r " ' " Leedey EMERGENCY MEDICAL"' SERVICE BOARD 2016-2017 ESTIMATE OF NEEDS AND FINANCIAL STATEMENT OF THE FISCAL YEAR 2015-2016 EMERGENCY MEDICAL SERVICE BOARD OF THE COUNTY OF ROGER MILLS STATE OF OKLAHOMA Q OCT2oms StateA^or&lnspector Two copies of this Financial Statement and Estimate of Needs should be filed with the County Clerk not later than August 17 for all Counties. After approval by the Excise Board and the levies are made, both statements should be signed by the appropriate Board Members. One complete signed copy must be sent to the State Auditor and Inspector, Suite 106, 4545 N. Lincoln Blvd., Oklahoma City, OK 73105-3453. If publication may not be had by date required for filing, affidavit and proof of publication are required to be attached within five days after date of filing. Chairman Memb Member THE 2016-2017 ESTIMATE OF NEEDS AND FINANCIAL STATEMENT OF THE FISCAL YEAR 2015-2016 PREPARED BY PK AND COMPANY, PLLC SUBMITTED TO THE ROGER MILLS COUNTY EXCISE BOARD THIS ^ a*/- ¥ 2016. EMERGENCY MEDICAL SERVICE BOARD -C I^K\^-m?- Member s^^lnivU^ £u^> A l^s— Membei r^cdJ^c^ ^n/JL r Lhdd*4 ^ <&>^ ^2— S.A.&I. Form 268BR98 Entity: ROGER MILLS County EMS Dist., 065
Transcript
r
"
'
"
LeedeyEMERGENCY MEDICAL"' SERVICE BOARD
2016-2017
ESTIMATE OF NEEDS
AND FINANCIAL STATEMENT OF THE
FISCAL YEAR 2015-2016
EMERGENCY MEDICAL SERVICE BOARD OF
THE COUNTY OF ROGER MILLS
STATE OF OKLAHOMA
Q OCT2omsStateA^or&lnspector
Two copies of this Financial Statement and Estimate of Needs should be filed with the County Clerk not later than
August 17 for all Counties. After approval by the Excise Board and the levies are made, both statements should be
signed by the appropriate Board Members. One complete signed copy must be sent to the State Auditor and Inspector,
Suite 106, 4545 N. Lincoln Blvd., Oklahoma City, OK 73105-3453. If publication may not be had by date required for
filing, affidavit and proof of publication are required to be attached within five days after date of filing.
Chairman
Memb
Member
THE 2016-2017 ESTIMATE OF NEEDS AND FINANCIAL
STATEMENT OF THE FISCAL YEAR 2015-2016
PREPARED BY P K AND COMPANY, PLLC
SUBMITTED TO THE ROGER MILLS COUNTY
EXCISE BOARD THIS ^ a*/-¥ 2016.
EMERGENCY MEDICAL SERVICE BOARD
-C I^K\^-m?- Member
s^^lnivU^£u^> Al^s—
Membei
r^cdJ^c^ ^n/JLr Lhdd*4 ^ <&>^̂ 2—
S.A.&I. Form 268BR98 Entity: ROGER MILLS County EMS Dist., 065
p?l
LeedevEMERGENCY MEDICAL-'SERVICE BOARD
OF
ROGER MILLS COUNTY
2016-2017
ESTIMATE OF NEEDS
AND FINANCIAL STATEMENT OF THE
FISCAL YEAR 2015-2016
INDEX
Page
Letters and Certifications:
Letter To Excise Board 1
Affidavit of Publication 2
Accountant's Letter 3
Certificate of Excise Board Exhibit «Y" - Page 1
Exhibits:
Exhibit "Fn Emergency Medical Service Fund Filed Yes X No
Exhibit "G" Sinking Fund Filed Yes No X
Exhibit "J" Capital Project Funds Filed Yes No X
Exhibit "Y" Certificate of Excise Board
Estimate of Needs Filed Yes No
Y
Publication Sheet Filed With County Budget Filed Yes No "
v
Exhibit "Z" Publication Sheet (When Not Filed With County Budget) Filed Yes •"• No
S.A.&I. Form 268BR98 Entity: ROGER MILLS County EMS Dist., 065
Page 1
LeedeyEMERGENCY MEDICAL SERVICE BOARD
OF
ROGER MILLS COUNTY
2016-2017
ESTIMATE OF NEEDS
AND FINANCIAL STATEMENT OF THE
FISCAL YEAR 2015-2016
LeedeyROGER MILLS COUNTY, EMERGENCY MEDICAL SERVICE BOARD
STATE OF OKLAHOMA, COUNTY OF ROGER MILLS , ss:
To the County Excise Board of said County and State, Greeting:-
Pursuant to the requirements of 68 O.S. 1991 Section 3002, we submit herewith for your consideration, the within
statement of the fiscal condition of the Emergency Medical Service Board, County of ROGER MILLS , State of Oklahoma,
for the fiscal year beginning July 1, 2015 and ending June 30, 2016, together with an itemized statement of the
estimated needs thereof for the fiscal year beginning July 1, 2016 and ending June 30, 2017. The same have been
prepared in conformity to Statute, in relation to which be it further noted that:
1. We, the members of the Emergency Medical Service Board of said County and State, do hereby certify that the
statements herein submitted show the true and correct conditions of the fiscal affairs of said Emergency Medical
Service Board for the fiscal year ending June 30, 2016, that said statements comprise a "full and accurate
statement of the assessments, receipts and expenditures of the preceding year, made out in detail under separate
heads" as required by 19 O.S. 1991 Section 345; that said preparation was had at an official session of said
Board, begun on the first Monday in July, 2016 pursuant to the provisions of 68 O.S. 1991 Section 3002.
2. And we further certify that the estimates of the several amounts necessary for current expenses for the fiscal
year beginning July 1, 2016 and ending June 30, 2017 as shown under "Schedule 8" were prepared and filed with the
Emergency Medical Service Board as of the first Monday in July 2016, that the same have been correctly entered, and
that all estimates made are entered as certified by Department Heads for the respective purposes herein set out.
We further certify that the sums requested for salaries are calculated and based upon authority of salary statutes
currently effective and applicable in this county.
3. We further certify that the estimated income from sources other than ad valorem tax, shown on "Schedule 4",
may reasonably be expected to be collected as a revenue during the ensuing fiscal year, and is not in excess
of the 90% of the amounts collected for the same sources during the fiscal year ending June 30, 2016.
Dated at the office of the County Clerk, at CHEYENNE, Oklahoma, this g' day of for¥
LeedeyEMERGENCY MEDICAL SERVICE BOARD
Chairman /?' j^/frT^ ^Q(/]A A.P/\ Member
Member .•Ul,aXu*JL Of^ Member
Member OfaL^TlA V\6^^
Clerk
%tk^ Mqjpr'fjuZ, gZ ^L£*
, 2016.
Filed this Wy day of forf, 2016 Secretary and Clerk of Excise Board, ROGER MILLS County, Oklahoma
S.A.&I. Form 268BR98 Entity: ROGER MILLS County EMS Dist., 065
r
AFFIDAVIT OF PUBLICATION
nc, ITT*?«_? P if*'')otn
STATE OF OKLAHOMA, COUNTY OF ROGER MILLS
Personally appeared before me, the undersigned Notary Pub
County Clerk of the County and State aforesaid, who being first duly swotn according to law, deposes and says:
That he/she complied with the law by having the financial statement for the fiscal year ending June 30, 2016,
and the estimated needs and the estimated income from sources other than ad valorem taxes, for the fiscal yea:
beginning July 1, 2016 and ending June 30, 2017 published in one issue of CHEYENNE STAR
a legally-qualified newspaper published - of general circulation, in said county (strike inapplicable phrase)
a copy of which together with proof of publication is herewith attached marked Exhibit "Z" and made a part
of hereof.
Subscribed and sworn to before me thisQ^J day o
xt-wNotary Public My Commission Expires
S.A.&I. Form 268BR98 Entity: ROGER MILLS County EMS Dist., 065
Page 2
, 2016.
f rcoifM.,%: I
PUBLISHER'S AFFIDAVIT
Cheyenne, Oklahoma October 6.2016
I, the undersigned of lawful age, being first
duly sworn on oath states that I am the
Publisher or Foreman of CHEYENNE STAR,
of Cheyenne, Oklahoma, a weekly newspa
per printed in the English language, print
ed, published and delivered to the United
States mails in Cheyenne, Roger Mills
County, Oklahoma, and having a bonafide
paid general subscription circulation there
in, and admitted to the United States mail
as second class matter. That the notice by
publication, a copy of which is hereto
attached, was published in the regular and
entire issue of said newspaper and not in
any supplement thereof for One (1) time
with the publication being on the 6th day
of October. 2016. That said newspaper has
been continuously and uninterruptedly
published in Roger Mills County during a
period of One Hundred and Four (104) con
secutive weeks immediately prior to the
first publication of the attached notice, and
said Cheyenne Star has a paid circulation in
said Roger Mills County and meets all re
quirements of law with reference to legal
publication.
That said newspaper comes within all the
prescriptions and requirements of Section
One, Chapter Four, Title 25, Oklahoma Ses
sion Laws, 1943, as amended by House Bill
No. 495, 22nd Legislature.a Legislature
;avu QaTT?/Juanita NewlUtJI'eblisher
Subscribed an
6th day ofGfctfibSfc 2016,
Melanie A. /Sjsp&igk No:Commission Nd^6e/^US0bSvw^g v.My Commission Ex^faj^J^fttf^O
\v v
PublicationFees $_ f^(h
Leedey "°»°" oaai tomes mum nuinno* raw*tvawttu. tnraon or m taaioa root roa m* rtteat. mi
roa tmj rucai. njm msiro tm J». hit, « ts>
irou (SORT. QtUUKKt
rax* it. mi, i» trrtmn at i
koum. nancs town or
exaszrscasx - omuwun mjjq
tan or nrttrrrat, cemnyerjuwn xnit, m
•»• °a imdaccljed JmpShr Hadleai Jorrlt. booed .( zoen kiu* ooaatr oblabiaa, do hanky certify tbat gtgaoatlas ol tbg Eaoiycagy Xadleal tgrtloa boardot tho raid County, bora gt tbg blagpco.ld.dty U» tot Cointl.. '—buncos to lb. pclginc of «» 0. I. Uil loo. S0«J, chg tarofolnt ctottaaot hi yoyo"' "Ait * trig tad'omncoodltlogot lb. rluaoial attain of gild twryooy aodlcal r.rrioo lotrd go rcUcttod by tho t.oordc of tbg aukgodTnocoru. Mg twtbor o.rtlfy thgt tbg fonsolaf utiogto for ggrcgst gxygogoo foe tho (legal yggybofltologJuly 1, Jtll. cadoadltr fa* l». «l». go Own org roaasagbty oggggggry (as tbg reap.' contact ot tho.attain oftbg eld (agrygggyHgditll (arcloa board, tbot tbg tattooed Idco-g to bg datlood toga aoaacaa otbar thoo gd .aloraatgggttagdoe nog axooad cbg lultu, gatbocled cello of tbg nmic dacltad(cog tbo ggao gotten dsrlay tbgpending tlctcj yggy.
,/iJ^t4r>Mi/Vojt/Cfctlrsmi of Bo%z4 Maator
•••*•« Mgcbg. I""
, »* SVuribodgad ohpto to batata go tbla "Siday ot ooyntt. loll.
VlU^
W
p*»
pn
Page 3
Honorable Emergency Medical Service Board (Leedey)ROGER MILLS County
We have compiled the 2015-16 financial statements and 2016-17 Estimate of Needs (S.A.&I. Form 268BR98) and 2016-17
Publication Sheet (S.A.&I. Form 268BR98, Exhibit "Z") included in the accompanying prescribed form in accordance
with Statements on Standards for Accounting and Review Services issued by the American Institute of Certified
Public Accountants. The financial statements and schedules have been prepared on a prescribed basis of accounting
that demonstrates compliance with the cash basis and the budget laws of the State of Oklahoma which is a basis of
accounting other than generally accepted accounting principles.
Our compilation was limited to presenting, in the form prescribed by the State Auditor and Inspector of Oklahoma,
information that is the representation of management. We have not audited or reviewed the accompanying financial
statements and schedules referred to above and, accordingly, do not express an opinion or any other form of
assurance on them.
These financial statements and schedules are presented in accordance with the requirements of the State of Oklahoma
are not intended to be a presentation in conformity with generally accepted accounting principles. This report is
intended soley for the information and use of the Emergency Medical Service Board of ROGER MILLS County and for
filing with the State Auditor and Inspector of Oklahoma and should not be used for any other purpose. Management
has elected to omit substantially all of the disclosures required by generally accepted accounting principles.
If the omitted disclosures were included in the financial statements and schedules, they might influence the user's
conclusions about the financial position and the results of operations. Accordingly, these financial statements and
schedules are not designed for those who are not informed about such differences.
P K AND COMPANY, PLLC
1
August 25, 2016
EXHIBIT "F"
EMERGENCY MEDICAL SERVICE FUND ACCOUNTS COVERING THE PERIOD JULY 1, 2015, to JUNE 30, 2016
ESTIMATE OF NEEDS FOR 2016-17PAGE 1
Schedule 1, Current Balance Sheet - June 30, 2016
Amount
ASSETS:
Cash Balance June 30, 2016 $ 147,538 08
Investments 0 00
TOTAL ASSETS $ 147,538 08
LIABILITIES AND RESERVES:
Warrants Outstanding 150 00
Reserve for Interest on Warrants 0 00
Reserves From Schedule 8 0 00
TOTAL LIABILITIES AND RESERVES $ 150 00
CASH FUND BALANCE JUNE 30, 2016 $ 147,388 08
TOTAL LIABILITIES, RESERVES AND CASH FUND BALANCE $ 147,538 08
Schedule 2, Revenue and Requirements - 2016-17
Detail Total
REVENUE:
Cash Balance June 30, 2015 $ 421,775 60
Cash Fund Balance Transferred From Prior Years 0 00
Current Ad Valorem Tax Apportioned 108,364 60
Miscellaneous Revenue Apportioned 26,971 88
TOTAL REVENUE $ 557,112 08
REQUIREMENTS:
Claims Paid by Warrants Issued $ 409,724 00
Reserves From Schedule 8 0 00
Interest Paid on Warrants 0 00
Reserve for Interest on Warrants 0 00
TOTAL REQUIREMENTS $ 409,724 00
ADD: CASH FUND BALANCE AS PER BALANCE SHEET 6-30-16 $ 147,388 08
TOTAL REQUIREMENTS AND CASH FUND BALANCE $ 557,112 08
Schedule 3, Cash Fund Balance Analysis - June 30, 2016 Amount
ADDITIONS:
Miscellaneous Revenue Collected in Excess of Estimates-Net $ 26,971 88
Warrants Estopped, Cancelled or Converted 0 00
Fiscal Year 2015-16 Lapsed Appropriations 109,571 46
Fiscal Year 2014-15 Lapsed Appropriations 0 00
Ad Valorem Tax Collections in Excess of Estimate 10,844 74
Prior Years Ad Valorem Tax 0 00
TOTAL ADDITIONS $ 147,388 08
DEDUCTIONS:
Supplemental Appropriations $ o 00
Current Tax in Process of Collection 0 00
TOTAL DEDUCTIONS $ o 00
Cash Fund Balance as per Balance Sheet 6-30-16 $ 147,388 08
Composition of Cash Fund Balance:
Cash 147,388 08
Cash Fund Balance as per Balance Sheet 6-30-16 $ 147,388 08
S.A.&I. Form 268BR98 Entity: ROGER MILLS County EMS Dist., 065
JULY 1, 2015, to JUNE 30, 2016EMERGENCY MEDICAL SERVICE FUND ACCOUNTS COVERING THE PERIOD
ESTIMATE OF NEEDS FOR 2016-17EXHIBIT "F" 2
Schedule 4, Miscellaneous Revenue
SOURCE
2015-16 ACCOUNT
AMOUNT ACTUALLY
ESTIMATED COLLECTED
1000 CHARGES FOR SERVICES:
1111 Service Fees, Ambulance Runs $ o 00 $ 20,419 60
1112 Service Fees 0 00 0 00
1113 Training Fees 0 00 0 00
1114 Other - 0 00 0 00
Total Charges For Services $ o 00 $ 20,419 60
INTERGOVERNMENTAL REVENUES:
2000 INTERGOVERNMENTAL REVENUES - LOCAL SOURCES:
2111 Local Contributions $ o 00 $ 4,220 00
2112 Local Governmental Reimbursements 0 00 0 00
2113 Local Payments in Lieu of Tax Revenue 0 00 0 00
2114 Other - 0 00 0 00
Total - Local Sources $ 0 00 $ 4,220 00
3000 INTERGOVERNMENTAL REVENUES - STATE SOURCES:
3111 County Sales Tax - OTC $ 0 00 $ 0 00
3112 Other - OTC 0 00 0 00
Sub-Total - OTC $ o 00 $ o 00
3211 State Grants 0 00 0 00
3212 State Payments in Lieu of Tax Revenue 0 00 0 00
