Free None - Wisconsin


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Date: November 21, 2006
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State: Wisconsin
Category: Health Care
Author: SlateRA
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http://dhs.wisconsin.gov/forms1/F6/F62674A.pdf

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DEPARMENT OF HEALTH AND FAMILY SERVICES Office of Quality Assurance OQA-2674 (10-06)

STATE OF WISCONSIN

ASSISTED LIVING FACILITY MODEL BALANCE SHEET
Name ­ Facility Date Completed

Address

ASSETS

LIABILITIES AND NET WORTH

CURRENT ASSETS Cash in bank Other short-term investments (e.g., money market, stocks, CDs) Receivables Prepaid Expenses Other (specify)

CURRENT LIABILITIES Accounts payable Taxes payable Loans payable ­ due within 12 months Current portion long-term debt Accrued payroll / withholding Other current liabilities (specify)

TOTAL CURRENT ASSETS TOTAL CURRENT LIABILITIES FIXED ASSETS Vehicles Furniture and equipment Leasehold improvements Real estate / buildings Other (specify) TOTAL LONG TERM LIABILITIES TOTAL FIXED ASSETS TOTAL LIABILITIES (current + long term) TOTAL ASSETS (current + fixed) OWNER'S EQUITY (Net Worth) (total assets minus total liabilities) TOTAL LIABILITIES PLUS OWNER'S EQUITY LONG TERM LIABILITIES Loans payable - greater than 12 mo., (e.g., land contract, mortgage, vehicles, bank loans, etc.) Other long-term debt (specify)

OQA-2674 (10-06)

The Assisted Living Model Balance Sheet, OQA-2674, is a suggested format. Other balance sheet formats will be accepted, however, the same basic information is required. A. What is a balance sheet? What is it used for? A balance sheet is a financial "snapshot" of you or your business at a given date in time. The balance sheet provides information on what you or your business owns (assets), what your or your business owes (liabilities), and your net worth or the value of the business (equity). The name balance sheet is derived from the fact that these accounts must always be in balance. Assets must always equal the sum of liabilities and equity. By analyzing your balance sheet one can assess your financial status and examine the following: · Can you or your business meet short-term obligations? · Can you or your business pay all current and long-term debts as they come due? · Are you or your business overly indebted, i.e., do your liabilities exceed your assets? B. Terms 1. Current assets are assets that are usually converted to cash within one year. a.. Cash ­ on hand and/or on deposit and is available b. Short-term investments ­ generally converted into cash easily, such as money market funds or U.S Government securities c. Receivables ­ money customers owe to you or your business d. Prepaid expenses ­ items like insurance premiums or rentals which you have already paid but have not yet "used" 2. Fixed assets are tangible assets with a useful life greater than one year. a. b. c. d. e. 3. 4. Vehicles Furniture and equipment Leasehold improvements ­ improvements on a leased asset that increase the value of the asset Land Buildings

Total assets is the total dollar value of current and fixed assets. Current liabilities are those obligations that are usually paid within 12 months, such as accounts payable, interest on long-term debts, and taxes payable. a. b. c. d. e. Accounts payable Taxes payable Loans payable (due within 1 year) Current portion of long-term debt Accrued payroll and withholding ­ includes any wages or withholdings owed to or for employees but have not yet been paid

5.

Long-term liabilities are any debts owed that are due more than 1 year out from the current date, including loans payable such as a mortgage, vehicle loan, or bank loan. Total liabilities is the total dollar value of current and long-term liabilities. Owner's equity is what is left when you subtract liabilities from assets.

6. 7.

C. Total assets must be equal to total liabilities and owner's equity (net worth). Assets = Liabilities + Owner's Equity EXAMPLE: Assets Liabilities Owner's Equity

$100,000 $ 50,000 $ 50,000

Assets ($100,000) = Liabilities ($50,000) + Owner's Equity ($50,000)