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COST DATA SHEET Organization Name: MCDPH-Clinical Services-Refugee Contract Service: Coordination - Domestic Medical Screening Cost Data Period: 10101/2017 - 9/30/2018 1, PERSONNEL Number of FTE Total Salary for the Positions Level Position Title Contract Period TOTAL COST ADES COST 1 1,00 Registered Nurse 56,501.00 $ 56,501.00 $ 56,501.00 1 0.60 Client Service Coordinator 48,880.00 $ 29,328.00 $ 29,328,00 1.00 Administrative Supervisor 49,465.00 $ 49,465.00 $ 49,466.00 TOTAL $135,294.00 $135,294.00 2. EMPLOYEE RELATED EXPENSES Fixed Variable 19.15% $0.1915 1.00 Registered Nurse 11,400.00 $ 22,219.94 $ 22,219.94 0.60 Client Service Coordinator 11,400.00 $ 12,456.31 $ 12,456.31 1,00 Administrative Supervisor 11,400.00 $ 20,872.55 $ 20,872.66 TOTAL $ 55,548.80 $ 55,548.80 ITEM BASIS TOTAL COST ADES COST $190,842.80 $190,842.80 3. PROFESSIONAL AND OUTSIDE SERVICES ITEM BASIS TOTAL COST ADES COST Language Line $4,900.00 $4,900.00 $4,900.00 4.TRAVEL ITEM BASIS TOTAL COST ADES COST Mileage $1,512.77 $1,512.77 $1,512,77 5. SPACE ITEM BASIS TOTAL COST ADES COST $0.00 $0.00 6. EQUIPMENT ITEM BASIS TOTAL COST ADES COST $0.00 $0.00 7. MATERIALS AND SUPPLIES ITEM BASIS TOTAL COST ADES COST $0.00 $0.00 FY18 Cost Data Sheet_MCDPH_7-13-2017.xls 8. OPERATING SERVICES ITEM BASIS TOTAL COST ADES COST $6,412.77 $0.00 9. INDIRECT COSTS $0.00 ITEM BASIS TOTAL COST ADES COST $197,255.57 $197,255.57 16.60% $32,744.42 $32,744.42 $230,000.00 $230,000.00 9. TOTALS $230,000.00 Anticipated number of staff hours during the contract period: 2,088 Calculated hourly rate (ADES Cost/anticipated number of staff hours): $110.15 FY18 Cost Data Sheet_MCDPH_7-13-2017.xis