HomeMy WebLinkAboutAgreement A-18-622-1 with Mental Health Systems Inc..pdfAgreement No . 18-622-1
1 AMENDMENT I TO AGREEMENT
2 THIS AMENDMENT is made and entered into this 4th day of June , 2019 , by and between
3 the COUNTY OF FRESNO , a political subdivision of the State of California , hereinafter referred to as
4 "COUNTY", and MENTAL HEAL TH SYSTEMS , INC ., a California non-profit corporation whose
5 address is 9465 Farnham Street, San Diego, California , 92123, hereinafter referred to as
6 "CONTRACTOR" (collect ively the "parties ").
7 WHEREAS , the parties entered into that certain Agreement , identified as COUNTY Agreement
8 No . 18-622 , effective November 1, 2018 ; and
9 WHEREAS , CONTRACTOR agreed to provide mental health and substance use disorder (SUD)
10 treatment services to adolescents incarcerated at the Fresno County Juvenile Justice Campus (JJC), and
11 SUD treatment serv ices for adolescents and their families referred by Fresno County Juvenile Drug Court ,
12 and adolescents released from the JJC; and
13 WHEREAS the parties desire to amend the Agreement , regarding changes as stated below and
14 restate the Agreement in its entirety .
15 NOW , THEREFORE , in consideration of their mutual promises , covenants and conditions,
16 hereinafter set forth , the sufficiency of wh ich is acknowledged , the parties agree as follows :
17 1. That the existing COUNTY agreement No . 18-622, Paragraph Four (4)-
18 COMPENSATION -in the Agreement on Page Six (6), beginning on Line Thirteen (13) with the word ""In "
19 and ending on Line Seventeen ( 17) with the year "2023 " be deleted and the following inserted in its place :
20 "JDC and PROPS : For claims submitted under this Agreement for Court-ordered
21 outpatient SUD treatment services and outpat ient services upon release from the SAU , COUNTY agrees
22 to pay CONTRACTOR and CONTRACTOR agrees to rece ive compensation in excess of the amounts
23 reimbursed by DMC and non-DMC based on CONTRACTOR's annual (or prorated) costs up to a
24 maximum of Seventy-Three Thousand Three Hundred Thirty-Three and No/Dollars ($73 ,333) for the first
25 contract period ending June 30 , 2019 ; and up to a maximum of One Hundred Ten Thousand and
26 No/Dollars ($110,000) for each subsequent twelve-month period , as set forth in the Fiscal Year Budgets
27 attached hereto as Exh ibit F-4 and by this reference incorporated herein .
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In no event shall the total compensation for actual services performed under this Agreement be in
excess of Six Hundred Seventy-Three Thousand Three Hundred Thirty-Three and No/Dollars ($673,333)
for the period between November 1, 2018 and June 30, 2019. In no event shall the total compensation for
actual services performed under this Agreement be in excess of One Million Ten Thousand and
No/Dollars ($1,010,000) for each twelve-month period between July 1, 2019 through June 30, 2023.”
2. That the existing COUNTY agreement No. 18-622, Paragraph Four (4) –
COMPENSATION – in the Agreement on Page Six (6), beginning on Line Twenty-Two (22), Section B
with the word ““Funding” and ending on Line Twenty-Six (26) with the word “source” be deleted and the
following inserted in its place:
“B. Funding availability – The contract maximum amount as defined in this Agreement
and in Exhibits F-1 through F-4 may be reduced based upon Federal, State, and local funding availability.
In the event of such action, the COUNTY’s DBH Director or his/her designee shall notify the
CONTRACTOR in writing of the reduction in the maximum amount within 30 days of advisement from the
funding source.”
3. That a new Exhibit F-4 is attached hereto and incorporated herein by this reference.
4. That the existing COUNTY agreement No. 18-622, Paragraph Five (5) – INVOICING – in
the Agreement on Page Nine (9), beginning with Section A, Line Two (2), with the word “For” and ending
on Line Six (6) with the word “Services” be deleted in its entirety and the following inserted in its place:
“A. For SUD services, CONTRACTOR shall invoice COUNTY by the 20th day of each
month, for prior month’s expenditures of actual services delivered. Invoices for SUD services shall be
submitted via email to SAS@fresnocountyca.gov with a copy to the assigned analyst. No reimbursement
for services shall be made until the invoice is received, reviewed and approved by COUNTY DBH – SUD
Services.”
5. That the existing COUNTY agreement No. 18-622, Paragraph Sixteen (16) – INSURANCE
– be amended starting on Page Twenty-Two (22), Line Fourteen after the word “basis” by inserting the
following:
“F. Cyber Liability
Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or
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claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations
as is undertaken by CONTRACTOR in this agreement and shall include, but not be limited to, claims
involving infringement of intellectual property, including but not limited to infringement of copyright,
trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of
electronic information, release of private information, alteration of electronic information, extortion and
network security. The policy shall provide coverage for breach response costs as well as regulatory fines
and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations.”
6. COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend
Agreement No. 18-622, and that upon execution of this Amendment, Agreement and Amendment I
together shall be considered the Agreement.
7. 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 be retroactively effective November 1, 2018.
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EXECUTED AND EFFECTIVE as of the date first above set forth.
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President & CEO
Print Name & Title (Chairman of Board, or
Pr · ent, or Vice President)
~
(Authorized Si ture) ~ Ma,'l(_p\._
Title (Secretary of Corporation, or Chief
Financial Officer/Treasurer, or any
Assistant Secretary or Treasurer)
946S F-aRM!ltf'fl Sheet
San Diego, CA 92123
Mailing Address
FOR ACCOUNTING USE ONLY:
ORG No.: 56302081
25 Account No.: 7295
Requisition No.:
26
27
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COUNTY OF FRESNO
~:s~ ~
Nathan Magsig, Chairman of the Board
of Supervisors of the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
By: S,.As.tlu\ ~~s.b¥
Deputy
4
Exhibit F-4
Page 1 of
20
Mailing Address:
Street Address:
1.20 Phone Number:
2.30 Fax Number:
E-mail Address:
(8 mo.)% of FTE
Annual dedicated to
Salary this program Admin.Direct Admin.Direct
0101 Program Manager 43,333$ 37%100%0%16,033$ -$ 16,033$
0102 SUD Counselor 27,733$ 100%0%100%-$ 27,733$ 27,733$
0103 Case Manager 24,960$ 50%0%100%-$ 12,480$ 12,480$
0104 Administrative Assistant 24,960$ 60%100%0%14,976$ -$ 14,976$
0105 Vice President 69,333$ 16%100%0%11,093$ -$ 11,093$
0106 Program Analyst 43,333$ 7%100%0%3,033$ -$ 3,033$ 0107 Intern -$ 80%100%-$ -$ -$
SALARIES TOTAL 45,135$ 40,213$ 85,348$
Rate 52.88%47.12%100.00%
0151 F.I.C.A. Social Security and Medicare SS 6.2 % rate applied to $127.2k of gross earnings per employee 7.649%3,452$ 3,076$ 6,528$
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 $7k of gross earnings per employee 0.699%316$ 281$ 597$
PAYROLL TAXES TOTAL 3,768$ 3,357$ 7,125$
EMPLOYEE BENEFITS Rate 52.88%47.12%100.00%
0201 Health Insurance 12.35%5,574$ 4,966$ 10,540$
0202 Life Insurance 0.04%18$ 16$ 34$
0203 Retirement 8.00%3,611$ 3,217$ 6,828$
0204 Workers' Compensation Insurance 1.00%451$ 402$ 853$ 0205 Benefits Other - Specify 0.00%-$ -$
EMPLOYEE BENEFITS TOTAL 9,654$ 8,601$ 18,255$
TAXES & BENEFITS TOTAL 25,380$
TOTAL DIRECT (ADMIN) SALARIES, PAYROLL TAXES, AND EMPLOYEE BENEFITS 110,728$
TOTAL PERCENT OF BENEFITS TO SALARIES 29.7%
Services and Supplies
0252 514$
0253 -$
514$
0301 7,213$
0302
7,213$
0351 1,466$
0352
0353 150$
0354
0355
1,616$
0401 6,796$
0402 1,736$
0403 608$
9,140$
FACILITIES
0451 10,355$
0452 3,580$
0453 1,800$
15,735$
0501 1,191$
0502 254$
0503 1,200$
0504 2,000$
4,645$
0551 -$
0552 400$
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2018-19 - Effective November 1
Provider Name:Mental Health Systems, Inc.9465 Farnham Street
Program Name:Family & Youth Alternatives San Diego, CA 92123
Approved by:Agustin Ochoa 3122 N. Millbrook Suite B
Fresno, CA 93703
No. of Budgeted FTEs - Admin:(858) 573-2600
No. of Budgeted FTEs - Direct:(858) 573-2914
to services
Total Proposed Budget(Must be Itemized)
aochoa@mhsinc.org
Budget Categories-% Time dedicated Proposed Program Budget
PAYROLL TAXES
INSURANCE
Liability Insurance
Line Item Description
PERSONNEL/SALARIES
Insurance Other-Specify
INSURANCE TOTAL
Purchase of Equipment (Computers/Furniture/VOIP Phone)
Telecommunications/data lines
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
COMMUNICATIONS
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Equipment Rent/Lease (Copy Machines)
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
TRAVEL COSTS TOTAL
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Transportation
Exhibit F-4
Page 2 of
20
0553 400$
800$
0601 3,000$
0602
0603 2,700$
0604 1,600$
7,300$
0651
0652 50$
50$
0701 23,641
0702 3,742
0703 -
0749 1,561
28,944$
186,685$
3120 106,551$
3121
3125 6,801$
3130
3140
3150
3160
113,352$
73,333$
PROGRAM SUPPLIES TOTAL
CONSULTANCY
Consultant Services (Interpretive Services)
Contracted Services (Recruitment)
Program Supplies-Food
Contracted Services (Medical Director)
Contracted Services (Urinalysis)
TOTAL PROGRAM EXPENDITURES
FISCAL AND AUDITS
Accounting/Bookkeeping (IT Support)
External Audit
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
Licenses/Taxes
CONSULTANCY TOTAL
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
ONE TIME ADVANCE - Start Up Costs
Client Fees
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
REVENUE/MATCH
Drug Medi-Cal
Mental Health Medi-Cal
Youth Treatment Services (SAPT)
State Grant
Private Donations
Insurance
Exhibit F-4
Page 3 of
20
Provider Name:
16,033$ 37%
27,733$ 100%
12,480$ 50%
14,976$ 60%
11,093$ 16%
3,033$ 7%
-$ 80%
List Amount
PAYROLL TAXES TOTAL $ 7,125
EMPLOYEE BENEFITS
TOTAL $ 18,255
853$
514$
-$
7,213$
1,466$
150$
6,796$
1,736$
608$
10,355$
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2018-19 Narrative
Mental Health Systems, Inc.
PERSONNEL / SALARIES
SUD Counselor
Administrative Assistant
Case Manager
Vice President
Program Analyst
Intern
Annual Salary and FTE equivalence as in budget.
Budget Categories-Line Item Description Annual Salary for
this Program
% of FTE dedicated
to this program
Program Manager
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
COMMUNICATIONS 0301 - Telecommunications/data lines - Costs of telephone expense @ facility for staff.
For employees that share time between programs, costs are estimated based on budgeted
FTEs.
0302 - Answering Service - N/A
OFFICE EXPENSE 0351 - Office Supplies: Includes Items necessary to carry out the daily activities to
accomplish the program goals and objectives including paper, filing supplies, pens, pencils,
scissors, and other supplies.
0352 - Social/Rec, Workbooks.- N/A
0353 - Printing/Reproduction includes items such as the printing of business cards,
program pamphlets, position vacancy advertising and other materials related to the program.
0354 - Publications - N/A
0355 - Legal Notices/Advertising - N/A
EQUIPMENT List the following equipment categories and provide a brief description for each category:
0401 - Purchase of Equipment - One-time cost of desk/chair setup for staff, plus minor
equipment needs
0402 - Equipment Rent/Lease- Cost for lease of copy machine and water dispenser
for clients.
0403 - Equipment Maintenance: minor equipment repair for copier, IT equipment, and
vehicle maintenance.
FACILITIES List the following facilities categories and provide a brief description for each category:
0451 - Rent/Lease Building - Cost to rent facility.
Exhibit F-4
Page 4 of
20
3,580$
1,800$
1,191$
254$
1,200$
2,000$
-$
400$
400$
3,000$
2,700$
1,600$
50$
23,641$
3,742$
-$
1,561$
106,551$
6,801$
0604 - Contracted Services - Urinalysis testing
0452 - Facilities Maintenance - Cost for a portion of the custodial/janitorial services for
facility, alarm service, as well as minor building repairs like key replacements.
0453 - Utilities - Gas, water, electric at program facility
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification. The amount
t d 1/12th f th t t l t l f thi ti The amount cannot exceed 1/12th of the total cost proposal for this section.
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for each
t 0551 - Program Supplies - Client Incentives: N/A
0552 - Program Supplies - Curriculum: Cost of supplies for client curriculum and
supplies for recreational therapy and occupational therapy.
0553 - Program Supplies - Food: Food for clients
3140 - Private Donations -
0703 - County Administration Fee -N/A
0749 - Other Costs - Other business services such as applicant TB tests, drug
screens, and other program-related items that don't necessarily fit into another line item.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue offsets
dit f th i ti / d
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - 14.5% of total Direct Costs to allow for Administrative cost of
running the program, such as staff providing support in payroll processing, accounts payable
and other management departments. See Cost Allocation Plan.
3150 - Client Fees -
0603 - Contracted Services - Medical Director
CONSULTANCY List the following consulting categories and provide a brief description for each category:
0601 - Consultant Services - Interpretive Service: Allows program staff to reach an
interpreter to provide language services to serve clients in their primary language.
0702 - Licenses/Taxes - Cost of DMC Certification, Avatar (EHR) user fees, DMV
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 travel to
multiple sites, as well as for coverage when traveling for training, or home visits. Mileage
reimbursement rate is limited to the IRS standards.
0502 - Staff Travel (Out of County) - Covers the cost of program staff attending
meetings and trainings out of county, for example, the Program Manager's travel to San
Diego for the quarterly PMs meeting.
0503 - Staff Training/Registration - Cost for staff to attend trainings relevant to the
SOW.
0504 - Transportation - To purchase bus passes to allow transportation to treatment
appointments for clients who are able to access public transportation but are not financially
able. A log is kept to track distribution of passes.
3160 - Insurance -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for each
t 0651 - Accounting/Bookkeeping - See Indirect
0652 - External Audit - Independent CPA Audit - Cost for annual audit to include this
program.
3120 - Drug Medi-Cal - estimated funding generated from DMC clients
•3121 - Mental Health Medi-Cal -
•3125 - Youth Treatment Services - (SAPT) - estimated funding generated from Youth
treatment clients
3130 - State Grant -
Exhibit F-4
Page 5 of
20
Mailing Address:
Street Address:
1.20 Phone Number:
2.30 Fax Number:
E-mail Address:
% of FTE
Annual dedicated to
Salary this program Admin.Direct Admin.Direct
0101 Program Manager 66,955$ 37%100%0%24,773$ -$ 24,773$
0102 SUD Counselor 42,848$ 100%0%100%-$ 42,848$ 42,848$
0103 Case Manager 38,563$ 50%0%100%-$ 19,282$ 19,282$
0104 Administrative Assistant 38,563$ 60%100%0%23,138$ -$ 23,138$
0105 Vice President 104,000$ 16%100%0%16,640$ -$ 16,640$
0106 Program Analyst 65,000$ 7%100%0%4,550$ -$ 4,550$ 0107 Intern -$ 80%100%-$ -$ -$
SALARIES TOTAL 69,101$ 62,130$ 131,231$
Rate 52.66%47.34%100.00%
0151 F.I.C.A. Social Security and Medicare SS 6.2 % rate applied to $127.2k of gross earnings per employee 7.650%5,286$ 4,753$ 10,039$
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 $7k of gross earnings per employee 0.700%484$ 435$ 919$
PAYROLL TAXES TOTAL 5,770$ 5,188$ 10,958$
EMPLOYEE BENEFITS Rate 52.66%47.34%100.00%
0201 Health Insurance 12.35%8,534$ 7,673$ 16,207$
0202 Life Insurance 0.04%27$ 24$ 51$
0203 Retirement 8.00%5,528$ 4,970$ 10,498$
0204 Workers' Compensation Insurance 1.00%691$ 621$ 1,312$ 0205 Benefits Other - Specify 0.00%-$ -$
EMPLOYEE BENEFITS TOTAL 14,780$ 13,288$ 28,068$
TAXES & BENEFITS TOTAL 39,026$
TOTAL DIRECT (ADMIN) SALARIES, PAYROLL TAXES, AND EMPLOYEE BENEFITS 170,257$
TOTAL PERCENT OF BENEFITS TO SALARIES 29.7%
Services and Supplies
0252 770$
0253 -$
770$
0301 10,819$
0302
10,819$
0351 2,619$
0352
0353 250$
0354
0355
2,869$
0401 5,344$
0402 2,604$
0403 1,912$
9,860$
FACILITIES
0451 14,214$
0452 5,870$
0453 1,800$
21,884$
0501 1,191$
0502 254$
0503 3,300$
0504 2,750$
7,495$
0551 -$
0552 600$
Utilities
FACILITIES TOTAL
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
TRAVEL COSTS TOTAL
PROGRAM SUPPLIES
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Program Supplies-Client Incentives
Program Supplies-Curriculum
Transportation
Equipment Rent/Lease (Copy Machines)
Insurance Other-Specify
INSURANCE TOTAL
Purchase of Equipment (Computers/Furniture/VOIP Phone)
Telecommunications/data lines
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
COMMUNICATIONS
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
PAYROLL TAXES
INSURANCE
Liability Insurance
Line Item Description
PERSONNEL/SALARIES
to services
Total Proposed Budget(Must be Itemized)
dheld@mhsinc.org
Budget Categories-% Time dedicated Proposed Program Budget
Fresno, CA 93703
No. of Budgeted FTEs - Admin:(858) 573-2600
No. of Budgeted FTEs - Direct:(858) 573-2914
Program Name:Family & Youth Alternatives San Diego, CA 92123
Approved by:Lindsay Santino 3122 N. Millbrook Suite B
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2019-20
Provider Name:Mental Health Systems, Inc.9465 Farnham Street
Exhibit F-4
Page 6 of
20
0553 840$
1,440$
0601 5,400$
0602
0603 3,600$
0604 3,600$
12,600$
0651
0652 50$
50$
0701 35,480
0702 5,443
0703 -
0749 1,204
42,127$
280,171$
3120 159,961$
3121
3125 10,210$
3130
3140
3150
3160
170,171$
110,000$
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
REVENUE/MATCH
Drug Medi-Cal
Mental Health Medi-Cal
Youth Treatment Services (SAPT)
State Grant
Private Donations
Insurance
Client Fees
Contracted Services (Medical Director)
Contracted Services (Urinalysis)
TOTAL PROGRAM EXPENDITURES
FISCAL AND AUDITS
Accounting/Bookkeeping (IT Support)
External Audit
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
Licenses/Taxes
CONSULTANCY TOTAL
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
ONE TIME ADVANCE - Start Up Costs
Consultant Services (Interpretive Services)
Contracted Services (Recruitment)
CONSULTANCY
PROGRAM SUPPLIES TOTAL
Program Supplies-Food
Exhibit F-4
Page 7 of
20
Provider Name:
24,773$ 37%
42,848 100%
19,282 50%
23,138 60%
16,640 16%
4,550 7%
- 80%
List Amount
PAYROLL TAXES TOTAL $ 10,958
EMPLOYEE BENEFITS
TOTAL $ 28,068
1312
770
0
10819
2619
250
5344
2604
1912
14214
FACILITIES List the following facilities categories and provide a brief description for each category:
0451 - Rent/Lease Building - Cost to rent facility.
EQUIPMENT List the following equipment categories and provide a brief description for each category:
0401 - Purchase of Equipment - minor equipment needs & replacement of old/broken
equipment
0402 - Equipment Rent/Lease- Cost for lease of copy machine and water dispenser
for clients.
0403 - Equipment Maintenance: minor equipment repair for copier, IT equipment, and
vehicle maintenance.
COMMUNICATIONS 0301 - Telecommunications/data lines - Costs of telephone expense @ facility for staff.
For employees that share time between programs, costs are estimated based on budgeted
FTEs.
0302 - Answering Service - N/A
OFFICE EXPENSE 0351 - Office Supplies: Includes Items necessary to carry out the daily activities to
accomplish the program goals and objectives including paper, filing supplies, pens, pencils,
scissors, and other supplies.
0352 - Social/Rec, Workbooks.- N/A
0353 - Printing/Reproduction includes items such as the printing of business cards,
program pamphlets, position vacancy advertising and other materials related to the program.
0354 - Publications - N/A
0355 - Legal Notices/Advertising - N/A
Program Manager
Position descriptions submitted with proposal.
Case Manager
Vice President
Program Analyst
Intern
Administrative Assistant
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance- Professional Liability and Malpractice Insurances
0253 - Insurance Other - N/A
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2019-20 Narrative
Mental Health Systems, Inc.
PERSONNEL / SALARIES
SUD Counselor
Annual Salary and FTE equivalence as in budget.
Budget Categories-Line Item Description Annual Salary for
this Program
% of FTE dedicated
to this program
Exhibit F-4
Page 8 of
20
5870
1800
1191
254
3300
2750
0
600
840
5400
3600
3600
50
35480
5443
0
1204
159961
10210
CONSULTANCY List the following consulting categories and provide a brief description for each category:
0601 - Consultant Services - Interpretive Service: Allows program staff to reach an
interpreter to provide language services to serve clients in their primary language.
0702 - Licenses/Taxes - Cost of DMC Certification, Avatar (EHR) user fees, DMV
verification
TRAVEL
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for each
t 0651 - Accounting/Bookkeeping - See Indirect
0652 - External Audit - Independent CPA Audit - Cost for annual audit to include this
program.
3120 - Drug Medi-Cal - estimated funding generated from DMC clients
List the following travel categories and provide a brief description for each category:
0501 - Staff Mileage - Cost for mileage reimbursement for staff who may travel to
multiple sites, as well as for coverage when traveling for training, or home visits. Mileage
reimbursement rate is limited to the IRS standards.
0502 - Staff Travel (Out of County) - Covers the cost of program staff attending
meetings and trainings out of county, for example, the Program Manager's travel to San
Diego for the quarterly PMs meeting.
0503 - Staff Training/Registration - Cost for staff to attend trainings relevant to the
SOW.
0703 - County Administration Fee -N/A
0504 - Transportation - To purchase bus passes to allow transportation to treatment
appointments for clients who are able to access public transportation but are not financially
able. A log is kept to track distribution of passes.
0603 - Contracted Services - Medical Director
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue offsets
dit f th i ti / d
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - 14.5% of total Direct Costs to allow for Administrative cost of
running the program, such as staff providing support in payroll processing, accounts payable
and other management departments. See Cost Allocation Plan.
3150 - Client Fees -
3160 - Insurance -
•3121 - Mental Health Medi-Cal -
•3125 - Youth Treatment Services - (SAPT) - estimated funding generated from Youth
treatment clients
3130 - State Grant -
0453 - Utilities - Gas, water, electric at program facility
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification. The amount
t d 1/12th f th t t l t l f thi ti The amount cannot exceed 1/12th of the total cost proposal for this section.
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for each
t 0551 - Program Supplies - Client Incentives: N/A
0552 - Program Supplies - Curriculum: Cost of supplies for client curriculum and
supplies for recreational therapy and occupational therapy.
0553 - Program Supplies - Food: Food for clients
3140 - Private Donations -
0604 - Contracted Services - Urinalysis testing
0452 - Facilities Maintenance - Cost for a portion of the custodial/janitorial services for
facility, alarm service, as well as minor building repairs like key replacements.
0749 - Other Costs - Other business services such as applicant TB tests, drug
screens, and other program-related items that don't necessarily fit into another line item.
Exhibit F-4
Page 9 of
20
Mailing Address:
Street Address:
1.20 Phone Number:
2.30 Fax Number:
E-mail Address:
% of FTE
Annual dedicated to
Salary this program Admin.Direct Admin.Direct
0101 Program Manager 68,952$ 37%100%0%25,512$ -$ 25,512$
0102 SUD Counselor 44,138$ 100%0%100%-$ 44,138$ 44,138$
0103 Case Manager 39,728$ 50%0%100%-$ 19,864$ 19,864$
0104 Administrative Assistant 39,728$ 60%100%0%23,837$ -$ 23,837$
0105 Vice President 104,000$ 16%100%0%16,640$ -$ 16,640$
0106 Program Analyst 65,000$ 7%100%0%4,550$ -$ 4,550$ 0107 Intern -$ 80%100%-$ -$ -$
SALARIES TOTAL 70,539$ 64,002$ 134,541$
Rate 52.43%47.57%100.00%
0151 F.I.C.A. Social Security and Medicare SS 6.2 % rate applied to $127.2k of gross earnings per employee 7.650%5,396$ 4,896$ 10,292$
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 $7k of gross earnings per employee 0.700%494$ 448$ 942$
PAYROLL TAXES TOTAL 5,890$ 5,344$ 11,234$
EMPLOYEE BENEFITS Rate 52.43%47.57%100.00%
0201 Health Insurance 12.35%8,711$ 7,904$ 16,615$
0202 Life Insurance 0.04%27$ 24$ 51$
0203 Retirement 8.00%5,643$ 5,120$ 10,763$
0204 Workers' Compensation Insurance 1.00%705$ 640$ 1,345$ 0205 Benefits Other - Specify 0.00%-$ -$
EMPLOYEE BENEFITS TOTAL 15,086$ 13,688$ 28,774$
TAXES & BENEFITS TOTAL 40,009$
TOTAL DIRECT (ADMIN) SALARIES, PAYROLL TAXES, AND EMPLOYEE BENEFITS 174,550$
TOTAL PERCENT OF BENEFITS TO SALARIES 29.7%
Services and Supplies
0252 770$
0253 -$
770$
0301 10,819$
0302
10,819$
0351 2,619$
0352
0353 150$
0354
0355
2,769$
0401 5,344$
0402 2,604$
0403 1,150$
9,098$
FACILITIES
0451 14,640$
0452 5,870$
0453 1,800$
22,310$
0501 1,191$
0502 254$
0503 1,753$
0504 2,500$
5,698$
0551 -$
0552 400$
Program Supplies-Client Incentives
Program Supplies-Curriculum
Transportation
Utilities
FACILITIES TOTAL
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Purchase of Equipment (Computers/Furniture/VOIP Phone)
Telecommunications/data lines
Answering Service
TRAVEL COSTS TOTAL
PROGRAM SUPPLIES
Equipment Rent/Lease (Copy Machines)
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
PAYROLL TAXES
INSURANCE
Liability Insurance
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
COMMUNICATIONS
Insurance Other-Specify
INSURANCE TOTAL
PERSONNEL/SALARIES
to services
Total Proposed Budget(Must be Itemized)
dheld@mhsinc.org
Budget Categories-% Time dedicated Proposed Program Budget
Line Item Description
Fresno, CA 93703
No. of Budgeted FTEs - Admin:(858) 573-2600
No. of Budgeted FTEs - Direct:(858) 573-2914
Program Name:Family & Youth Alternatives San Diego, CA 92123
Approved by:Lindsay Santino 3122 N. Millbrook Suite B
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2020-21
Provider Name:Mental Health Systems, Inc.9465 Farnham Street
Exhibit F-4
Page 10 of
20
0553 780$
1,180$
0601 3,600$
0602
0603 3,600$
0604 3,600$
10,800$
0651
0652 50$
50$
0701 35,480
0702 5,443
0703 -
0749 1,204
42,127$
280,171$
3120 159,961$
3121
3125 10,210$
3130
3140
3150
3160
170,171$
110,000$
Client Fees
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
REVENUE/MATCH
Drug Medi-Cal
Mental Health Medi-Cal
Youth Treatment Services (SAPT)
State Grant
Private Donations
Insurance
Contracted Services (Urinalysis)
TOTAL PROGRAM EXPENDITURES
FISCAL AND AUDITS
Accounting/Bookkeeping (IT Support)
External Audit
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
Licenses/Taxes
PROGRAM SUPPLIES TOTAL
CONSULTANCY
Consultant Services (Interpretive Services)
Contracted Services (Recruitment)
Contracted Services (Medical Director)
CONSULTANCY TOTAL
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
ONE TIME ADVANCE - Start Up Costs
Program Supplies-Food
Exhibit F-4
Page 11 of
20
Provider Name:
25,512$ 37%
44,138 100%
19,864 50%
23,837 60%
16,640 16%
4,550 7%
- 80%
List Amount
PAYROLL TAXES TOTAL $ 11,234
EMPLOYEE BENEFITS
TOTAL $ 28,774
1345
770
0
10819
2619
150
5344
2604
1150
14640
EQUIPMENT List the following equipment categories and provide a brief description for each category:
0401 - Purchase of Equipment - minor equipment needs & replacement of old/broken
equipment
0402 - Equipment Rent/Lease- Cost for lease of copy machine and water dispenser
for clients.
0403 - Equipment Maintenance: minor equipment repair for copier, IT equipment, and
vehicle maintenance.
FACILITIES List the following facilities categories and provide a brief description for each category:
0451 - Rent/Lease Building - Cost to rent facility.
COMMUNICATIONS 0301 - Telecommunications/data lines - Costs of telephone expense @ facility for staff.
For employees that share time between programs, costs are estimated based on budgeted
FTEs.
0302 - Answering Service - N/A
OFFICE EXPENSE 0351 - Office Supplies: Includes Items necessary to carry out the daily activities to
accomplish the program goals and objectives including paper, filing supplies, pens, pencils,
scissors, and other supplies.
0352 - Social/Rec, Workbooks.- N/A
0353 - Printing/Reproduction includes items such as the printing of business cards,
program pamphlets, position vacancy advertising and other materials related to the program.
0354 - Publications - N/A
0355 - Legal Notices/Advertising - N/A
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance- Professional Liability and Malpractice Insurances
0253 - Insurance Other - N/A
SUD Counselor
Position descriptions submitted with proposal.
Annual Salary and FTE equivalence as in budget.
Budget Categories-Line Item Description Annual Salary for
this Program
% of FTE dedicated
to this program
Program Manager
Case Manager
Vice President
Program Analyst
Intern
Administrative Assistant
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2020-21 Narrative
Mental Health Systems, Inc.
PERSONNEL / SALARIES
Exhibit F-4
Page 12 of
20
5870
1800
1191
254
1753
2500
0
400
780
3600
3600
3600
50
35480
5443
0
1204
159961
10210
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for each
t 0651 - Accounting/Bookkeeping - See Indirect
0652 - External Audit - Independent CPA Audit - Cost for annual audit to include this
program.
3120 - Drug Medi-Cal - estimated funding generated from DMC clients
0749 - Other Costs - Other business services such as applicant TB tests, drug
screens, and other program-related items that don't necessarily fit into another line item.
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 travel to
multiple sites, as well as for coverage when traveling for training, or home visits. Mileage
reimbursement rate is limited to the IRS standards.
0502 - Staff Travel (Out of County) - Covers the cost of program staff attending
meetings and trainings out of county, for example, the Program Manager's travel to San
Diego for the quarterly PMs meeting.
0503 - Staff Training/Registration - Cost for staff to attend trainings relevant to the
SOW.
0504 - Transportation - To purchase bus passes to allow transportation to treatment
appointments for clients who are able to access public transportation but are not financially
able. A log is kept to track distribution of passes.
0604 - Contracted Services - Urinalysis testing
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification. The amount
t d 1/12th f th t t l t l f thi ti The amount cannot exceed 1/12th of the total cost proposal for this section.
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for each
t 0551 - Program Supplies - Client Incentives: N/A
0552 - Program Supplies - Curriculum: Cost of supplies for client curriculum and
supplies for recreational therapy and occupational therapy.
0553 - Program Supplies - Food: Food for clients
3140 - Private Donations -
0703 - County Administration Fee -N/A
3150 - Client Fees -
0603 - Contracted Services - Medical Director
CONSULTANCY List the following consulting categories and provide a brief description for each category:
0601 - Consultant Services - Interpretive Service: Allows program staff to reach an
interpreter to provide language services to serve clients in their primary language.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue offsets
dit f th i ti / d
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - 14.5% of total Direct Costs to allow for Administrative cost of
running the program, such as staff providing support in payroll processing, accounts payable
and other management departments. See Cost Allocation Plan.
0702 - Licenses/Taxes - Cost of DMC Certification, Avatar (EHR) user fees, DMV
verification
3160 - Insurance -
•3121 - Mental Health Medi-Cal -
•3125 - Youth Treatment Services - (SAPT) - estimated funding generated from Youth
treatment clients
3130 - State Grant -
0452 - Facilities Maintenance - Cost for a portion of the custodial/janitorial services for
facility, alarm service, as well as minor building repairs like key replacements.
0453 - Utilities - Gas, water, electric at program facility
Exhibit F-4
Page 13 of
20
Mailing Address:
Street Address:
1.20 Phone Number:
2.30 Fax Number:
E-mail Address:
% of FTE
Annual dedicated to
Salary this program Admin.Direct Admin.Direct
0101 Program Manager 71,032$ 37%100%0%26,282$ -$ 26,282$
0102 SUD Counselor 45,448$ 100%0%100%-$ 45,448$ 45,448$
0103 Case Manager 40,914$ 50%0%100%-$ 20,457$ 20,457$
0104 Administrative Assistant 40,914$ 60%100%0%24,548$ -$ 24,548$
0105 Vice President 104,000$ 16%100%0%16,640$ -$ 16,640$
0106 Program Analyst 65,000$ 7%100%0%4,550$ -$ 4,550$ 0107 Intern -$ 80%100%-$ -$ -$
SALARIES TOTAL 72,020$ 65,905$ 137,925$
Rate 52.22%47.78%100.00%
0151 F.I.C.A. Social Security and Medicare SS 6.2 % rate applied to $127.2k of gross earnings per employee 7.650%5,510$ 5,042$ 10,551$
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 $7k of gross earnings per employee 0.700%504$ 461$ 965$
PAYROLL TAXES TOTAL 6,014$ 5,503$ 11,516$
EMPLOYEE BENEFITS Rate 52.22%47.78%100.00%
0201 Health Insurance 12.35%8,894$ 8,139$ 17,033$
0202 Life Insurance 0.04%27$ 24$ 51$
0203 Retirement 8.00%5,762$ 5,272$ 11,034$
0204 Workers' Compensation Insurance 1.00%720$ 659$ 1,379$ 0205 Benefits Other - Specify 0.00%-$ -$
EMPLOYEE BENEFITS TOTAL 15,403$ 14,094$ 29,497$
TAXES & BENEFITS TOTAL 41,013$
TOTAL DIRECT (ADMIN) SALARIES, PAYROLL TAXES, AND EMPLOYEE BENEFITS 178,938$
TOTAL PERCENT OF BENEFITS TO SALARIES 29.7%
Services and Supplies
0252 770$
0253 -$
770$
0301 10,819$
0302
10,819$
0351 2,079$
0352
0353 150$
0354
0355
2,229$
0401 5,044$
0402 2,604$
0403 912$
8,560$
FACILITIES
0451 15,079$
0452 4,870$
0453 1,800$
21,749$
0501 1,191$
0502 254$
0503 1,753$
0504 1,500$
4,698$
0551 -$
0552 200$
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2021-22
Provider Name:Mental Health Systems, Inc.9465 Farnham Street
Program Name:Family & Youth Alternatives San Diego, CA 92123
Approved by:Lindsay Santino 3122 N. Millbrook Suite B
Fresno, CA 93703
No. of Budgeted FTEs - Admin:(858) 573-2600
No. of Budgeted FTEs - Direct:(858) 573-2914
Line Item Description to services
Total Proposed Budget(Must be Itemized)
dheld@mhsinc.org
Budget Categories-% Time dedicated Proposed Program Budget
COMMUNICATIONS
PERSONNEL/SALARIES
PAYROLL TAXES
INSURANCE
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
Purchase of Equipment (Computers/Furniture/VOIP Phone)
Telecommunications/data lines
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Transportation
Equipment Rent/Lease (Copy Machines)
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
TRAVEL COSTS TOTAL
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Exhibit F-4
Page 14 of
20
0553 600$
800$
0601 3,600$
0602
0603 3,600$
0604 2,400$
9,600$
0651
0652 50$
50$
0701 35,480
0702 5,443
0703 -
0749 1,035
41,958$
280,171$
3120 159,961$
3121
3125 10,210$
3130
3140
3150
3160
170,171$
110,000$
CONSULTANCY TOTAL
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
Consultant Services (Interpretive Services)
Contracted Services (Recruitment)
Contracted Services (Medical Director)
Contracted Services (Urinalysis)
TOTAL PROGRAM EXPENDITURES
FISCAL AND AUDITS
Accounting/Bookkeeping (IT Support)
External Audit
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
Licenses/Taxes
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
ONE TIME ADVANCE - Start Up Costs
Client Fees
Insurance
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
REVENUE/MATCH
Drug Medi-Cal
Mental Health Medi-Cal
Youth Treatment Services (SAPT)
State Grant
Private Donations
Exhibit F-4
Page 15 of
20
Provider Name:
26,282$ 37%
45,448 100%
20,457 50%
24,548 60%
16,640 16%
4,550 7%
- 80%
List Amount
PAYROLL TAXES TOTAL $ 11,516
EMPLOYEE BENEFITS
TOTAL $ 29,497
1379
770
0
10819
2079
150
5044
2604
912
15079
Annual Salary and FTE equivalence as in budget.
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2021-22 Narrative
Mental Health Systems, Inc.
PERSONNEL / SALARIES
Budget Categories-Line Item Description Annual Salary for
this Program
% of FTE dedicated
to this program
Program Manager
SUD Counselor
Case Manager
Administrative Assistant
Vice President
Program Analyst
Intern
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
COMMUNICATIONS 0301 - Telecommunications/data lines - Costs of telephone expense @ facility for staff.
For employees that share time between programs, costs are estimated based on budgeted
FTEs.
0302 - Answering Service - N/A
OFFICE EXPENSE 0351 - Office Supplies: Includes Items necessary to carry out the daily activities to
accomplish the program goals and objectives including paper, filing supplies, pens, pencils,
scissors, and other supplies.
0352 - Social/Rec, Workbooks.- N/A
0353 - Printing/Reproduction includes items such as the printing of business cards,
program pamphlets, position vacancy advertising and other materials related to the program.
0354 - Publications - N/A
0355 - Legal Notices/Advertising - N/A
FACILITIES List the following facilities categories and provide a brief description for each category:
0451 - Rent/Lease Building - Cost to rent facility.
EQUIPMENT List the following equipment categories and provide a brief description for each category:
0401 - Purchase of Equipment - minor equipment needs & replacement of old/broken
equipment
0402 - Equipment Rent/Lease- Cost for lease of copy machine and water dispenser
for clients.
0403 - Equipment Maintenance: minor equipment repair for copier, IT equipment, and
vehicle maintenance.
Exhibit F-4
Page 16 of
20
4870
1800
1191
254
1753
1500
0
200
600
3600
3600
2400
50
35480
5443
0
1035
159961
10210
0452 - Facilities Maintenance - Cost for a portion of the custodial/janitorial services for
facility, alarm service, as well as minor building repairs like key replacements.
0453 - Utilities - Gas, water, electric at program facility
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 travel to
multiple sites, as well as for coverage when traveling for training, or home visits. Mileage
reimbursement rate is limited to the IRS standards.
0502 - Staff Travel (Out of County) - Covers the cost of program staff attending
meetings and trainings out of county, for example, the Program Manager's travel to San
Diego for the quarterly PMs meeting.
0503 - Staff Training/Registration - Cost for staff to attend trainings relevant to the
SOW.
0504 - Transportation - To purchase bus passes to allow transportation to treatment
appointments for clients who are able to access public transportation but are not financially
able. A log is kept to track distribution of passes.
CONSULTANCY List the following consulting categories and provide a brief description for each category:
0601 - Consultant Services - Interpretive Service: Allows program staff to reach an
interpreter to provide language services to serve clients in their primary language.
0603 - Contracted Services - Medical Director
0604 - Contracted Services - Urinalysis testing
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for each
t 0551 - Program Supplies - Client Incentives: N/A
0552 - Program Supplies - Curriculum: Cost of supplies for client curriculum and
supplies for recreational therapy and occupational therapy.
0553 - Program Supplies - Food: Food for clients
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for each
t 0651 - Accounting/Bookkeeping - See Indirect
0652 - External Audit - Independent CPA Audit - Cost for annual audit to include this
program.
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - 14.5% of total Direct Costs to allow for Administrative cost of
running the program, such as staff providing support in payroll processing, accounts payable
and other management departments. See Cost Allocation Plan.
0702 - Licenses/Taxes - Cost of DMC Certification, Avatar (EHR) user fees, DMV
verification
0703 - County Administration Fee -N/A
0749 - Other Costs - Other business services such as applicant TB tests, drug
screens, and other program-related items that don't necessarily fit into another line item.
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification. The amount
t d 1/12th f th t t l t l f thi ti 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 offsets
dit f th i ti / d 3120 - Drug Medi-Cal - estimated funding generated from DMC clients
•3121 - Mental Health Medi-Cal -
•3125 - Youth Treatment Services - (SAPT) - estimated funding generated from Youth
treatment clients
3130 - State Grant -
3140 - Private Donations -
3150 - Client Fees -
3160 - Insurance -
Exhibit F-4
Page 17 of
20
Mailing Address:
Street Address:
1.20 Phone Number:
2.30 Fax Number:
E-mail Address:
% of FTE
Annual dedicated to
Salary this program Admin.Direct Admin.Direct
0101 Program Manager 71,032$ 37%100%0%26,282$ -$ 26,282$
0102 SUD Counselor 45,448$ 100%0%100%-$ 45,448$ 45,448$
0103 Case Manager 40,914$ 50%0%100%-$ 20,457$ 20,457$
0104 Administrative Assistant 40,914$ 60%100%0%24,548$ -$ 24,548$
0105 Vice President 104,000$ 16%100%0%16,640$ -$ 16,640$
0106 Program Analyst 65,000$ 7%100%0%4,550$ -$ 4,550$ 0107 Intern -$ 80%100%-$ -$ -$
SALARIES TOTAL 72,020$ 65,905$ 137,925$
Rate 52.22%47.78%100.00%
0151 F.I.C.A. Social Security and Medicare SS 6.2 % rate applied to $127.2k of gross earnings per employee 7.650%5,510$ 5,042$ 10,551$
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 $7k of gross earnings per employee 0.700%504$ 461$ 965$
PAYROLL TAXES TOTAL 6,014$ 5,503$ 11,516$
EMPLOYEE BENEFITS Rate 52.22%47.78%100.00%
0201 Health Insurance 12.35%8,894$ 8,139$ 17,033$
0202 Life Insurance 0.04%27$ 24$ 51$
0203 Retirement 8.00%5,762$ 5,272$ 11,034$
0204 Workers' Compensation Insurance 1.00%720$ 659$ 1,379$ 0205 Benefits Other - Specify 0.00%-$ -$
EMPLOYEE BENEFITS TOTAL 15,403$ 14,094$ 29,497$
TAXES & BENEFITS TOTAL 41,013$
TOTAL DIRECT (ADMIN) SALARIES, PAYROLL TAXES, AND EMPLOYEE BENEFITS 178,938$
TOTAL PERCENT OF BENEFITS TO SALARIES 29.7%
Services and Supplies
0252 770$
0253 -$
770$
0301 10,819$
0302
10,819$
0351 2,079$
0352
0353 150$
0354
0355
2,229$
0401 5,044$
0402 2,604$
0403 912$
8,560$
FACILITIES
0451 15,532$
0452 4,870$
0453 1,800$
22,202$
0501 1,191$
0502 254$
0503 1,300$
0504 1,500$
4,245$
0551 -$
0552 200$
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2022-23
Provider Name:Mental Health Systems, Inc.9465 Farnham Street
Program Name:Family & Youth Alternatives San Diego, CA 92123
Approved by:Lindsay Santino 3122 N. Millbrook Suite B
Fresno, CA 93703
No. of Budgeted FTEs - Admin:(858) 573-2600
No. of Budgeted FTEs - Direct:(858) 573-2914
Line Item Description to services
Total Proposed Budget(Must be Itemized)
dheld@mhsinc.org
Budget Categories-% Time dedicated Proposed Program Budget
COMMUNICATIONS
PERSONNEL/SALARIES
PAYROLL TAXES
INSURANCE
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
Purchase of Equipment (Computers/Furniture/VOIP Phone)
Telecommunications/data lines
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Transportation
Equipment Rent/Lease (Copy Machines)
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
TRAVEL COSTS TOTAL
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Exhibit F-4
Page 18 of
20
0553 600$
800$
0601 3,600$
0602
0603 3,600$
0604 2,400$
9,600$
0651
0652 50$
50$
0701 35,480
0702 5,443
0703 -
0749 1,035
41,958$
280,171$
3120 159,961$
3121
3125 10,210$
3130
3140
3150
3160
170,171$
110,000$
CONSULTANCY TOTAL
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
Consultant Services (Interpretive Services)
Contracted Services (Recruitment)
Contracted Services (Medical Director)
Contracted Services (Urinalysis)
TOTAL PROGRAM EXPENDITURES
FISCAL AND AUDITS
Accounting/Bookkeeping (IT Support)
External Audit
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
Licenses/Taxes
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
ONE TIME ADVANCE - Start Up Costs
Client Fees
Insurance
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
REVENUE/MATCH
Drug Medi-Cal
Mental Health Medi-Cal
Youth Treatment Services (SAPT)
State Grant
Private Donations
Exhibit F-4
Page 19 of
20
Provider Name:
26,282$ 37%
45,448 100%
20,457 50%
24,548 60%
16,640 16%
4,550 7%
- 80%
List Amount
PAYROLL TAXES TOTAL $ 11,516
EMPLOYEE BENEFITS
TOTAL $ 29,497
1379
770
0
10819
2079
150
5044
2604
912
15532
Annual Salary and FTE equivalence as in budget.
18-042: Juvenile Drug Court Services/Post Release Outpatient Services
Projected Budget - Fiscal Year 2022-23 Narrative
Mental Health Systems, Inc.
PERSONNEL / SALARIES
Budget Categories-Line Item Description Annual Salary for
this Program
% of FTE dedicated
to this program
Program Manager
SUD Counselor
Case Manager
Administrative Assistant
Vice President
Program Analyst
Intern
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
COMMUNICATIONS 0301 - Telecommunications/data lines - Costs of telephone expense @ facility for staff.
For employees that share time between programs, costs are estimated based on budgeted
FTEs.
0302 - Answering Service - N/A
OFFICE EXPENSE 0351 - Office Supplies: Includes Items necessary to carry out the daily activities to
accomplish the program goals and objectives including paper, filing supplies, pens, pencils,
scissors, and other supplies.
0352 - Social/Rec, Workbooks.- N/A
0353 - Printing/Reproduction includes items such as the printing of business cards,
program pamphlets, position vacancy advertising and other materials related to the program.
0354 - Publications - N/A
0355 - Legal Notices/Advertising - N/A
FACILITIES List the following facilities categories and provide a brief description for each category:
0451 - Rent/Lease Building - Cost to rent facility.
EQUIPMENT List the following equipment categories and provide a brief description for each category:
0401 - Purchase of Equipment - minor equipment needs & replacement of old/broken
equipment
0402 - Equipment Rent/Lease- Cost for lease of copy machine and water dispenser
for clients.
0403 - Equipment Maintenance: minor equipment repair for copier, IT equipment, and
vehicle maintenance.
Exhibit F-4
Page 20 of
20
4870
1800
1191
254
1300
1500
0
200
600
3600
3600
2400
50
35480
5443
0
1035
159961
10210
0452 - Facilities Maintenance - Cost for a portion of the custodial/janitorial services for
facility, alarm service, as well as minor building repairs like key replacements.
0453 - Utilities - Gas, water, electric at program facility
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 travel to
multiple sites, as well as for coverage when traveling for training, or home visits. Mileage
reimbursement rate is limited to the IRS standards.
0502 - Staff Travel (Out of County) - Covers the cost of program staff attending
meetings and trainings out of county, for example, the Program Manager's travel to San
Diego for the quarterly PMs meeting.
0503 - Staff Training/Registration - Cost for staff to attend trainings relevant to the
SOW.
0504 - Transportation - To purchase bus passes to allow transportation to treatment
appointments for clients who are able to access public transportation but are not financially
able. A log is kept to track distribution of passes.
CONSULTANCY List the following consulting categories and provide a brief description for each category:
0601 - Consultant Services - Interpretive Service: Allows program staff to reach an
interpreter to provide language services to serve clients in their primary language.
0603 - Contracted Services - Medical Director
0604 - Contracted Services - Urinalysis testing
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for each
t 0551 - Program Supplies - Client Incentives: N/A
0552 - Program Supplies - Curriculum: Cost of supplies for client curriculum and
supplies for recreational therapy and occupational therapy.
0553 - Program Supplies - Food: Food for clients
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for each
t 0651 - Accounting/Bookkeeping - See Indirect
0652 - External Audit - Independent CPA Audit - Cost for annual audit to include this
program.
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - 14.5% of total Direct Costs to allow for Administrative cost of
running the program, such as staff providing support in payroll processing, accounts payable
and other management departments. See Cost Allocation Plan.
0702 - Licenses/Taxes - Cost of DMC Certification, Avatar (EHR) user fees, DMV
verification
0703 - County Administration Fee -N/A
0749 - Other Costs - Other business services such as applicant TB tests, drug
screens, and other program-related items that don't necessarily fit into another line item.
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification. The amount
t d 1/12th f th t t l t l f thi ti 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 offsets
dit f th i ti / d 3120 - Drug Medi-Cal - estimated funding generated from DMC clients
•3121 - Mental Health Medi-Cal -
•3125 - Youth Treatment Services - (SAPT) - estimated funding generated from Youth
treatment clients
3130 - State Grant -
3140 - Private Donations -
3150 - Client Fees -
3160 - Insurance -