Exhibit 12 Sample Annual Financial Plan

Division of Aging Services

Fiscal Year:

2017 (July 1, 2016 - June 30, 2017)

Human Service Providers

Historical Usage*

Suggested Allocation

Adjustments **

NEW FY ALLOCATION

Comments

Totals

$0.00

$0.00

$0.00

$0.00

* Historical usage comes directly from previous fiscal years expenditures.

** Adjustments are requested changes to the suggested allocations and must net a zero total balance unless funds are being removed or added by Aging Services. Any amount other than

$0.00 in the adjustments column must be justified in the comments section.

Comments: