CMS-718-721 CMS-718-721.BP9SOW - Forms - OCN-0938-0579
Business Proposal Forms For Quality Improvement Organizations (QIOs)
CMS-718-721.BP9SOW - Forms - OCN-0938-0579.xlsx
Business Proposal Forms For Quality Improvement Organizations (QIOs)
OMB: 0938-0579
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0579 can be found here:
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QIO F719
QIO F720
QIO F721
QIO STAFFING
QIOSubconts 1
QIOSubconts 2
QIO Staff Sum
QIO ODC
Benef. Protec. Supp.
Overview
F718 BP SUMQIO F719
QIO F720
QIO F721
QIO STAFFING
QIOSubconts 1
QIOSubconts 2
QIO Staff Sum
QIO ODC
Benef. Protec. Supp.
Sheet 1: F718 BP SUM
| 1. Name and Address of QIO Organization | 3. RFP # | |||||||||||
| 4: Proposed Contract Period | ||||||||||||
| 2. QIO Area (State): | From: | |||||||||||
| To: | ||||||||||||
| Medicare | 5. Total Proposed | 6. CMS Recommended | 7. $ | 8. % | ||||||||
| Contract | Costs | Costs | Difference | DIfference | ||||||||
| Direct Cost | ||||||||||||
| a. LABOR: | ||||||||||||
| 1. Professional | $0 | $0 | $0 | #DIV/0! | ||||||||
| 2. Information Systems | $0 | $0 | $0 | #DIV/0! | ||||||||
| 3. Corporate Management | $0 | $0 | $0 | #DIV/0! | ||||||||
| 4. Support Staff | $0 | $0 | $0 | #DIV/0! | ||||||||
| SUBTOTAL - Direct Labor | $0 | $0 | $0 | #DIV/0! | ||||||||
| b. Leave | #DIV/0! | $0 | #DIV/0! | #DIV/0! | ||||||||
| c. Fringe Benefits | $0 | $0 | $0 | #DIV/0! | ||||||||
| SUBTOTAL - Leave/Fringe | #DIV/0! | $0 | #DIV/0! | #DIV/0! | ||||||||
| d. Subcontractors | ||||||||||||
| 1. Physician Reviewers/ Phys.Advisors | $0 | $0 | $0 | #DIV/0! | ||||||||
| 2. Other Consultants | $0 | $0 | $0 | #DIV/0! | ||||||||
| 3. Other Subcontracts | $0 | $0 | $0 | #DIV/0! | ||||||||
| SUBTOTAL - Subcontractors | $0 | $0 | $0 | #DIV/0! | ||||||||
| e. Travel | $0 | $0 | $0 | #DIV/0! | ||||||||
| f. Other Direct Costs | $0 | $0 | $0 | #DIV/0! | ||||||||
| SUBTOTAL - DIRECT | #DIV/0! | $0 | #DIV/0! | #DIV/0! | ||||||||
| g. Indirect Costs | $0 | $0 | $0 | #DIV/0! | ||||||||
| h. Pass-thru Costs | $0 | $0 | $0 | #DIV/0! | ||||||||
| TOTAL COSTS | #DIV/0! | $0 | #DIV/0! | #DIV/0! | ||||||||
| i. Fee | $0 | $0 | $0 | #DIV/0! | ||||||||
| TOTAL COST WITH FEE | #DIV/0! | $0 | #DIV/0! | #DIV/0! | ||||||||
| 9. | ||||||||||||
| 10. Signature of Authorized Official: | CMS USE ONLY | |||||||||||
| Fringe Rate | ||||||||||||
| 14. Proposal Receipt Date: | ||||||||||||
| Indirect Rate | 11. Type or Print Name and Title: | |||||||||||
| Other Rate | 15. Review By: | |||||||||||
| 12. DATE: | 13. Telephone # | |||||||||||
| 16. Signature/Title: | ||||||||||||
Sheet 2: QIO F719
| 1. RFP Number: | 2. Name and Address of QIO Organization: | 3. QIO Area (State): | 4. Contract Period | |||||||||||||||||||||||||||||
| 0 | 0 | From: | 12/30/1899 | |||||||||||||||||||||||||||||
| 0 | 0 | To: | 12/30/1899 | |||||||||||||||||||||||||||||
| 0 | ||||||||||||||||||||||||||||||||
| 5. Quality Data Reporting | 6. Other Beneficiary Protection Costs | RESERVED 7. Patient Pathways | 8. MRSA | 9. NH Pressure Ulcers | 10. Hospital Pressure Ulcers | 11. NH Restraints | 12. SCIP | 13. Drug Safety | 14. Poor Performing NH | 15. Core Prevention | RESERVED 16. Disparities | RESERVED 17. CKD | 18. IS | 19. Total | ||||||||||||||||||
| Theme: Beneficiary Protection | Theme: Beneficiary Protection | Theme: Patient Pathways | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Prevention | Theme: Prevention | Theme: Prevention | ||||||||||||||||||||
| HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | |||
| a. LABOR: | ||||||||||||||||||||||||||||||||
| 1. Professional | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | ||
| 2. Information Systems | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | ||
| 3. Corporate Management | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | ||
| 4. Support Staff | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | ||
| SUBTOTAL - Direct Labor | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | ||
| b. Leave | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | ||
| c. Fringe Benefits | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| SUBTOTAL - Leave / Fringe | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | ||
| d. Subcontracts: | ||||||||||||||||||||||||||||||||
| 1. Physician Reviewers / Phys. Advisors | 0.0 | $0 | 0.0 | $- | ||||||||||||||||||||||||||||
| 2. Other Consultants | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| 3. Other Subcontractors | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| SUBTOTAL - Subcontracts | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | ||
| e. Travel | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| f. Other Direct Costs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| SUBTOTAL - DIRECT | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | ||
| g. Indirect Costs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| h. Pass-thru Costs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| TOTAL COSTS | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | ||
| i. Fee | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | ||||||||||||||||||||
| TOTAL COSTS WITH FEE | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | |||||||||||||||||
| TOTAL PROPOSED PROVIDERS | ||||||||||||||||||||||||||||||||
| AVERAGE 3 YR COSTS/PROVIDER | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | ||||||||||||||||||||||||
Sheet 3: QIO F720
| FRINGE BENEFIT PROPOSAL | ||||||||||||||
| QUALITY IMPROVEMENT ORGANIZATION 9th SOW BUSINESS PROPOSAL | ||||||||||||||
| CENTERS FOR MEDICARE & MEDICAID SERVICES | ||||||||||||||
| 1. Name and Address of QIO Organization | 3. RFP # | |||||||||||||
| 0 | 0 | |||||||||||||
| 0 | ||||||||||||||
| 0 | 4: Proposed Contract Period | |||||||||||||
| 2. QIO Area (State): | 0 | From: | 12/30/1899 | |||||||||||
| To: | 12/30/1899 | |||||||||||||
| 6. Prior Year | 7. Projected | 8. Prior Year | 9. Projected | |||||||||||
| DETAIL COSTS | Total | Total 3-YR | Total | Total 3-YR | ||||||||||
| Organization Costs | Organization Costs | Medicare Costs | Medicare Costs | |||||||||||
| Fringe Benefits | ||||||||||||||
| a. Employer's FICA Expense | $0 | $0 | ||||||||||||
| b. Federal Unemployment Insurance | $0 | $0 | ||||||||||||
| c. State Unemployment Insurance | $0 | $0 | ||||||||||||
| d. Disability Insurance | $0 | $0 | ||||||||||||
| e. Pension Expense | $0 | $0 | ||||||||||||
| f. Workers Compensation | $0 | $0 | ||||||||||||
| g. Group Health Insurance | $0 | $0 | ||||||||||||
| h. Group Life Insurance | $0 | $0 | ||||||||||||
| i. Empl. Relations & Welfare | $0 | $0 | ||||||||||||
| j. Leave | $0 | $0 | ||||||||||||
| k. Other - see attached | $0 | $0 | ||||||||||||
| l. Total Fringe Benefits | $0 | $0 | ||||||||||||
| m. Fringe Benefit Rate | 0.00% | 0.00% | 0.00% | 0.00% | ||||||||||
Sheet 4: QIO F721
| INDIRECT AND OTHER DIRECT COST | ||||||||
| QUALITY IMPROVEMENT ORGANIZATION 9th SOW BUSINESS PROPOSAL | ||||||||
| CENTERS FOR MEDICARE & MEDICAID SERVICES | ||||||||
| 1. Name and Address of QIO Organization | 3. RFP # | |||||||
| 0 | 0 | |||||||
| 0 | ||||||||
| 0 | 4: Proposed Contract Period | |||||||
| 2. QIO Area (State): | 0 | From: | 12/30/1899 | |||||
| To: | 12/30/1899 | |||||||
| 5. Prior Year | 6. Projected | 7. Prior Year | 8. Projected | 9. Prior Year | 10. Projected | |||
| DETAIL COSTS | Total | Total 3yr. | Medicare | Medicare 3yr | Medicare | Medicare 3yr | ||
| Indirect Costs | Indirect Costs | Indirect Costs | Indirect Costs | Other Direct. | Other Direct. | |||
| a. Indirect Labor | $0 | $0 | ||||||
| b. Indirect Leave | $0 | $0 | ||||||
| c. Indirect Fringe | $0 | $0 | ||||||
| d. Rent | $0 | $0 | $0 | $0 | ||||
| e. Storage | $0 | $0 | $0 | $0 | ||||
| f. Utilities | $0 | $0 | $0 | $0 | ||||
| g. Maintenance & Repairs | $0 | $0 | $0 | $0 | ||||
| h. Depreciation | $0 | $0 | $0 | $0 | ||||
| i. Data Processing | $0 | $0 | $0 | $0 | ||||
| j. Equipment Leasing & Rental | $0 | $0 | $0 | $0 | ||||
| k. Office Supplies | $0 | $0 | $0 | $0 | ||||
| l. Reproduction & Printing | $0 | $0 | $0 | $0 | ||||
| m. Telephone | $0 | $0 | $0 | $0 | ||||
| n. Postage & Express Mail | $0 | $0 | $0 | $0 | ||||
| o. Consultants | $0 | $0 | ||||||
| p. Meeting & Conferences | $0 | $0 | $0 | $0 | ||||
| q. Travel | $0 | $0 | ||||||
| r. Training | $0 | $0 | $0 | $0 | ||||
| s. Garage & Parking Spaces | $0 | $0 | $0 | $0 | ||||
| t. Dues & Subscriptions | $0 | $0 | $0 | $0 | ||||
| u. Recruiting | $0 | $0 | $0 | $0 | ||||
| v. Temporary Help | $0 | $0 | $0 | $0 | ||||
| w. Continuing Education | $0 | $0 | $0 | $0 | ||||
| x. Legal Fees | $0 | $0 | $0 | $0 | ||||
| y. Accounting/Audit Fees | $0 | $0 | $0 | $0 | ||||
| z. Board of Directors Fees | $0 | $0 | $0 | $0 | ||||
| aa. Insurance | $0 | $0 | $0 | $0 | ||||
| bb. Bank Charges | $0 | $0 | $0 | $0 | ||||
| cc. Other - see attached | $0 | $0 | $0 | $0 | ||||
| dd. ** TOTAL | $0 | $0 | $0 | $0 | ||||
| ee. Indirect Cost Rate | 0.00% | 0.00% | ||||||
Sheet 5: QIO STAFFING
| 11. Average | 12. Total 3yr | 13. Average | 14. Total 3yr | Patient Pathways | 19. Average | 20. Total 3yr | 21. Average | 22. Total 3yr | 23. Average | 24.Total 3yr | 29. Average | 30. Total 3yr | IS | IS | IS | IS | IS | IS | IS | IS | |||||||||||||||||||||||||||||||||||||||||||||
| 5. Proposed | 7. Proposed | 9. Proposed | Quality Data | Quality Data | Other | Other | 15. Average | Support | 16. Total 3yr | 17. Average | 18. Total 3yr | NH Pressure | NH Pressure | Hosp. Pressure | Hosp. Pressure | NH | NH | 25. Average | 26. Total 3yr | 27. Average | 28. Total 3yr | Poor Perfor. | Poor Perfor. | 31. Average | 32. Total 3yr. | 33. Average | 34. Total 3yr | 35. Average | 36. Total 3yr | 37. Average | Prof. Hours | IS hrs | Corp Admin | Support | 38. Total 3yr | Prof. Labor | IS labor | Corp Admin | Support | 39 | 40 | 41. Average | 42. Total 3yr | 43. Average | 44. Total 3yr | 45. Average | 47. Average | 48. Total 3yr | 49. Average | 50. Total 3yr | 51. Average Total | 52. Leave as a | 53. Total 3yr | 54. Average Total | 55. Total 3yr | ||||||||||
| 1. Staff | 2. Position | 3. Labor | 4. Current | Year 1 | 6. Percent | Year 2 | 8. Percent | Year 3 | 10. Percent | Reporting | Reporting | Benef Protec | Benef Protec | Patient Pathways | Staff Hrs per | Patient Pathways | MRSA | MRSA | Ulcers | Ulcers | Ulcers | Ulcers | Restraints | Restraints | SCIP | SCIP | Drug Safety | Drug Safety | NH | NH | Core Preven. | Core Preven. | Disparities | Disparities | CKD | CKD | IS | per year | per year | hours per yr | Staff Hrs per | IS | costs 3yr | $$ 3 year | Labor $ 3 yr | Staff | Total Direct Labor | Direct | Indirect Labor | Indirect | Total Labor | 46. Total 3yr | Direct Leave | Direct Leave | Indirect Leave | Indirect Leave | Leave Hours | % of Hours | Leave | Labor and Leave | Labor/ | 56. FTE | |||
| Name | Title | Category Code | Hourly Rate | Hourly Rate | Change | Hourly Rate | Change | Hourly Rate | Change | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | yr, avg | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | avg | avg | avg | yr, avg | Labor Costs | Labor $$ 3yr | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Labor Costs | Hours Per Year | Costs | Hours Per Year | Costs | Per Year | Worked | Costs | Hours Per Year | Leave Costs | Per Year | ||||||
| 1 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 2 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 3 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 4 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 5 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 6 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 7 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 8 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 9 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 10 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 11 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 12 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 13 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 14 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
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| 71 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 72 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 73 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 74 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 75 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 76 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 77 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 78 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 79 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 80 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 81 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 82 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 83 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 84 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 85 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 86 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 87 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 88 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 89 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 90 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 91 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 92 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 93 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 94 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 95 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 96 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 97 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 98 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 99 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 100 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 101 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 102 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 103 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 104 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 105 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 106 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| 107 | #DIV/0! | #DIV/0! | #DIV/0! | $0 | $0 | 0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | $0 | 0.0 | $0 | $0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||||||||||||||||||||||||||
| Grand Total | N/A | N/A | N/A | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $0 | 0.0 | $0 | 0.0 | 0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0 | 0 | 0 | 0 | 0 | $0 | $- | $- | $- | $- | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | #DIV/0! | $0 | 0 | $0 | 0.00 | ||
| By Category | 0.0 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| P=Professional | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | #DIV/0! | $- | 0 | $- | 0 | ||||||||||||||
| I=Info Systems | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | #DIV/0! | $- | 0 | $- | 0 | ||||||||||||||
| C=Corp Mgmt | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | #DIV/0! | $- | 0 | $- | 0 | ||||||||||||||
| S=Support Staff | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | #DIV/0! | $- | 0 | $- | 0 | ||||||||||||||
| Check Cell for Columns: Sum of 114 through 117 should equal value in 112 | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | $- | 0.0 | #DIV/0! | $- | 0 | $- | 0.00 | |||||||||||||||||||||
| Averaging | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Counts | 0 | 0 | 0 |
Sheet 6: QIOSubconts 1
| Physician Reviewer Cost for Beneficiary Protection | |||||
| 1. Current | 2. Yr-1 | 3. Yr-1 | 4. Yr-1 | 5. Yr-1 | 6. Yr-1 |
| Phys. Reviewer | Number of | Hours | Hours | Phys. Reviewer | Benef. Protection |
| Hourly Rate | Reviews | Per Review | Per Year | Hourly Rate | Review Costs |
| 0.0 | $0 | ||||
| 7. Yr-2 | 8. Yr-2 | 9. Yr-2 | 10. Yr-2 | 11. Yr-2 | |
| Number of | Hours | Hours | Phys. Reviewer | Benef. Protection | |
| Reviews | Per Review | Per Year | Hourly Rate | Review Costs | |
| 0.0 | $0 | ||||
| 12. Yr-3 | 13. Yr-3 | 14. Yr-3 | 15. Yr-3 | 16. Yr-3 | 17. Total 3 Yr |
| Number of | Hours | Hours | Phys. Reviewer | Benef. Protection | Benef. Protection |
| Reviews | Per Review | Per Year | Hourly Rate | Review Costs | Review Costs |
| 0.0 | $0 | $0 | |||
Sheet 7: QIOSubconts 2
| 2. Total 3-Year | 3. Total 3-Year | 4. Total 3-Year | 5. Total 3-Year | 6. Total 3-Year | 7. Total 3-Year | 8. Total 3-Year | 9. | 10. Total 3-Year | 11. Total 3-Year | 12. Total 3-Year | 13. Total 3-Year | 14. Total 3-Year | 15. Total 3-Year | 16. | 17. Total 3-Year | 18. | ||||
| 1. | Quality Data | Other Ben. | Patient | MRSA | NH Pressure | Hosp Pressure | NH Restraints | SCIP | Drug Safety | Poor Perf. | Core Preven. | Disparities | CKD | Information | Total | 19. | 20. | |||
| Name | Reporting | Protec. Costs | Pathways | Ulcers | Ulcers | NH | Services | 3 YR Costs | Current Activity | Proposed Activity | ||||||||||
| Theme: Beneficiary Protection | Theme: Beneficiary Protection | Theme: Patient Pathways | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Patient Safety | Theme: Prevention | Theme: Prevention | Theme: Prevention | ||||||||
| 1 | Other Consultants: | |||||||||||||||||||
| a | $0 | |||||||||||||||||||
| b | $0 | |||||||||||||||||||
| c | $0 | |||||||||||||||||||
| d | $0 | |||||||||||||||||||
| e | $0 | |||||||||||||||||||
| f | $0 | |||||||||||||||||||
| g | $0 | |||||||||||||||||||
| h | $0 | |||||||||||||||||||
| i | $0 | |||||||||||||||||||
| j | $0 | |||||||||||||||||||
| k | (See Attached) | $0 | ||||||||||||||||||
| Subtotal - Other Consultants | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
| 2 | Other Subcontractors: | |||||||||||||||||||
| a | $0 | |||||||||||||||||||
| b | $0 | |||||||||||||||||||
| c | $0 | |||||||||||||||||||
| d | $0 | |||||||||||||||||||
| e | $0 | |||||||||||||||||||
| f | $0 | |||||||||||||||||||
| g | $0 | |||||||||||||||||||
| h | $0 | |||||||||||||||||||
| i | $0 | |||||||||||||||||||
| j | $0 | |||||||||||||||||||
| k | (See Attached) | $0 | ||||||||||||||||||
| Subtotal - Other Subcontractors | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||||
Sheet 8: QIO Staff Sum
| Labor Category | 1. Average | 2. Proposed | 4. Proposed | 6. Proposed | 8. Total | 9. Total | 10. Total | 11. Total | 12. Total | 13. Total | 14. Total | 15. Total | 16. Total | 17. Total | 18. Total | 19. Total | 20. Total | 21. Total | 22. Total | 23. Total | 24. Total | 25. Total | 26. Total | 27. Total | 28. Total | 29. Total | 30. Total | 31. Total | 32. Total | 33. Total | 36 | 37 | 38. Total | 39. Total | 40. Total | 41. Total | 42. Total | 43. Total | 44. Total | 45. Total | 46. Total | 47. Total | 48. Total | 49. Leave as a | 50. Total | 51. Total | 52. Total | ||||||
| Current | Average Year 1 | 3. Percent | Average Year 2 | 5. Percent | Average Year 3 | 7. Percent | Quality Data Rep. | Quality Data Rep. | Other Ben. Protection | Other Ben. Protection | Patient Pathways | Patient Pathways | MRSA | MRSA | NH Pressure Ulcers | NH Pressure Ulcers | Hosp. Pressure Ulcers | Hosp. Pressure Ulcers | NH Restraints | NH Restraints | SCIP | SCIP | Drug Safety | Drug Safety | Poor Perfor. NH | Poor Perfor. NH | Core Preven. | Core Preven. | Disparities | Disparities | CKD | CKD | 34. Total IS | 35. Total IS | Direct Labor | Direct Labor | Indirect Labor | Indirect Labor | Labor | Labor | Direct Leave | Direct Leave | Indirect Leave | Indirect Leave | Leave | % of Hours | Leave | Labor and Leave | Labor and Leave | 53.Total FTE | |||
| Hourly Rate | Hourly Rate | Change | Hourly Rate | Change | Hourly Rate | Change | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Labor Costs | Hours | Costs | Hours | Costs | Hours | Costs | Hours | Costs | Hours | Costs | Hours | Worked | Costs | Hours | Costs | Per Year | |||
| Professional | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | #DIV/0! | $0 | 0.0 | $0 | 0.00 |
| Information Systems | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | #DIV/0! | $0 | 0.0 | $0 | 0.00 |
| Corporate Management | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | #DIV/0! | $0 | 0.0 | $0 | 0.00 |
| Support Staff | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | #DIV/0! | $0 | 0.0 | $0 | 0.00 |
| Total | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | #DIV/0! | $0 | 0.0 | $0 | 0.00 |
Sheet 9: QIO ODC
| OTHER DIRECT COST | |||||||||||||||||
| QUALITY IMPROVEMENT ORGANIZATION 9th SOW BUSINESS PROPOSAL | |||||||||||||||||
| CENTERS FOR MEDICARE & MEDICAID SERVICES | |||||||||||||||||
| 1. Name and Address of QIO Organization | 3. RFP # | ||||||||||||||||
| 0 | 0 | ||||||||||||||||
| 0 | |||||||||||||||||
| 0 | 4: Proposed Contract Period | ||||||||||||||||
| 2. QIO Area (State): | 0 | From: | 12/30/1899 | ||||||||||||||
| To: | 12/30/1899 | ||||||||||||||||
| DETAIL COSTS | 5. Quality Data Reporting | 6. All Other Beneficiary Protection Costs | 7. Patient Pathways | 8. MRSA | 9. NH Pressure Ulcers | 10. Hospital Pressure Ulcers | 11. NH Restraints | 12. SCIP | 13. Drug Safety | 14. Poor Performing NH | 15. Core Prevention | 16. Disparities | 17. CKD | 18. IS | Total Projected Medicare - 3yr Other Direct Costs | ||
| d. Rent | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| e. Storage | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| f. Utilities | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| g. Maintenance & Repairs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| h. Depreciation | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| i. Data Processing | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| j. Equipment Leasing & Rental | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| k. Office Supplies | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| l. Reproduction & Printing | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| m. Telephone | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| n. Postage & Express Mail | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| o. Consultants | |||||||||||||||||
| p. Meeting & Conferences | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| q. Travel | |||||||||||||||||
| r. Training | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| s. Garage & Parking Spaces | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| t. Dues & Subscriptions | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| u. Recruiting | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| v. Temporary Help | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| w. Continuing Education | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| x. Legal Fees | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| y. Accounting/Audit Fees | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| z. Board of Directors Fees | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| aa. Insurance | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| bb. Bank Charges | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| cc. Other - see attached | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| TOTAL | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
Sheet 10: Benef. Protec. Supp.
| 1. Name and Address of QIO Organization: | 2. QIO Area (State): | 3. Contract Period | |||||||||||||||||||||||||||||||
| 0 | 0 | From: | 12/30/1899 | ||||||||||||||||||||||||||||||
| 0 | To: | 12/30/1899 | |||||||||||||||||||||||||||||||
| 0 | |||||||||||||||||||||||||||||||||
| 4. Quality of Care Reviews Cost Per Case | 5. Utilization Reviews Cost Per Case | 6. Hospital Based Notice Appeals Cost Per Case | 7. Fee-for-Service (FFS) Expedited Appeals Costs Per Case | 8. Medicare Advantage (MA) Fast Track Appeals Cost Per Case | 9. EMTALA: 5-day Reviews Costs Per Review | 10. EMTALA: 60-day Reviews Costs Per Review | 11. Quality Improvement Activities (QIA) Costs | 12. Alternative Dispute Resolution Costs Per ADR | 13. Sanction Activities Costs Per Sanction | 14. Physician Acknowledgement Monitoring | 15. Collaboration with CMS Contractors | 16. Transparency Through Reporting | 17. Beneficiary Help Line | 18. Other Non-Review Activities | 19. Total | ||||||||||||||||||
| HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | HOURS | COSTS | ||
| a. LABOR: | |||||||||||||||||||||||||||||||||
| 1. Professional | 0.0 | $- | |||||||||||||||||||||||||||||||
| 2. Information Systems | 0.0 | $- | |||||||||||||||||||||||||||||||
| 3. Corporate Management | 0.0 | $- | |||||||||||||||||||||||||||||||
| 4. Support Staff | 0.0 | $- | |||||||||||||||||||||||||||||||
| SUBTOTAL - Direct Labor | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | |
| b. Leave | 0.0 | $- | |||||||||||||||||||||||||||||||
| c. Fringe Benefits | $- | ||||||||||||||||||||||||||||||||
| SUBTOTAL - Leave / Fringe | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | |
| d. SUBCONTRACTS: | |||||||||||||||||||||||||||||||||
| 1. Physician Reviewers / Phys. Advisors | 0.0 | $- | |||||||||||||||||||||||||||||||
| 2. Other Consultants | $- | ||||||||||||||||||||||||||||||||
| 3. Other Subcontractors | $- | ||||||||||||||||||||||||||||||||
| SUBTOTAL - Subcontracts | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $- | |
| e. Travel | $- | ||||||||||||||||||||||||||||||||
| f. Other Direct Costs | $- | ||||||||||||||||||||||||||||||||
| SUBTOTAL - DIRECT | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | |
| g. Indirect Costs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| h. Pass-thru Costs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| TOTAL COSTS | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | 0.0 | $0 | |
| i. Fee | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| TOTAL COSTS WITH FEE | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $- | |||||||||||||||||
| Projected Volume - # of cases for: | |||||||||||||||||||||||||||||||||
| Year 1 | |||||||||||||||||||||||||||||||||
| Year 2 | |||||||||||||||||||||||||||||||||
| Year 3 | |||||||||||||||||||||||||||||||||
| GRAND TOTAL: | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | |||||||||||||||||
| ** Please note, the totals for these activities DO NOT roll into the column OTHER BENEFICIARY PROTECTION on the form "QIO F719". | |||||||||||||||||||||||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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