LIC 401: Monthly Operating Statement

Understanding CCLD Forms

The LIC 401 is a form the applicant completes, estimating its monthly expenses and revenues.  The document is used by CCLD to a) verify a facility's operating budget is reasonable, and b) as the basis for the facility to pledge three-months' assets necessary to carry the facility through its first three months of operation.  

if CARR has scanned LIC 401s for any individual facility, the document will be displayed as a document icon, identified as LIC 401.  

  • Food Budget: On this form, you can see how much the Licensee has estimated for food.  Take that monthly number, divide by the number of residents the facility is licensed for.  You now have the monthly food budget for 1 resident.   Divide that number by 3 to estimate the amount per meal the Licensee plans on spending on your resident.

  • Profit:  You can also evaluate the amount of profit the Licensee is projecting by looking at the last line on the LIC 401.

  • In 95% of the files, the only LIC 401 in the file is the one the Licensee submitted with his application.  Annual updates of the LIC 401 are not required, nor collected by CCL.   


In most cases, the figures provided by a facility are estimates (actuals are only available if the Licensee operates another facility prior to the opening of the current one under consideration).  

To view the form:

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