2016-582-E Finance - Freedom House Recovery Center, Inc. - Outside Agency Performance Agreement

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DocuSign Envelope ID:636AFD33-DA5C-4B55-88DC-03C0863BAFE3 t A - continued Provider's Outside Agency Application MAIN APPLICATION a.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment. Example Program: Credit Counseling Class Cost Elements Cost($) Quantity/Unit of Measure Subtotal ($) Credit Counseling Teacher–in class $25 96 hours(8 hrs/mth x 12 months) $2,400 Credit Counseling Teacher—class prep $25 48 hours(4hrs/mth x 12 mths) $1,200 Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Com•Iete the table below for the •ro'ect/•ro•ram for which ou are re•uestin• funds. Attach additional rows/pages, as needed. Program: Facility-Based Crisis and Detox/Behavioral Health Urgent Crisis Care Services Cost Elements Cost($) Quantity/Unit of measure Subtotal ($) Staff $4,608.65 One Bed Day (24 hours) X 365 $1,682,160 Utilities $119.18 One Bed Day (24 hours) X 365 $43,500 Supplies and Equipment $270,68 One Bed Day (24 hours)X 365 $98,800 Travel and Training $12.71 One Bed Day(24 hours)X 365 $4,640 Mortga•e $211.23 One Bed Day(24 hours)X 365 $77,100 Total 1,906,200 b.) Cost per Unit Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program $1,824,056 $1,875,549 $1,906,200 Total # of Units 5673 5735 5792 Cost Per Unit $321.53 $327.04 $329.11 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 1/25/2016 4:55:19 PM Page 21 of 24