$

N/A

S1200070

Management Fee

$

N/A

S1200090

Utilities

$

N/A

S1200100

Salaries and Wages

$

N/A

S1200110

Operating and Maintenance

$

N/A

S1200120

Real Estate Taxes

$

N/A

S1200140

Property Insurance

$

N/A

S1200150

Miscellaneous Taxes and Insurance

$

N/A

S1200160

Tenant Security Deposits

$

N/A

AFS Submission

Page 2 of 5

S1200170

Other Operating Expenses

$

N/A

S1200180

Interest on First Mortgage

$

N/A

S1200181

Interest Payments - Second Mortgage

$

N/A

S1200182

Interest Payments - Third Mortgage

$

N/A

S1200190

Interest on Notes Payable

$

N/A

S1200210

Mortgage Insurance Premium (MIP)

$

N/A

S1200220

Miscellaneous Financial

$

N/A

S1200225

Entity/Construction Disbursements

$

[Details]

S1200230

Total Disbursements

$

N/A

S1200240

Net Cash provided by (used in) Operating
Activities

$

N/A

Cash Flow from Investing Activities
S1200245

Net Deposits to the Mortgage Escrow account

$

N/A

S1200250

Net Deposits to the Reserve for Replacement
account

$

N/A

S1200255

Net Deposits to Other Reserves

$

N/A

S1200260

Net Deposits to the Residual Receipts account

$

N/A

S1200300

Net Deposits to the Management Improvement
and Operating Plan account

$

N/A

S1200310

Net Deposits to the Long Term Investment
account

$

N/A

S1200330

Net Purchase of Fixed Assets

$

N/A

S1200340

Other Investing Activities

$

[Details]

S1200345

Entity/Construction Investing Activities

$

[Details]

S1200350

Net Cash used in Investing Activities

$

N/A

$

N/A

Cash Flow from Financing Activities
S1200360

Principal Payments - First Mortgage (or
Bonds)

AFS Submission

Page 3 of 5

S1200361

Principal Payments - Second Mortgage

$

N/A

S1200362

Principal Payments - Third Mortgage

$

N/A

S1200365

Proceeds from Mortgages, Loans, or Notes
Payable

$

N/A

S1200370

Principal Payments on Loans or Notes
Payable

$

N/A

S1200385

Proceeds from Flexible Subsidy Loans

$

N/A

S1200390

Flexible Subsidy Loan principal payments

$

N/A

S1200395

Proceeds from Capital Improvement Loans

$

N/A

S1200400

Principal payments on Capital Improvement
Loan Payable

$

N/A

S1200405

Proceeds from Operating Loss Loans

$

N/A

S1200410

Principal payments on Operating Loss Loan
Payable

$

N/A

S1200420

Distributions

$

N/A

S1200430

Contributions

$

N/A

S1200450

Other Financing Activities

$

[Details]

S1200455

Entity/Construction Financing Activities

$

[Details]

S1200460

Net Cash used in Financing Activities

$

N/A

S1200470

Net increase (decrease) in Cash and Cash
Equivalents

$

N/A

Cash and Cash Equivalents
S1200480

Beginning of Period Cash

$

N/A

S1200T

End of Period Cash

$

N/A

Reconciliation of Net Profit (Loss) to Net Cash Provided by (Used in) Operating Activities
3250

Profit or Loss (Net Income or Loss)

$

N/A

Adjustments to Reconcile Net Profit (Loss) to Net Cash Provided by (Used in) Operating
Activities
6600

Depreciation Expenses

$

N/A

6610

Amortization Expense

$

N/A

AFS Submission

Page 4 of 5

S1200490

Decrease (increase) in Tenant/Member
Accounts Receivable

$

N/A

S1200500

Decrease (increase) in Accounts Receivable Other

$

N/A

S1200510

Decrease (increase) in Accrued Receivable

$

N/A

S1200520

Decrease (increase) in Prepaid Expenses

$

N/A

S1200530

Decrease (increase) in Cash Restricted for
Tenant Security Deposits

$

N/A

S1200535

Decrease (increase) in Entity/ Construction
Asset accounts

$

[Details]

S1200540

Increase (decrease) in Accounts Payable

$

N/A

S1200550

Increase (decrease) in Accounts Payable HUD Excess Rents

$

N/A

S1200560

Increase (decrease) in Accrued Liabilities

$

N/A

S1200570

Increase (decrease) in Accrued Interest
Payable

$

N/A

S1200580

Increase (decrease) in Tenant Security
Deposits held in trust

$

N/A

S1200590

Increase (decrease) in Prepaid Revenue

$

N/A

S1200600

Other adjustments to reconcile net profit (loss)
to Net Cash provided by (used in) Operating
Activities

$

[Details]

S1200605

Increase (decrease) in Entity/Construction
Liability accounts

$

[Details]

$

N/A

Net Cash provided by (used in) Operating Activities
S1200610

Net Cash provided by (used in) Operating
Activities

S1200620

Comments

N/A
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AFS Submission

Page 5 of 5


Comments or Questions 

AFS Submission

Page 1 of 2

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data

Account

Description

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports

Auditor's Reports

Notes

Date From

Supplemental
Data

Findings & Prior Audits

Value

Details

S3100010

Organization and Presentation Note

N/A

S3100020

Prior Period Adjustment Note

N/A

S3100030

Prior Period Adjustment

S3100040

Summary of Significant Accounting
Policies Note

N/A

S3100050

Mortgages (or Bond) Payable Note

N/A

$

[Details]

Please enter the Mortgages Payable:
S3100120

Interest Reduction Payments from
Subsidy

S3100130

Notes/Loans Payable Note

Please Enter the Notes/Loans Payable

N/A

$

N/A

N/A

[Details]

AFS Submission

Page 2 of 2

S3100190

Total of Notes/Loans Payable

S3100200

Related Party Transactions Note

S3100230

Management Fee Note

$

N/A

[Details]

N/A

[Details]

Please enter the additional notes:
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Supplemental
Data

AFS Submission

Page 1 of 2

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Notes
Account

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports

Auditor's Reports
Description

Date From

Supplemental
Data

Findings & Prior Audits
Value

Details

Report on the Financial Statement
S2100-020 Opinion

None

N/A
None

S2100-050 Going Concern Issue

S2100-030 Opinion Explanation

N/A

N/A

Report on Supplemental Data
S2100-100 Opinion

None

N/A

S2100-110 Opinion Explanation

N/A

Report on Internal Controls
S2200-020 Reportable Conditions Indicator

None

N/A

S2200-030 Material Weaknesses Indicator

None

N/A

S2200-040 Comments on Internal Controls

N/A

Report on Compliance - Major Programs
S2300-020 Opinion
S2300-030 Material Non-Compliance Indicator

None

N/A
None

N/A

AFS Submission

Page 2 of 2

S2300-040 Comments on Non-compliance

N/A

Report on Compliance - Non-Major Programs
None

S2400-020 Material Non-Compliance Indicator

S2400-040 Comments on Non-compliance

N/A

N/A

Report on Compliance - Affirmative Fair Housing
None

S2500-020 Material Non-Compliance Indicator

S2500-040 Comments on Non-compliance

N/A

N/A

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Supplemental
Data

AFS Submission

Page 1 of 1

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Notes

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports

Auditor's Reports

Supplemental
Data

Findings & Prior Audits

Description

Account

Date From

Value

Details

Schedule of Findings and Questioned Costs

[Details]

Please enter the findings associated with this audit:
S2700-110

Contact Person First Name

N/A

S2700-120

Contact Person Middle Initial

N/A

S2700-130

Contact Person Last Name

N/A

Auditee's Comments on Audit Resolution Matters
Please enter the Prior Audit Matters for which there are comments:
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Data

AFS Submission

Page 1 of 2

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Reserve Accounts
Data

Surplus Cash & Fixed
Asset Data

Date From

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports

NH/Assisted Living
Data

Certification/Federal Awards
Data

Description

Account

Supplemental
Data

Value

Details

Schedule of Reserve for Replacement
1320P

Balance at Beginning of Year

$

N/A

Total Monthly Deposits

$

N/A

1320ODT

Other Deposits

$

[Details]

1320INT

Interest on Replacement Reserve Accounts

$

N/A

1320RGL

Realized Gain or (Loss)

$

N/A

1320UGL

Unrealized Gain or (Loss)

$

N/A

1320WT

Approved Withdrawals

$

N/A

Other Withdrawals

$

[Details]

Balance at End of Year, Confirmed by Mortgagee

$

N/A

1320DT

1320OWT
1320
1320R

None

Deposits Suspended or Waived Indicator

N/A

Schedule of Residual Receipts
1340P

Balance at Beginning of Year

$

N/A

1340DT

Total Deposits

$

N/A

1340ODT

Other Deposits

$

[Details]

1340INT

Interest on Residual Receipt Accounts

$

N/A

1340RGL

Realized Gain or (Loss)

$

N/A

1340UGL

Unrealized Gain or (Loss)

$

N/A

AFS Submission

1340WT
1340OWT
1340

Page 2 of 2

Approved Withdrawals

$

N/A

Other Withdrawals

$

[Details]

Balance at Current Fiscal Year End

$

N/A

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Asset Data

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Data

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Reports

Supplemental
Data

FASSUB Main Menu

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AFS Submission

Page 1 of 5

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Reserve Accounts
Data

Surplus Cash & Fixed
Asset Data

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports

NH/Assisted Living
Data

Description

Account

Date From

Supplemental
Data

Certification/Federal Awards
Data

Value

Details

Computation of Surplus Cash, Distributions, and Residual Receipts (Annual)
S1300010

Cash

$

N/A

Accounts Receivable - HUD

$

N/A

S1300030

Other

$

[Details]

S1300040

Total Cash

$

N/A

S1300050

Accrued Mortgage (or Bond) Interest
Payable

$

N/A

S1300060

Delinquent Mortgage (or Bond) Principal
Payments

$

N/A

S1300070

Delinquent Deposits to Reserve for
Replacements

$

N/A

S1300075

Accounts Payable - 30 days

$

N/A

S1300080

Loans and Notes Payable [due within 30
days]

$

N/A

S1300090

Deficient Tax Insurance or MIP Escrow
Deposits

$

N/A

S1300100

Accrued Expenses [not escrowed]

$

N/A

2210

Prepaid Revenue

$

N/A

2191

Tenant/Patient Deposits Held In Trust
(Contra)

$

N/A

Other Current Obligations

$

[Details]

1135

S1300110

AFS Submission

Page 2 of 5

S1300140

Total Current Obligations

$

N/A

S1300150

Surplus Cash (Deficiency)

$

N/A

S1300160

Annual Distribution earned during fiscal
period covered by the statement

$

N/A

S1300170

Distribution Accrued and Unpaid as of the
end of the prior fiscal period

$

N/A

S1300180

Distributions and Entity Expenses paid
during fiscal period covered by statement

$

N/A

S1300190

Distribution Earned but Unpaid

$

N/A

S1300200

Amount Available for distribution during next
fiscal period

$

N/A

S1300210

Deposit Due Residual Receipts

$

N/A

Computation of Surplus Cash, Distributions, and Residual Receipts (Mid-year)

ex:

S1400010

Semi-Annual Period Ended

S1400020

Cash

$

N/A

S1400030

Tenant Subsidy due for semi-annual period

$

N/A

S1400040

Other

$

[Details]

S1400050

Total Cash

$

N/A

S1400060

Accrued Mortgage Interest Payable

$

N/A

S1400070

Delinquent Mortgage Principal Payments

$

N/A

S1400080

Delinquent Deposits to Reserve for
Replacements

$

N/A

S1400090

Accounts Payable [due within 30 days]

$

N/A

S1400100

Loans and Notes Payable [due within 30
days]

$

N/A

S1400110

Deficient Tax Insurance or MIP Escrow
Deposits

$

N/A

S1400120

Accrued Expenses [not escrowed]

$

N/A

S1400130

Prepaid Revenue

$

N/A

S1400-

Tenant Security Deposits Liability

$

N/A

12/31/1999

N/A

AFS Submission

Page 3 of 5

140
S1400150

Other Current Obligations

$

[Details]

S1400180

Total Current Obligations

$

N/A

S1400190

Surplus Cash (Deficiency)

$

N/A

S1400200

Distribution earned during semi-annual
period

$

N/A

S1400210

Distribution Accrued and Unpaid as of the
end of the semi-annual period

$

N/A

S1400220

Distributions and Entity Expenses paid
during semi-annual period

$

N/A

S1400230

Distribution Earned but Unpaid

$

N/A

S1400240

Amount Available for Distribution during next
fiscal period

$

N/A

S1400250

Deposit Due Residual Receipts

$

N/A

Beginning Balance for 1410

$

N/A

1410AT

Additions for 1410

$

[Details]

1410DT

Deductions for 1410

$

[Details]

Land

$

N/A

Beginning Balance for 1420

$

N/A

1420AT

Additions for 1420

$

[Details]

1420DT

Deductions for 1420

$

[Details]

Buildings

$

N/A

Beginning Balance for 1440

$

N/A

1440AT

Additions for 1440

$

[Details]

1440DT

Deductions for 1440

$

[Details]

Building Equipment (Portable)

$

N/A

Beginning Balance for 1450

$

N/A

1450AT

Additions for 1450

$

[Details]

1450DT

Deductions for 1450

$

[Details]

Schedule of Changes in Fixed Asset Accounts
1410P

1410
1420P

1420
1440P

1440
1450P

AFS Submission

1450

Page 4 of 5

Furniture for Project/Tenant Use

$

N/A

Beginning Balance for 1460

$

N/A

1460AT

Additions for 1460

$

[Details]

1460DT

Deductions for 1460

$

[Details]

Furnishings

$

N/A

Beginning Balance for 1465

$

N/A

1465AT

Additions for 1465

$

[Details]

1465DT

Deductions for 1465

$

[Details]

Office Furniture and Equipment

$

N/A

Beginning Balance for 1470

$

N/A

1470AT

Additions for 1470

$

[Details]

1470DT

Deductions for 1470

$

[Details]

Maintenance Equipment

$

N/A

Beginning Balance for 1480

$

N/A

1480AT

Additions for 1480

$

[Details]

1480DT

Deductions for 1480

$

[Details]

Motor Vehicles

$

N/A

Beginning Balance for 1490

$

N/A

1490AT

Additions for 1490

$

[Details]

1490DT

Deductions for 1490

$

[Details]

Miscellaneous Fixed Assets

$

N/A

1400PT

Total Beginning Balance for Fixed Assets

$

N/A

1400AT

Total Asset Additions

$

N/A

1400DT

Total Asset Deductions

$

N/A

1400T

Total Fixed Assets

$

N/A

1495P

Beginning Balance for 1495

$

N/A

Total Provisions

$

N/A

1460P

1460
1465P

1465
1470P

1470
1480P

1480
1490P

1490

6600

AFS Submission

1400ADT
1495
1400N

Page 5 of 5

Total Accumulated Depreciation from
Disposed Assets

$

N/A

Ending Balance for Accumulated
Depreciation

$

N/A

Total Net Book Value

$

N/A

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Reserve Accounts
Data

Surplus Cash & Fixed
Asset Data

NH/Assisted Living
Data

Supplemental Schedules with Financial
Statement Data

Certification/Federal Awards
Data

Notes & Auditor
Reports

Supplemental
Data

FASSUB Main Menu

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AFS Submission

Page 1 of 5

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Reserve Accounts
Data

Surplus Cash & Fixed
Asset Data

Date From

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports

NH/Assisted Living
Data

Certification/Federal Awards
Data

Description

Account

Supplemental
Data

Value

Details

Schedule of 5300 Accounts
5301

Private Pay Room & Board

$

N/A

5302

Private Pay Ancillary

$

N/A

5303

Contractual Adjustments

$

N/A

5305

Medicare Room & Board

$

N/A

5306

Medicare Ancillary

$

N/A

5307

Medicare Contractual Adjustments

$

N/A

5309

Medicaid Room & Board

$

N/A

5310

Medicaid Ancillary

$

N/A

5311

Swimming Pool Maintenance Expense

$

N/A

5312

Medicaid Contractual Adjustments

$

N/A

5315

VA Room & Board

$

N/A

5316

VA Ancillary

$

N/A

5317

VA Contractual Adjustments

$

N/A

5321

Hospice

$

N/A

5325

Other Public Room & Board

$

N/A

5326

Other Public Ancillary

$

N/A

AFS Submission

Page 2 of 5

5327

Other Public Adjustment

$

N/A

5330

Dietary Salaries

$

N/A

5331

Contributions and Gifts

$

N/A

5332

Food

$

N/A

5333

Dietary Supplies

$

N/A

5340

Registered Nurses Payroll

$

N/A

5341

Licensed Practical Nurses Payroll

$

N/A

5342

Other Nursing Salaries

$

N/A

5350

Housekeeping Salaries

$

N/A

5351

Housekeeping Supplies

$

N/A

5352

Other Housekeeping

$

N/A

5360

Drugs/Medical Supplies and Pharmaceuticals

$

N/A

5361

Medical Salaries

$

N/A

5362

Other Medical

$

N/A

5365

Food Servicing

$

N/A

5370

Laundry and Linen

$

N/A

5375

Housekeeping

$

N/A

5376

Health/Medical Services

$

N/A

5380

Recreation (Activities) and Rehabilitation

$

N/A

5385

Rehabilitation

$

N/A

5390

Other Service Revenue

$

N/A

5395

Adult Day Care

$

N/A

5396

Child Day Care

$

N/A

Schedule of 6900 Accounts
6930

Dietary Salaries

$

N/A

6931

Dietary Purchased Services

$

N/A

6932

Food

$

N/A

AFS Submission

Page 3 of 5

6933

Dietary Supplies

$

N/A

6940

Registered Nurses Payroll

$

N/A

6941

Licensed Practical Nurses Payroll

$

N/A

6942

Other Nursing Salaries

$

N/A

6943

Director of Nurses Salaries

$

N/A

6944

Nursing Purchase Services

$

N/A

6950

Housekeeping Salaries

$

N/A

6951

Housekeeping Supplies

$

N/A

6952

Other Housekeeping

$

N/A

6953

Housekeeping Purchased Services

$

N/A

6960

Drugs and Pharmaceuticals

$

N/A

6961

Medical Salaries

$

N/A

6962

Other Medical

$

N/A

6963

Medical Supplies

$

N/A

6964

Medical Purchased Services

$

N/A

6965

Pharmacy Salaries

$

N/A

6966

Pharmacy Supplies

$

N/A

6967

Pharmacy Purchased Services

$

N/A

6970

Laundry and Linen

$

N/A

6971

Laundry Salaries

$

N/A

6972

Laundry, Linen, Bedding, Disposables, Purchased
Services

$

N/A

6973

Laundry Supplies

$

N/A

6975

Medical Records Salaries

$

N/A

6976

Medical Records Supplies

$

N/A

6977

Medical Records Purchased Services

$

N/A

6980

Recreation and Rehabilitation

$

N/A

6981

Activities Supplies

$

N/A

AFS Submission

Page 4 of 5

6982

Activities Purchased Services

$

N/A

6983

Rehabilitation Salaries

$

N/A

6984

Rehabilitation Supplies

$

N/A

6985

Rehabilitation Purchased Services

$

N/A

6990

Other Service Expenses

$

N/A

Nursing Home Supplemental Data
S1900-010 Total Licensed Beds

N/A

S1900-020 Capacity

N/A

S1900-030 Medicare Pay Patient Days

N/A

S1900-040 Medicare Pay Patient Days Percentage

N/A

S1900-050 Medicaid Pay Patient Days

N/A

S1900-060 Medicaid Pay Patient Days Percentage

N/A

S1900-070 Private Pay Patient Days

N/A

S1900-080 Private Pay Patient Days Percentage

N/A

S1900-090 VA Pay Patient Days

N/A

S1900-100 VA Pay Patient Days Percentage

N/A

S1900-110 Other Pay Patient Days

N/A

S1900-120 Other Pay Patient Days Percentage

N/A

S1900-130 Actual Patient Days

N/A

S1900-140 Utilization

N/A
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Reserve Accounts
Data

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Asset Data

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Data

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Statement Data

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Data

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Supplemental
Data

AFS Submission

Page 5 of 5

Comments or Questions 

AFS Submission

Page 1 of 2

Project Name

FHA/Contract Number

WONDERFUL MANOR

010TC111

Supplemental Schedules with Financial
Statement Data
Reserve Accounts
Data

Surplus Cash & Fixed
Asset Data

Description

Account

Date From

Date To

01/01/2004

12/31/2004

Notes & Auditor
Reports

Supplemental
Data

NH/Assisted Living Certification/Federal Awards
Data
Data

Value

Details

Mortgagor's Certification

S2900010

Narrative

N/A

S2900020

Name of Signatory #1

N/A

S2900025

Title of Certifying Official

N/A

S2900030

Name of Signatory #2

N/A

S2900040

Auditee Telephone Number

N/A

S2900050

Date of Certification

ex: 12/31/1999

N/A

Managing Agent's Certification

S3000010

Narrative

N/A

S3000020

Name of Managing Agent

N/A

S3000030

Name of Signatory

N/A

S3000040

Managing Agent TIN

N/A

S3000-

Name of Individual (i.e., Property

AFS Submission

050

Page 2 of 2

Manager)

N/A

Auditor's Transmittal Letter
S3200005

Audit Firm ID (UII)

S3200010

Audit Firm

N/A

S3200020

Lead Auditor First Name

N/A

S3200030

Lead Auditor Middle Name

N/A

S3200040

Lead Auditor Last Name

N/A

S3200050

Auditor Street Address Line 1

N/A

S3200060

Auditor Street Address Line 2

N/A

S3200070

Auditor City

N/A

S3200080

Auditor State

N/A

S3200090

Auditor Zip Code

N/A

S3200100

Auditor Zip Code Extension

N/A

S3200110

Telephone Number

N/A

S3200120

Audit Firm TIN

N/A

S3200130

Date of Independent Auditor's
Report

N/A

ex: 12/31/1999

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Reserve Accounts
Data

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Asset Data

NH/Assisted Living Certification/Federal Awards
Data
Data

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Statement Data

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Reports

Supplemental
Data

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