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FAR No. 5
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REPORT OF REVENUE AND OTHER RECEIPTS
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 Third Quarter, 2015
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 (In Pesos)
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Department
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DEPARTMENT OF HEALTH
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Agency
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TONDO MEDICAL CENTER
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Operating Unit
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Organization Code (UACS)
:13-001-14-00005
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CLASSIFICATION / SOURCES
OF REVENUE AND OTHER RECEIPTS		UACS CodeREVENUE TARGET (Annual)ACTUAL REVENUE AND OTHER RECEIPTS COLLECTIONS CUMULATIVE REMITTANCE /DEPOSITS TO DATEVARIANCERemarks
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1st Quarter2nd Quarter3rd Quarter4th QuarterTOTALRemittance to BTrDeposited with AGDBTotalAmount%
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12345678=(4+5+6+7)91011=(9+10)12=(8-3)13 = (12 / 3)14
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A. General Fund (formerly Fund 101)
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- Tax
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Documentary Stamp Tax
40104010 00
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- Non-Tax
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Permit Fees Import
40201010 01
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B. Special Account in the
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General Fund (formerly Fund 105, 183, 401, 151-159)
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- Tax
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- Non-Tax
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C. Off-Budget Accounts (formerly Fund 161 to 164, etc.)
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Hospital Fees
40202170-00 71,961,130.00 8,232,772.30 14,401,779.42 22,634,551.72 22,634,551.72 22,634,551.72 (49,326,578.28) (0.69)
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Sales Revenue
40202160-00 27,259,000.00 1,949,370.04 1,077,339.66 552,309.60 3,579,019.30 3,579,019.30 3,579,019.30 (23,679,980.70) (0.87)
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D. Custodial Funds (formerly Fund 101-184, 187)
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TOTAL
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Certified Correct:
Approved By:
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ZONDA RHEA C. APANAY, CPA,MPA
MARIA ISABELITA M. ESTRELLA MD,MHA, FPOGS
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Accountant III
Medical Center Chief II
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Date: October 26, 2015
Date:
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FAR No. 5
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INSTRUCTIONS
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1.
This Quarterly Report of Revenue and Other Receipts shall reflect the agency's/OUs actual revenue and other receipts collections from all sources remitted with the Bureau of the Treasury (BTr) and deposited in other Authorized Government Depository Bank (AGDB),
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for the budget year, broken down by quarter. This shall be submitted to DBM and COA not later than the 30th day following the end of the quarter.
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2.
Column 1 shall reflect the classification of revenue and other receipts as to tax or non-tax and should identify the specific source (Tax Income: e.g., Tax on Domestic Goods and Services, Tax on Net Profits, etc.; Non-tax Income: e.g. Permits and Licenses, Service
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Income, Business Income, etc) consistent with the Revised Chart of Accounts prescribed by COA.
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3.
Column 2 shall reflect the Unified Accounts Codes Structure (UACS) Code per COA-DBM-DOF Joint Circular No. 2013-1 dated 6 August 2013.
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4.
Columns 3 shall reflect the revenue targets for the year. This should be consistent with the amounts indicated in the Budget of Expenditures and Sources of Financing (BESF) tables for the budget year.
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5.
Columns 4 to 8 shall reflect the actual quarterly revenue and other receipts collections for the year covered by the report.
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6.
Columns 9 to 11 shall reflect the cumulative revenue and other receipts deposited by the agency with the BTr / AGDB as of date (from January 1 of the current year).
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7.
Columns 12 and 13 shall reflect the variance between the annual targeted collection and the actual revenue and other receipts collection as of the period covered by the report.
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8.
Column 14 shall reflect any additional information i.e., reasons for any variance between targeted and actual collections; new fees imposed; increase in fees and charges; or implementation of new programs.
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9.
This form shall be Certified Correct by the Chief Accountant/Head of Accounting Unit and approved by Head of Agency/Authorized Representative.
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