New York State Education Department                       
                         Office of Management Services                          
                                 State Aid Unit                                 
                                 (518) 474-2977                                 
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                         District Code:    200901               
      WELLS CSD                          Vendor ID:  1000002058                 
                                                                                
                                                                                
                                                                                
     2013-14 Certificate of Excess Cost Aid for Students with Disabilities      
                                                                                
 1. TOTAL EXCESS COST AID (less Estimated or calc)                      $0.00   
 2. Total Aug-Nov State Share Medicaid Paid By DOH                    $318.50   
 3. Total Overpayments Deducted                                         $0.00   
 4. December Net Payment                                                $0.00   
    (Line 1 X .25 minus St Sh Med & Overpayments)                               
 5. Check Date                                                                  
                                                                                
 6. TOTAL EXCESS COST AID (less Estimated or calc)                $111,029.00   
 7. Total Dec-Feb State Share Medicaid Paid by DOH                  $1,001.05   
 8. Total Overpayments Deducted                                         $0.00   
 9. March Net Payment                                              $76,400.75   
    (Line 6 X .70 less previous EC, St Sh Med & O/P's )                         
10. Check Date                                                     03/14/2014   
                                                                                
11. TOTAL EXCESS COST AID (less Estimated or calc)                $111,029.00   
12. Total Mar-May State Share Medicaid Paid by DOH                  $1,435.22   
13. Total Foster Care Deducted                                          $0.00   
14. Total Overpayments Deducted                                         $0.00   
15. June Net Payment                                               $15,219.13   
    (Line 11 X .85 less previous EC,St Sh Med,FC, & O/P's)                      
16. Check Date                                                     06/13/2014   
                                                                                
17. Est** Accrued Aug Excess Cost                                  $16,654.35   
 (Line 11 X 100% minus total of previous deducts & Net EC paid)                 
                                                                                
18. Est Accrued Sept Ex Cost (Actual - Estimated)                       $0.00   
                                                                                
 Check will be mailed under separate cover from the Division of the Treasury.   
 (ST-3 Code A3101 Basic Formula Aid - Excess Cost Only)                         
                                                                                
**The estimated Aug payment will be reduced by June & July State Share Medicaid.
                                                                                
                                                                                

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