HomeMy WebLinkAbout320881
2
3
4
5
Agreement No.10-295-2
AMENDMENT II TO AGREEMENT
TinS AMENDMENT, hereinafter referred to as Amendment IT, is made and entered into this
19th day of_---=.:M.=:aL-y __ ____, 2015, by and between COUNTY OF FRESNO, a Political
Subdivision of the State of California, hereinafter referred to as "COUNTY'', and KINGS VIEW
CORPORATION, a private Non-profit Corporation, whose business address is 7170 N. Financial
6 Drive, Suite 110, Fresno, CA 93720 and service location address is 1617 E Saginaw, Fresno, CA.
93704, hereinafter referred to as "CONTRACTOR" (collectively the "parties''). 7
8 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement
9 No. 10-295, effective July 1, 2010, and Amendment IT to Agreement (COUNTY Agreement No. 10-
10
11
12
13
14
15
16
17
18
19
20
21
553) effective October 5, 2010, hereinafter collectively.referred to as ''the Agreement" whereby,
CONTRACTOR agreed to provide Mental Health Services Act (MHSA) Peer/Family Support Program
wellness center services for adults and youth empowerment center programs as part of the wellness and
recovery support services to clients with mental illness and their family members/support system; and
WHEREAS, COUNTY, through its Department ofBehavioral Health (DBH), is a Mental
Health Plan (MHP) as defined in Title 9 of the California Code of Regulations (C.C.R.), section
1810.226; and
WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement regarding ·
changes as stated below and restate the Agreement in its entirety.
NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
is hereby aclaiowledged, COUNTY and CONTRACTOR agree as follows:
1. That the Agreement, Page One (1), Section One.(1), beginning with Line
22 Nineteen (19), with the letter "A" and ending on Line Twenty~Four (24) with the word "designee" be
2 3 deleted and the following inserted in its place:
2 4 "A. CONTRACTOR shall perform all services and fulfill all responsibilities as
25 set forth in Revised Exhibit A-1, 'Mental Health Services Act Peer and Family Support Blue Sky
2 6 Wellness Center and Youth Empowerment Centers Scope of Work,' attached hereto and by this
2 7 reference incorporated herein and made part of this Agreement. Services are to be provided at the
28 service location address, 1617 E. Saginaw, Fresno, CA 93704 for the Blue Sky Wellness Center and
- 1 -
COUN1Y OF FRESNO
Fresao,CA
1
2
the service locations identified in revised Exhibit A -1 for the Youth Empowerment Centers ; the
location of services cannot be changed without prior approval of the DBH Director or designee."
3 2. That the Agreement, Section two (2) ''TERM'', shall be revised by adding the
4 following at page Three (3), Line One (1) after the word "term.":
5 "This Agreement shall be extended for an additional six (6) month period beginning July 1, 2015
6 through December 31, 2015."
7 3. That the Agreement, Page Three (3), beginning with Section Four (4), Line
8 Twenty-Five (25), with the word "Contingent," and ending on Page Four (4), Line Nine (9) with the
9 word "Agreement" be deleted and the following inserted in its place:
1 0 "Contingent upon confirmation of funding by the California Department of Health Care
11 Services, COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
12 compensation for actual expenditures incurred by CONTRACTOR in accordance with Revised Exhibit
13 B-1, 'MHSA PEl Project-Blue Sky Wellness Center and Youth Empowerment Centers Budget',
14 attached hereto and by this reference incorporated herein.
15 A. Maximum Contract Amount
16 For the period of July 1, 2010 through June 30,2011, in no event shall the maximum
17 contract amount for the services provided by the CONTRACTOR to COUNTY under the terms and
18 conditions of this Agreement be in excess of One Million Two Hundred Four Thousand Ninety-Five
19 and No/1 00 Dollars ($1,204,095.00).
2 0 For the period of July 1, 2011 through June 30, 2015, in no event shall the maximum
21 contract amount for the services provided by the CONTRACTOR to COUNTY under the terms and
22 conditions of this Agreement be in excess of One Million Two Hundred Sixty-Nine Thousand Six
2 3 Hundred Thirty-Eight and No/100 Dollars ($1,269,638.00) during each twelve month period .
2 4 For the period of July 1, 2015 through December 31, 2015, in no event shall the
2 5 maximum contract amount for the services provided by the CONTRACTOR to COUNTY under the
2 6 terms and conditions of this Agreement be in excess of Six Hundred Fifty-Seven Thousand Six
2 7 Hundred Thirteen and No/100 Dollars ($657,613.00)
2 8 Contingent upon the funding award from the State Department of Health Care Services,
-2 -COUNTY OF FRESNO
Fresno,CA
1 in no event shall the maximum contract amount for the services provided by the CONTRACTOR to
2 COUNTY under the terms and conditions of this Agreement be in excess of Six Million Nine Hundred
3 Forty Thousand Two Hundred Sixty and No/100 Dollars ($6,940,260.00) during the total five (5) year,
4 six ( 6) month term of the Agreement."
5 4. That the following be inserted on Page Twenty-Four (24), Line Seven (7) of the
6 Agreement :
7 "25. DISCLOSURE OF OWNERSHIP AND/OR CONTROL
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal
agent, or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101
455.104, and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101,455.104, 455.105 and
455.106(a)(1),(2), the following information must be disclosed by CONTRACTOR by completing
Exhibit (F ), "Disclosure of Ownership and Control Interest Statement", attached hereto and by this
reference incorporated herein and made part of this Agreement. CONTRACTOR shall submit this
form to the Department of Behavioral Health within thirty (30) days of the effective date of this
Agreement. Additionally, CONTRACTOR shall report any changes to this information within thirty
five (35) days of occurrence by completing Exhibit (F), "Disclosure of Ownership and Control Interest
Statement." Submissions shall be scanned pdf copies and are to be sent via email to
DBHAdministration@co.fresno.ca. us attention: Contracts Administration."
5. That the Agreement, Sections Twenty-Five (25) ("DATA SECURITY") through
Twenty-Nine (29) ("ENTIRE AGREEMENT") be renumbered to read Sections Twenty-Six (26)
through Thirty (30).
6. That all references in the Agreement to "Revised Exhibit A"
shall be changed to read "Revised Exhibit A -1 ", which is attached hereto and incorporated herein by
reference.
7. That all reference in existing COUNTY Agreement No. 10-295 to "Revised
- 3 -
COUN'IY OF FRESNO
Fresno,CA
1 Exhibit B" shall be changed to read "Revised Exhibit B-1", which is attached hereto and incorporated
2 herein by reference.
3 8. That the Agreement, Page Twenty Six (26) beginning with Line Sixteen (16)
4 with the word "The" and ending on Page Twenty-Six (26), Line Twenty-One (21), with the number
5 "93720" be deleted and the following inserted in its place:
6 "The persons having authority to give and receive notices under this Agreement and
7 their addresses include the following:
8
9
10
11
12
COUNTY
Director, Fresno County
Department of Behavioral Health
4441 E. Kings Canyon Road
Fresno, CA 93702
CONTRACTOR
Chief Executive Officer
Kings View Corporation
7170 N. Financial Dr. Suite 110'
Fresno, CA 93720"
13 COUNTY and CONTRACTOR agree that this Amendment II is sufficient to amend the
14 Agreement; and that upon execution ofthis Amendment II, the Agreement, Amendment No. I, and
15 Amendment II together shall be considered the Agreement.
16 The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
1 7 covenants, conditions and promises contained in the Agreement and not amended herein shall remain in
18 full force and effect. This Amendment II shall become effective upon execution by all parties.
19 Ill
20 Ill
21 Ill
22 Ill
23 Ill
24 Ill
25 Ill
2 6 Ill
27 Ill
28 Ill
-4 -COUNTY OF FRESNO
Fresno,CA
1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment II to Agreement as of the
2 day and year first hereinabove written.
3
4 ATTEST:
5 CONTRACTOR
6 KINGS VIEW CORPORATION
7
8
9
10
11
12
13
14
15
16
17
Print Name: kco~ /b.('?'
Title: G~
Chairman of the Board, or
President, or any Vice President
By_£~ 7
18 Print Name: $~ S ,G,oiUo(cni=2--
19
20
21
22
23
24
25
26
Title: C 10
any Assistant Secretary, or
Chief Financial Officer, or
Assistant Treasurer
Mailing Address:
P.O. Box 28923
Fresno, CA. 93 729
Phone No. (559) 230-2501
Contact: Chief Executive Officer
27 ///
28 ///
COUNTY OF FRESNO
BERNICE E. SEIDEL, Clerk
Board of Supervisors
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
- 5 -
COUNTY OF FRESNO
Fresno,CA
1 APPROVED AS TO LEGAL FORM:
2 DANIEL CEDERBORG, COUNTY COUNSEL
3
4 By
5
6
APPROVED AS TO ACCOUNTING FORM:
7 VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
8 TREASURER-TAX COLLECTOR
9
10 By 0&0----:=14=
11
12
REVIEWED AND RECOMMENDED FOR
13 APPROVAL:
14
15By~~
16
17
18
19
20
Dawan Utecht, Director
Department of Behavioral Health
21 Fund/Subclass: 0001110000
Organization: 56304521 2 2 Account/Program: 7294/0
23
24
25
26
27
28
FY 2010-11
FY 2011-12
FY 2012-13
FY 2013-14
FY 2014-15
FY 2015-16
$1,204,095.00
$1,269,638.00
$1,269,638.00
$1,269,638.00
$1,269,638.00
$ 657,613.00
- 6 -COUNTY OF FRESNO
Fresno,CA
Revised Exhibit A-1
Page 1 ofll
Mental Health Services Act Peer and Family Support
Blue Sky Wellness and Recovery Center and Youth Empowerment Centers
Scope of Work
ORGANIZATION:
ADDRESS:
PROJECT DIRECTOR:
Phone Number:
Kings View Corporation
7170 N. Financial Drive, Suite 110
Fresno, CA 93720
Brenda Kent, LMFT
Regional Mental Health Director
(559) 459-0334
Mitch Collins-Manager
Blue Sky Wellness Center
(559) 230-2501
CONTRACT PERIOD: FY 2010-11
FY 2011-12
FY 2012-13
FY 2013-14
FY 2014-15
$1 ,204,095.00
$1 ,269,638.00
$1 ,269,638.00
$1 ,269,638.00
$1 ,269,638.00
$ 657,613.00 July 1, 2015 -December 31, 2015
CONTRACT AMOUNT: $6,940,260.00
SCHEDULE OF SERVICES
CONTRACTOR staff shall be available to provide services to consumers and family
members between the hours of 8:00 AM and 5:00 PM Monday through Saturday at the
Blue Sky Wellness and Recovery Center, located at 1617 E. Saginaw, Fresno, CA. Any
change to location of services shall be pre-approved by DBH Director or designee. Any
change in the Blue Sky hours of operation shall be communicated in writing to the DBH
Director or designee for approval before implementation.
TARGET POPULATION
Participation in CONTRACTOR's Peer and Family Support programs shall be voluntary.
Blue Sky prevention activities under this Agreement shall be designed to target
individuals living with mental illness and their family members and other support persons
who reside in Fresno County and fall into the following four age groups: Youth (16-18
years old), Transitional Age Youth (TAY) (18-24 years old), Adults (25-59 years old) and
Older Adults (60 years and older). Youth (16-18 years old) shall be served at a County
approved off-site location that may be a natural community setting aJld not necessarily a
mental health facility. The number of individuals who participate in activities through Blue
Sky shall be a minimum of 1300 TAY, adult and older adults. Prevention services shall
be provided to at least fifty percent (50%) ofTAY (defined as ages 16-24), and at least
fifty percent (50%) of adults and older adults (defined as age 25 and older).
PROGRAM DESCRIPTION
Revised Exhibit A-I
Page 2 of 11
The wellness and recovery-focused activities shall be provided by CONTRACTOR
through the wellness and recovery model. The well ness and recovery model leverages
experiences and expert knowledge of consumers and family members and interested
members of the community for the purpose of developing a wellness recovery center
team. The wellness recovery center team will address mental health well ness and
recovery needs of unserved and underserved cultural, ethnic, linguistic and racial
communities including the Latino, Southeast Asian, Native American and African-
American communities and will be trained in basic behavioral health and physical health
education. This program shall build capacity through the expansion of current activities
that will address youth, ages 16-18, at an off-site County approved location, for the
purpose of providing well ness and recovery through education, socialization, life-skills
building and other peer support activities. Blue Sky Well ness Center staff will work
collaboratively with other Prevention and Early Intervention (PEl) projects that address
mental health prevention and early intervention. needs in other natural community
settings as detailed in the County's three-year PEl Plan, including such projects as the
Horticultural Therapeutic Community Center, and the school-based project, as well as at
senior centers and other natural settings where there are unserved and underserved
cultural and linguistic communities. Blue Sky will specifically serve many of the
unserved and underserved individuals within the main metropolitan area of Fresno
County. Blue Sky activities shall also include outreach to rural areas in order to increase
access for underserved populations.
CONTRACTOR shall provide activities and programs such as support groups, food bank
and clothing exchange, laundry services, transportation, peer counseling, life skills
training, reading and literacy readiness, recreational, leisure, interpersonal activities, and
.supportive employment and job readiness training. Peer support groups shall continue to
be held weekly for each of fourteen (14) diagnosis specific areas. Relapse Prevention
shall meet daily; holistic health group and freedom of expression group shall remain
available once weekly and journaling groups shall remain available twice each week.
Activities to be provided include art (morning and afternoon sessions) Qaily; gardening
project three times weekly, cinema four times weekly, beading group is held twice each
week (morning and afternoon sessions are available). Crocheting, quilting, karaoke,
humor and bingo are each available weekly. CONTRACTOR reserves the right to
change, alter, discontinue or start up groups or activities, their times and amounts as it
deems best in collaboration with Blue Sky's Peer Advisory Council. Any such changes
will be communicated in writing to COUNTY.
Blue Sky shall receive individuals living with mental illness who are identified through
other PEl projects, including, but not limited to:
• First Onset Consumer and Family Support (housed at DBH's main campus on Kings
Canyon);
• Federally Qualified Health Centers (FQHC) at which prevention and early
intervention activities may be provided (cf. Fresno County's Prevention and Early
Intervention Three-Year Plan); and
• Cultural-based Access and Navigation Specialists/Community Health Workers
(CHW) and Community-based Peer Support (cf. Fresno County's Prevention and
Early Intervention Three-Year Plan).
Blue Sky shall be a collaborative site for the First Onset Consumer and_ ~~mily ~upport
project through its support components, including peer support a~~ ac~1V1t1es. _F1rst
Onset consumers will be immediately linked to Blue Sky to get cnt1cal 1nformat1on
Revised Exhibit A-1
Page 3 ofll
about living with mental illness, to socialize, and to participate in wellness and recovery
activities that will help them obtain best possible outcomes. Family members of these
individuals shall receive important information and build important relationships with
other family members through the activities and mental health educational
opportunities outlined under Educational Services below.
Blue Sky will also collaborate closely with the Access and Navigation specialists'
project as a site where important outreach and engagement can be conducted in a
non-stigmatizing and non-discriminatory environment. The CHW project will be able to
reach an increased number of people from the unserved and underserved
communities within the major metropolitan area of the County as a result of the
connectedness of Blue Sky to the mental health community; to the proximity of
consumer experts and family member experts; and general knowledge of where to go
for what need.
In addition, the Horticultural Therapeutic Community Centers project has a peer
support component that can leverage Blue Sky for education and outreach to the
community leaders and consull)ers from various underserved ethnic and linguistic
communities. While the Horticultural Therapeutic Community Centers are designed to
be a natural community site for culturally appropriate peer support, consumers from
the cultural and ethnic communities can avail themselves of the prevention and early
intervention supports provided through Blue Sky.
Below is a list of the core prevention and early intervention services that are currently
offered at Blue Sky and will continue to be offered during the term of the Agreement.
Peer Advisory Council
Blue Sky requires a Peer Advisory Council to steer the process planning and
implementation of prevention and early intervention activities from the consumer and
family member perspective. The Peer Advisory Council requires representation from
the TA Y Advisory Council and will ensure active participation from adults, older adults,
and family member populations. TAY will have an active role in guiding and having
ownership of their TAY prevention and early intervention activities at Blue Sky.
It will be required that a TAY consumer-driven advisory council will be developed and
operated separately from the Peer Advisory Council noted above within thirty (30) days
of contract execution. The TAY Peer Advisory Council will meet weekly/monthly.
Sign in sheet and meeting minutes shall be available to COUNTY upon request. This
will give the TAY consumers a voice in the decision-making process and operations at
Blue Sky, such as the types of activities, groups, and rules of Blue Sky.
Volunteers and Consumer-Paid Staff
The Blue Sky staff will consist of consumers and family members, including
consumer/family member volunteers, who will provide the supportive services available
at Blue Sky, including, but not limited to:
• Group and individual supportive services in addition to teaching Wellness
Recovery Action Plan and Crisis Plan Services;
• Transportation
Revised Exhibit A-1
Page 4 ofll
• Education in the area of life skills, e.g., money management, independent living
skills, cooking, cleaning, etc.;
• The provision of social and recreational opportunities and leisure education;
• Job readiness services;
• Social benefits counseling;
• Literacy and other educational services; and
• Other needed support services as identified through consumers and family
members.
Volunteer Peer Support staff training is a six-week program held Friday mornings for
two hours. There is no pre-registration required, all participants are accepted and are
required to attend four of the six weeks to obtain a certificate of completion. Following
completion of initial training, volunteers are required to attend weekly one-hour on-
going training sessions to discuss assigned duties, challenges, and the feeling of
accomplishment. The trainer introduces current national, state and local mental health
consumer issues for discussion as well as mental health trends and state well ness and
recovery center activities.
Specifically identified Peer Support staff at Blue Sky shall be bilingual and bicultural in
order to provide culturally and linguistically appropriate strength-based mental health
supportive services that are consumer and family driven. All bilingual staff will be
required to meet the language proficiency requirements set by County policy. Should a
potential consumer require language assistance outside the proficiency of the staff, a
certified interpreter will be required.
The staffing plan for Blue Sky should consist of three positions equivalent to Fresno
County's Community Mental Health Specialist, six Peer Support Specialists, and two
Office Assistants. Staffing patterns should allow for staff specialization in services to
the three different age groups; CONTRACTOR shall have a staffing plan that identifies
staff fully devoted to family services and capable of meeting families' identified needs.
Blue Sky will also require the consultation or staffing of a Licensed Mental Health
Clinician to provide oversight to the program. Any changes in staffing volume must be
requested in writing and approved by DBH Director or designee before
implementation.
Educational Services
Blue Sky shall provide appropriate mental health awareness and educational services
to individuals on-site and off-site (in the case of TAY age 16-18) to all age groups. Blue
Sky staff will provide appropriate educational services to individuals living with mental
illness and to family members or other support persons.
Educational services for families and loved ones should be appropriately tailored to
meet the mental health educational needs of the family/support persons of the
consumer. Specifically, mental health education activities shall increase the
knowledge of the family members and support persons specifically with respect to:
1. Learning about mental illness in general, and information specific to their
loved ones disorder;
Revised Exhibit A-1
Page 5 ofll
2. Developing strategies to assist in managing wellness and recovery;
3. Reducing stressors and building protective factors within the family;
4. Providing social support, a sense of connectedness to others with lived
experiences, and encouragemenUhope;
5. Developing strategies to focus on the future;
6. Finding innovative ways for families and supporters to help consumers in
their recovery
Consumer mental health education classes will focus on encouraging wellness and
independence in the community. Training and curriculum for individual support shall
include:
1. Problem solving
2. Education about the consumer's illness and encouraging active participation
and decision-making in the therapeutic process
3. Life-skills development, including:
a. Personal hygiene
b. Household chores (housekeeping/cooking/laundry/shopping)
. c. Money management skills
d. Using community transportation
e. Housing--locating, financing and maintaining safe, clean and affordable
housing
Employment Services
Blue Sky will be required to provide pre-employment and job exploration supportive
services to clients. Staff will provide resource education regarding employment
services within the community for referrals as appropriate. In order to enhance the
performance measures of both Blue Sky and Fresno County DBH, Blue Sky
administrators shall leverage and collaborate specifically with appropriate existing
County services, including but not limited to the Fresno County Supportive Education
and Employment Services (SEES) program.
Family Support and Education
Programming that is specific to family members and other support persons of
individuals living with mental illness is an integral component to the wellness and
recovery model for consumer populations being served through MHSA. Family support
services shall be appropriately tailored to the age group of the consumer populations
being served. Staffing at Blue Sky shall include individuals living with mental illness as
well as family members in order to build a partnership among consumers, families,
supporters and practitioners. Through appropriate relationship building, education,
collaboration, and problem solving, an atmosphere of hope and cooperation will be
created.
Incoming call documentation shall be gathered and maintained for the purpose of
County contract management.
Youth Empowerment Centers
Blue Sky shall include a wellness and recovery plan to specifically address Children,
Youth and TAY ages 10-18 at five (5) off-site locations (approved by the County) that
may be any appropriate natural community setting and not necessarily a mental health
facility. These Youth Empowerment groups shall be age-appropriate and offer
Revised Exhibit A-1
Page 6 of 11
socialization, life-skills training, and other peer support activities. A minimum of 2,400
duplicated youth and families will be served and participate in prevention/wellness and
recovery activities through the Youth Empowerment program. Blue Sky shall
specifically target Children, Youth and TAY population, age 10-18, to participate in
offsite wellness and recovery activities.
Peer Support Groups:
Contractor will provide five (5) peer support groups. Support groups will be held at
each identified site twice a week. Support group topics will be based on community
needs and will include but not limited to mental health discussions such as depression,
self-esteem, anger management, social skills, etc. Sites activities will consist of the
following and not limited to:
1. Facilitate peer directed groups, with mental health themes like depression, self-
esteem, anger management, healthy life styles, etc.
2. Provide curriculum classes to both youth and families such as parenting
classes, anger management, self-esteem, etc.
3. Provide one to one support to youth.
4. When necessary make referrals to mental health resources other than DBH,
except for critical, Serious Emotional Disturbance (SED) or Serious Mental
Illness (SMI) children and youth.
5. Develop and foster mentor relationships between older teens and younger
ones.
6. Develop sport, arts/crafts, and music activities at all sites to draw youth in,
particularly high school teenagers.
7. Insure that culturally specific approaches and activities are incorporated into the
Youth Empowerment sites.
8. Collaborate with other community groups to provide specialized activities at the
sites, aimed at increasing participation and penetration.
9. Explore need for youth literacy classes at each site.
Reporting Requirements
CONTRACTOR will provide a monthly progress report to the DBH Director or designee
to show services provided to at least fifty percent (50%) of TAY, and at least fifty
percent (50%) of adults and older adults.
CONTRACTOR shall collect, organize, and report on relevant data that can be used to
measure and evaluate consumer and staff participation, staff performance, and
general trends that can be used to appropriately measure services and related
program features. CONTRACTOR shall utilize a satisfaction survey, approved by DBH
MHSA Coordinator that will comply with mandated State performance outcomes and
quality improvement reports/outcomes. A minimum of seventy-five percent (75%) of
clients shall report their satisfaction with program services through MHSIP Client
Oriented Report Card overall score, semi-annually. If the satisfaction with program
Revised Exhibit A -1
Page 7 of 11
services falls below 75%, corrective actions will be required in consultation with
DBH/MHSA.
CONTRACTOR will provide a monthly report to DBH Director or designee indicating
types of activity and services attended, number of one-to-one peer counseling, and
number of crisis contacts per month by consumer; this information will be obtained
from the service log developed in collaboration with DBH staff.
CONTRACTOR shall provide work schedules, cultural competency trainings, and
demographic ethnic information as required by COUNTY.
Youth Empowerment Reporting/Outcomes
1. Grades improvement from the prior year of 50% of those attending weekly
groups.
2. A minimum of 2,400 (duplicated) youth will participate.
3. A minimum of 300 completed satisfaction surveys per quarter.
4. A minimum of 20 mental health presentations, servicing 150 youth.
Transition Age Youth (16-18) Service Provision
Blue Sky shall include a well ness and recovery plan to specifically address TA Y ages
16-18 at an off-site County location that may be any appropriate natural community
setting and not necessarily a mental health facility. These age~appropriate TAY-targeted
wellness and recovery activities shall include, but not be limited to education,
socialization, life-skills training, and other peer support activities. A minimum of 200
individuals that are TAY (ages 16-18) will participate in prevention/wellness and recovery
activities through Blue Sky. Blue Sky shall specifically target the TAY population, ages
16-18, to participate in off-site wellness and recovery activities.
COUNTY RESPONSIBILITIES
Revised Exhibit A-1
Page 8 ofll
1. D~H MHSA Coordinator or designee shall assist the contractor in making linkages
w1th the total mental health system. This will be accomplished through regularly
scheduled meetings as well as formal and informal consultation.
2. DBH MHSA Coordinator or designee shall participate in evaluating the progress of
the overall program and the efficiency and will be available to the contractor for
ongoing consultation.
3. DBH MHSA Coordinator or designee will gather outcome information from target
consumer groups and CONTRACTOR throughout the term of contract. DBH
MHSA Coordinator or designee will notify CONTRACTOR when its participation is
required. The performance outcome measurement process will not be limited to
survey instruments but will also include, as appropriate, consumer and staff
interviews, chart reviews, and other methods of obtaining required information.
4. The County Department of Behavioral Health (DBH), Mental Health Services Act
Coordinator or designee will provide oversight of "Blue Sky" services funded
through MHSA Prevention and Early Intervention (PEl) funding and collaborate
with contactor(s) and other County Departments and community agencies to help
achieve State program goals and outcomes. In addition to contract monitoring of
program(s}, oversight includes, but is not limited to, coordination with the State
Department of Mental Health in regard to program administration and outcomes.
CONTRACTOR RESPONSIBILITIES
1. CONTRACTOR will maintain facilities and equipment, and operate continuously with
the number and classification of staff required for the provision of services.
2. CONTRACTOR must have a location that is accessible by pubic transportation and
approved by COUNTY.
3. CONTRACTOR will be required to comply with all State regulations regarding State
Performance Outcomes measurement requirements, and participate in the outcomes
measurement process as required by the County and applicable funding sources.
4. CONTRACTOR will participate in performance outcomes throughout the term of the
contract. DBH MHSA Coordinator or designee will notify CONTRACTOR when its
participation is required. The performance outcome measurement process will not be
limited to survey instruments but will also include, as appropriate, consumer and staff
interviews, chart reviews, and other methods of obtaining needed information, as
outlined in the Mental Health Services Act (MHSA} Prevention and Early Intervention
(PEl} Plan.
5. CONTRACTOR's staff will possess appropriate licenses and certificates and be
qualified in accordance with applicable statutes and regulations. CONTRACTOR will
obtain maintain and comply with all necessary government authorizations, permits
and li~enses required to conduct its operations. In addition, the CONTRACTOR's will
comply with all applicable Federal, State and local laws, rules, regulations and orders
in its operations including compliance with all applicable safety and health
requirements as to the CONTRACTOR's employees.
'
Revised Exhibit A-1
Page 9 ofll
6. CONTRACTOR shall log all complaints and the disposition of all complaints from a
consumer or a consumer's family . .CONTRACTOR shall provide a summary of the
complaint log entries concerning County-sponsored consumers to County at monthly
intervals, by the tenth (1oth) fifteenth (15th) day of the following month, in a format
that is mutually agreed upon. CONTRACTOR shall post signs, provided by the
County, informing consumers of their right to file a grievance and appeal.
CONTRACTOR will abide by the Fresno County Mental Health Plan (MHP) grievance
process (Exhibit D) and notify County of all incidents reportable to state licensing
bodies that affect County consumers within twenty-four (24) hours of receipt of a
complaint. CONTRACTOR shall use existing County Department Incident Report
form (Exhibit D) and submit to County a copy of the Incident Report within 24 hours.
Within fifteen (15) days after each incident or complaint affecting County-
sponsored consumers, CONTRACTOR shall provide County with the complaint
and CONTRACTOR's disposition of, or corrective action taken to resolve the
complaint or incident.
7. CONTRACTOR shall provide a monthly staff work schedule to DBH MHSA
Coordinator or designee.
8. CONTRACTOR shall maintain a service log in collaboration with DBH staff that
reports type of activity/services attended, number of one-to-one peer support
contacts, and number of crisis contacts per month
by consumer. This information will be provided to the DBH Director or designee in
a monthly report, submitted with the monthly invoice.
9. CONTRACTOR shall provide work schedules, cultural competency training, and
demographic ethnic information as required by the COUNTY.
1 0. CONTRACTOR shall arrange activities for consumer and provide supplies for
such activities. A schedule of activities and the number of participants will be
included in the monthly reports submitted to the COUNTY.
11. CONTRACTOR shall attend a provider meeting hosted by DBH monthly or at intervals
determined appropriate by the department.
PROJECTED OUTCOMES
CONTRACTOR will communicate full understanding of the intended outcomes for
individual, system and families. Outcomes to be tracked include, but are not limited to:
1. Decrease positive and negative symptoms
2. Maintain or increase cognitive abilities
3. Enhance quality of life
4. To preserve psychosocial skills
5. To preserve family and social supports
6. Provide a more rapid recovery
7. Provide a better prognosis of recovery
8. Reduce disability and lower risk of relapse
9. Reduced risk of suicide
Revised Exhibit A-1
Page 10 of 11
Individual consumers who attend Blue Sky at least three times a week as logged in on
the daily sign-in sheet will show an improvement in the nine (9) stated goals at the end
of one year as measured by the following:
1. Number of support groups attended per week
2. Number of new consumers attending volunteer training
3. Ninety percent (90%) satisfaction rating with Blue Sky as noted on Satisfaction
Survey.
4. Fifty Percent (50%) decrease in the number of incident reports by individuals
5. Fifty percent (50%) decrease in the number of 911 calls to police for 5150 crisis
at Blue Sky.
6. Fifty percent (50%) increase in the number of individuals currently not attending
support groups that attend at least one group per week.
7. Self report by consumers of better socialization and personal well-being
Family:
1. Increase coping skills, knowledge
2. Reduce fear, stigma, distress and isolation
The stated goals for family members of consumers will be met at the end of one year
by:
1. Family member attending at least one family support meeting a week
2. Family member will report ninety percent (90%) satisfaction on Satisfaction Survey.
3. A consumer of a family member who has never attended Blue Sky will attend at
least twice a month for two months.
System:
1. Lower hospitalization, law enforcement costs
2. Enhance awareness, reduce stigma
The stated system goals for the local mental health system will be met at the end of
one year by:
1. Increasing the number of outside agencies and organizations using Blue Sky as a
meeting place to discuss mental health issues and concerns.
2. A twenty-five percent (25%) increase in the number of public presentations by Blue
Sky to outside agencies.
Revised Exhibit A-1
Page 11 ofll
3. Establishing an ongoing relationship with local psychiatric facilities about the
services available at Blue Sky for consumers leaving their facilities, particularly those
experience their first hospitalization.
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2010-2011
Revised Exhibit B -1
Budget Categories -Total Proposed Budget
Line Item Description (Must be itemized) FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Executive Director 0.68 $75,033 $75,033
0002 Mental Health Specialist 3.00 $107,249 $107,249
0003 Peer Support Specialist 7.30 $152,622 $152,622
0004 Admin Specialist II 1.00 $32,502 $32,502
0005 Peer Support Director 1.00 $43,259 $43,259
0006 Parent Partner 1.00 $22,714 $22,714
0007 Parent Partner 0.60 $16,224 $16,224
0008 Parent Partner 0.60 $16,224 $16,224
0009 Title $0
0010 Title $0
0011 Title $0
0012 Title $0
SALARY TOTAL 15.18 $32,502 $433,325 $465,827
PAYROLL TAXES:
0030 OASDI $0
0031 FICA/MEDICARE $35,636
0032 U.l. $11,498
PAYROLL TAX TOTAL $47,134
EMPLOYEE BENEFITS:
0040 Retirement $5,423
0041 Workers Compensation $10,018
0042 Health Insurance (medical vision, life, dental) $63,337
EMPLOYEE BENEFITS TOTAL $78,778
SALARY & BENEFITS GRAND TOTAL $591,739
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building $188,306
1030 Rent/Lease Equipment $12,000
1050 Utilities $29,898
1051 Janitorial/Building Maintenance $31,690
FACILITY/EQUIPMENT TOTAL $261,894
MHSA PEl PROJECT -BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2010 • 2011
OPERATING EXPENSES:
1060 Telephone
1061 Answering Service
1062 Postage
1063 Printing/Repr9duction
1064 Publications
1065 Legal Notices/Advertising
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Food
1069 Program Supplies -Support Groups
1070 Program Supplies -Medical
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Other-Vehicle Leasing
1077 Other-Miscellaneous
1078 Fingerprint checks
1079 Communication cell phone, internet
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES:
1 080 Accounting/Bookkeeping
1081 External Audit
1 082 Liability Insurance
1 083 Other -Professional Liability
1 084 Other -Administrative Overhead
FINANCIAL SERVICES TOTAL
SPECIAL EXPENSES (Consultant/Etc.):
1 090 Subcontracts: Office Site Rents
1091 Translation Services
1092 Medication Supports
1 093 Contractor Labor
SPECIAL EXPENSES TOTAL
2
Revised Exhibit 8 -1
$23,050
$0
$251
$20,200
$0
$0
$12,000
$15,500
$25,650
$31,068
$0
$0
$12,330
$0
$1,000
$0
$9,600
$1,800
$0
$0
I $152,449
$0
$0
$13,811
$7,950
$142,152
I $163,913
$3,600
$1,000
$0
$0
I $4,600
MHSA PEl PROJECT -BLUE SKY WELLNESS CENTER
Kings View Corporation
Revised Exhibit B -1
NON MEDI-CAL CLIENT SUPPORTS
1192.2 Clothing
1192.4-.6 Transportation Assistance
1192.7 Volunteer Stipends
NON MEDI-CAL CLIENT SUPPORTS
FIXED ASSETS·
2000 · Computers & Software
2001 Furniture & Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL
OTHER PROJECTED REVENUE:
4000
4100
4200
4300
Client Rents
Other-Private Insurance
Other
Other
OTHER PROJECTED REVENUE TOTAL
MHSAFUNDS·
5000 PEl Funds
5100 CSS Funds
MHSA FUNDS TOTAL
3
FY 2010-2011
I
TOTAL PROGRAM EXPENSES
I
TOTAL PROGRAM REVENUE
Over/(Under)
$2,000
$2,500
$17,000
$21,500
$8,000
$0
$0
$0
$8,000
$1,204,095
$0
$0
$0
$0
$0
$1,204,095
$0
$1,204,095
$1,204,095
$0
MHSA PEl PROJECT -BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2011 -2012
Revised Exhibit B-1
Budget Categories -Total Proposed Budget
Line Item Description (Must be itemized) FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Executive Director 0.68 $76,534 $76,534
0002 Mental Health Specialist 3.00 $109,040 $109,040
0003 Peer Support Specialist 7.30 $155,684 $155,684
0004 Admin Specialist II 1.00 $33,148 $33,148
0005 Peer Support Director 1.00 $57,679 $57,679
0006 Parent Partner 1.00 $30,285 $30,285.
0007 Parent Partner 0.60 $21,632 $21,632
0008 Parent Partner 0.60 $21,632 $21,632
0009 Title $0
0010 Title $0
0011 Title $0
0012 Title $0
SALARY TOTAL 15.18 $33,148 $472,486 $505,634
PAYROLL TAXES:
0030 OASDI $0
0031 FICNMEDICARE $38,681
0032 U.l. $12,086
PAYROLL TAX TOTAL $50,767
EMPLOYEE BENEFITS:
·' 0040 Retirement $5,946
0041 Workers Compensation $10,290
0042 Health Insurance (medical vision, life, dental) $68,569
EMPLOYEE BENEFITS TOTAL $84,805
SALARY & BENEFITS GRAND TOTAL $641,206
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building $197,187
1030 Rent/Lease Equipment $12,000
1050 Utilities $31,030
1051 Janitorial/Building $32,230
FACILITY/EQUIPMENT TOTAL $272,447
MHSA PEl PROJECT -BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2011 -2012
OPERATING EXPENSES:
1060 Telephone
1061 Answering Service
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Food
1069 Program Supplies -Support Groups
1070 Program Supplies -Medical
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Other-Vehicle Leasing
1077 Other -Miscellaneous
1078 Fingerprint checks
1079 Communication cell phone, internet
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1083 Other-Professional Liability
1084 Other-Administrative Overhead
FINANCIAL SERVICES TOTAL
SPECIAL EXPENSES (Consultant/Etc.):
1 090 Subcontracts: Office Site Rents
1091 Translation Services
1 092 Medication Supports
1 093 Contractor Labor
SPECIAL EXPENSES TOTAL
Revised Exhibit B-1
$24,400
$0
$250
$21,267
$0
$0
$13,000
$13,500
$26,160
$28,401
$0
$0
$14,730
$0
$1,000
$0
$9,600
$800
$0
$0
l $153,108
$0
$0
$16,811
$7,950
$149,616
I $174,377
$6,000
$1,000
$0
$0
I $7,000
Revised Exhibit B-1
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2011 -2012
NON MEDI-CAL CLIENT SUPPORTS
1192.2 Clothing
1192.4-.6 Transportation Assistance
1192.7 Client Stipends
NON MEDI-CAL CLIENT SUPPORTS I
FIXED ASSETS·
2000 Computers & Software
2001 Furniture & Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL
OTHER PROJECTED REVENUE:
4000
4100
4200
4300
Client Rents
Other-Private Insurance
Other
Other
OTHER PROJECTED REVENUE TOTAL
MHSA FUNDS·
5000 PEl Funds
5100 CSS Funds
MHSA FUNDS TOTAL·
TOTAL PROGRAM EXPENSES
I
TOTAL PROGRAM REVENUE
Over/(Under)
$2,000
$2,500
$17,000
$21,500
$0
$0
$0
$0
$0
$1,269,638
$0
$0
$0
$0
$0
$1,269,638
$0
$1,269,638
$1,269,638
$0
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2012-2013
Revised Exhibit B-1
Budget Categories -Total Proposed Budget
Line Item Description (Must be itemized) FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Executive Director 0.68 $78,064 $78,064
0002 Mental Health Specialist 3.00 $111,062 $111,062
0003 Peer Support Specialist 7.30 $158,747 $158,747
0004 Admin Specialist II 1.00 $33,815 $33,815
0005 Peer Support Director 1.00 $57,679 $57,679
0006 Parent Partner 1.00 $30,285 $30,285
0007 Parent Partner 0.60 $21,632 $21,632
0008 Parent Partner 0.60 $21,632 $21,632
0009 Title $0
0010 Title $0
0011 Title $0
0012 Title $0
SALARY TOTAL 15.18 $33,815 $479,101 $512,916
PAYROLL TAXES:
0030 OASDI $0
0031 FICA/MEDICARE $39,238
0032 U.l. $12,086
PAYROLL TAX TOTAL $51,324
EMPLOYEE BENEFITS:
0040 Retirement $6,029
0041 Workers Compensation $10,290
0042 Health Insurance (medical vision, life, dental) $71,834
EMPLOYEE BENEFITS TOTAL $88,153
SALARY & BENEFITS GRAND TOTAL $652,393
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building $204,106
1030 Rent/Lease Equipment $12,000
1050 Utilities $31,030
1051 Janitorial/Building $29,530
FACILITY/EQUIPMENT TOTAL $276,666
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2012-2013
OPERATING EXPENSES:
1060 Telephone
1061 Answering Service
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Food
1069 Program Supplies -Support Groups
1070 Program Supplies -Medical
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Other-Vehicle Leasing
1077 Other -Miscellaneous
1078 Fingerprint checks
1079 Communication cell phone, internet
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES:
1 080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1 083 Other -Professional Liability
1 084 Other -Administrative Overhead
FINANCIAL SERVICES TOTAL
SPECIAL EXPENSES (Consultant/Etc.):
1 090 Subcontracts: Office Site Rents
1091 Translation Services
1 092 Medication Supports
1 093 Contractor Labor
SPECIAL EXPENSES TOTAL
Revised Exhibit B-1
$24,400
$0
$250
$15,267
$0
$0
$11,000
$10,500
$25,160
$26,662
$0
$0
$14,730
$0
$0
$0
$9,600
$800
$0
$0
T $138,369
$0
$0
$16,811
$7,950
$148,949
I $173,710
$6,000
$1,000
$0
$0
l $7,000
Revised Exhibit B-1
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corporation
NON MEDI-CAL CLIENT SUPPORTS
1192.2 Clothing
1192.4-.6 Transportation Assistance
1192.7 Client Stipends
NON MEDI-CAL CLIENT SUPPORTS
FIXED ASSETS·
2000 Comp~ters & Software
2001 Furniture & Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL
OTHER PROJECTED REVENUE:
4000
4100
4200
4300
Client Rents
Other-Private Insurance
Other
Other
OTHER PROJECTED REVENUE TOTAL
MHSAFUNDS·
5000 PEl Funds
5100 CSS Funds
MHSA FUNDS TOTAL
FY 2012-2013
I
TOTAL PROGRAM EXPENSES
J
TOTAL PROGRAM REVENUE
Over/(Under)
$2,000
$2,500
$17,000
$21,500
$0
$0
$0
$0
$1,269,638
$0
$0
$0
$0
$0
$1,269,638
$0
$1,269,638
$1,269,638
$0
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2013 • 2014
Revised Exhibit B-1
Budget Categories -Total Proposed Budget
Line lt~m Description (Must be itemized) FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Executive Director 0.68 $84,930 $84,930
0002 Mental Health Specialist 3.00 $113,445 $113,445
0003 Peer Support Specialist 7.30 $161,964 $161,964
0004 Admin Specialist II 1.00 $34,481 $34,481
0005 Peer Support Director 1.00 $57,679 $57,679
0006 Parent Partner 1.00 $30,285 $30,285
0007 Parent Partner 0.60 $21,632 $21,632
0008 Parent Partner 0.60 $21,632 $21,632
0009 Title $0
0010 Title $0
0011 Title $0
0012 Title $0
SALARY TOTAL 15.18 $34,481 $491,567 $526,048
PAYROLL TAXES:
0030 OASDI $0
0031 FICA/MEDICARE $40,243
0032 U.l. $12,066
PAYROLL TAX TOTAL $52,309
EMPLOYEE BENEFITS:
0040 Retirement $6,221
0041 Workers Compensation $10,271
0042 Health Insurance (medical vision, life, dental) $66,800
EMPLOYEE BENEFITS TOTAL $83,292
SALARY & BENEFITS GRAND TOTAL $661,649
FACILITIES/EQUIPMENT EXPENSES· -
1010 Rent/Lease Building $211,025
1030 Rent/Lease Equipment $12,000
1050 Utilities $31,030
1051 Janitorial/Building $29,230
FACILITY/EQUIPMENT TOTAL $283,285
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corp_oration
FY 2013-2014
OPERATING EXPENSES:
1060 Telephone
1061 Answering Service
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Food
1069 Program Supplies -Support Groups
1070 Program Supplies -Medical
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Other-Vehicle Leasing
1077 Other-Miscellaneous
1078 Fingerprint checks
1079 Communication cell phone, internet
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1 083 Other -Professional Liability
1 084 Other -Administrative Overhead
FINANCIAL SERVICES TOTAL
SPECIAL EXPENSES (Consultant/Etc.):
1 090 Subcontracts: Office Site Rents
1091 Translation Services
1 092 Medication Supports
1 093 Contractor Labor
SPECIAL EXPENSES TOTAL
Revised Exhibit B-1
$24,400
$0
$250
$15,267
$0
$0
$11,000
$4,500
$18,160
$19,453
$0
$0
$14,730
$0
$0
$0
$9,600
$800
$0
$0
l $118,160
$0
$0
$16,811
$7,950
$148,283
I $173,044
$6,000
$1,000
$0
$0
I $7,000
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corporation
NON MEDI-CAL CLIENT SUPPORTS
1192.2 Clothing
1192.4-.6 Transportation Assistance
1192.7 Client Stipends
NON MEDI-CAL CLIENT SUPPORTS
FIXED ASSETS·
2000 Computers & Software
2001 Furniture & Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL
OTHER PROJECTED REVENUE:
4000
4100
4200
Client Rents
Other-Private Insurance
Other
4300 Other
FY 2013-2014
I
TOTAL PROGRAM EXPENSES
Revised Exhibit B-1
I
$2,000
$2,500
$17,000
$21,500
$5,000
$0
$0
$0
$5,000
$1,269,638
$0
$0
$0
$0
OTHER PROJECTED REVENUE TOTAL 1 $0
MHSAFUNDS·
5000 PEl Funds $1,269,638
5100 CSS Funds $0
MHSA FUNDS TOTAL $1,269,638
TOTAL PROGRAM REVENUE $1,269,638
Over/(Under) $0
MHSA PEl PROJECT -BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2014-2015
Revised Exhibit B-1
Budget Categories -Total Proposed Budget
Line Item Description (Must be itemized) FTE% Admin. Direct Total
PERSONNEL SALARIES:
0001 Executive Director 0.68 $86,623 $86,623
0002 Mental Health Specialist 3.00 $115,710 $115,710
0003 Peer Support Specialist 7.30 $165,180 $165,180
0004 Admin Specialist II 1.00 $35,169 $35,169
0005 Peer Support Director 1.00 $57,679 $57,679
0006 Parent Partner 1.00 $30,285 $30,285
0007 Parent Partner 0.60 $21,632 $21,632
0008 Parent Partner 0.60 $21,632 $21,632
0009 Title $0
0010 Title $0
0011 Title $0
0012 Title $0
SALARY TOTAL 15.18 $35,169 $498,741 $533,910
PAYROLL TAXES:
0030 OASDI $0
0031 FICA/MEDICARE $40,844
0032 U.l. $12,066
PAYROLL TAX TOTAL $52,910
EMPLOYEE BENEFITS:
0040 Retirement $6,977
0041 Workers Compensation $10,271
0042 Health Insurance (medical vision, life, dental) $67,184
EMPLOYEE BENEFITS TOTAL $84,432
SALARY & BENEFITS GRAND TOTAL $671,252
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building $213,610
1030 Rent/Lease Equipment $12,000
1050 Utilities $30,530
1051 Janitorial/Building $28,230
FACILITY/EQUIPMENT TOTAL $284,370
MHSA PEl PROJECT -BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2014-2015
OPERATING EXPENSES:
1060 Telephone
1061 Answering Service
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Food
1069 Program Supplies -Support Groups
1070 Program Supplies -Medical
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Other -Vehicle Leasing
1077 Other -Miscellaneous
1078 Fingerprint checks
1079 Communication cell phone, internet
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES:
1 080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1083 Other-Professional Liability
1084 Other-Administrative Overhead
FINANCIAL SERVICES TOTAL
SPECIAL EXPENSES (Consultant/Etc.):
1 090 Subcontracts: Office Site Rents
1091 Translation Services
1092 Medication Supports
1 093 Contractor Labor
SPECIAL EXPENSES TOTAL
Revised Exhibit B-1
$24,400
$0
$250
$11,267
$0
$0
$10,000
$4,500
$18,160
$19,453
$0
$0
$14,730
$0
$0
$0
$9,600
$800
$0
$0
I $113,160
$0
$0
$16,811
$7,950
$147,595
I $172,356
$6,000
$1,000
$0
$0
I $7,000
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER
Kings View Corporation
FY 2014-2015
NON MEDI-CAL CLIENT SUPPORTS
1192.2 Clothing
1192.4-.6 Transportation Assistance
1192.7 Client Stipends
Revised Exhibit B-1
$2,000
$2,500
$17,000
NON MEDI-CAL CLIENT SUPPORTS I $21,500
FIXED ASSETS·
2000 Computers & Software
2001 Furniture & Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL
OTHER PROJECTED REVENUE:
4000
4100
4200
Client Rents
Other-Private Insurance
Other
4300 Other
OTHER PROJECTED REVENUE TOTAL
MHSAFUNDS·
5000 PEl Funds
5100 CSS Funds
MHSA FUNDS TOTAL
TOTAL PROGRAM EXPENSES
I
TOTAL PROGRAM REVENUE
Over/( Under)
$0
$0
$0
$0
$0
$1,269,638
$0
$0
$0
$0
$0
$1,269,638
$0
$1,269,638
$1,269,638
$0
Revised Exhibit 8-1
MHSA PEl PROJECT-BLUE SKY WELLNESS CENTER AND YOUTH EMPOWERMENT CENTERS BUDGET
Kings View Corporation
July 1, 2015-December 31, 2016 (6 Months)
Budget Categories -
Line Item Description (Must be itemized)
PERSONNEL SALARIES:
0001 Executive Director
0002 Program Manager (BiueSky)
0003 Program Manager (Youth Empowerment)
0004 Parent Partners (Youth Empowerment)
0005 Peer Support Specialist (Blue Sky)
0006 Title
0007 Title
SALARY TOTAL
PAYROLL TAXES:
0030 Workers Compensation
0031 FICA/MEDICARE
0032 U.l.
PAYROLL TAX TOTAL
EMPLOYEE BENEFITS:
0040 Retirement
0042 Health Insurance (medical vision, life, dental)
EMPLOYEE BENEFITS TOTAL
SALARY & BENEFITS GRAND TOTAL
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building
1030 Rent/Lease Equipment
1050 Utilities
1051 Janitorial/Building & Grounds Maintenance
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES:
1060
1061
1062
Telephone
Answering Service
Postage
FTE%
0.61
2.00
1.00
3.80
7.68
15.09
$47,255
$52,446
$24,037
$63,859
$100,659
$0
$0
$288,256
$3,500
$22,052
$5,000
$30,552
$4,180
$27,620
$31,800
$350,608
$100,860
$0
$24,000
$16,550
$141,410
$11,000
$0
$50
Revised Exhibit B-1
1063 Printing/Reproduction $3,950
1064 Publications $0
1065 Legal Notices/Advertising $0
1066 Office Supplies & Equipment $5,400
1067 Household Supplies $10,500
1068 Food $18,000
1069 Program Supplies -Support Groups $7,100
1070 Program Supplies -Medical $0
1071 Transportation of Clients $0
1072 Staff Mileage/vehicle maintenance $3,500
1073 Staff Travel (Out of County) $0
1074 Staff Training/Registration $0
1075 Lodging $0
1076 Other -Vehicle Leasing $7,100
1077 Other -Miscellaneous $600
1078 Fingerprint checks $0
1079 Communication cell phone, internet $0
OPERATING EXPENSES TOTAL I $67,200
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $0
1081 External Audit $0
1082 Liability Insurance $4,200
1083 Other -Professional Liability $4,500
1084 Other -Administrative Overhead $59,783
FINANCIAL SERVICES TOTAL I $68,483
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant -Network & Data Management $17,412
1091 Translation Services $500
1092 Medicatjon Supports $0
1093 Contractor Labor $0
SPECIAL EXPENSES TOTAL I $17,912
NON MEDI-CAL CLIENT SUPPORTS
1192.2 Clothing $0
1192.4-.6 Transportation Assistance $4,000
1192.7 Client Stipends $8,000
NON MEDI-CAL CLIENT SUPPORTS I $12,000
FIXED ASSETS:
2000 Computers & Software
2001 Furniture & Fixtures
2002 Other
2003 Other
FIXED ASSETS TOTAL
OTHER PROJECTED REVENUE:
4000
4100
4200
4300
Client Rents
Other-Private Insurance
Other
Other
OTHER PROJECTED REVENUE TOTAL
MHSAFUNDS·
5000 PEl Funds
5100 CSS Funds
MHSA FUNDS TOTAL
I
Revised Exhibit B-1
$0
$0
$0
$0
$0
$657,613
$0
$0
$0
$0
$0
$657,613
$0
$657,613
$657,613
$0
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
ZIP code
Exhibit F
Page 1 of .• ~
q3120
-71PIO
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under "Remarks" on page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII, XIX, or XX? ........................................................................................................................ .
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? .................................................................................... ..
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ......... ..
YES NO
Ill. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under "Remarks."
NAME ADDRESS EIN
B. Type of entity: LJ Sole proprietorship
Ll Unincorporated Associations
Ll Partnership
Ll Other (specify)---------
~-Corporation
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under "Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers .......................................................................................................... . Ll Ll
NAME ADDRESS PROVIDER NUMBER
Exhibit F
Page 2 ofJ-}
IV. A
1
.f Has ~herde bteen a change in ownership or control within the last year? ...................................................... .
yes, g1ve a e. -------------------
B. D
1
fo you ahnticipate any change of ownership or control within the year?.................................................. .
yes, wen? ... ·
C. Do you anticipate filing for bankruptcy within the year? .................................................................... .. If yes, when? ..........
V. Is the fa?ility operated by a management company or leased in whole or part by another organization? ..........
If yes, g1ve date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year? ........ .
VII. A. Is this facility chain affiliated? .............................................................................. ! ...................................... .
(If es; list name, address of cor oration, and EIN.)
Name EIN
Address (number, name) City State
B. If the answer to question VII .A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State
ZIP code
ZIP code
Exhibit F
Page3 of
YES NO
Ll X'
Ll )(
Ll '5(
Ll )(
Ll X
Ll J(
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) TrUe
Date
Remarks
.q
KINGS VIEW
BOARD MEMBER CONTACT INFORMATION
2015-2016
LISA FINKE, M.S.
Home: 2207N. Sheldon Ct.
Reedley, CA 93654
Home: 559/480-5713
E-Mail: I isal@consultingservicesintemational. biz
(Consulting Services)
lstTennExpires: 12131/17
E. JANE MIDDLETON, DSW
Home: 8814N. lone Avenue
Fresno, CA 93720
Mail: P.O. Box 28006
Fresno, CA 93720
Cell: 559/434-3560
Business: 559/278-2688
E-Mail: jrniddletl@csufresno.edu
(Social Work)
lstTerm Expires: 12/31115
. PHILIP NEUFELD, M.B.A.
Home: 5718 West Decatur
Fresno, CA 93722
559/277-8577
Cell: 559/244-1738
E-Mail: philneufeldl@yahoo.com
(Information Technology)
2nd Tenn Expires: 12/31/16
DARLENE PRETTYMAN, RN C
Home: 1801 North Dupree Lane
Clovis, CA 93619
559/297-1804
Cell: 661/703-4198
E-Mail: dprett6859@aol.com
(Healthcare)
1'1 Term Expires: 12/31117
KEVIN SCHELLENBERG, Ph.D.,Secretary
Home: 286 Houston Ave.
Clovis,CA 93611
559-289-2624
Business: 559/435-1133
E-mail: klschellenberg<@aol.com
(Healthcare)
2°d Term Expires: 12/31/J 6
RON SHEPPARD, M.A.
Home: 1325LansingAve.
Clovis, CA 93612
559/348-9654
Business: 559/348-9654
Cell: 559/593-1037
E-mail: ron.sheppard78@gmail.co m
(Education)
I "Term Expires: 12/31/17
AL TRUJILLO, AA
Home: 879 E. Catalina Circle
Fresno, CA 93730
Cell: 559/974-49I8
E-mail: a.trujillo5l@gmail.com
(Finance)
Ist Term Expires: 12/31117
MALCOLM H. LIGHT Ill
Home: 1389 S. Kline
Reedley, CA93654
Cell: 559/847-7500
E-mail: rnalcolm@reedleymbc.org
(Church)
!51 Partial Term Expires: 12/31/15
2nd Full Term Expires 12/31/18
KINGS VIEW CORPORATION
7170 No. Financial Drive, Suite llO
Fresno, CA 93720
Phone: (559) 256-7608
Exhibit F
Page 4 of4
Z:\Board -KV 2015-2016\Memher Contact Information 2015-2016.doc