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HomeMy WebLinkAbout328551 2 Agreement No. 15-317-1 AMENDMENT I TO AGREEMENT THIS AMENDMENT, hereinafter referred to as "Amendment I", is made and entered into 3 this 1.01b. day of ,July , 2018, by and between the COUNTY OF FRESNO, a Political Subdivision of 4 the State of California, hereinafter referred to as "COUNTY", and KINGS VIEW BEHAVIORAL 5 HEALTH, whose address is 7170 North Financial Drive, Suite 110, Fresno, California, 93720, 6 hereinafter referred to as "CONTRACTOR" (collectively as the "parties"). 7 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement 8 No. 15-317, effective July 1, 2015, whereby CONTRACTOR agreed to provide Rural Mental Health 9 Triage Services (Rural Triage Services) in East and West rural Fresno County cities; and 1 O WHEREAS, CONTRACTOR has requested greater access to the COUNTY's Department of 11 Behavioral Health (DBH) electronic health record system (Avatar); and 12 WHEREAS, COUNTY, through DBH, is willing to provide CONTRACTOR with greater access 13 to its electronic health record system; and 14 WHEREAS, the parties desire to amend COUNTY Agreement No. 15-317, regarding changes 15 as stated below and restate the Agreement in its entirety. 16 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which 1 7 is hereby acknowledged, the parties agree to amend the Agreement as follows: 18 1. That the following shall be inserted into COUNTY Agreement No. 15-317 Section One 19 (1), at Page Two (2), Line Twenty-Five (25), as subsection "H".: 20 21 22 23 24 25 26 27 28 "H. CONTRACTOR may maintain its records in COUNTY's Electronic Health Record (EHR) system, Avatar, in accordance with Exhibit E, "Documentation Standards for Client Records," as licenses become available. The client record shall begin with registration and intake and include client authorizations, assessments, plans of care, and progress notes, as well as other documents as approved by the COUNTY's DBH. COUNTY shall be allowed to review records of services provided, including the goals and objectives of the treatment plan, and how the therapy provided is achieving the goals and objectives. If at any time CONTRACTOR chooses to no longer maintain its records in Avatar, it shall provide COUNTY'S DBH Director, or his or her designee, with thirty (30) days advance written notice and CONTRACTOR will be responsible for obtaining its own -1 -COUNTY OF FRESNO Fresno, CA COUNTY OF FRESNO Fresno, CA -2 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 system, at its own cost, for electronic health records management. Disclaimer COUNTY makes no warranty or representation that information entered into the COUNTY’s EHR system by CONTRACTOR will be accurate, adequate or satisfactory for CONTRACTOR’s own purposes or that any information in CONTRACTOR’s possession or control, or transmitted or received by CONTRACTOR, is or will be secure from unauthorized access, viewing, use, disclosure, or breach. CONTRACTOR is solely responsible for client information entered by CONTRACTOR into the COUNTY’s EHR system. CONTRACTOR agrees that all Private Health Information (PHI) maintained by CONTRACTOR in COUNTY’s EHR system will be maintained in conformance with all HIPAA laws, as stated in Section Nineteen (19), “Health Insurance Portability and Accountability Act.” 2.That the existing COUNTY Agreement No. 15-317, as set forth in the original Agreement ending on Page Three (3), Line Two (2) shall be revised by adding the following after the number “2018”: “This Agreement shall be extended effective on the 1st day of July, 2018 and shall terminate on the 30th June, 2020.” 3.That the existing COUNTY Agreement No. 15-317 Section Four (4), Page Four (4), beginning with Line Six (6), with the word “The” and ending on Page Six (6), Line Twenty-Six (26) with the number “($0.00)” be deleted and the following inserted in its place: “The maximum compensation amount under this Agreement for Mental Health Triage services in East Fresno County and West Fresno County combined for the period July 14, 2015, through June 30, 2020, shall not exceed Twelve Million, One Hundred Eighty-One Thousand, Six Hundred Thirty-Nine and No/100 Dollars ($12,181,639.00). East Fresno County The maximum compensation amount under this Agreement for East Fresno County Triage Services for the period July 14, 2015, through June 30, 2020, for all funding and revenue streams collectively shall not exceed Six Million, Seven Hundred Two Thousand, Two Hundred Four and No/100 Dollars ($6,702,204.00). COUNTY OF FRESNO Fresno, CA -3 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 The maximum compensation amount under this Agreement for East Fresno County Triage Services for the period of July 14, 2015, through June 30, 2016, shall not exceed One Million, Three Hundred Thousand, Four Hundred Thirty-One and No/100 Dollars ($1,300,431.00). The maximum amount of SB 82 funding under this Agreement shall not exceed Eight Hundred, Forty-Nine Thousand, Six Hundred Fifty-Three and No/100 Dollars ($849,653.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate Four Hundred Fifty Thousand, Seven Hundred Seventy-Eight and No/100 Dollars ($450,778.00) in Medi-Cal Federal Financial Participation (FFP) to offset CONTRACTOR’s program costs. The maximum compensation amount under this Agreement for East Fresno County Triage Services for the period of July 1, 2016, through June 30, 2017, shall not exceed One Million, Two Hundred Eighty-Eight Thousand, One Hundred Twenty-Four and No/100 Dollars ($1,288,124.00). The maximum amount of SB 82 funding under this Agreement shall not exceed Eight Hundred Forty-Two Thousand, One Hundred Twenty-Two and No/100 Dollars ($842,122.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate Four Hundred Forty-Six Thousand, Two and No/100 Dollars ($446,002.00) in Medi-Cal FFP to offset CONTRACTOR’s program costs. The maximum compensation amount under this Agreement for East Fresno County Triage Services for the period of July 1, 2017, through June 30, 2018, shall not exceed One Million, Three Hundred Twenty-Seven Thousand, Three Hundred Twenty-Two and No/100 Dollars ($1,327,322.00). The maximum amount of SB 82 funding under this Agreement shall not exceed Eight Hundred Sixty-Seven Thousand, One Hundred Sixty-Eight and No/100 Dollars ($867,168.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate Four Hundred Sixty Thousand, One Hundred Fifty-Four and No/100 Dollars ($460,154.00) in Medi-Cal FFP to offset CONTRACTOR’s program costs. The maximum compensation amount under this Agreement for East Fresno County Triage Services for the period of July 1, 2018, through June 30, 2019, shall not exceed One Million, Three Hundred Seventy-Five Thousand, Nine Hundred Fifty-Two and No/100 Dollars ($1,375,952.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR COUNTY OF FRESNO Fresno, CA -4 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 estimates to generate Three Hundred Thousand, Three Hundred Sixty and No/100 Dollars ($300,360.00) in Medi-Cal FFP to offset CONTRACTOR’s program costs. The maximum compensation amount under this Agreement for East Fresno County Triage Services for the period of July 1, 2019, through June 30, 2020, shall not exceed One Million, Four Hundred Ten Thousand, Three Hundred Seventy-Five and No/100 Dollars ($1,410,375.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate Three Hundred Thousand, Three Hundred Sixty and No/100 Dollars ($300,360.00) in Medi- Cal FFP to offset CONTRACTOR’s program costs. West Fresno County The maximum compensation amount under this Agreement for West Fresno County Triage Services for the period October 1, 2015, through June 30, 2020, shall not exceed Five Million, Four Hundred Seventy-Nine Thousand, Four Hundred Thirty-Five and No/100 Dollars ($5,479,435.00). The maximum compensation amount under this Agreement for West Fresno County Triage Services for the period of October 1, 2015, through June 30, 2016, shall not exceed Nine Hundred Eight Thousand, Four Hundred Twenty and No/100 Dollars ($908,420.00). The maximum amount of Public Safety Realignment funding under this Agreement in this term shall not exceed Three Hundred Fifty Thousand and No/100 Dollars ($350,000.00). The maximum amount of Mental Health Services Act (MHSA) funding under this Agreement in this term shall not exceed One Hundred Ninety-Eight Thousand, Four Hundred Fifty-Three and No/100 Dollars ($198,453.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate Three Hundred Fifty-Nine Thousand, Nine Hundred Sixty-Seven and No/100 Dollars ($359,967.00) in Medi- Cal FFP in this term to offset CONTRACTOR’s program costs. The maximum compensation amount under this Agreement for West Fresno County Triage Services for the period of July 1, 2016, through June 30, 2017, shall not exceed One Million, Eighty-Nine Thousand, Five Hundred Fifty and No/100 Dollars ($1,089,550.00). The maximum amount of Public Safety Realignment funding under this Agreement in this term shall not exceed Three Hundred Fifty Thousand, and No/100 Dollars ($350,000.00). The maximum amount of MHSA COUNTY OF FRESNO Fresno, CA -5 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 funding under this Agreement in this term shall not exceed Two Hundred Ninety-Three Thousand, Five Hundred Forty-Eight and No/100 Dollars ($293,548.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate Four Hundred Forty-Six Thousand, Two and No/100 Dollars ($446,002.00) in Medi-Cal FFP in this term to offset CONTRACTOR’s program costs. In the event that Public Safety Realignment funds are not allocated for this term, MHSA funding will be increased by Three Hundred Fifty Thousand and No/100 Dollars ($350,000.00), bringing the maximum amount of MHSA funding under this Agreement in this term to Six Hundred Forty-Three Thousand, Five Hundred Forty-Eight and No/100 Dollars ($643,548.00); and reducing the maximum amount of Public Safety Realignment funding to Zero and No/100 Dollars ($0.00). The maximum compensation amount under this Agreement for West Fresno County Triage Services for the period of July 1, 2017, through June 30, 2018, shall not exceed One Million, One Hundred Twenty-Two Thousand, Seven Hundred Ninety-One and No/100 Dollars ($1,122,791.00). The maximum amount of Public Safety Realignment funding under this Agreement in this term shall not exceed Three Hundred Fifty Thousand and No/100 Dollars ($350,000.00). The maximum amount of MHSA funding under this Agreement in this term shall not exceed Three Hundred Twelve Thousand, Six Hundred Thirty-Seven and No/100 Dollars ($312,637.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate Four Hundred Sixty Thousand, One Hundred Fifty-Four and No/100 Dollars ($460,154.00) in Medi-Cal FFP in this term to offset CONTRACTOR’s program costs. In the event that Public Safety Realignment funds are not allocated for this term, MHSA funding will be increased by Three Hundred Fifty Thousand and No/100 Dollars ($350,000.00), bringing the maximum amount of MHSA funding under this Agreement in this term to Six Hundred Sixty-Two Thousand, Six Hundred Thirty-Eight and No/100 Dollars ($662,638.00); and reducing the maximum amount of Public Safety Realignment funding to Zero and No/100 Dollars ($0.00).” The maximum compensation amount under this Agreement for West Fresno County Triage Services for the period of July 1, 2018, through June 30, 2019, shall not exceed One Million, One Hundred Sixty-Five Thousand, Two Hundred Eighty-Six and No/100 Dollars ($1,165,286.00). In COUNTY OF FRESNO Fresno, CA -6 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate One Hundred Nine Thousand, Eight Hundred Ninety-Five and No/100 Dollars ($109,895.00) in Medi-Cal FFP to offset CONTRACTOR’s program costs. The maximum compensation amount under this Agreement for West Fresno County Triage Services for the period of July 1, 2019, through June 30, 2020, shall not exceed One Million, One Hundred Ninety-Three Thousand, Three Hundred Eighty-Eight and No/100 Dollars ($1,193,388.00). In addition, it is understood by CONTRACTOR and COUNTY that CONTRACTOR estimates to generate One Hundred Nine Thousand, Eight Hundred Ninety-Five and No/100 Dollars ($109,895.00) in Medi-Cal FFP to offset CONTRACTOR’s program costs.” 4.That the following shall be inserted into COUNTY Agreement No. 15-317, at Page Nine (9), Section Five (5), Line Twelve (12), as Section Five (5), Subsection “A”: “A. COUNTY’s DBH shall invoice CONTRACTOR in arrears by the fifth (5th) day of each month for the prior months hosting, maintenance, and hosting perceptive fees for access to Avatar in accordance with the fee schedule as set forth in Exhibit N, “Electronic Health Records Software Charges”, attached hereto and incorporated herein by reference. COUNTY shall invoice CONTRACTOR annually for the annual maintenance and licensing fee for access to Avatar in accordance with the fee schedule as set forth in Exhibit N. CONTRACTOR shall provide payment for these expenditures to COUNTY’s Fresno County Department of Behavioral Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712, Attention: Business Office, within forty-five (45) days after the date of receipt by CONTRACTOR of the invoicing provided by COUNTY.” 5.That the existing COUNTY Agreement No. 15-317 Section Five (5)A throug h Section Five (5)N be re-lettered as Section Five (5)B through Section Five (5)O. 6.That, effective July 1, 2018, all references in existing COUNTY Agreement No. 15-317 to “Exhibit C ‘East’” and “Exhibit C ‘West’” shall be changed to read “Revised Exhibit C ‘East’” and “Revised Exhibit C ‘West’”, respectively, each attached hereto and incorporated herein by reference. 7.COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend the Agreement; and that upon execution of this Amendment I, the Agreement and Amendment I together shall be considered the Agreement. COUNTY OF FRESNO Fresno, CA -7 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 The Agreement, as hereby amended, is ratified and continued. All provisions, terms, covenants, conditions and promises contained in the Agreement, and not amended herein, shall remain in full force and effect. This Amendment I shall become effective upon execution by all parties. /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// 1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment I to COUNTY 2 Agreement No. 15-317 as of the day and year first hereinabove written . 3 4 CONTRACTOR: COUNTY OF FRESNO KINGS VIEW BEHAVIORAL HEALTH By:~/~ Print Name:~ -f/qp_ ve,r 5 6 7 8 9 Title : ___ (~_a'--"a ________ _ Date: __ ,...;__----I D....__-___ \5? ___ _ 1 0 11 Chairman of Board, or President, or any Vice President ATTEST: BERNICE E . SEIDEL 1 2 By: -~4 ~~~.:::;a~;i-c:::;:__ Clerk of the Board of Supervisors County of Fresno , State of California 13 14 15 16 1 7 18 1 9 By 51 .bSi&ro ~ shet:p 20 21 Secretary (of Corporation), or any Assistant Secretary, or Chief Financial Officer, or any Assistant Treasurer Mailing Address: Kings View Behavioral Health 7170 North Financial Avenue, Suite 110 Fresno, CA 93720 FOR ACCOUNTING PURPOSES ONLY: Date: ) -I O -I ]? 22 Fund/Subclass : 0001/10000 Account/Program: 7295/0 2 3 Organization: 56304766 East 56304767 West 2 4 25 26 27 28 FY 2015-16 FY 2016-17 FY 2017-18 FY 2018-19 FY 2019-20 TOTAL: EAST $1,300,431 $1,288,124 $1,327,322 $1 ,375,952 $1.410,375 $6 ,702,204 WEST $ 908,420 (9 months) $1,089,550 $1,122,791 $1,165,286 $1.193,388 $5,479,435 -8 -COUNTY OF FRESNO Fresno, CA Revised Exhibit C - East 1 FY 2015-2016 FY 2016-2017 FY 2017-2018 FY 2018-2019 FY 2019-2020 PERSONNEL SALARIES: 0001 Executive Director (Licensed) 0.02 FTE $3,066 $3,158 $3,253 $3,601 $3,709 0002 Program Director (Licensed) 0.08 FTE $7,488 $7,713 $7,944 $10,052 $10,354 0009 Clinical Director (Licensed) 0.33 FTE $40,000 $41,200 0003 Program Manager (Licensed) .50 FTE $46,800 $48,204 $49,650 $57,363 $59,084 0004 UR Specialist (Licensed) .40 FTE $20,800 $21,424 $22,067 $37,133 $38,247 0005 Licensed Clinician 7 FTE $553,280 $569,878 $586,975 $596,960 $614,869 0006 Program Support 0.83 FTE $19,760 $20,353 $20,963 $46,005 $47,385 0007 Medical Director (on-call)$6,240 $6,427 $6,620 $0 $0 0008 Per Diem Team responders (Licensed) 1,000 hours/year $40,000 $41,200 $42,436 $28,709 $29,570 SALARY TOTAL $697,434 $718,357 $739,908 $819,823 $844,418 PAYROLL TAXES: 0031 FICA/MEDICARE $53,354 $54,954 $56,603 $62,716 $64,598 0032 U.I.$6,974 $7,184 $7,399 $8,198 $8,444 0033 Workers Compensation $27,897 $28,734 $29,596 $22,793 $23,777 PAYROLL TAX TOTAL $88,225 $90,872 $93,598 $93,708 $96,819 EMPLOYEE BENEFITS:$785,659 $809,229 $833,506 $913,530 $941,236 0040 Retirement $14,367 $14,798 $8,198 $8,444 0041 Health Insurance (medical vision, life, dental)$118,564 $122,121 $125,784 $122,973 $126,663 EMPLOYEE BENEFITS TOTAL $118,564 $136,488 $140,582 $131,172 $135,107 SALARY & BENEFITS GRAND TOTAL $904,223 $945,717 $974,089 $1,044,702 $1,076,343 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building $12,000 $12,360 $12,731 $19,113 $19,686 1011 Rent/Lease Equipment (copier)$1,800 $1,854 $1,910 $1,967 $2,026 1012 Utilities $3,000 $3,090 $3,183 $3,278 $3,377 1013 Janitorial/Building $1,500 $1,545 $1,591 $7,639 $7,868 1015 Other - Vehicle Leasing (4 vehicles)$22,000 $17,600 $17,600 $17,600 $17,600 FACILITY/EQUIPMENT TOTAL $40,300 $36,449 $37,014 $49,597 $50,557 OPERATING EXPENSES: 1060 Telephone $14,640 $15,079 $15,532 $3,998 $4,117 1062 Postage $125 $125 $125 $125 $125 1063 Printing/Reproduction $2,500 $1,500 $1,500 $2,059 $1,422 1066 Office Supplies & Equipment $7,500 $4,000 $4,120 $4,244 $4,371 1069 Program Supplies $5,000 $5,150 $5,305 $2,964 $3,053 1072 Staff Mileage/vehicle maintenance $5,000 $5,150 $5,305 $5,464 $5,628 1074 Staff Training/Registration $10,000 $10,000 $10,000 $5,000 $8,000 1077 Other - Miscellaneous $1,800 $800 $800 $800 $800 1078 Staff Recruitment/backgound checks $7,550 $2,250 $2,250 $2,250 $2,250 1079 Communications (cell phone & mobile internet)$14,550 $12,600 $12,600 $16,000 $15,100 OPERATING EXPENSES TOTAL $68,665 $56,654 $57,536 $42,902 $44,865 FINANCIAL SERVICES EXPENSES: 1082 Liability Insurance (Auto, Property, General)$8,200 $8,446 $8,699 $10,960 $11,289 1083 Other - Professional Liability $3,600 $3,708 $3,819 $3,934 $4,052 Line Item Description RURAL MENTAL HEALTH TRIAGE - East Kings View Corporation FYS 2015 - 2016 THROUGH 2019-2020 Revised Exhibit C - East 2 RURAL MENTAL HEALTH TRIAGE - East Kings View Corporation FYS 2015 - 2016 THROUGH 2019-2020 1084 Other - Administrative Overhead (11%)$111,148 $110,096 $113,446 $135,530 $138,942 FINANCIAL SERVICES TOTAL $122,948 $122,250 $125,965 $150,424 $154,283 SPECIAL EXPENSES (Consultant/Etc.): 1090 Consultant (network & data management)$77,804 $77,067 $79,412 $70,000 $70,000 1091 Translation Services $2,000 $2,000 $2,000 $2,000 $2,000 1092 CVSPH Dispatcher services 6,570 hrs. (50%)$53,381 $43,986 $45,306 $0 $0 1093 Avatar License Fee $8,327 $8,327 SPECIAL EXPENSES TOTAL $133,185 $123,053 $126,718 $80,327 $80,327 FIXED ASSETS: 2000 Computers & Software $23,610 $4,000 $6,000 $8,000 $4,000 2001 Furniture & Fixtures $7,500 $0 $0 $0 $0 2002 Other $0 $0 $0 $0 $0 2003 Other $0 $0 $0 $0 $0 FIXED ASSETS TOTAL $31,110 $4,000 $6,000 $8,000 $4,000 $1,300,431 $1,288,124 $1,327,322 $1,375,952 $1,410,375 Revised Exhibit C - West FY 2015-2016 (9 Months)FY 2016-2017 FY 2017-2018 FY 2018-2019 FY 2019-2020 PERSONNEL SALARIES: 0001 Executive Director (Licensed) 0.02 FTE $2,300 $3,158 $3,253 $3,601 $3,709 0002 Program Director (Licensed) 0.08 FTE $5,616 $7,713 $7,944 $10,052 $10,354 0009 Clinical Director (Licensed) 0.33 FTE $40,000 $41,200 0003 Program Manager (Licensed) .50 FTE $46,800 $48,204 $49,650 $57,363 $59,084 0004 UR Specialist (Licensed) .40 FTE $15,600 $21,424 $22,067 $37,133 $38,247 0005 Clinician (2 Licensed, 5 Unlicensed) 7 FTE $330,720 $440,960 $454,189 $433,680 $446,691 0006 Program Support 0.5 FTE $19,760 $20,353 $20,963 $46,005 $47,385 0007 Medical Director (on-call)$4,680 $6,427 $6,620 $0 $0 0008 Per Diem Team responders (Licensed) 1,000 hours/year $30,000 $41,200 $42,436 $39,709 $38,400 SALARY TOTAL $455,476 $589,439 $607,122 $667,543 $685,070 PAYROLL TAXES: 0031 FICA/MEDICARE $34,844 $45,092 $46,445 $51,067 $52,408 0032 U.I.$4,555 $5,894 $6,071 $6,675 $6,851 0033 Workers Compensation $18,219 $23,578 $24,285 $16,702 $17,403 PAYROLL TAX TOTAL $57,618 $74,564 $76,801 $74,444 $76,661 EMPLOYEE BENEFITS:$513,093 $664,003 $683,923 $741,988 $761,731 0040 Retirement $11,789 $12,142 $6,675 $6,851 0041 Health Insurance (medical vision, life, dental)$77,431 $100,205 $103,211 $100,131 $102,760 EMPLOYEE BENEFITS TOTAL $77,431 $111,993 $115,353 $106,807 $109,611 SALARY & BENEFITS GRAND TOTAL $590,524 $775,996 $799,276 $848,794 $871,342 FACILITIES/EQUIPMENT EXPENSES: 1010 Rent/Lease Building $12,000 $12,360 $12,731 $17,113 $19,626 1011 Rent/Lease Equipment (copier)$1,800 $1,854 $1,910 $1,967 $2,026 1012 Utilities $3,000 $3,090 $3,183 $3,278 $3,377 1013 Janitorial/Building $1,500 $1,545 $1,591 $9,639 $10,787 1015 Other - Vehicle Leasing (4 vehicles)$22,000 $17,600 $17,600 $17,600 $17,600 FACILITY/EQUIPMENT TOTAL $40,300 $36,449 $37,014 $49,597 $53,416 OPERATING EXPENSES: 1060 Telephone $14,640 $15,079 $15,532 $3,998 $4,117 1062 Postage $125 $125 $125 $125 $125 1063 Printing/Reproduction $2,500 $1,500 $1,500 $1,356 $1,500 1066 Office Supplies & Equipment $7,500 $4,000 $4,120 $4,244 $4,371 1069 Program Supplies $5,000 $5,150 $5,305 $2,964 $3,053 1072 Staff Mileage/vehicle maintenance $5,000 $5,150 $5,305 $13,464 $13,868 1074 Staff Training/Registration $10,000 $10,000 $10,000 $5,000 $5,000 1077 Other - Miscellaneous $1,800 $800 $800 $800 $800 1078 Staff Recruitment/backgound checks $7,550 $2,250 $2,250 $2,250 $2,250 1079 Communications (cell phone & mobile internet)$14,550 $12,600 $12,600 $12,600 $12,600 OPERATING EXPENSES TOTAL $68,665 $56,654 $57,536 $46,799 $47,683 FINANCIAL SERVICES EXPENSES: Line Item Description RURAL MENTAL HEALTH TRIAGE - West Kings View Corporation FYS 2015 - 2016 THROUGH 2019-2020 Revised Exhibit C - West 1082 Liability Insurance (Auto, Property, General)$8,200 $8,446 $8,699 $8,960 $9,229 1083 Other - Professional Liability $3,600 $3,708 $3,819 $3,934 $4,052 1084 Other - Administrative Overhead (11%)$77,643 $93,124 $95,965 $114,654 $117,438 FINANCIAL SERVICES TOTAL $89,443 $105,278 $108,484 $127,548 $130,719 SPECIAL EXPENSES (Consultant/Etc.): 1090 Consultant (network & data management)$54,350 $65,187 $67,176 $75,220 $76,901 1091 Translation Services $2,000 $2,000 $2,000 $1,000 $1,000 1092 CVSPH Dispatcher services 6,570 hrs. (50%)$32,029 $43,986 $45,306 $0 $0 1093 Avatar License Fee $8,327 $8,327 SPECIAL EXPENSES TOTAL $88,379 $111,173 $114,481 $84,547 $86,228 FIXED ASSETS: 2000 Computers & Software $23,610 $4,000 $6,000 $8,000 $4,000 2001 Furniture & Fixtures $7,500 $0 $0 $0 $0 2002 Other $0 $0 $0 $0 $0 2003 Other $0 $0 $0 $0 $0 FIXED ASSETS TOTAL $31,110 $4,000 $6,000 $8,000 $4,000 $908,420 $1,089,550 $1,122,791 $1,165,286 $1,193,388 Exhibit N Page 1 of 1 Electronic Health Records Software Charges CONTRACTOR understands that COUNTY utilizes Netsmart’s Avatar for its Electronic Health Records management. CONTRACTOR agrees to reimburse COUNTY for all user license fees for accessing Netsmart’s Avatar, as set forth below: Estimated Fee Per Fiscal Year Estimated Fee Per Fiscal Year Description Effective Fee Per User Est. Quantity of Users FY 18-19 FY 19-20 NetSmart Avatar Monthly Hosting Service (per named user per month) 07/01/2017 $37.00 22-25 $9,768 - $11,100 $9,768 - $11,100 NetSmart Avatar Monthly Maintenance/License (per named user per month) 07/01/2017 $14.00* 22-25 $3,696 - $4,200 $3,696 - $4,200 NetSmart Avatar Monthly Hosting Perceptive (per named user per month) 07/01/2017 $4.66 22-25 $1,231 - $1,398 $1,231 - $1,398 Estimated Total Per Fiscal Year $14,695 - $16,698 $14,695 - $16,698 *Monthly maintenance increases each FY on July 1st based upon the CPI rate. Should CONTRACTOR choose not to utilize Netsmart’s Avatar for its Electronic Health Records management, CONTRACTOR will be responsible for obtaining its own system for Electronic Health Records management.