HomeMy WebLinkAbout32840Agreement No. 13-395-3
AMENDMENT Ill TO AGREEMENT 1
2
3
THIS AMENDMENT, hereinafter referred to as Amendment Ill, is made and entered into this
_.._.12...,,th..___ day of _ _,J..,.u.._.n..._e __ , 2018, by and between the COUNTY OF FRESNO, a political
4 subdivision of the State of California, hereinafter referred to as "COUNTY", and MENTAL HEALTH
5 SYSTEMS, INC., whose address is 9465 Farnham StrJet, San Diego, California, 92123, hereinafter
6 referred to as "CONTRACTOR" (collectively the "parties").
7 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement
8 No. 13-395, effective July 1, 2013, as amended by Amendment I, identified as County Agreement No.
9 13-395-1 effective September 16, 2014, as amended by Amendment 11, identified as County
10 Agreement No. 13-395-2 effective May 24, 2016, hereafter referred to collectively as the Agreement
11 whereby CONTRACTOR agreed to provide substance use disorder treatment services and mental
12 health services to adolescents incarcerated at County's Juvenile Justice Campus (JJC) and provide
13 intensive outpatient services to adolescents upon release from JJC and to adolescents referred to
14 outpatient treatment by Juvenile Drug Court; and
15 WHEREAS the parties desire to amend the Agreement, regarding changes as stated below and
16 restate the Agreement in its entirety.
17 NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
18 hereinafter set forth, the sufficiency of which is acknowledged, the parties agree as follows:
19 1. That existing COUNTY Agreement No. 13-395, Paragraph Two (2) "TERM", shall be
20 revised by adding the following at Page Three (3), Line Ten (10) after the word "term":
21 "This Agreement shall be extended for an additional four (4) month period beginning July 1,
22 2018 through October 31, 2018."
23 2. That the existing County Agreement No. 13-395, Paragraph Four (4), "COMPENSATION",
24 shall be revised by adding the following at Page Four (4), Line Eleven (11) after the word "herein":
25 "For claims submitted for services rendered under this Agreement, COUNTY agrees to pay
26 CONTRACTOR and CONTRACTOR agrees to receive compensation for Intensive Outpatient Adolescent
27 Drug Court Services, Post Release Outpatient Services and Substance Use Disorder and Mental Health
28 Services for Incarcerated Youth at the JJC Substance Abuse Unit (SAU) based on CONTRACTOR's
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actual cost for a maximum of Two Hundred Thirty Six Thousand Six Hundred Sixty-Eight and No/100
Dollars ($236,668.00) for the four (4) month period beginning July 1, 2018 and ending October 31, 2018,
as set forth in the four (4) month budgets attached hereto as Exhibit C-3a and Exhibit C-3b and by this
reference incorporated herein.”
3. That the existing County Agreement No. 13-395, Paragraph Four (4), “COMPENSATION”,
shall be revised by adding the following at Page Four (4), Line Seventeen (17) after the word “herein”:
“For claims submitted for services rendered under this Agreement, COUNTY agrees to pay
CONTRACTOR and CONTRACTOR agrees to receive compensation for Intensive Substance Use
Disorder and Mental Health Services for Incarcerated Youth at the JJC “New Horizons Program” based
on CONTRACTOR’s actual cost for a maximum of One Hundred Thousand and No/100 Dollars
($100,000.00) for the four (4) month period beginning July 1, 2018 and ending October 31, 2018, as set
forth in Exhibit C-4 attached hereto and incorporated herein by reference.
In no event shall the total compensation for actual services performed under this
Agreement be in excess of Five Million, Three Hundred Eighty-Six Thousand, Six Hundred Sixty-Eight
and No/100 Dollars ($5,386,668.00).”
4. That, effective July 1, 2018, all references in existing COUNTY Agreement No. 13-395 to
“Exhibit C-1 and Exhibit C-2,” shall be changed to read “Exhibit C-1, Exhibit C-2, Exhibit C-3a, Exhibit C-
3b, and Exhibit C-4”.
5. COUNTY and CONTRACTOR agree that this Amendment III is sufficient to amend the
Agreement, and that upon execution of this Amendment III, the Agreement, Amendment I, Amendment II
and Amendment III together shall be considered the Agreement.
The Agreement, as hereby amended, is ratified and continued. All provisions, terms, covenants,
considerations and promises contained in the Agreement and not amended herein remain in full force and
effect. This Amendment III shall become effective upon execution by all parties.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment Il l to Agreement
2 No. 13-395 as of the day and year first hereinabove written.
3
4 CONTRACTOR
5 MENTALHEALT~S ~/INC/ /
6 ~-. ~c~ ~~#r~
(Authorized Signature)
James C. Callaghan, Jr.
7
8 Print Name
9 President.& CEO
10 Title (Chairman of Board , or President, or
CEO)
(Auth~
-Sta c~ rY\oJ<o.
11
12
13
14
15
16
Print Name
CJ"\\ e .f T -, 0CLf\ Ci CL.\ o-Cfi c.-.t.r
Title (Secretary of Corporation, or Chief
Financial OfficerfTreasurer, or any
17 Assistant Secretary or Treasurer)
18
19
20
21
22
23
MAILING ADDRESS:
9465 Farnham Street
San Diego, CA 92123
24 FOR ACCOUNTING USE ONLY:
25 Organ ization :
Fund /Subclass:
26 AccounUProgram :
27
28
56302081
0001 /10000
7295/0
COUNTY OF FRESNO
s
s
ATTEST:
airperson of the Board of
e County of Fresno
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
By: ~~ ~~°'(1
Deputy
EXHIBIT C-3a
Mailing Address:
Street Address:
0.89 Phone Number:
6.20 Fax Number:
E-mail Address:
% of FTE
dedicated to
this program Admin.Direct Admin.Direct
0101 Susan Murdock, Program Manager 22,360$ 20%100%0%4,472.00$ -$ 4,472.00$ 0102 Josefina Ceja, Clinical Supervisor - LCSW (FF-SAU)25,695 20%100%0%5,139.00 - 5,139.00 0103 Candida Rojas, Administrative Assistant 11,093 35%100%0%3,883.00 - 3,883.00 0104 Kathryn Wilbur, Vice President 34,667 7%100%0%2,427.00 - 2,427.00 0105 Agustin Ochoa, Program Analyst 21,667 7%100%0%1,517.00 - 1,517.00 0106 Vidal Bejarano, Lead AOD Certified Counselor - Boys 13,867 100%0%100%- 13,867.00 13,867.00 0107 Kimberlynn Silva & Marina Herrera, AOD Counselors 11,093 200%0%100%- 22,187.00 22,187.00 0108 Cynthia Williams, Family Support Partner 9,707 50%0%100%- 4,853.00 4,853.00 0109 Marty Castanon, AOD Certified Counselor 13,173 100%0%100%- 13,173.00 13,173.00 0110 TBD, Program Supervisor / Lead AOD Certified Counselor 14,560 50%0%100%- 7,280.00 7,280.00 0111 Ciera Nelson, AOD Certified Counselor 12,133 100%0%100%- 12,133.00 12,133.00 0112 Alisha Lamp, AOD Certified Counselor 10,573 20%0%100%- 2,115.00 2,115.00
SALARIES TOTAL 200,588.27$ 17,438$ 75,608$ 93,046$
Rate 18.74%81.26%100.00%
0151 F.I.C.A. Social Security and Medicare SS 6.2 % rate applied to $127.2k of gross earnings per employee 7.650%1,334$ 5,784$ 7,118$
0152 Federal Unemployment (FUTA)Rate applied to only first $7k of gross earnings per employee 0.000%-$ -$ -$
0153 State Employment Training Tax (ETT)Rate applied to only first $7k of gross earnings per employee 0.000%-$ -$ -$ 0154 State Unemployment Insurance (UI)Rate applied to only first $7k of gross earnings per employee 0.700%122$ 529$ 651$
PAYROLL TAXES TOTAL 1,456$ 6,313$ 7,769$
EMPLOYEE BENEFITS Rate 18.74%81.26%100.00%
0201 Health Insurance 8.98%1,565$ 6,786$ 8,351$
0202 Life Insurance -$ -$ -$
0203 Retirement 8.00%1,395$ 6,049$ 7,444$
0204 Workers' Compensation Insurance 174$ 756$ 930$ 0205 Benefits Other - Specify -$
EMPLOYEE BENEFITS TOTAL 3,134$ 13,591$ 16,725$
PERSONNEL/SALARIES
Line Item Description to services
PAYROLL TAXES
No. of Budgeted FTEs - Admin:(858) 573-2600
No. of Budgeted FTEs - Direct:(858) 573-2914
Total Proposed
Budget(Must be Itemized)
dheld@mhsinc.org
Budget Categories-% Time dedicated Proposed Program BudgetOne Fourth of
Annual Salary
Program Name:Fresno Juvenile Treatment (FF-SAU
Approved by:Dominic Held, Finance Manager 3333 E American Avenue, Fresno CA
Substance Abuse Unit - Substance Use Disorder Services
Projected Budget - Fiscal Year 2018-19
Provider Name:Mental Health Systems, Inc.
, g
92123
EXHIBIT C-3a
TAXES & BENEFITS TOTAL 0.000%24,494$
TOTAL DIRECT (ADMIN) SALARIES, PAYROLL TAXES, AND EMPLOYEE BENEFITS 117,540$
TOTAL PERCENT OF BENEFITS TO SALARIES 26.3%
Services and Supplies
0252 957$
0253 -$
957$
0301 3,990$
0302 -$
3,990$
0351 1,001$
0352 -$
0353 33$
0354 -$
0355 -$
1,034$
0401 128$
0402 2,088$
0403 902$
3,118$
FACILITIES
0451 4,600$
0452 1,623$
0453 600$
6,823$
0501 235$
0502 262$
0503 847$
0504 543$
1,886$
0551 -$
FACILITIES TOTAL
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Utilities
Printing/Reproduction
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment (Computers/Furniture/VOIP Phone)
Equipment Rent/Lease (Copy Machines)
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Soc Rec., Workbooks
INSURANCE
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
EXHIBIT C-3a
0552 80$
0553 700$
780$
0601 -$
0602 2,200$
2,200$
0651 -$
0652 -$
-$
0701 Indirect Costs 20,684$
0702 Licenses/Taxes 3,473$
0703 -$
0749 848$
25,006$
-$
163,334$
3120 23,333$
3130 3,333$
3140 Private Donations -$
3150 -$
3160 -$
26,667$
136,668$
Insurance
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
ONE TIME ADVANCE - Start Up Costs
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Drug Medi-Cal
State Grant
Client Fees
OTHER COSTS TOTAL
CONSULTANCY
Consultant Services (Interpretive Services)
Contracted Services (Recruitment)
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping (IT Support)
External Audit
FISCAL AND AUDITS TOTAL
OTHER COSTS
County Administration Fee
Other Business Services
PROGRAM SUPPLIES TOTAL
Program Supplies-Curriculum
Program Supplies-Food
EXHIBIT C-3a
Provider Name:
4,472$ 20%
5,139 20%
3,883 35%
2,427 7%
1,517 7%
13,867 100%
22,187 200%
4,853 50%
13,173 100%
7,280 50%
12,133 100%
2,115 20%
93,046$
List Amount
PAYROLL TAXES $ 7,769
EMPLOYEE BENEFITS
TOTAL $ 16,725
930$
957$
-$
3,990$
-$
1,001$
-$
33$
-$
-$
128$
2,088$
902$
4,600$
1,623$
600$
EQUIPMENT List the following equipment categories and provide a brief description for each
0401 - Purchase of Equipment - One-time costs for certain needs, i.e.,
0402 - Equipment Rent/Lease- Cost for lease of copy machine.
0403-Equipment Maintenance: minor equipment repair for copier and vehicle
FACILITIES List the following facilities categories and provide a brief description for each
0451 - Rent/Lease Building - Costs projected include a portion of the building
0452 - Facilities Maintenance - Cost for a portion of the custodial/janitorial
0453 - Utilities - Costs projected include a portion of the utilities cost to
COMMUNICATIONS 0301 - Telecommunications/data lines - Costs projected to include a portion of
0302 - Answering Service - N/A
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily activities
0352 - Social/Rec, Workbooks.- N/A
0353-Printing/Reproduction includes items such as the printing of business
0354 - Publications - N/A
0355 - Legal Notices/Advertising - N/A
TBD, Program Supervisor / Lead AOD Certified Counselor
Ciera Nelson, AOD Certified Counselor
Alisha Lamp, AOD Certified Counselor
Position descriptions submitted with proposal.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance- Professional Liability and Malpractice Insurances
0253 - Insurance Other - N/A
Marty Castanon, AOD Certified Counselor
Budget Categories-Line Item Description One Fourth of
Annual Salary
% of FTE
dedicated to this
program
Susan Murdock, Program Manager
Josefina Ceja, Clinical Supervisor - LCSW (FF-SAU)
Candida Rojas, Administrative Assistant
Kathryn Wilbur, Vice President
Agustin Ochoa, Program Analyst
Vidal Bejarano, Lead AOD Certified Counselor - Boys
Kimberlynn Silva & Marina Herrera, AOD Counselors
Cynthia Williams, Family Support Partner
Annual Salary and FTE equivalence as in budget.
TYPE OF SERVICE
Projected Budget - Fiscal Year 2018-19 Narrative
Mental Health Systems, Inc.
PERSONNEL / SALARIES
EXHIBIT C-3a
235$
262$
847$
543$
-$
80$
700$
-$
2,200$
-$
-$
20,684$
3,473$
-$
848$
23,333$
3,333$
-$
-$
-$
-$
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification.
The amount cannot exceed 1/12th of the total cost proposal for this section.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue
3120 - Drug Medi-Cal, Contract no. 16-360
3140 - Private Donations -
3150 - Client Fees -
3160 - Insurance -
3130 - State Grant - Youth Treatment, contract no. 13-574
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - N/A
0652 - External Audit - Independent CPA Audit - Cost for annual audit to
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - 14.5% of total Salary and Benefits cost to allow for
0702 - Licenses/Taxes -N/A
0703 - County Administration Fee -N/A
0749-Other Costs - Other business services such as applicant TB tests, drug
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services: Allows program staff to reach an interpreter to
0602 - Contracted Services: Costs related to recruiting of staff and verification
TRAVEL List the following travel categories and provide a brief description for each category:
0501 - Staff Mileage - Cost for mileage reimbursement for staff who may
0502 - Staff Travel (Out of County) - Cost for mileage reimbursement for staff
0503 - Staff Training/Registration - Cost for staff to attend trainings relevant
0504 - Transportation - To purchase bus passes and tokens to allow
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for
0551 - Program Supplies - Client Incentives: To provide incentives for
0552 - Program Supplies - Curriculum: N/A
0553 - Program Supplies - Food: N/A
EXHIBIT C-3b
Mailing Address:
Street Address:
1.14 Phone Number:
3.00 Fax Number:
E-mail Address:
% of FTE
dedicated to
this program Admin.Direct Admin.Direct
0101 Susan Murdock, Program Manager 20,973$ 40%100%0%8,389.00$ -$ 8,389.00$ 0102 Josefina Ceja, Clinical Supervisor - LCSW 25,695 40%100%0%10,278.00 - 10,278.00 0103 Candida Rojas, Administrative Assistant 10,400 20%100%0%2,080.00 - 2,080.00 0104 Kathryn Wilbur, Vice President 34,667 7%100%0%2,427.00 - 2,427.00 0105 Agustin Ochoa, Program Analyst 21,667 7%100%0%1,517.00 - 1,517.00 0106 - - - 0107 Tammie Makely, Unlicensed Mental Health Clinician- Girls 13,867 100%0%100%- 13,867.00 13,867.00 0108 14,560 100%0%100%- 14,560.00 14,560.00 0109 13,173 100%0%100%- 13,173.00 13,173.00 0110 - - - 0111 - - - 0112 - - -
SALARIES TOTAL $155,002 24,691$ 41,600$ 66,291$
Rate 37.25%62.75%100.00%
0151 F.I.C.A. Social Security and Medicare SS 6.2 % rate applied to $127.2k of gross earnings per employee 7.650%1,889$ 3,182$ 5,071$
0152 Federal Unemployment (FUTA)Rate applied to only first $7k of gross earnings per employee 0.000%-$ -$ -$
0153 State Employment Training Tax (ETT)Rate applied to only first $7k of gross earnings per employee 0.000%-$ -$ -$ 0154 State Unemployment Insurance (UI)Rate applied to only first $7k of gross earnings per employee 0.400%99$ 166$ 265$
PAYROLL TAXES TOTAL 1,988$ 3,348$ 5,336$
EMPLOYEE BENEFITS Rate 37.25%62.75%100.00%
0201 Health Insurance 6.27%1,547$ 2,607$ 4,154$
0202 Life Insurance -$ -$ -$
0203 Retirement 8.00%1,975$ 3,328$ 5,303$
0204 Workers' Compensation Insurance 247$ 416$ 663$ 0205 Benefits Other - Specify -$
EMPLOYEE BENEFITS TOTAL 3,769$ 6,351$ 10,120$
Substance Abuse Unit - Mental Health Services
Projected Budget - Fiscal Year 2018-19
Provider Name:Mental Health Systems, Inc.
, g
92123
Program Name:SAMHSA MHBG
Approved by:Dominic Held, Finance Manager 3333 E American Avenue, Fresno CA
No. of Budgeted FTEs - Admin:(858) 573-2600
No. of Budgeted FTEs - Direct:(858) 573-2914
dheld@mhsinc.org
Budget Categories-% Time dedicated Proposed Program Budget
Line Item Description to services Total Proposed
Budget(Must be Itemized)
PERSONNEL/SALARIES
Sandra Rentfrow, Unlicensed Mental Health Clinician- Boys
Lindsay Fisher, Unlicensed Mental Health Clinician- Boys
PAYROLL TAXES
One Fourth of
Annual Salary
EXHIBIT C-3b
TAXES & BENEFITS TOTAL 0.000%15,457$
TOTAL DIRECT (ADMIN) SALARIES, PAYROLL TAXES, AND EMPLOYEE BENEFITS 81,748$
TOTAL PERCENT OF BENEFITS TO SALARIES 23.3%
Services and Supplies
0252 390$
0253 -$
390$
0301 48$
0302 -$
48$
0351 513$
0352 -$
0353 17$
0354 -$
0355 -$
530$
0401 60$
0402 -$
0403 200$
260$
FACILITIES
0451 -$
0452 -$
0453 -$
-$
0501 214$
0502 -$
0503 287$
0504 -$
501$
0551 -$
Soc Rec., Workbooks
INSURANCE
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Utilities
Printing/Reproduction
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment (Computers/Furniture/VOIP Phone)
Equipment Rent/Lease (Copy Machines)
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Program Supplies-Client Incentives
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
PROGRAM SUPPLIES
FACILITIES TOTAL
TRAVEL COSTS
Staff Mileage
EXHIBIT C-3b
0552 200$
0553 250$
450$
0601 1,200$
0602 -$
1,200$
0651 -$
0652 -$
-$
0701 Indirect Costs 12,664$
0702 Licenses/Taxes 1,776$
0703 -$
0749 434$
14,874$
-$
100,000$
3120 -$
3130 -$
3140 Private Donations -$
3150 -$
3160 -$
-$
100,000$
FISCAL AND AUDITS TOTAL
Program Supplies-Curriculum
Program Supplies-Food
Accounting/Bookkeeping (IT Support)
External Audit
OTHER COSTS
County Administration Fee
Insurance
REVENUE/MATCH TOTAL
OTHER COSTS TOTAL
CONSULTANCY
Consultant Services (Interpretive Services)
Contracted Services (Recruitment)
CONSULTANCY TOTAL
FISCAL AND AUDITS
Other Business Services
PROGRAM SUPPLIES TOTAL
NET PROGRAM BUDGET
ONE TIME ADVANCE - Start Up Costs
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Drug Medi-Cal
State Grant
Client Fees
EXHIBIT C-3b
Provider Name:
8,389$ 40%
10,278.0 40%
2,080.0 20%
2,427.0 7%
1,517.0 7%
13,867.0 100%
14,560.0 100%
13,173.0 100%
Total 66,291.00$
List Amount
PAYROLL TAXES $ 5,336
$ 10,120
663$
390$
-$
48$
-$
513$
-$
17$
-$
-$
60$
-$
200$
-$
-$
-$
Annual Salary and FTE equivalence as in budget.
TYPE OF SERVICE
Projected Budget - Fiscal Year 2018-19 Narrative
Mental Health Systems, Inc.
PERSONNEL / SALARIES
Lindsay Fisher, Unlicensed Mental Health Clinician- Boys
Budget Categories-Line Item Description One Fourth of
Annual Salary
% of FTE
dedicated to this
program
Susan Murdock, Program Manager
Josefina Ceja, Clinical Supervisor - LCSW
Candida Rojas, Administrative Assistant
Kathryn Wilbur, Vice President
Agustin Ochoa, Program Analyst
Tammie Makely, Unlicensed Mental Health Clinician- Girls
Sandra Rentfrow, Unlicensed Mental Health Clinician- Boys
Position descriptions submitted with proposal.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance- Professional Liability and Malpractice Insurances
0253 - Insurance Other - N/A
EMPLOYEE BENEFITS TOTAL
COMMUNICATIONS 0301 - Telecommunications/data lines - Costs projected to include a portion of
0302 - Answering Service - N/A
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily activities
0352 - Social/Rec, Workbooks.- N/A
0353-Printing/Reproduction includes items such as the printing of business
0354 - Publications - N/A
0355 - Legal Notices/Advertising - N/A
FACILITIES List the following facilities categories and provide a brief description for each
0451 - Rent/Lease Building - Costs projected include a portion of the building
0452 - Facilities Maintenance - Cost for a portion of the custodial/janitorial
0453 - Utilities - Costs projected include a portion of the utilities cost to
EQUIPMENT List the following equipment categories and provide a brief description for each
0401 - Purchase of Equipment - One-time costs for certain needs, i.e.,
0402 - Equipment Rent/Lease- Cost for lease of copy machine.
0403-Equipment Maintenance: minor equipment repair for copier and vehicle
EXHIBIT C-3b
214$
-$
287$
-$
-$
200$
250$
1,200$
-$
-$
-$
12,664$
1,776$
-$
434$
-$
3130 - State Grant - -$
-$
-$
-$
-$
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services: Allows program staff to reach an interpreter to
0602 - Contracted Services: Costs related to recruiting of staff and verification
TRAVEL List the following travel categories and provide a brief description for each category:
0501 - Staff Mileage - Cost for mileage reimbursement for staff who may
0502 - Staff Travel (Out of County) - Cost for mileage reimbursement for staff
0503 - Staff Training/Registration - Cost for staff to attend trainings relevant
0504 - Transportation - To purchase bus passes and tokens to allow
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for
0551 - Program Supplies - Client Incentives: To provide incentives for
0552 - Program Supplies - Curriculum: N/A
0553 - Program Supplies - Food: N/A
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - N/A
0652 - External Audit - Independent CPA Audit - Cost for annual audit to
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - 14.5% of total Salary and Benefits cost to allow for
0702 - Licenses/Taxes -N/A
0703 - County Administration Fee -N/A
0749-Other Costs - Other business services such as applicant TB tests, drug
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification.
The amount cannot exceed 1/12th of the total cost proposal for this section.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue
3120 - Drug Medi-Cal -
3140 - Private Donations -
3150 - Client Fees -
3160 - Insurance -
EXHIBIT C-4
Mailing Address:
Street Address:
1.04 Phone Number:
3.33 Fax Number:
E-mail Address:
% of FTE
dedicated to
this program Admin.Direct Admin.Direct
0101 Susan Murdock, Program Manager 20,973$ 30%100%0%6,292.00$ -$ 6,292.00$ 0102 Josefina Ceja, Clinical Supervisor - LCSW 25,695 40%100%0%10,278.00 - 10,278.00 0103 Candida Rojas, Administrative Assistant 10,400 20%100%0%2,080.00 - 2,080.00 0104 Kathryn Wilbur, Vice President 34,667 7%100%0%2,427.00 - 2,427.00 0105 Agustin Ochoa, Program Analyst 21,667 7%100%0%1,517.00 - 1,517.00 0106 - - - 0107 Jason Franklin, Therapist, Lic elig, MA level 13,867 100%0%100%- 13,867.00 13,867.00 0108 13,867 83%0%100%- 11,556.00 11,556.00 0109 10,053 100%0%100%- 10,053.00 10,053.00 0110 9,013 50%0%100%- 4,507.00 4,507.00 0111 - - - 0112 - - -
SALARIES TOTAL 160,202$ 22,594$ 39,983$ 62,577$
Rate 36.11%63.89%100.00%
0151 F.I.C.A. Social Security and Medicare SS 6.2 % rate applied to $127.2k of gross earnings per employee 7.650%1,728$ 3,059$ 4,787$
0152 Federal Unemployment (FUTA)Rate applied to only first $7k of gross earnings per employee 0.000%-$ -$ -$
0153 State Employment Training Tax (ETT)Rate applied to only first $7k of gross earnings per employee 0.000%-$ -$ -$ 0154 State Unemployment Insurance (UI)Rate applied to only first $7k of gross earnings per employee 0.650%147$ 260$ 407$
PAYROLL TAXES TOTAL 1,875$ 3,319$ 5,194$
EMPLOYEE BENEFITS Rate 36.11%63.89%100.00%
0201 Health Insurance 6.60%1,491$ 2,638$ 4,129$
0202 Life Insurance -$ -$ -$
0203 Retirement 8.00%1,807$ 3,199$ 5,006$
0204 Workers' Compensation Insurance 226$ 400$ 626$ 0205 Benefits Other - Specify -$
EMPLOYEE BENEFITS TOTAL 3,524$ 6,237$ 9,761$
Peter Flores, AOD Cerified Counselor
Cynthia Williams, Family Support Partner
PAYROLL TAXES
(858) 573-2600
No. of Budgeted FTEs - Direct:(858) 573-2914
dheld@mhsinc.org
Budget Categories-% Time dedicated Proposed Program Budget
Line Item Description to services Total Proposed
Budget(Must be Itemized)
PERSONNEL/SALARIES
TBD (currently, Chris Esqueda), Therapist, Lic elig, MA level
One Fourth of
Annual Salary
New Horizons Program
Projected Budget - Fiscal Year 2018-19
Provider Name:Mental Health Systems, Inc.
, g
92123
Program Name:New Horizons
Approved by:Dominic Held, Finance Manager 3333 E American Avenue, Fresno CA
No. of Budgeted FTEs - Admin:
EXHIBIT C-4
TAXES & BENEFITS TOTAL 0.000%14,954$
TOTAL DIRECT (ADMIN) SALARIES, PAYROLL TAXES, AND EMPLOYEE BENEFITS 77,531$
TOTAL PERCENT OF BENEFITS TO SALARIES 23.9%
Services and Supplies
0252 760$
0253 -$
760$
0301 456$
0302 -$
456$
0351 883$
0352 -$
0353 33$
0354 -$
0355 -$
917$
0401 213$
0402 800$
0403 424$
1,437$
FACILITIES
0451 -$
0452 -$
0453 -$
-$
0501 535$
0502 178$
0503 348$
0504 321$
1,382$
0551 -$
FACILITIES TOTAL
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Utilities
Printing/Reproduction
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment (Computers/Furniture/VOIP Phone)
Equipment Rent/Lease (Copy Machines)
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Soc Rec., Workbooks
INSURANCE
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
EXHIBIT C-4
0552 67$
0553 1,000$
1,067$
0601 1,650$
0602 -$
1,650$
0651 -$
0652 -$
-$
0701 Indirect Costs 12,664$
0702 Licenses/Taxes 1,607$
0703 -$
0749 530$
14,800$
-$
100,000$
3120 -$
3130 -$
3140 Private Donations -$
3150 -$
3160 -$
-$
100,000$
Insurance
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
ONE TIME ADVANCE - Start Up Costs
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Drug Medi-Cal
State Grant
Client Fees
OTHER COSTS TOTAL
CONSULTANCY
Consultant Services (Interpretive Services)
Contracted Services (Recruitment)
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping (IT Support)
External Audit
FISCAL AND AUDITS TOTAL
OTHER COSTS
County Administration Fee
Other Business Services
PROGRAM SUPPLIES TOTAL
Program Supplies-Curriculum
Program Supplies-Food
EXHIBIT C-4
Provider Name:
6,292$ 30%
10,278$ 40%
2,080$ 20%
2,427$ 7%
1,517$ 7%
13,867$ 100%
11,556$ 83%
10,053$ 100%
4,507$ 50%
Total 62,577$
List Amount
PAYROLL TAXES $ 5,194
EMPLOYEE BENEFITS
TOTAL $ 9,761
626$
760$
-$
456$
-$
883$
-$
33$
-$
-$
213$
800$
424$
-$
-$
-$
EQUIPMENT List the following equipment categories and provide a brief description for each
0401 - Purchase of Equipment - One-time costs for certain needs, i.e.,
0402 - Equipment Rent/Lease- Cost for lease of copy machine.
0403-Equipment Maintenance: minor equipment repair for copier and vehicle
FACILITIES List the following facilities categories and provide a brief description for each
0451 - Rent/Lease Building - Costs projected include a portion of the building
0452 - Facilities Maintenance - Cost for a portion of the custodial/janitorial
0453 - Utilities - Costs projected include a portion of the utilities cost to
COMMUNICATIONS 0301 - Telecommunications/data lines - Costs projected to include a portion of
0302 - Answering Service - N/A
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily activities
0352 - Social/Rec, Workbooks.- N/A
0353-Printing/Reproduction includes items such as the printing of business
0354 - Publications - N/A
0355 - Legal Notices/Advertising - N/A
Cynthia Williams, Family Support Partner
Position descriptions submitted with proposal.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance- Professional Liability and Malpractice Insurances
0253 - Insurance Other - N/A
Peter Flores, AOD Cerified Counselor
Budget Categories-Line Item Description One Fourth of
Annual Salary
% of FTE
dedicated to this
program
Susan Murdock, Program Manager
Josefina Ceja, Clinical Supervisor - LCSW
Candida Rojas, Administrative Assistant
Kathryn Wilbur, Vice President
Agustin Ochoa, Program Analyst
Jason Franklin, Therapist, Lic elig, MA level
TBD (currently, Chris Esqueda), Therapist, Lic elig, MA level
Annual Salary and FTE equivalence as in budget.
TYPE OF SERVICE
Projected Budget - Fiscal Year 2018-19 Narrative
Mental Health Systems, Inc.
PERSONNEL / SALARIES
EXHIBIT C-4
535$
178$
348$
321$
-$
67$
1,000$
1,650$
-$
-$
-$
12,664$
1,607$
-$
530$
-$
3130 - State Grant - -$
-$
-$
-$
-$
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification.
The amount cannot exceed 1/12th of the total cost proposal for this section.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue
3120 - Drug Medi-Cal -
3140 - Private Donations -
3150 - Client Fees -
3160 - Insurance -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - N/A
0652 - External Audit - Independent CPA Audit - Cost for annual audit to
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - 14.5% of total Salary and Benefits cost to allow for
0702 - Licenses/Taxes -N/A
0703 - County Administration Fee -N/A
0749-Other Costs - Other business services such as applicant TB tests, drug
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services: Allows program staff to reach an interpreter to
0602 - Contracted Services: Costs related to recruiting of staff and verification
TRAVEL List the following travel categories and provide a brief description for each category:
0501 - Staff Mileage - Cost for mileage reimbursement for staff who may
0502 - Staff Travel (Out of County) - Cost for mileage reimbursement for staff
0503 - Staff Training/Registration - Cost for staff to attend trainings relevant
0504 - Transportation - To purchase bus passes and tokens to allow
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for
0551 - Program Supplies - Client Incentives: To provide incentives for
0552 - Program Supplies - Curriculum: N/A
0553 - Program Supplies - Food: N/A