CONTRACT AMENDMENT NO. 2

CONTRACT FOR HIV/AIDS SERVICES DELIVERY FUNDED UNDER THE FY 2015 TITLE XXVI OF THE PHS ACT, AS AMENDED BY THE RYAN WIDTE HIV/AIDS TREATMENT

EXTENSION ACT OF 2009: PART A SUPPLEMENT AL FUNDING GRANT CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CFDA) NO. 93.914

between

DALLAS COUNTY HEALTH & HUMAN SERVICES (Contractor)

I. PURPOSE:

and

RESOURCE CENTER OF DALLAS (Sub-Contractor)

Contract Amendment No. 2 amends the HIV/AIDS Services Delivery Funded under the FY2015 Title XXVI of the PHS Act, as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009: Pai1 A Supplemental grant agreement executed between Dallas County Health & Human Services and Resource Center of Dallas effective March 1, 2015.

II. AMENDED PROVISIONS:

Contract Amendment No. 2 shall not change any contractual provisions agreed upon in the Ryan White HIV/AIDS Treatment Extension Act Part A Supplemental funded agreement; each provision shall remain in effect throughout the term of the agreement with the exception of the following amended provisions:

A. AMENDED CONTRACT AMOUNT:

The contract payment provisions are revised to decrease funds in the amount of $200,000 Insurance Assistance. The total contract is decreased to $629,125 due to contract amendment No. 2.

Original Part A Supplemental grant contract amount: Award due to Amendment No. 2:

Total amended contract amount:

$ 829,125.00 $ 200,000.00

$ 629,125.00

B. AMENDED PROVISIONS:

The revised Exhibit A-1 (detai led for the line item service budget), A-3 (budget justification), B-1 (performance objectives), and Cl and C2 (multiple funding sources) reflect decreased funding in the Insurance Assistance service categories.

C. TERM:

Contract Amendment No. 2 shall not affect the original term of the contact that is in effect through February 29, 2016.

For: Resource Center of Dallas: For: Dallas County:

By: M0w1t'~ ¥ Executive Director

I - 2-J-- f b JAN I 9 2016

RECOMMENDED:

APPROVED AS TO FORM*

*BY LAW, THE DISTRICT ATTORNEY'S OFFICE MAY ONLY ADVISE OR APPROVE CONTRACTS OR LEGAL DOCUMENTS ON BEHALF OF ITS CLIENTS. IT MAY NOT ADVISE OR APPROVE A LEASE, CONTRACT, OR LEGAL DOCUMENT ON BEHALF OF OTHER PARTIES. OUR REVIEW OF THIS DOCUMENT WAS CONDUCTED SOLELY FROM THE LEGAL PERSPECTIVE OF OUR CLIENT. OUR APPROVAL OF THIS DOCUMENT WAS OFFERED SOLELY FOR THE BENEFIT OF OUR CLIENT. OTHER PARTIES SHOULD NOT RELY ON THIS APPROVAL, AND SHOULD SEEK REVIEW AND APPROVAL BY THEIR OWN RESPECTIVE ATTORNEY(S).

ATTACHMENT A-1 (a): DETAILED LINE ITEM BUDGET FOR DlRECT COST

AGENCY:RESOURCECENTER GRANT:20.15-:?0l6 RYAN WH ITE PART A SUPPL

SERVICE CATEGORY: INSURANCE ASSISTANCE GHANT J'ERIOD: ~·lARCll I, 2015 TO Ff.II 29, 20.16

DIRECI' PERSONNEL EXl'ENDJTURE ITEMS TOTAL % Bdgtd. TOTAL AMOUNT ANNUAL from ALLOCATED

POSITION TITLE SALARY D.C.P.T.G TO GRANT

A B c D

J ChiefOoeratin2 Officer, M. Elliott 93.476 8.56% 8,000

2 HlV Client Services Manu)l.or, D. Carrillo 60 000 26.67% 16.000

3 Insurance Assistance Coordinator, A. Gudino 38,256 16.21% 6;'00

4 Client Services Coordinntor, Insurance Assistnncc, Roberts 28,000 22.14% 6,200

5 Client Services Coordiiiator Insurance Assistance, Santosuosso 31,200 26.54% 8.280

6 Client Services Coordinator Insurance Assistance. Mitchell 31 200 26.54% 8,280

7 Client Services Coordinator, Insurance Assistance, L. McMurrav 31,200 26.54% 8,280

8 Datubosc Annlvst-AR!ES (McNeil) 52,000 38.46% 20.000

9 I-HY Client Services Coordinator-ARIES G. Benecke 40.000 7.50% 3,000

to HTV Client Services Soccialist-AR!ES. T. Allen 31.200 16.03% 5,000

11 HIV Client Services Suecialist-ARJES, S. Bentmm 12027 24.94% 3,000

12

13 SALARY - 92.240

14 flUNGE BENEFITS . . - 20,671

15 'fOTAL DIRECT PERSONNEL COST 112.911

OlRECT NON-P.ERSONNEL F.XPENDITURE ITEMS

OTHER ITEll'lIZED EXPENl)[TURES

E F'

16 TRAVEL -17 EOUfPMENT -18 SUPPLIES 3.150

19 CONTRACTUAL -20 OTl:IER DIRECT COSTS (Provide brief iustilkalion for each line) 123,294

21

22

23

24

25

26 TOTAL DlllECT NON-PERSONNEL COST - 126,444

27 TOTAL DDlECT COST 239,355

l

ATTACHMENT A-1 (b): DETAILED LINE ITEM BUDGET FOR lNDlRECT COST

A GENCY: RESOURCE CENTER GllANT:lOIS-2016 RYAN WIOTE PART A SUPPL

SERVICE CATEGORY: INSURANCE ASSISTANCE GRANT PERIO D: MAHCH l , 2 015 TO l'EU 29, 2Ql6

INDIRECT PERSONNEL EXPENDITURE ITEMS TOTAL % 13dgtd. TOTAL AMOUNT ANNUAL from ALLOCATED

POSITION Tll'LE SALARY D.C.P.T.G TO GRANT

A B c 0

1 CEO. C. Cox 140,000 5.00% 7,000

2 E.xecuiive Assistant B. Garcin 36 091 5.00% 1,805

3 Information & Technology Coordinator, K. Kawnak 62 055 5.00% 3.JOJ

4 Facilities Mnnnger, L, Solis 30 104 5.00% 1,505

5 Facilities Assistant, S. Tew 12.854 5.00% 643

6 Volunteer Resources Coordinator, D. Cavazos 44 113 5.00% 2,206

7

8

9

10

11 SALARY ' 16.262

12 FRINGE BENEFITS 2,945

13 .T.dTAL JNDlRECI' PERSONNEL COST 19,207

INDIRECT NON-PERSONNEL EXPENDITUUE ITEMS

OTHER ITEJ\HZED EXPENDITURES

E F 14 TRAVEL . 15 EQUIPMENT . 16 SUPPLIES . 17 CONTRACTUAL 4,550

I S OTHER fNDIRECT COSTS (Provide bri~f iustificntion for each line) 2,838

19

20

21

22 23

.24 TOTAL lNDIRECT NON-PERSONNEL cosr 7,388

25 TOTAL l NDffiECT COST• -

26,595

I 26,TOTALCOST(!:!IRECT+ INDffiECI') I 265.950 I • NOTE: Totnl Indirect cost cannot exceed I 0% of the approved awn rd tor the service rntegor)'.

A TT A CHM ENT A-J (n): BUDGET JUSTll'ICA T!ON FOR DffiECT COSTS

RESOUftCE CENTER, P.O. nox 190869, DALLAS TX 752 19, 75-1892059 rY 20 15- 201 6 Rynn White Pn rt A Supplcmentnl

Scl'l'ice C<itegory- lnsnrnncc Assistance

DIRECT Cl PERSONNEL

A.

B.

c.

D.

(~.

F.

G.

I-1.

I.

J.

Chief Operating Officer, M. Elliott

Supervise HIV Client Services Manager. Review utilization of MCM services.

HIV Client Services Manager, D. Carrillo

93,476

60,000

s 8 . .56%

26.67% Resp9nsible f9r ensuring the provisjon of financial assistance for eligible individuals. Oversee eligibility for the program. Ma1iagc prognun staff. Oversee data input, including ARJES. Ensures the case files hnve documentation that clieut· meets eligibility criteria, knows responsibility to report relevant changes and coordinates the client's needs have been evaluated on a periodic basis.

Insurance Assistance Coordinntor, A. Gudino 38,256 16.21%

Assis ls with intakes and quarterly veJificalions as needed. Responsible for all timely payment of insurance premiums. Contact person with insurance companies on behalf of the clients. Coordinates wich pharmacies to insure proper billing or client information.

Client Services Coordinator, Insurance Assistance, Roberls 28,000 22. 14%

Will complete q1rnrterly verifications of eligibility, ensure receipt or necessary documentation to continue payments for all lnsurnnce Assistance clients, assist with inlnkes and billing as needed. Provide inlbrmatfon refcr.rnls and or assistance as needed with linkages tp c;irc. Provide information system of cnre.

Client Services Coordinntor, Insurance Assistance, Sanlosuosso 31,200 26.54%

WiU complete quarterly vcrificacimt~ of eligibility, ensure receipt of necessary documentation to continue payments for all Insurance Assistance clients, assist wilh intakes and billii1g as needed. Provide i11lb1111atio1i referrals nnd or assistance as needed with.liukngcs 10 cnrc. Provide information system of care.

Client Services Coordinator, Insurance Assistance, Mitchell 31,200 26.54%

Will complete quarterly vcrilicalions of eligibili1y, .ensure receipt of necessary <locmnenlation lo continue payments lQ[ all lnsnrnnce Assistance clients, assist with intakes and billing as needed. Provide information referrals nnd or assistance as needed with linkages IQ care. Provide information system of care.

Client Services Coordinator, Insurance Assistance, L. McMnrray 31,200 26.54%

Will C01)1plete quarterly verifications-of eligibility, ensure receipt of necessary documcnlntion to continue payments for all Insurance Assistance clients, assist with i111nkes a1\d billing as needed. Provide iufomiation referrals nud or assistance as needed witb linkages to care. Provide in fo rmation system of care.

Database Analyst - ARIES (McNeil) 52,000

Assist in Iosurnuce Assistance with record-keeping. Assisi with dala entry, billing mid maintaining client ARIES records.

HfY Client Services Coordi;ator-ARIES, G. Dcnccke ~0.000

Enlcrnlata and maintains·client ARIES records.

HIV Client Services Specialist-ARIES,'!'. Allen 31,200

Euters data nnd 111ni111ains client ARIES records.

38.46%

7.50%

16.03%

s 92,240

8,000

16,000

6,200

6,200

8,280

8,280

8,280

20,000

-J,000

5,000

f(, HIV Client Services Specialist-AIUES, S. Aentrum

Enters data and maintains client ARIES records.

II l•'lllNGE BENEFITS

lnsurnncc (Medical/Dental/Life) Social Security Rclircmcnl Workers Compensalion Olhers (Disability, Unemployment)

1U TRAVEL

i\. Local Travel None requested

B. Ont-of Jurisdiction Travel. None req11ested

IV EQUTPM"ENT

i\, None requesled

V SUPPLIES

A. General Office Supplies

12,027 24.94%

Toner cartridges, medical forms, paper goods, fil e fo lders, pens, dircclly related lo program.

B. Check stock for insurance premium payment checks

VJ CONTHACTUAL

A. ·None requested

VII OTHER DIRECI' COSTS (Provide brief juslilicntion for each line)

A. Rent 5450 Denton Drive CutofY n. Utilities C. Telephone D. Bnilding mainle1mnce

E. Premium nnd medical co-paymenl funds

Vlll TOTAL DmECT COSTS

IX PROGRAM INCOME A. Lisi any progrnm income lo be generated and describe

how it will be rcin1cgra1cd into lhe program II. Attach Fee Schedule if applicable

X THIRD-l'AllTY REIJVIBURSEMENTS A. lfavailable, describe how clients will be screened for potential cligibilily B. E.~pl~in billing and reimbursements

3,000

s 20,67J

s J 1,526 7,056

2,089

s

s

,s 3,150

2,475

675

S.

; $ 123,294

s 1,000 1,000

500 1,000

119,79-1

Is 239,Jss I

ATTACHMENT A-3 (h): BUDGET .JUSTIFICATION FOR INDIRECT COSTS

RESOURCE CENTER; P.O. nox 190869, DALLAS TX 7521 9, 75-1892059 F\' 2015· 2016 Ryan White Pa1·1 A Supplemental

Ser l'icc Category- l nsurnncc Assistnncc

TNDIBECT PEHSONNEL

;\,

n.

c.

D.

CEO,C. Cox $ 7,000 140,000 5.00%

Supervises and oversees development, fundraising, and progrnms ofRCD.

Executive Assistant, B. Gnrcin l ,805

36,09 1 5.00% Scheduling cpntact fur executive director. Responsible for tl1e scheduling nnd coordiuntion of meetings with program directors and coordinators.

lnfonnation & Technology Coordinator, K. Kawrrnk

62,055 5.00% Responsible for ongoing 111ai11tenauce nnd support of all of the agency's computers and coordination with the network consultants.

Facilities Mauagcr, L. Solis 30,104 5.00%

3,103

1,505

i S

Responsible for agency filcilities, plant and equipment, ttnd supervision of custodial staff. Responsible for overseeing compliance with city and county rules, codes nnd regulations for operation of progrnms.

E.

F.

Facilities Assistant, S. Tew 12,854

Assi~ts with agency facililics, planl and equipment mnintcmmce.

Volunteer Resources Coordinator, D. Cavazos 44,1 IJ

Trains and evuluntes nil volnnteers.

643 5.00%

2,206 5.00%

Insures that there nre volunteer receptionists. and trained staff to assist wilh program activities. Mninlains n database of volunteers interested in work for future needs.

IT FRINGE BENEFITS

Insurance (Mcdicnl/Lifo) Social Security Retire111ent Workers Compcnsat ion Others (Disubility, Unernploy111ent, etc.)

Ill TRAVEL

A. Local Travel None requested

Il. Out·of Jurisdiction Travel. None requested

IV EQUIPMENT

A. None requested

V SUPPLIES

A. Norte requested

Vl CONTRACTUAL

A. Name ofSubconlractor: Avior [nnovations, Inc. Portion of Subcontract: Method of selection: bid/interview process

s J ,440 1,244

261

s

2,000

Ls

l s

s

i S

16,262 :

2,9.fS

4,550

D.

c.

Period of Performance: Mnrch I, 2015 - February 29, 2016 Description of Activity: Accounting and Payroll subcontractor for the Resource Center of Dallns. Accounts Receivable and Payable, Payroll, MFR county reports. Maintains nil financial records for County fimdcd service categories. Human Resources. Total of subcontract: Percent applied:

Name of Subcontractor: Solace Consulting Portion of Subcontract: Method of selection: bid/interview process Period of Performance: March I, 2015 -Fcbruury29, 2016

93,600 2.14%

Description of Activity: Information and technology consulting and network support. Total of su!Jcontract: I 08,000 Percent applied: J.62%

Nmnc of Subcontractor: Jani-King Portion of Subcontract Method of selection: bid/interview process Period of Performance: March I , 2015 - February 29, 2016 Description of Activity: Jnnitorial services for Resource Center of Dallas locutions. To!al of subcontract: 9,450 Percent applied: 8.47%

J,750

800

VU OTHER TNDffiECT COSTS (Provide brief justification for cnch line)

A. B. c. D. E. F.

Postage Annual audit as required l>y OMB Corporate insurance - linbility, property Copying/printing General cquipmen! repair Equipment leases/rentals

vm TOTAL l'NTHRECT COSTS

s 588 750 250 150 100

1,000

, s 2,838 .

rs

~NCE OBJECTIVE FORM

TACHMENT B-1

RAL INFORMATION

AGENCY: Resource Center

ADDRESS:

270 1 Reagan St, Dallas, TX 75219

GRANT: 2015-2016 Ryan White Part A Supplemental

GRANT PERIOD: March 1, 2015 - February 29, 2016

PREPARED BY: Marisa Elliott

PHONE NUMBER: 214-540-4454

"

. OBJECTIVES

, . .

EIN: 75-1 892059

·, . , .. . ' - ,. . ,, - . ;

Briefly state your measurable objectives. If there are problem areas, describe your plan to solve them; including your target

completion date.

1tegory a nd Performance Unit of Annua l K:ompletion Dates and

Obj ectives Measure Goal r Plans, Comments

A B c D

3. Service Category Insurance Assistance ** $ 265,950.00

1it Cost per Client Sl ,899.6-l

Unduplicated Clients Person 140 2/29/20 16

Unit of Service I pmt per month 590 2/29/2016

Unit of Service - - - -

Persons Served ' -·- ·- -- - -Women Person 3

Infants Person 0

Children Person 0

Youth Person 0

. .. ,

·--- .,.

ATTACHMENT C-2: MlJL TIPLE FUNDfNG Al,LOCA TION FORM

AGENCY:l\ESOURCE CEl<TER

AODRESS:P.O. BOX 190869. DALL..S TX 75219

BUDGETUNE ITEM

" A DlflECT PERSOMiEL (Tille. Naitte)

I HIV CLIENT SERVICES MANAGER CARRILLO

2 HIV CLIENT SERVICES COORDINATOR-CG-Pav. RICHARDSON

3 DENTIST SHAW , DENTIST. LINARES

5 INSURANCE ASSISTA NCE COORD. GUDINO

6 MEDICAL CASE MANAGERIDENTAL COORDINATOR. BOOKS

7 HIV CLIENT SERVICES COORDINATOR-CG-Pav SOMMERLADISANTOSUOSSO

8 HN CLIENT SERVICES COORDINATOR-CG-Pav RODRIGUEZ/MITCHELL

9 CLIENT SERVICES COORDINATOR. INSURANCE ASSISTANCE. MCMURRAY

10 CASE MANAGER NARVAEZ

11 CASE MANAGER. SALAS

12 MEALS PROGRAM COORD DENSMORE

14 NUTRITION CENTER SUPERVISOR. SANCHEZ

IS NUTRITION CENTER INVENTORY COORDINATOR. DEAVILA

16 HIV CLIENT SERVICES COORDINATOR-ARIES BENECKE

17 HIV CLIENT SERVICES SPECIAUST·ARIES. ALLEN

I s HIV CLIENT SERVICES SPECIALIST-ARIES. BENTRUM

19 DATABASE ANALYST-ARIES. MCNEIL

20 CHIEF OPERATING OFFICER, ELLIOTI

21 MEDICAL CASE MANAGER. JONES 22 CLINIC OFFICE COORDINATOR. JOHNSON

21 DENTAL ASSISTANT. CALHOUN

24 DENTAL ASSISTANT TAPIA

25 DENTAL ASSISTANT FALGOUT

26 DENTAL MVGIENIST. LYNN

27

28

29

30 Tot:tl 01her l'osirions Not Funded bv DCPTG 31

J2 Tobi Dirttt Pcr':Ctlud

33 Frin1.;c fkncliu

DIRECT NON-PERSONNEL

34 T~"CI

35 IEcuiomcn1 36 Sunnlics 37 Conmie1u3f

38 Od1cr 39

40

41

42 43

44 Total Dircc1 Non·PC"rsonnd

INDI RECT cos1·

.is ·rm!!! Indirect Cost funded bv DCPTG 46 Tat:a! lndireer Cost not fundC"d by DCPTG 47 Totnl lndi~cr Co~~

4S CU.ANO 1'01'A t.. (R••r l,t l1+:.S+ll)

ANNUAL BUDGET

B

60.000

31.200

131.325

126.250

.l8.lS6 35.350

31.200

31.200

26.000

35.350

35000

20.eoo 33.290

27.059 .c.D.000

31.200

12.027

52.000

93.476

54,964

36,428

29.999

'7.457

29,411

60.600

1.277.591

s l..J1Y,'1S?

$ 501,643

l0.9H

~7G..t2.?

101.7 .. 7

1,171.GU

s 2.JSn::21 s

$ .. 0.!12

• S.ltt.11! S

s s.,.a2J11 s

FUNDING SOURCF.S DALLAS COUJ\'TY PASS TllllOUClf GRANTS (DCPTC)

P:utA P>nA P:utB STATE FORMULA SUPPLEMENTAL MAT SD SERVICES

('/.) (%) (%) ('/,) (%)

c D E F G

43.33% 4S.°"% 1.33% 10.30-/o 0.00-/.

n46'4. 26.54~'. O.~'. 0.00% 0.0~~

M.S1% 11.10-/o •US~. O.W,. 0.00%

29.46% 61.6S% o.~~ o.w.~ 0.0°'"~

13.7~'. 16.21% 0.00% 0.00'/. 0.00%

l.8391. 1.41% OS~~ 0.004'1. 0.00''/. 73.46% ?6.14~· 0.00",. 0.00'/. o.om-. 1).46•!. 26.S.:% 0.00% 0.00',.\ 0.00"1•

77.86% 22.1 4•;. 0.00% 0.00',.\ 0.00%

SS.16% 43.14% 0.00"1. 0.00% 0.00%

s:?.S6•J. 37.29"1. 0.00% 0.00% 0.00% 0.00',.\ O.Ob4'/o 0.00% 100.00% 0.00%

60.08% 3S64% vrt. I.SI% 000'/.

61.3S'Y, 36.l?~• O.iS~~ 1.70'.4 0.00"t. ?1.22'"{. IS.00% I.SS~~ o.is•,• 0.0~~

68.63% 2?.IZ-1. I.SJ% D.004'1. 0.00'/o

S0.89% 32.u•t. 2.9!"1~ 0.00% 0.00% 44.40% JS.46% o.ocn-• 0.00% b.O~/.

IS.51% 18.72% 2.30% 3.SO"/. 0.00%

S7,4.7% J'.!.57•/. 9.96~~ 0.00-1. 0.00'"1.

46.67% 47.0,..t. l .6S% O.OO"h. o.~•

56.619/. 36.70',; j.86% 0.00% 0.00'/o

4806% 47.2"79 .... 4,2&% O.OO'Y. 0 00'/.

54 .4~~ 41.20"/. 3.40% 0.00'.4 0.00%

33.0"'1 60.21"1. 6.0S% 0.00% 0.00%

24,:;-,.,r, 14.6SY. 0.94~- 0,18% O.M~

0.00"1. O.OO'Y• 0.00% 0.00"/o 000%

o.oo~• 0.00% o.~~ 0.00% 0.0U%

17.76% !O.ISo/. IO OO'i~ II.IC-/. O.~A

0.00".t.. o.ow. 0.00-1. o°"'~ o.oo-..-34.97'!·~ 9.4141/. l.04~'. oOs•;. 0.00"1.

I s • s • s • s . s

ll.31% l 4.6SY • 1.9S% 2.47% 0.00"1.

• s • s • ~ 0 s . s

I s I s • s • s • s

EIN:7S-18920S9

TOTAL DSHS TOTAL~• OTI'!ER PROGRAM FUNDING

HOPWA FUNDED FUNDING INCOME SOURCES (%) BYOCJ>TG (~~) (%) (hJ+K )

(C+O+r:-,F<tG+lfi • 100-.19

H l 1 K L

100.00% 0.00% ... 100 00%

100.0D'-' 0.00% • 100.~ 100.00V. o.om .. Ul000%

9 1. ll% S .!7~4i 100.00Y.

100.00'.4 0.00'/o 100.00%

• .ll% 9S.19','9 100.00%

100.om .. 0.00'/o -· 100.00'!1

JOO.CO'-' 0.00% 100.o<W. 100.00% 0.00% ' 100.011',.\

9S.l llll 1.; 0% 100.00%

90.15% 9.85% 1 00.00~~

100.0CW. 0.00"~ le».~~

100.00'.4 0.00% MOOO% 100.00% 0.00% 100.00% U .lt1">• 11.86% 100.00'.4

92.21™. 1.12•1. - 100.00\0

86.70'/. l l .30% lOOOM' 82.171~ 17.13% 100.00%

0 .3311 56.61¥. lOOOO'll

100.00% O.OO'JI ,. 1 00~~~

97.39% 2.61% ·100.00!.

9714'1 2.76% 100.00%

99.61% 0.39'.4 100 00%

100.00% o.~I. 1 00.~'

09.?6% 0.7-1 % T 100 00!1

0.00% O.®'-~

O,OOV. O.OO'll 0 ()()'/,. 0.00%

0.00% o.~~

40.U~I 40.'4~•

0.00% 100.~'. 100.()()1}.

().0°'~ 0.00% ~ 0.00% 66.7~% 3l .2S% 100.00"-"'

o~~ too~" 100.o<w.

4-'.50% 54.50% 1 00.~;

0.00% 0.00'.4

o.ow. 0.00'.4

0.00% ~· 0.00%

0.00% 0.00'-< 1

. -

42.<S% S7 SS~I 100.00'01 0.00% 0.00'.4

I -

ATIACHMENTC-1:, MULTIPLE FUNDING SOURCEFQRM

AGENCY: RESOURCECENTER

ADilRESS: P.O. BOX 190869, DALLAS TX 75219 EIN: 75-1892059

FUNDING SOURCES DALLAS COUNTY PASS'H,ROUGll GRANTS OTHER GRANTS

BUDGET LINE ITEM PanA PartA PartB S1a1e DSHS Other Other Prot?ram TOTAL Formula Supplemental MAI SD Services HOPWA Federal Locali Jnd;;mc FUNDING

Private SO URCES # A B C D E F G H I J K

Fundin!! in l'crcenta!!e 0.259286614 0.133470427 0 O.Ol8033506 0.023100712 0 0 0.566 108742 0 I ~ \ -· .. r ,.... - -. - i ~ ._

l Direct Personnel 588417 374177 25622 3 1740 1.399.796 S 1.419,752 2 Fringe Benefits 122230 73473 4720 4427 296,793 501,643 3 Travel 0 0 0 0 30.925, 30,925 4 Eouinment 0 0 0 0 - -5 Supplies 84614 99498 47666 S6255 158.389 ~76,422 6 Contractual 0 0 0 0 201.749 201,749 7 Other Direct Cost 619555 166666 18438 1501 965.465 1,771.6!5

S Totnl Di1-.:ct Co~t S l.414,K16 S 713,81.t S - S 96.446' S 123,9l3• S - S - S 3,053,117 S - S 5.402,116

9 Total Indirect Cost 125950 79311 10715 13349 310.887 540,212 10 jl

12 ,13 TOTAL AWARD S 1,5-10,766 S 793,125 S' '- - S 107,161 s 137,172' S ·- - S •' • - S 3,3641004 S • S 5,942,328

FY 2015 · 2016 R11an White Part A . Attachment A FY 2015 FY 2015 FY 2015 FY 2015 FY 2015 FY 2015 FY 2015

PART A PART A PART A PART A TOTAL

Agency Service Category TOTALAWARO FORMUlA FUNDS TOTAL AWARD TOTAL AWARD SUPl'lfMEHTAL

TOTAL AV/ARD PART A

FUNDS ANAL AWARD FORUIJlA REl\JRt.'ED FORMUl.A SIJPl'lfMEHTAL

RETIJRNED SIJPPl.EMEHTAL

OW1115· 03101115 . 02/29/16 OJI01115. 02129118 03101115. 02129118 Ol/01115 • 02129116

02JZ9/16

11/412015 11/412015 AIDS Arms

A I OS rtmrmnccuticnl J\ssistnncc 195 497 50,000 145,497 106,272 10,000 96272 241 769 Case MannC1cmcnl 376,954 376954 204 913 204 913 581 867 Mtdical Case l\t:mne.cmcnl 225,498 225 498 122581 122 581 348 079 Outpnticnl Medical Care 616 247 230 000 386247 334 993 334 993 721 240

TOTAL l,414,196 280 000 l ,134 196 768 759 JO 000 758,759 1,892 955

AIDS Interfaith Nelwork Lin(!uist ic Services 46 613 46613 25 339 25339 71 952 Mcdicnl Trnnsaortation 332,885 332 885 180 956 180 956 513 841 Rcsnitc Care for Adults 32 802 32 802 17 831 17 831 50633

TOTAL 412,300 412 300 224,126 224,126 636 426

Al OS Services or Dallas Case Mnnaecment · llousin2 Based 74 282 74 282 40 380 40,380 114662 Home Dt'livcrcd Mcnls 173 674 173 874 94410 94,410 268,084 Medical Case Manncmcnt 94 445 94 445 51,340 51340 145 785 Medical T unsoortation 47,847 47 847 26,009 26009 73856

TOTAL 390 248 390,248 212.139 212.139 602<r

Dallas Countv Heallh Division Enrlv lnttrvc111ion Services 129 998 129 998 66878 66 878 0 129 998

TOTAL 129 998 129 998 66 878 66 878 0 129 998

Dallas Countv Hosnilnl District IPARKLANDl AIDS Pharntnc<"uticnl Assist1rncc 512 780 512 780 278 748 278 748 791 528

Cll5e MnnaPemcnt 378 438 378 438 205 719 120469 85250 463888 Medical Can Mnnaeemcnt 447 954 447 954 243 508 243 508 691 462 Mcntnl Hcnlth 16 274 16 274 8 847 8 ,847 25121 Outoatient Medical C1re 1841174 1841174 1 000864 186,311 814 553 2 655 727 O utreach - Lost to C1re 23307 23 307 12 670 12 670 35 977

TOTAL 3,219 927 3 219,927 1.750 356 306,780 l,443,576 4 663.503

Dnll11s Lt'enl Hosnice Leoni Services 44 887 44 887 24 401 24 401 69 288

TOTAL 44 887 44 887 24,401 24,401 69 288

Dcntol Hulth Proe.rams Ornl Health 377 121 377121 205 004 205 004 582,125

TOTAL 377 121 377,lll 205 004 205 004 582.125

Heallh Services or North Tu ns AIDS Pharmaceutical Assistance 112630 112 630 61,226 61,226 173.856 Case Mnnae.emcnt 84468 15000 69468 45,916 45 916 115384 food Bank 87621 87621 47631 47,631 135 252 Insurance Assistance 120 856 120 856 65697 10000 55.697 176 553 Medical Cruc tt'lana2ement 119946 119 946 65.203 65.203 185149 Medical Tnnsoortation 97 484 97 484 52,993 52993 150477 Mental Hcnllh 5,523 5 523 3 ,003 3,003 8.526 Outontienl Medical C11rr 232 321 232,321 126.290 126,290 358.611

TOTAL 860 849 15.000 845 849 467.959 10,000 457,959 1,303,808

Home Hcnllh Services or Onllns Home and Community Based I-IS Home Health Care

TOTAL 0

Leeacv CounsdinP Ccnlt'r Case Mann"emcnt - HousinP Based 4 269 4 269 2 ,320 2 320 6589 Home Delivered Meals 25 725 25 725 13 984 4 000 9,984 35709 Mental Heallh 57618 57618 31321 31 321 0 57618 Substance Abuse 51792 51 792 28 154 13 000 15154 66946

TOTAL 139 404 139 404 75 779 48 321 27,458 166,862

Ooe.n Arms Cnse Mannacment 27 745 27 745 15082 15082 42 827 Childcare Services 1726 1726 939 939 2665 Dav Resoite for CYA 25896 25 896 0 0 0 25 896

TOTAL 55,367 55,367 16,021 0 16,021 71388

Rnource Cen1er or Dallas C11c M:mneemenl 57750 57750 31393 31393 89143 Food Dnnk 135,948 135948 73,902 73902 209,850 Insurance Assistance 857154 857154 465.950 200.000 265,950 1.123104 Medical Case l\1ann2emcnt 63,407 63.407 34.488 34468 97 875 Ornl Henlth 410 984 410 984 223 412 223,412 634 396

TOTAL 1.525.2~3 1.525.243 819.125 200.000 629.125 Z.ISU68

TOTAL FY 2015 -2016 RW PART A RENEWAL AWARD OBLIGATED FOR SERVI CE DELIVERY 8 569 540 295 000 8 274 540 4 640 547 641 979 3 998 568 12.273 108 UNAL LOCATED UNOBUGATEO

Home nnd Communilv Bnsed HS 6 ,906 6 ,906 3.754 3 754 10660 Home Henlth Care 19,854 19,854 10,792 10792 30646 Dav Resoile for CYA 14078 14078 14078 Enrlv Intervention S en'ices 35,737 35 737 23216 23,216 58953 FY 2014-15 Carrv Over 282.038 282,038 0 0 282,038

TOTAL FY 2015-2016 RW PART A AWARD-SERVICE DELIVERY 8 914 075 8 619 075 4 692.387 4 050 408 12.669 483 DCHHS I Clinical OM 507,766 190,000 317,766 317 766 OCH HS Grnntee Adrnin. 1 015 532 50,000 965,532 965,532

TOTAL rv 2015 - 2016 RW PART A AWARD -FORMULA & SUPPLEMENTAL 10 4.37 373 535 000 9 902 373 4 692 387 0 4050408 13 952 781

JK, 12129/2015 C:\UserslKLETCHER\AppData\Local\Mie<osofl\Windows\Temporary lntemel Files\Content.Oullook\2VY8SU2MIFY2015-16 Part A • Allachment A 12 07 15 CT jk