Appendix B - Best Start Wage Improvement Funding Utilization Statement Form

Children's Services	Effective Date:
Topic: Appendices	Replaces:
Subject: Best Start Wage Improvement Funding Utilization Statement	Appendix B

BEST START WAGE IMPROVEMENT FUNDING UTILIZATION STATMENT

SECTION1: BASIC PROGRAM INFORMATION

This completed statement is due within 30 days after the end of the reporting period.

Program Name: *

Licence Holder/Corporation: *

Licence Holder/Corporation Address: *

Reporting Period: *

SECTION 2: SALARIES/PROVIDER PAYMENTS EXPENDITURES

Staff Position #1:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #2:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #3:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #4:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #5:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #6:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #7:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #8:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #9:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #10:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #11:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Staff Position #12:

Number of Full Time Equivalent Staff:

Base Salary/Wage:

Best Start Wage Improvement Funding:

Total:

Total Base Salary/Wage: *

Total Best Start Wage Improvement Funding:

Total: *

Number of Private-Home Day Care Providers: *

SECTION 3: VARIANCE REPORT

1. Total Wage Improvement Funding received:

2. Amount used for salaries:

3. Amount used for Employers' mandatory benefit costs:

4. Amount used for non mandatory benefit costs:

5. Amount used for Private-Home Day Care Provider payments:

6. Total Wage Improvement Funding used (2+3+4+5):

7. Variance* (1-6):

*If a variance exists, please explain:

SERVICE PROVIDER INFORMATION

Verification Acceptance: *

I, Signing Office #1, verify that the wage subsidies have been used for the purposes intended, as stated above.

Signing Officer #1 Name: *

Date: *

Verification Acceptance: *

I, Signing Officer #2, verify that the wage subsidies have been used for the purposes intended, as stated above.

Signing Officer #2 Name: *

Date: *

MANITOULIN-SUDBURY DISTRICT SERVICES BOARD INFORMATION

Reviewed by: *

Date: *

Recovery Required:

Comments:

Notes on Wage Subsidy Utilization Statement

Section 3 (Line # | Explanation):

Total Best Start Wage Improvement Funding received by service provider for the previous fiscal year.
Best Start Wage Improvement Funding used to increase salaries.
Best Start Wage Improvement Fudning used to pay the employer's share of benefit costs (CPP, Worker's Compensation, Employment Insurance, Ontario Health Tax) resulting from the wage subsidy funding.
Best Start Wage Improvement Funding used towards non-mandatory benefits (i.e. Dental Plan, Group Insurance)
Total Private-Home Day Care Provider Grant distributed to private-home day care providers.
The total of lines 2+3+4+5
Variance: Line 1 minus Line 6

Note: If Wage Subsidy, Best Start Wage Subsidy and Best Start Wage Improvement Funding in total exceed $20,000, an audited financial statement, including third party verficiation in the special purpose report that funding was used for the purposes intended must be submitted with these utilization statements.

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