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Home My WebLink AboutAgreement A-13-395-3 with Mental Health Systems Inc..pdf Agreement No. 13-395-3 1 AMENDMENT III TO AGREEMENT 2 THIS AMENDMENT, hereinafter referred to as Amendment III, is made and entered into this 3 12th day of June , 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 Street, 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 II, 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 1 actual cost for a maximum of Two Hundred Thirty Six Thousand Six Hundred Sixty-Eight and No/100 2 Dollars ($236,668.00)for the four(4) month period beginning July 1, 2018 and ending October 31, 2018, 3 as set forth in the four(4) month budgets attached hereto as Exhibit C-3a and Exhibit C-3b and by this 4 reference incorporated herein." 5 3. That the existing County Agreement No. 13-395, Paragraph Four(4), "COMPENSATION", 6 shall be revised by adding the following at Page Four(4), Line Seventeen (17) after the word "herein": 7 "For claims submitted for services rendered under this Agreement, COUNTY agrees to pay 8 CONTRACTOR and CONTRACTOR agrees to receive compensation for Intensive Substance Use 9 Disorder and Mental Health Services for Incarcerated Youth at the JJC "New Horizons Program" based 10 on CONTRACTOR's actual cost for a maximum of One Hundred Thousand and No/100 Dollars 11 ($100,000.00)for the four(4) month period beginning July 1, 2018 and ending October 31, 2018, as set 12 forth in Exhibit C-4 attached hereto and incorporated herein by reference. 13 In no event shall the total compensation for actual services performed under this 14 Agreement be in excess of Five Million, Three Hundred Eighty-Six Thousand, Six Hundred Sixty-Eight 15 and No/100 Dollars ($5,386,668.00)." 16 4. That, effective July 1, 2018, all references in existing COUNTY Agreement No. 13-395 to 17 "Exhibit C-1 and Exhibit C-2," shall be changed to read "Exhibit C-1, Exhibit C-2, Exhibit C-3a, Exhibit C- 18 3b, and Exhibit C-4". 19 5. COUNTY and CONTRACTOR agree that this Amendment III is sufficient to amend the 20 Agreement, and that upon execution of this Amendment III, the Agreement, Amendment I, Amendment II 21 and Amendment III together shall be considered the Agreement. 22 The Agreement, as hereby amended, is ratified and continued. All provisions, terms, covenants, 23 considerations and promises contained in the Agreement and not amended herein remain in full force and 24 effect. This Amendment III shall become effective upon execution by all parties. 25 /// 26 27 28 /// 1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment III to Agreement 2 No. 13-395 as of the day and year first hereinabove written. 3 4 CONTRACTOR COUNTY OF FRESNO 5 MENTAL HEALT S- S INC. ,ze:� 7 (Authorized Signature) S Qu t o, airperson of the Board of James C. Callaghan,Jr, S so e County of Fresno 8 Print Name 9 President&CEO 10 Title (Chairman of Board, or President, or ATTEST: CEO) Bernice F. Seidel 11 r Clerk of the Board of Supervisors 12 County of Fresno, State of California (Authorized Signat e) 13 By: _�L 1SCtm CST . j C1 Cal fl'�O`aCO� — Deputy 14 Print Name 15 T 1► NCX n C.t CL- G( C- Title (Secretary of Corporation, or Chief 16 Financial Officer/Treasurer, or any 17 Assistant Secretary or Treasurer) 18 19 20 MAILING ADDRESS: 21 9465 Farnham Street San Diego, CA 92123 22 23 24 1 FOR ACCOUNTING USE ONLY: 25 Organization: 56302081 Fund/Subclass: 0001/10000 26 Account/Program: 7295/0 27 28 EXHIBIT C-3a Substance Abuse Unit - Substance Use Disorder Services Projected Budget- Fiscal Year 2018-19 Provider Name: Mental Health Systems, Inc. Mailing Address: 92123 Program Name: Fresno Juvenile Treatment (FF-SAU Approved by: Dominic Held, Finance Manager Street Address: 3333 E American Avenue, Fresno CA No. of Budgeted FTEs -Admin: 0.89 Phone Number: (858) 573-2600 No. of Budgeted FTEs -Direct: 6.20 Fax Number: (858) 573-2914 E-mail Address: dheld@mhsinc.org Budget Categories- One Fourth of %of FTE %Time dedicated Proposed Program Budget Line Item Description dedicated to to services Total Proposed (Must be Itemized) Annual Salary this program Admin. Direct Admin. Direct Budget PERSONNEL/SALARIES 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 U112 Allsha Lamp,AUU Certltled Counselor 1U,b/3 2U1/0 U% 1UU1/0 - 2,115.UU 2,115.00 SALARIES TOTAL $ 200,588.27 r $ 17,438 $ 75,608 $ 93,046 PAYROLL TAXES 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 5,184 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 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 INSURANCE 0252 Liability Insurance $ 957 0253 Insurance Other-Specify $ - INSURANCE TOTAL $ 957 COMMUNICATIONS 0301 Telecommunications/data lines $ 3,990 0302 Answering Service $ - COMMUNICATIONS TOTAL $ 3,990 OFFICE EXPENSE 0351 Office Supplies $ 1,001 0352 Soc Rec.,Workbooks $ - 0353 Printing/Reproduction $ 33 0354 Publications $ - 0355 Legal Notices/Advertising $ - OFFICE EXPENSE TOTAL $ 1,034 EQUIPMENT 0401 Purchase of Equipment(Computers/Furniture/VOIP Phone) $ 128 0402 Equipment Rent/Lease(Copy Machines) $ 2,088 0403 Equipment Maintenance $ 902 EQUIPMENT TOTAL $ 3,118 FACILITIES 0451 Rent/Lease Building $ 4,600 0452 Facilities Maintenance $ 1,623 0453 Utilities $ 600 FACILITIES TOTAL $ 6,823 TRAVEL COSTS 0501 Staff Mileage $ 235 0502 Staff Travel(Out of County) $ 262 0503 Staff Training/Registration $ 847 0504 Transportation $ 543 TRAVEL COSTS TOTAL $ 1,886 PROGRAM SUPPLIES 0551 Program Supplies-Client Incentives $ - EXHIBIT C-3a 0552 Program Supplies-Curriculum $ 80 0553 Program Supplies-Food $ 700 PROGRAM SUPPLIES TOTAL $ 780 CONSULTANCY 0601 Consultant Services(Interpretive Services) $ - 0602 Contracted Services(Recruitment) $ 2,200 CONSULTANCY TOTAL $ 2,200 FISCAL AND AUDITS 0651 Accounting/Bookkeeping(IT Support) $ - 0652 External Audit $ - FISCAL AND AUDITS TOTAL $ - OTHER COSTS 0701 Indirect Costs $ 20,684 0702 Licenses/Taxes $ 3,473 0703 County Administration Fee $ - 0749 Other Business Services $ 848 OTHER COSTS TOTAL $ 25,006 ONE TIME ADVANCE-Start Up Costs $ - TOTAL PROGRAM EXPENDITURES $ 163,334 REVENUE/MATCH 3120 Drug Medi-Cal $ 23,333 3130 State Grant $ 3,333 3140 Private Donations $ - 3150 Client Fees $ - 3160 Insurance $ - REVENUE/MATCH TOTAL $ 26,667 NET PROGRAM BUDGET $ 136,668 EXHIBIT C-3a TYPE OF SERVICE Projected Budget - Fiscal Year 2018-19 Narrative Provider Name: Mental Health Systems, Inc. PERSONNEL / SALARIES Annual Salary and FTE equivalence as in budget. One Fourth of % of FTE Budget Categories-Line Item Description Annual Salary dedicated to this program Susan Murdock, Program Manager $ 4,472 20% Josefina Ceja, Clinical Supervisor - LCSW (FF-SAU) 5,139 20% Candida Rojas, Administrative Assistant 3,883 35% Kathryn Wilbur, Vice President 2,427 7% Agustin Ochoa, Program Analyst 1,517 7% Vidal Bejarano, Lead AOD Certified Counselor - Boys 13,867 100% Kimberlynn Silva & Marina Herrera, AOD Counselors 22,187 200% Cynthia Williams, Family Support Partner 4,853 50% Marty Castanon, AOD Certified Counselor 13,173 100% TBD, Program Supervisor/ Lead AOD Certified Counselor 7,280 50% Ciera Nelson, AOD Certified Counselor 12,133 100% Alisha Lamp, AOD Certified Counselor 1 2,115 20% $ 93,046 Position descriptions submitted with proposal. List Amount PAYROLL TAXES EMPLOYEE BENEFITS TOTAL $ 16,725 INSURANCE List the following insurance categories: ❑ 0251 -Workers Compensation Insurance $ 930 ❑ 0252 - Liability Insurance- Professional Liability and Malpractice Insurances $ 957 0253 - Insurance Other- N/A $ - COMMUNICATIONS ❑ 0301 -Telecommunications/data lines - Costs projected to include a portion of $ 3,990 ❑ 0302 -Answering Service- N/A $ - OFFICE EXPENSE ❑ 0351-Office Supplies: Includes Items necessary to carry out the daily activities $ 1,001 ❑ 0352 - Social/Rec, Workbooks.- N/A $ - ❑ 0353-Printing/Reproduction includes items such as the printing of business $ 33 ❑ 0354 - Publications - N/A $ - ❑ 0355 - Legal Notices/Advertising - N/A $ - 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., $ 128 ❑ 0402 - Equipment Rent/Lease- Cost for lease of copy machine. $ 2,088 ❑ 0403-Equipment Maintenance: minor equipment repair for copier and vehicle $ 902 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 $ 4,600 ❑ 0452 - Facilities Maintenance- Cost for a portion of the custodial/janitorial $ 1,623 ❑ 0453 - Utilities - Costs projected include a portion of the utilities cost to $ 600 EXHIBIT C-3a 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 $ 235 0502 - Staff Travel (Out of County)- Cost for mileage reimbursement for staff $ 262 ❑ 0503 - Staff Training/Registration - Cost for staff to attend trainings relevant $ 847 ❑ 0504 -Transportation -To purchase bus passes and tokens to allow $ 543 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 $ 80 ❑ 0553 - Program Supplies - Food: N/A $ 700 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 $ 2,200 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 $ 20,684 ❑ 0702 - Licenses/Taxes -N/A $ 3,473 ❑ 0703 - County Administration Fee -N/A $ - 0749-Other Costs - Other business services such as applicant TB tests, drug $ 848 REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue ❑ 3120 - Drug Medi-Cal, Contract no. 16-360 $ 23,333 ❑ 3130 - State Grant-Youth Treatment, contract no. 13-574 $ 3,333 ❑ 3140 - Private Donations - $ - ❑ 3150 - Client Fees - $ - ❑ 3160 - Insurance- $ - ONE TIME ADVANCE I 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. $ - EXHIBIT C-3b Substance Abuse Unit - Mental Health Services Projected Budget- Fiscal Year 2018-19 Provider Name: Mental Health Systems, Inc. Mailing Address: 92123 Program Name: SAMHSA MHBG Approved by: Dominic Held, Finance Manager Street Address: 3333 E American Avenue, Fresno CA No. of Budgeted FTEs -Admin: 1.14 Phone Number: (858) 573-2600 No. of Budgeted FTEs -Direct: 3.00 Fax Number: (858) 573-2914 E-mail Address: dheld@mhsinc.org Budget Categories- %of FTE %Time dedicated Proposed Program Budget Line Item Description One Fourth of Annual Salary dedicated to to services Total Proposed (Must be Itemized) this program Admin. Direct Admin. Direct Budget PERSONNEL/SALARIES 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 Sandra Rentfrow, Unlicensed Mental Health Clinician- Boys 14,560 100% 0% 100% - 14,560.00 14,560.00 0109 Lindsay Fisher, Unlicensed Mental Health Clinician- Boys 13,173 100% 0% 100% - 13,173.00 13,173.00 0110 - - - 0111 - - U112 - - - SALARIES TOTAL $155,002 $ 24,691 $ 41,600 $ 66,291 PAYROLL TAXES 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 6.277 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 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 INSURANCE 0252 Liability Insurance $ 390 0253 Insurance Other-Specify $ - INSURANCE TOTAL $ 390 COMMUNICATIONS 0301 Telecommunications/data lines $ 48 0302 Answering Service $ - COMMUNICATIONS TOTAL $ 48 OFFICE EXPENSE 0351 Office Supplies $ 513 0352 Soc Rec.,Workbooks $ - 0353 Printing/Reproduction $ 17 0354 Publications $ - 0355 Legal Notices/Advertising $ - OFFICE EXPENSE TOTAL $ 530 EQUIPMENT 0401 Purchase of Equipment(Computers/Furniture/VOIP Phone) $ 60 0402 Equipment Rent/Lease(Copy Machines) $ - 0403 Equipment Maintenance $ 200 EQUIPMENT TOTAL $ 260 FACILITIES 0451 Rent/Lease Building $ - 0452 Facilities Maintenance $ - 0453 Utilities $ - FACILITIES TOTAL $ - TRAVEL COSTS 0501 Staff Mileage $ 214 0502 Staff Travel(Out of County) $ - 0503 Staff Training/Registration $ 287 0504 Transportation $ - TRAVEL COSTS TOTAL $ 501 PROGRAM SUPPLIES 0551 Program Supplies-Client Incentives $ - EXHIBIT C-3b 0552 Program Supplies-Curriculum $ 200 0553 Program Supplies-Food $ 250 PROGRAM SUPPLIES TOTAL $ 450 CONSULTANCY 0601 Consultant Services(Interpretive Services) $ 1,200 0602 Contracted Services(Recruitment) $ - CONSULTANCY TOTAL $ 1,200 FISCAL AND AUDITS 0651 Accounting/Bookkeeping(IT Support) $ - 0652 External Audit $ - FISCAL AND AUDITS TOTAL MEMEEMEN $ - OTHER COSTS 0701 Indirect Costs $ 12,664 0702 Licenses/Taxes $ 1,776 0703 County Administration Fee $ - 0749 Other Business Services $ 434 OTHER COSTS TOTAL $ 14,874 ONE TIME ADVANCE-Start Up Costs $ - TOTAL PROGRAM EXPENDITURES $ 100,000 REVENUE/MATCH 3120 Drug Medi-Cal $ - 3130 State Grant $ - 3140 Private Donations $ - 3150 Client Fees $ - 3160 InsuranceX-1111-111- $ - REVENUE/MATCH TOTAL $NET PROGRAM BUDGET $ 100,000 EXHIBIT C-3b TYPE OF SERVICE Projected Budget - Fiscal Year 2018-19 Narrative Provider Name: Mental Health Systems, Inc. PERSONNEL / SALARIES Annual Salary and FTE equivalence as in budget. One Fourth of % of FTE Budget Categories-Line Item Description Annual Salary dedicated to this program Susan Murdock, Program Manager $ 8,389 40% Josefina Ceja, Clinical Supervisor - LCSW 10,278.0 40% Candida Rojas, Administrative Assistant 2,080.0 20% Kathryn Wilbur, Vice President 2,427.0 7% Agustin Ochoa, Program Analyst 1,517.0 7% Tammie Makely, Unlicensed Mental Health Clinician- Girls 13,867.0 100% Sandra Rentfrow, Unlicensed Mental Health Clinician- Boys 14,560.0 100% Lindsay Fisher, Unlicensed Mental Health Clinician- Boys 13,173.0 100% Totall $ 66,291.00 Position descriptions submitted with proposal. List Amount PAYROLL TAXES EMPLOYEE BENEFITS TOTAL $ 10,120 INSURANCE List the following insurance categories: ❑ 0251 -Workers Compensation Insurance $ 663 ❑ 0252 - Liability Insurance- Professional Liability and Malpractice Insurances $ 390 0253 - Insurance Other- N/A $ - COMMUNICATIONS ❑ 0301 -Telecommunications/data lines - Costs projected to include a portion of $ 48 ❑ 0302 -Answering Service- N/A $ - OFFICE EXPENSE ❑ 0351-Office Supplies: Includes Items necessary to carry out the daily activities $ 513 ❑ 0352 - Social/Rec, Workbooks.- N/A $ - ❑ 0353-Printing/Reproduction includes items such as the printing of business $ 17 ❑ 0354 - Publications - N/A $ - ❑ 0355 - Legal Notices/Advertising - N/A $ - 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., $ 60 ❑ 0402 - Equipment Rent/Lease- Cost for lease of copy machine. $ - ❑ 0403-Equipment Maintenance: minor equipment repair for copier and vehicle $ 200 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 $ - EXHIBIT C-3b 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 $ 214 0502 - Staff Travel (Out of County)- Cost for mileage reimbursement for staff $ - ❑ 0503 - Staff Training/Registration - Cost for staff to attend trainings relevant $ 287 ❑ 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 $ 200 ❑ 0553 - Program Supplies - Food: N/A $ 250 CONSULTANCY List the following consulting categories and provide a brief description for each 0601 - Consultant Services: Allows program staff to reach an interpreter to $ 1,200 0602 - Contracted Services: Costs related to recruiting of staff and verification $ - 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 $ 12,664 ❑ 0702 - Licenses/Taxes -N/A $ 1,776 ❑ 0703 - County Administration Fee -N/A $ - 0749-Other Costs - Other business services such as applicant TB tests, drug $ 434 REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue ❑ 3120 - Drug Medi-Cal - $ - ❑ 3130 - State Grant- $ - ❑ 3140 - Private Donations - $ - ❑ 3150 - Client Fees - $ - ❑ 3160 - Insurance- $ - ONE TIME ADVANCE I 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. $ - EXHIBIT C-4 New Horizons Program Projected Budget- Fiscal Year 2018-19 Provider Name: Mental Health Systems, Inc. Mailing Address: 92123 Program Name: New Horizons Approved by: Dominic Held, Finance Manager Street Address: 3333 E American Avenue, Fresno CA No. of Budgeted FTEs -Admin: 1.04 Phone Number: (858) 573-2600 No. of Budgeted FTEs -Direct: 3.33 Fax Number: (858) 573-2914 E-mail Address: dheld@mhsinc.org Budget Categories- One Fourth of %of FTE %Time dedicated Proposed Program Budget Line Item Description dedicated to to services Total Proposed (Must be Itemized) Annual Salary this program Admin. Direct Admin. Direct Budget PERSONNEL/SALARIES 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 TBD (currently, Chris Esqueda),Therapist, Lic elig, MA level 13,867 83% 0% 100% - 11,556.00 11,556.00 0109 Peter Flores,AOD Cerified Counselor 10,053 100% 0% 100% - 10,053.00 10,053.00 0110 Cynthia Williams, Family Support Partner 9,013 50% 0% 100% - 4,507.00 4,507.00 0111 - - - U112 - - - SALARIES TOTAL $ 160,202 $ 22,594 j $ 39,983 $ 62,577 PAYROLL TAXES 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 6.607 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 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 INSURANCE 0252 Liability Insurance $ 760 0253 Insurance Other-Specify $ - INSURANCE TOTAL $ 760 COMMUNICATIONS 0301 Telecommunications/data lines $ 456 0302 Answering Service $ - COMMUNICATIONS TOTAL $ 456 OFFICE EXPENSE 0351 Office Supplies $ 883 0352 Soc Rec.,Workbooks $ - 0353 Printing/Reproduction $ 33 0354 Publications $ - 0355 Legal Notices/Advertising $ - OFFICE EXPENSE TOTAL $ 917 EQUIPMENT 0401 Purchase of Equipment(Computers/Furniture/VOIP Phone) $ 213 0402 Equipment Rent/Lease(Copy Machines) $ 800 0403 Equipment Maintenance $ 424 EQUIPMENT TOTAL $ 1,437 FACILITIES 0451 Rent/Lease Building $ - 0452 Facilities Maintenance $ - 0453 Utilities $ - FACILITIES TOTAL $ - TRAVEL COSTS 0501 Staff Mileage $ 535 0502 Staff Travel(Out of County) $ 178 0503 Staff Training/Registration $ 348 0504 Transportation $ 321 TRAVEL COSTS TOTAL $ 1,382 PROGRAM SUPPLIES 0551 Program Supplies-Client Incentives $ - EXHIBIT C-4 0552 Program Supplies-Curriculum $ 67 0553 Program Supplies-Food $ 1,000 PROGRAM SUPPLIES TOTAL $ 1,067 CONSULTANCY 0601 Consultant Services(Interpretive Services) $ 1,650 0602 Contracted Services(Recruitment) $ - CONSULTANCY TOTAL $ 1,650 FISCAL AND AUDITS 0651 Accounting/Bookkeeping(IT Support) $ - 0652 External Audit $ - FISCAL AND AUDITS TOTAL $ - OTHER COSTS 0701 Indirect Costs $ 12,664 0702 Licenses/Taxes $ 1,607 0703 County Administration Fee $ - 0749 Other Business Services $ 530 OTHER COSTS TOTAL $ 14,800 ONE TIME ADVANCE-Start Up Costs $ - TOTAL PROGRAM EXPENDITURES $ 100,000 REVENUE/MATCH 3120 Drug Medi-Cal $ - 3130 State Grant $ - 3140 Private Donations $ - 3150 Client Fees $ - 3160 Insurance $ - REVENUE/MATCH TOTAL $NET PROGRAM BUDGET $ 100,000 EXHIBIT C-4 TYPE OF SERVICE Projected Budget - Fiscal Year 2018-19 Narrative Provider Name: Mental Health Systems, Inc. PERSONNEL / SALARIES Annual Salary and FTE equivalence as in budget. One Fourth of % of FTE Budget Categories-Line Item Description Annual Salary dedicated to this program Susan Murdock, Program Manager $ 6,292 30% Josefina Ceja, Clinical Supervisor - LCSW $ 10,278 40% Candida Rojas, Administrative Assistant $ 2,080 20% Kathryn Wilbur, Vice President $ 2,427 7% Agustin Ochoa, Program Analyst $ 1,517 7% Jason Franklin, Therapist, Lic elig, MA level $ 13,867 100% TBD (currently, Chris Esqueda), Therapist, Lic elig, MA level $ 11,556 83% Peter Flores, AOD Cerified Counselor $ 10,053 100% Cynthia Williams, Family Support Partner $ 4,507 50% Total $ 62,577 Position descriptions submitted with proposal. List Amount PAYROLL TAXES EMPLOYEE BENEFITS TOTAL $ 9,761 INSURANCE List the following insurance categories: ❑ 0251 -Workers Compensation Insurance $ 626 ❑ 0252 - Liability Insurance- Professional Liability and Malpractice Insurances $ 760 0253 - Insurance Other- N/A $ - COMMUNICATIONS ❑ 0301 -Telecommunications/data lines - Costs projected to include a portion of $ 456 ❑ 0302 -Answering Service- N/A $ - OFFICE EXPENSE ❑ 0351-Office Supplies: Includes Items necessary to carry out the daily activities $ 883 ❑ 0352 - Social/Rec, Workbooks.- N/A $ - ❑ 0353-Printing/Reproduction includes items such as the printing of business $ 33 ❑ 0354 - Publications - N/A $ - ❑ 0355 - Legal Notices/Advertising - N/A $ - 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., $ 213 ❑ 0402 - Equipment Rent/Lease- Cost for lease of copy machine. $ 800 ❑ 0403-Equipment Maintenance: minor equipment repair for copier and vehicle $ 424 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 $ - EXHIBIT C-4 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 $ 535 0502 - Staff Travel (Out of County)- Cost for mileage reimbursement for staff $ 178 ❑ 0503 - Staff Training/Registration - Cost for staff to attend trainings relevant $ 348 ❑ 0504 -Transportation -To purchase bus passes and tokens to allow $ 321 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 $ 67 ❑ 0553 - Program Supplies - Food: N/A $ 1,000 CONSULTANCY List the following consulting categories and provide a brief description for each 0601 - Consultant Services: Allows program staff to reach an interpreter to $ 1,650 0602 - Contracted Services: Costs related to recruiting of staff and verification $ - 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 $ 12,664 ❑ 0702 - Licenses/Taxes -N/A $ 1,607 ❑ 0703 - County Administration Fee -N/A $ - 0749-Other Costs - Other business services such as applicant TB tests, drug $ 530 REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the revenue ❑ 3120 - Drug Medi-Cal - $ - ❑ 3130 - State Grant- $ - ❑ 3140 - Private Donations - $ - ❑ 3150 - Client Fees - $ - ❑ 3160 - Insurance- $ - ONE TIME ADVANCE I 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. $ -