Budget



ATTACHMENT C – BUDGET

DIRECTIONS: Please use the definitions below to complete the Line-Item Budget and Budget Narrative template. Budgets should reflect strategies/activities described in the logic model and strategic plan. Lastly, budgets must fall within the prescribed range of $75,000 - $187,500 for the specified timeframe. Sub-total and total budget amounts should match in the Line-Item and Budget Narrative template. Budget is subject to Mercy Maricopa approval.

Line Item Budget Terms

Mercy Maricopa Integrated Care Revenue – Please list the budget amount being requested from Mercy Maricopa Integrated Care. This amount should match the “TOTAL REVENUE” line.

Personnel – Please identified each proposed staff member, including proposed FTE level, job title and their annual salary.

Fringe Benefits – Includes total cost for all employee related expenses for all proposed staff such as health benefits and taxes.

Contracted Consultant/Professional Services – If applicable, please include the proposed amount for delivered services outside of staff/agency capacity.

Rent & Occupancy – Include any rent/occupancy costs incurred specifically by the proposed program for direct personnel.

Travel/Transportation – Include the total costs for local travel, travel to trainings, and any target community/population-related transportation costs for direct personnel.

Supplies and Operating Expenses – The total costs related to needed program supplies and operating expenses directly related to program implementation.

Equipment – Total cost for any equipment necessary for program implementation.

Other Expenses – Total cost for any other expenses needed for program implementation.

Subtotal Direct Expenses – The total amount of expenses with the summation of the above line-items.

Indirect Expenses – If organization has a Federally-approved Indirect Rate and is claiming any indirect expenses, please include the proposed indirect costs to the program. It is important to note that the maximum allowed under indirect expenses is 14% of the total budget.

Total Expenses – The combined total of Direct and Indirect expenses. This should match the total revenue being requested. No profit is allowable for Mercy Maricopa Prevention Providers.

Budget Narrative Terms

For non-Mercy Maricopa income, please list any other funding streams that are contributing to the proposed program. This can include, but is not limited to: in-kind funding, local funding, state funding, federal funding, foundation funding or any other funding source(s).

Personnel – Position titles, name of the proposed staff, FTE level, salary, justification/primary responsibilities of the staff and total cost to the program.

Fringe Benefits – Please demonstrate the calculations used to determine the total health benefits and tax costs.

Contracted Consultant/Professional Services – Please specify the name of any subcontractors that will be working on this project, the services they will provide, justify their need to the program, the strategy they will be implementing (or contributing to), their hourly rate (or unit costs for services provided) and the total cost to the program. If a contractor has not been identified, please complete the rest of the sections to the best of your ability and list the name of the contractor as TBD. Please note that Evaluation services will be provided through Mercy Maricopa; no proposed costs for Evaluation subcontractors will be approved in this category.

Rent/Occupancy – Please demonstrate the unit and total costs for rent/occupancy related to program costs.

Travel/Transportation – Please tabulate the purpose of local travel, the estimated number of miles x’s the number of FTE’s x’s the frequency of travel x’s the approved mileage rate. Include total local travel costs. Additionally, under “Other Transportation Costs” please list any outstanding travel to conferences or trainings. Please include number of people attending, unit costs and total costs.

Supplies and Operating Expenses – Please specify the supplies and operating costs necessary to the implementation of the proposed program, including: unit costs (if possible), justification for these expenses, if applicable what strategy will these costs be associated with and the total cost for each item and the sub-section.

Equipment – List any equipment needed for program implementation, its unit cost, justification for its need, if applicable, what strategy will the equipment be associated with, total costs for each piece of equipment and for the sub-section.

Other Expenses – Calculate any other necessary expenses not already captured, along with unit cost, justification, if applicable what strategy they will be attributed to, total cost for each expense and for the sub-section.

LINE-ITEM BUDGET

|REVENUE |

|Mercy Maricopa Integrated Care Revenue |$ |

|TOTAL REVENUE |$ |

|EXPENSES |

|Direct Expenses |

|Personnel: Identify each contracted staff and FTE level. |$ |

|Example: Prevention Manager, [NAME], 0.5 FTE |$ |

| |$ |

| |$ |

| |$ |

|Fringe Benefits |$ |

|Contracted Consultant/Professional Services |$ |

|Rent & Occupancy |$ |

|Travel/Transportation |$ |

|Supplies & Operating Expenses |$ |

|Equipment |$ |

|Other Expenses |$ |

|Subtotal Direct Expenses |$ |

|Indirect Expenses |

|Subtotal Indirect Expenses |$ |

|TOTAL EXPENSES |$ |

October 1, 2015 – June 30, 2016

BUDGET NARRATIVE

Revenue:

Non-Mercy Maricopa Income: Provide amount of other prevention funds and a brief explanation of how these funds leverage and contribute to your prevention program (strategies, activities, substance use issues, etc.).

Expenses:

Personnel:

|Position |Name |FTE |Salary |Justification / Primary |Total Program |

| | | | |Responsibilities |Cost |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| |Total FTE: | | |Total Personnel |$ |

Fringe Benefits (Employee Related Expenses):

|Health |Position |Program FTE Level |Total Health Benefit Cost |Total Program Cost |

|Benefits | | | | |

| | | | |$ |

| | | | |$ |

| | | | |$ |

| | | |Total Health Cost |$ |

|Taxes |Employee Taxes & Other ERE|Total Salaries for this |Taxes calculation |Total Program Cost |

| | |project- | | |

| |FICA |$ |X 0.0765 |$ |

| |Workmen’s compensation |$ |X |$ |

| |Other Taxes |$ |X |$ |

| | | |Total Tax Costs |$ |

| | | |Total Fringe Benefits |$ |

Contracted Consultant/Professional Services:

|Name of Contractor |Services Provided |Justification to |Contracted Strategy (If |Total Cost |Total Program |

| | |Program |applicable) | |Cost |

| | | | |$/HR x #HR | |

| | | | | | |

| | | | |Total Outside Services |$ |

Rent/Occupancy:

|Item |Cost |Total Program Cost |

| | | |

| | | |

| |Total Rent/Occupancy Cost |$ |

Travel/Transportation

|Local Travel |Description |Miles per staff x’s |No. of Months |X’s Approved Rate (0.575 cents |Total Local Travel Cost |

| | |FTE | |per mile) | |

| | | | | | |

| | | | | | |

|Other Transportation | | | | | |

|Costs | | | | | |

| | | | |Total Travel Cost |$ |

Supplies and Operating Expenses:

|Item |Cost |Justification |Contracted Strategy |Total Program Cost |

| | | |(If applicable) | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

|Total Program Supplies and Operating Expenses | |$ |

Equipment

|Item |Cost |Justification |Contracted Strategy (If |Total Cost |Total Program Cost |

| | | |applicable) | | |

| | | | | | |

| | | | |Total Equipment Cost |$ |

Other Expenses:

|Item |Cost |Justification |Contracted Strategy (If |Total Program Cost |

| | | |applicable) | |

| | | | | |

| | | | | |

|Total Other Expenses |$ |

|TOTAL DIRECT EXPENSES | |$ |

Total Indirect Cost: $

Total Program Cost: $

Total Mercy Maricopa Integrated Care Request: $

PLEASE SEE NEXT PAGE

Please complete the table below to show a breakdown of funds by program strategy. Use the amounts from the “Contracted Strategy” columns in Budget Narrative to link to corresponding categories. Staff time to be spent on these activities, such as administrative functions, may also be utilized to estimate allocations. It is important to note that the total amount in this table should MATCH the total amount requested in the Line-Item Budget/Budget Narrative. Also note that strategies with allocated expenditures in this section must be referenced in the Strategic Plan.

| |Funding by Program Strategy and Administrative Functions |

| |Category |Allocated Expenditures |

| |Total Funding Request |$ |

| 1. |Planning, Coordination and Needs Assessment | |

|2. |Quality Assurance | |

|3. |Training/Workforce Development | |

|4. |Evaluation* | |

|5. |Information Systems | |

|6. |Environmental Strategies | |

|7. |Community Based Process | |

|8. |Problem Identification and Referral | |

|9. |Education (Community Education, Life Skills, Training) | |

|10. |Alternatives (Peer and Youth Leadership) | |

|11. |Information Dissemination | |

| |TOTAL |$ |

*Please note that Evaluation services will be provided through Mercy Maricopa; do not include proposed costs for Evaluation subcontractors in this category. It is acceptable to include an estimate of staff time to be spent meeting with Evaluators, administering and collecting surveys, etc.

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