HICAP BUDGET SUMMARY

Transcription

1 ATTACHMENT 1 State of California Health Insurance Counseling and Advocacy (HICAP) Budget CDA 229 (rev 4/216) Page 1 of 7 HICAP BUDGET SUMMARY BUDGET PERIOD 7/1/216-6/3/217 COST CATEGORY AAA ADMINISTRATION [] ORIGINAL EVISION #1 SUBMISSION DATE: [x] 9 MONTH 3 MONTH FEDERAL (SHIP) FUNDS (7/1-3/31) FEDERAL (SHIP) FUNDS (4/1-6/3) Admin Admin PSA No /3/16 12 MONTH LOCAL FUNDS STATE FUNDS HICAP Reimb. Admin HICAP Fund Admin FUNDS Income / Other Funds 18,52 21,739 1,869 57,277 Operating Expenses Indirect Admin 18,52 21,739 1,869 57,277 Personnel HICAP ADMINISTRATION HICAP PROGRAM Direct Services HICAP Reimb. Income / Other Funds HICAP Fund FUNDS Subrecipient Contractor Services 229,429 55,56 281,918 14,956 77,89 HICAP PROGRAM 229,429 55,56 281,918 14,956 77,89 247,931 61,673 33, , ,86 HICAP BUDGET HICAP Legal Representation Services are provided: [W&l Code, Section 9541 (c) (3)] [x ] Yes Amount Budgeted: $ 765

2 State of California Health Insurance Counseling and Advocacy (HICAP) Budget Page 2 of 7 CDA 229 (rev 4/216) AAA ADMINISTRATION BUDGET - FEDERAL & LOCAL FUNDS BUDGET PERIOD: 7/1/216-6/3/217 PERSONNEL Position Classification: [ ] ORIGINAL [x j REVISION #1 SUBMISSION DATE Monthly Total Annual FTE 9 Month Wage Rate FTE % of Time Worked Salaries & Wages PSA No: Month Salaries & Wages Salaries & Wages Senior Management Analyst I 8, % 6, 2, 8, Management Analyst II 7, % 1, 3, 13, Accountant II 6,1 5.% 2,52 1,167 3,669 SALARIES & WAGES 18,52 24,669 18,52 24,669 STAFF BENEFITS PERSONNEL OPERATING EXPENSES Rent: "Equipment (List Item below) 3 Month 9 Month Sq ft: Sq ft Rate/mo.: Quantity Travel: Other Operating Expenses (List below): OPERATING EXPENSES o INDIRECT COSTS FEDERAL & LOCAL ADMINISTRATION * Equipment exceeding $5 must be reported on Property page 18,52 24,669

3 State of California Health Insurance Counseling and Advocacy (HICAP) Budget CDA 229 (rev 4/216) Page 4 of 7 AAA ADMINISTRATION BUDGET - STATE & LOCAL FUNDS (12 MONTH) BUDGET PERIOD: 7/1/215 6//21 T 1 ] ORIGINAI lx ) REVISION #1 SUBMISSION DATE 1KV216 PERSONNEL Monthly Total Annual FTE HICAP Reimb. HICAP Fund Position Classification: Wage Rate FTE % of Time Worked Salaries SWages Salaries & Wages Senior Management Analyst I 8,577 9.% 6,4 2,869 Management Analyst II Accountant II OPERATING EXPENSES Rent: "Equipment (List Item below) Travel: 7, % 9,3 6,1 SALARIES & WAGES 11.% 6,39 STAFF BENEFITS PERSONNEL 6, 2, Salaries & Wages PSA No: ,3 8,39 21,739 1, ,739 1,869 HICAP Reimb. HICAP Fund Sqft: I Sq ft Rate (mo.): Quantity Other Operating Expenses (List): OPERATING EXPENSES INDIRECT COSTS STATE & LOCAL ADMINISTRATION 21,739 1,869 32,68 * Equipment exceeding $5 must be reported on Property page

4 State of California Health Insurance Counseling and Advocacy (HICAP) Budget CDA 229 (rev 4/216) Page 6 of 7 HICAP SUBRECIPIENT CONTRACTOR SERVICES SCHEDULE -12 Month BUDGET PERIOD: 7/1/216-6/3/217 ORIGINAL [x ] REVISION #1 SUBMISSION DATE PSA No: 25 HICAP HICAP HICAP HICAP Income Contractors 9 Month Federal Funds 3 Month Federal Funds Reimbursement Fund and Other CONTRACTED SERVICES Name: Center for Health care Rights 229,429 55,56 281,918 14,956 77,89 Telephone: 52 S. la Fayette Park PL, LA,CA (213) Contact Person: Ms. Aileen Harper Name: Telephone: Contact Person: Name: Telephone: Contact Person: Name: Telephone: Contact Person: 9 MONTH FED. 3 MONTH FED. HICAP REIMB. HICAP FUND LOCAL FUNDS HICAP CONTRACTED SERVICES 229,429 55,56 281,918 14,956 77,89 Budget Contracted expenses from all funding sources

5 STATE OF CALIFORNIA STANDARD AGREEMENT AMENDMENT STD. 213 A (Rev 6/3) ATTACHMENT 2 ~Xj CHECK HERE IF ADDITIONAL PAGES ARE ATTACHED 1 Page AGREEMENT NUMBER HI REGISTRATION NUMBER AMENDMENT NUMBER 1 1. This Agreement is entered into between the State Agency and Contractor named below: STATE AGENCY S NAME California CONTRACTOR'S NAME City of Los Angeles 2. The term of this Agreement is July 1, 216 through June 3, The maximum amount of this $ 765,86 Agreement after this amendment is: Seven hundred sixty-five thousand eighty-six and /1 dollars 4. The parties mutually agree to this amendment as follows. All actions noted below are by this reference made a part of the Agreement and incorporated herein: This Contract Amendment increases the funds provided to the Contractor by $25,27. The attached Budget Displays page 9, dated 1/27/216 hereby replaces the Original Exhibit B - Budget Display page 9, dated 7/1/216. The Budget, Amendment 1 is hereby incorporated by reference and replaces the original Budget. All other terms and conditions shall remain the same. IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto. CONTRACTOR CONTRACTOR'S NAME {If other than an individual, state whether a corporation, partnership, etc.) City of Los Angeles BY (Authorized Signature) DATE SIGNED (Do not type) & PRINTED NAME AND TITLE OF PERSON SIGNING CALIFORNIA Department of General Services Use Only ADDRESS 221 N. Figueroa Street, Suite 5 Los Angeles CA STATE OF CALIFORNIA AGENCY NAME California BY (Authorized Signature) & PRINTED NAME AND TITLE OF PERSON SIGNING Glenn Wallace, Manager, Contract and Business Services Section ADDRESS 13 National Drive, Suite 2, Sacramento, CA DATE SIGNED fdo not type) IXI Exempt per: Older Californians Act

6 State of California California CDA 33 Agreement #: Date: Amendment #: Date HI /1/16 1 1/27/16 Exhibit B - Budget Detail, Payment Provisions, and Closeout HEALTH INSURANCE COUNSELING AND ADVOCACY PROGRAM Budget Display July 1, June 3, 217 City of Los Angeles PROJECT STATE FISCAL YEAR PROGRAM ONE-TIME BASELINE ONLY AMENDMENT 1 ONE-TIME- ONLY HICAP Funds (July 1, 216-June 3, 217) Reimbursements (Ins Fund) State HICAP Fund HIRL HIHL 33, ,825 HIFL1 37,642 21,184 HIFL2 HIFL3 185,19 61,673 4,86 STATE FISCAL YEAR (12 MONTHS) 72,174 37,642 25,27 33,657 (a) 151,825 (a) 58,826 (b) 189,15 (b) 61,673 (c) 765,86 The maximum allowable expenditure for Administration from State Funding is: Reimbursements (Ins Fund) 21,739 State HICAP Fund 1,869 The maximum allowable expenditure for Administration from Project HIFL2 funding is: 18,52 The maximum allowable expenditure for Administration from Project HIFL3 funding is: CFDA# Project Title Project Award # Effective Date State Health Insurance Assistance HIFL 9SA /1/ State Health Insurance Assistance HIFL2 9SA /1/ State Health Insurance Assistance HIFL3 To Be Announced 4/1/217 (=> Funds must be expended by 6/3/17 and final expenditures reported in closeout by 8/15/17 w Funds must be obligated by 3/31/17 and final expenditures reported in closeout by 5/15/17 (cl Funds must be reported in closeout by 8/15/17 and may be carried over into the following year contract Page 9 of 9