7-Montco Budget Template RFP 25-65.xlsx
XLSX spreadsheet 63 KB Posted
- Solicitation number
- 25-65
- Issued by
- Montgomery County, Pennsylvania
About this file
This is a budget template submission form for Montgomery County agencies seeking funding for programs and services. The template is designed for agencies to submit comprehensive budget proposals across multiple expense categories and revenue streams. Agencies are required to complete detailed budget schedules covering staff and habilitation costs, room and board maintenance, property and equipment, transportation, residential adaptation, and agency indirect costs. Supporting documentation is required for wages and salaries, including separate schedules for direct service employees and indirect administrative staff. The template also includes detailed schedules for rent documentation, purchased treatment services, and program equipment, with agencies required to indicate cost participation eligibility and variance analysis of three percent or greater.
The budget template requires agencies to provide audited or actual data and projected financial information across three budget periods, with calculated gross and net fee-for-service rates per unit of service delivery (day, hour, session, or other specified unit). Agencies must document all revenue sources including Medical Assistance, liability payments, room and board income, third-party or private insurance, and other income, with the requested funding from Montgomery County calculated as total expenses less anticipated income. For agencies providing multiple programs, a cost allocation plan must be submitted explaining the methodology used to distribute indirect costs among various programs. The template includes specific account coding requirements aligned with standard chart of accounts classifications and requires documentation of property leases, purchases by related parties, and agency-owned properties with corresponding fair market value appraisals.
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Text version
Budget
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
| Program Name: | |||||
| 1 | 2 | 3 | 4 | 5 | 6 |
| Audited/Actual | Actual+Projected | Projected | |||
| DESCRIPTION | A/C | COMMENTS | |||
| # | |||||
| A . STAFF / HABILITATION | |||||
| 1) Wages and Salaries* | 111 | ||||
| 2) Employer Match Taxes | 121 | ||||
| 3) Retirement - Provider | 122 | ||||
| 4) Insurance and Other | 123 | ||||
| 5) Staff Development | 131 | ||||
| 6) Purchased Personnel | 132 | ||||
| 7) Habilitation Equipment | 345 | ||||
| 8) Purchased Practitioner Service* | 361 | ||||
| 9) Communications | 321 | ||||
| 10) Accounting Fees | 132 | ||||
| 11) Auditing Fees | 132 | ||||
| 12) Legal Fees | 132 | ||||
| 13) Advertising | 322 | ||||
| 14) Communications | 321 | ||||
| 15) Education Supplies and Equipment | 346 | ||||
| 16) Other | |||||
| SUB - TOTAL STAFF | $0 | $0 | $0 |
| Indicate VARIANCE of 3% (+/-) | N/A |
| * include a supporting schedule |
| B . ROOM , BOARD MAINTENANCE | |
| 1) Rent / Mortage Payment * | 311 |
| 2) Utilities (water, gas, electric, sewer, oil) | 312 |
| 3) Insurance - Casuality Loss/ Property | 313 |
| 4) Housekeeping | 314 |
| 5) Library | 371 |
| 6) Office Supplies | 331 |
| 7) Medical Supplies | 341 |
| 8) Drugs | 342 |
| 9) Food | 343 |
| 10) Clothing | 344 |
| 11) Recreational Supplies | 347 |
| 12) Household Goods | 348 |
| 13) Other Expenses* | 373 |
SUB -TOTAL ROOM , BOARD $0 $0 $0
Indicate VARIANCE of 3% (+/-) N/A
C . Property (Furniture & Equipment)
| 1) Program Equipment | 412 |
| 2) Furniture | 413 |
| 3) Office Equipment | 415 |
| 4) Program Equipment Repair | 422 |
| 5) Furniture Repair | 423 |
| 6) Office Equipment Repair | 425 |
SUB - TOTAL Property $0 $0 $0
Indicate VARIANCE of 3% (+/-) N/A
D . TRANSPORTATION
| 1) Client Transportation | 352 | |||
| 2) Automobile Leased /Purchased* | 315 | |||
| 3) Automobile Insurance | 313 | |||
| 4) Automotive Repairs & Maintenance | 313 | |||
| 5) Staff Travel | 351 | |||
| SUB - TOTAL TRANSPORTATION | $0 | $0 | $0 |
Indicate VARIANCE of 3% (+/-) N/A
| E . RESIDENTIAL ADAPTATION | ||||
| 1) Building Repairs | 421 | |||
| 2) Furniture & Equipment Repairs | 422 | |||
| 3) Building Adaptation - Minor | 421 | |||
| 4) Building Adaptation/Renovations | 424 | |||
| 5) Building Maintenance | 425 | |||
| 6) Interest Expense | 362 | |||
| Sub-Total Residential | $0 | $0 | $0 |
Indicate VARIANCE of 3% (+/-) N/A
| F . AGENCY INDIRECT | ||||
| 1) Indirect Budget | " F " | |||
| Admin Rate of Total Expense | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! |
TOTAL EXPENSES $0 $0 $0
Indicate VARIANCE of 3% (+/-) N/A
| G . REVENUE/ ANTICIPATED INCOME | |
| 1) Medical Assistance | 530 |
| 2) Liability Payments | 570 |
| 3) Room & Board | 571 |
| 4) Third Party/ Private Insurance | 580 |
| 5) Interest Income | |
| 6) Other Income- Specify |
TOTAL ANTICIPATED INCOME $0 $0 $0
Indicate VARIANCE of 3% (+/-) N/A
H . EXPENSES LESS INCOME $0 $0 $0
I . REQUESTED FROM Montgomery County $0 $0 $0
| Fee For Service Rate | Gross Rate : | ERROR:#DIV/0! | Per |
| Specify Unit : ( i. e. ) | |||
| Day / Hour / Session / Etc. | Net Rate : | ERROR:#DIV/0! | Per |
Wages
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
Program Name:
WAGES AND SALARIES
| Staffing Type | Agency Total Salary | Eligible for Participation |
| (D) Direct |
Hill, Synethia: Employees whose primary responsibilities involve providing services directly to program participants
| Title | Hours | Full Time | Salary | Full Time | Salary | |||
| (I) Indirect | ||||||||
| Hill, Synethia: Employees who support the program but primary duties do not involve direct work with participants (e.g., administrative staff, finance, HR, upper management, consultants, etc...) | Per | Annual | to be | Annual | to be | |||
| Name | Week | Rate | Paid | Rate | Paid |
Total
Indirect Costs
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
Program Name:
" F " INDIRECT SERVICES BUDGET
| ACCOUNT | ACCOUNT DESCRIPTION | AMOUNT | REMARKS | |
| # | ||||
| A. PERSONNNEL COSTS | ||||
| 111A | Salaries | |||
| 121A | Social Security Contribution | |||
| 122A | Retirement | |||
| 123A | Insurance and Other Benefits | |||
| 131A | Staff Development | |||
| 132A | Purchased Personnel Services | |||
| 133A | Other Personnel Expenses |
SUBTOTAL
| B. OPERATING COSTS | ||
| 311A | Rent | |
| 312A | Utilities | |
| 313A | Insurance | |
| 314A | Housekeeping | |
| 321A | Communications | |
| 331A | Office Supplies | |
| 351A | Staff Travel | |
| 371A | Library | |
| 372A | Debt Service | |
| 373A | Other Indirect Operating Expenses |
SUBTOTAL
| C. EQUIPMENT | ||
| 411A | Building and Land | |
| 412A | Office Equipment | |
| 415A | Motor Vehicles | |
| 421A | Building Repairs | |
| 422A | Equipment Repairs | |
| 423A | Motor Vehicle Repairs |
SUBTOTAL
TOTALS
COST ALLOCATION PLAN :
| If your agency provides more than one program , to which you allocate these indirect costs , please |
| provide an explanation of the method used to distribute these costs among the various programs. |
RENT A
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
Program Name:
| 311 RENT Schedule A |
| Listing of Property Leased From An Unrelated Party |
| Amount | Fair | |||||
| Site | Lessor | Type Of | Facility | Annual | Charged to | Rental |
| Address | Name and Address | Program | # | Rent | County | Appraisal |
RENT B
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
Program Name:
| 311 RENT Schedule B | ||||||||||
| Listing of Property Purchased By A Related Party | ||||||||||
| Site | Related Party | Annual | Amount | Fair | ||||||
| Address | Name and Address | Type of | Facility | Date of | Purchase | Down | Length of | Principal | Charged to | Rental |
| Program | # | Purchase | Price | Payment | Mortgage | Interest | County | Appraisal |
RENT C
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
Program Name:
| 311 RENT Schedule C | ||||||||||
| Listing of Property Purchased By Agency | ||||||||||
| Site | Agency | Annual | Amount | Fair | ||||||
| Address | Name and Address | Type of | Facility | Date of | Purchase | Down | Length of | Principal | Charged to | Rental |
| Program | # | Purchase | Price | Payment | Mortgage | Interest | County | Appraisal |
Rents
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
| Program Name: |
| 311 RENT Schedule A |
| Listing of Property Leased From An Unrelated Party |
| Amount | Fair | |||||
| Site | Lessor | Type Of | Facility | Annual | Charged to | Rental |
| Address | Name and Address | Program | # | Rental | County | Appraisal |
Treatment
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
Program Name:
PURCHASED TREATMENT SERVICES
| Definition | Number | Amt. Eligible | ||||
| Type | Providers | of Unit | of Units | for DPW | ||
| (List Individually) | Rate | for Rate | Provided | Total Cost | Participation |
Total
Assets
| Budget Submission |
| Montgomery County |
| Agency Name: | |
| Billing Address : | Facility Address: |
Program Name:
PROGRAM EQUIPMENT
| Cost | Amount | Amount Not | Amount | ||
| Center | Quantity | Description of Item | Expended | Eligible | Eligible |
| DPW Part. | for DPW |
TOTAL
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