New York State Education Department
Office of Management Services
State Aid Unit
(518) 474-2977
TREASURER District Code: 170600
JOHNSTOWN CITY SD Municipal Code: 170523000000
2 WRIGHT DR STE 101 Date of Payment: SEP 01, 2009
JOHNSTOWN, NY 12095-3099 Amount of Payment: $413,659.00
2008-09 Certificate of Excess Cost Aid for Students with Disabilities
1. TOTAL EXCESS COST AID (less Estimated or calc) $2,530,833.00
2. Total Aug State Share Medicaid Amount
3. Total Sept State Share Medicaid Amount $26,686.50
4. Total Oct State Share Medicaid Amount
5. Total Nov State Share Medicaid Amount $106,673.50
6. December Gross Payment (Line 1 X .25 - tot St Sh Medicaid) $499,348.25
7. December Net Excess Cost Payment $499,348.25
8. TOTAL EXCESS COST AID (less Estimated or calc) $2,530,833.00
9. Total Dec State Share Medicaid Amount $16,953.50
10. Total Jan State Share Medicaid Amount $26,200.50
11. Total Feb State Share Medicaid Amount
12. March Gross Payment (Line 8 x .70 - tot St Sh Medicaid & EC) $1,095,720.85
13. March Net Excess Cost Payment $1,095,720.85
14. TOTAL EXCESS COST AID (less Estimated or calc) $2,530,833.00
15. Total Mar State Share Medicaid Amount $30,776.00
16. Total Apr State Share Medicaid Amount
17. Total May State Share Medicaid Amount $40,400.38
18. June Gross Payment (Line 14 x .85 - tot St Sh Medicaid & EC) $308,448.57
19. Less Adjustments for Therapeutic Foster Care
20. June Net Excess Cost Payment $308,448.57
23. TOTAL EXCESS COST AID (less Estimated or calc) $2,530,833.00
24. Total June State Share Medicaid Amount $20,496.97
25. Total July State Share Medicaid Amount
26. August Gross Payment (Line 23 - tot St Sh Medicaid & EC) $359,127.98
27. August Net Excess Cost Payment $359,127.98
28. TOTAL EXCESS COST AID $2,944,492.00
29. September Gross Payment (Line 28 - tot St Sh Medicaid & EC) $413,659.00
30. September Net Excess Cost Payment $413,659.00
Deposit will take place sometime during the payment day and funds will be
available the following day.
(ST-3 Code A3101 Basic Formula Aid - Excess Cost Only)
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