Attachment_J.12b_Business_Proposal_Template.xlsx

XLSX spreadsheet 383 KB Posted Jun 6, 2018

Attached to: Network of Quality Improvement and Innovation Contractors (NQIIC) IDIQ
Solicitation number: 75FCMC18R0016
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

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Attachment J.12b Business Proposal Template

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File	Type	Posted
18R0016_Amendment_5_SF30.pdf	PDF	Jun 19, 2018
18R0016_Amendment_4_SF30.pdf	PDF	Jun 15, 2018
Attachment_J.12b_Business_Proposal_Template.xlsx	XLSX spreadsheet	Jun 15, 2018
Attachment_J.11(a)_NQIIC_Sample_Test_Scenario_Task_Order.docx	DOCX document	Jun 13, 2018
Questions_and_Responses.pdf	PDF	Jun 13, 2018
18R0016_Amendment_3_SF30.pdf	PDF	Jun 13, 2018
18R0016_Amendment_2_SF30.pdf	PDF	Jun 6, 2018
Attachment_J.12a__Business_Proposal_Instructions.docx	DOCX document	Jun 6, 2018
Attachment_J.11(b)_CMS_State-Level_Bene_and_Facility_Numbers.xlsx	XLSX spreadsheet	Jun 6, 2018
Attachment_J.14_VPAT.doc	DOC document	Jun 6, 2018
Attachment_J.1_NQIIC_IDIQ_Statement_of_Work.docx	DOCX document	Jun 6, 2018
Attachment_J.11(a)_NQIIC_Sample_Test_Scenario_Task_Order.docx	DOCX document	Jun 6, 2018
06-06-18_Amendment_2_Questions_and_Responses.pdf	PDF	Jun 6, 2018
Attachment_J.17_HCQIS_CFE_Guidelines_and_Requirements.docx	DOCX document	Jun 6, 2018
NQIIC_2018_RFP_Amendment.docx	DOCX document	Jun 6, 2018
AMENDMENT_2_Summary.docx	DOCX document	Jun 6, 2018
Network_of_Quality_Improvement_Webex.docx	DOCX document	May 17, 2018
NQIIC_IDIQ_Amendment_1.pdf	PDF	May 17, 2018
May_16_NQIIC_registered_participant_list.pdf	PDF	May 17, 2018
05-16-2018_NQIIC_Pre-Proposal_Conf_FINAL.pptx	PPTX presentation	May 15, 2018
Attachment_J.4_565_Report_of_Accountable_Property.pdf	PDF	May 15, 2018
Attachment_J.6_ServiceNow_CMS_Asset_and_Procurement_User_Guide.docx	DOCX document	May 15, 2018
Attachment_J.2_Consent_to_Subcontract.docx	DOCX document	May 15, 2018
Attachment_J.3_Small_Business_Subcontracting_Plan.doc	DOC document	May 15, 2018
Attachment_J.1_NQIIC_IDIQ_Statement_of_Work.pdf	PDF	May 15, 2018
Attachment_J.9_Compliance_Prog_Guidance_for_Medicare_Fee_For_Svc.pdf	PDF	May 15, 2018
Attachment_J.12a__Business_Proposal_Instructions_Final.docx	DOCX document	May 15, 2018
Attachment_J.11(a)_Sample_Task_Order_Statement_of_Work.docx	DOCX document	May 15, 2018
Attachment_J.11(b)_CMS_State-Level_Bene_and_Facility_Numbers.xlsx	XLSX spreadsheet	May 15, 2018
2018-05-16_NQIIC_Pre-Proposal_Conf_FINAL_17TO60-508_Slides.pptx	PPTX presentation	May 15, 2018
Attachment_J.7_Ktr_Personal_COI_Financial_Disclosure_Template.docx	DOCX document	May 15, 2018
Attachment_J.1a_Glossary_of_Terms.docx	DOCX document	May 15, 2018
Attachment_J.13_VDI_Onboarding_Signed_25-10-2016_14-06-10.pdf	PDF	May 15, 2018
Attachment_J.12b_Business_Proposal_Template1.xlsx	XLSX spreadsheet	May 15, 2018
Attachment_J.10_Question_Submission_Template.xlsx	XLSX spreadsheet	May 15, 2018
NQIIC_2018_RFP.pdf	PDF	May 15, 2018
Attachment_J.8_Ktr_Bus_Ethics_COI_and_Compliance_Prog_Req.docx	DOCX document	May 15, 2018

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F718 BP SUM

1. Name and Address of Contractor 3. RFP Number

4: Proposed Contract Period

2. RESERVED From:

To:

Medicare	5. Total Proposed	6. CMS Recommended	7. $	8. %
Contract	Costs	Costs	Difference	DIfference

Direct Cost

a. LABOR:
1. Professional	ERROR:#REF!	$0	ERROR:#REF!	ERROR:#REF!
2. Information Systems	ERROR:#REF!	$0	ERROR:#REF!	ERROR:#REF!
3. Corporate Management	ERROR:#REF!	$0	ERROR:#REF!	ERROR:#REF!
4. Support Staff	ERROR:#REF!	$0	ERROR:#REF!	ERROR:#REF!

SUBTOTAL - Direct Labor $0 $0 $0 ERROR:#DIV/0!

b. Leave	$0	$0	$0	ERROR:#DIV/0!
c. Fringe Benefits	$0	$0	$0	ERROR:#DIV/0!

SUBTOTAL - Leave/Fringe $0 $0 $0 ERROR:#DIV/0!

d. Subcontractors
1. Physician Reviewers/ Phys.Advisors	$0	$0	$0	ERROR:#DIV/0!
1. Other Consultants	$0	$0	$0	ERROR:#DIV/0!
2. Other Subcontracts	$0	$0	$0	ERROR:#DIV/0!

SUBTOTAL - Subcontractors $0 $0 $0 ERROR:#DIV/0!

e. Travel		$0	$0	ERROR:#DIV/0!
e. Other Direct Costs	$0	$0	$0	ERROR:#DIV/0!

SUBTOTAL - DIRECT $0 $0 $0 ERROR:#DIV/0!

f. Indirect Costs	$0	$0	$0	ERROR:#DIV/0!
g. Pass-thru Costs	$0	$0	$0	ERROR:#DIV/0!

TOTAL COSTS $0 $0 $0 ERROR:#DIV/0!

g. Fee $0 $0 $0 ERROR:#DIV/0!

TOTAL COST WITH FEE $0 $0 $0 ERROR:#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:

Indirect Leave Rate
	12. DATE:	13. Telephone #
			16. Signature/Title:

F719

1. RFP Number:	2. Name and Address of Contractor:
0	0
	0
	0
	4. Contract Period
3.	From:	12/31/99
RESERVED	To:	12/31/99

Quality Improvement Network Information Services Title3 Title4 Title5 Title6 Title7 Title8 Title9 Title10 Title11 Title12 TOTAL

MEDICARE 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

ERROR:#REF!

0.0

ERROR:#REF!

2. Information Systems

ERROR:#REF!

0.0

ERROR:#REF!

3. Corporate Management

ERROR:#REF!

0.0

ERROR:#REF!

4. Support Staff

ERROR:#REF!

0.0

ERROR:#REF!

SUBTOTAL - Direct Labor

0.0

ERROR:#REF!

0.0

ERROR:#REF!

b. Leave	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$0	0.0	$ - 0
c. Fringe Benefits		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$ - 0
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

d. Subcontracts:
1. Physician Reviewers / Phys. Advisors	0.0	$0																											0.0	$ - 0
1. Other Consultants	0.0	$0	0.0	ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		$0		$0		$ - 0
2. Other Subcontractors	0.0	$0	0.0	ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		$0		$0		$ - 0
SUBTOTAL - Subcontracts	0.0	$0	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	0.0	$0	0.0	$0	0.0	ERROR:#REF!

e. ODC $0

SUBTOTAL - DIRECT 0.0 $0 ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF!

f. Indirect Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $ - 0

g. Pass-thru Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $ - 0

TOTAL COSTS	0.0	$0	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	0.0	ERROR:#REF!	0.0	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!
g. Fee		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$0		$ - 0

QIO F720

	FRINGE BENEFIT PROPOSAL
QIN QUALITY IMPROVEMENT ORGANIZATION 12th SOW BUSINESS PROPOSAL
CENTERS FOR MEDICARE & MEDICAID SERVICES

ERROR:#REF!	ERROR:#REF!
ERROR:#REF!	ERROR:#REF!
ERROR:#REF!
ERROR:#REF!	ERROR:#REF!

ERROR:#REF! ERROR:#REF! From: ERROR:#REF!

To: ERROR:#REF!

			6. Prior Year		7. Projected	8. Prior Year	9. Projected
	DETAIL COSTS		Total		Total 5-YR	Total	Total 5-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%

Form 720 BP &D

F721 a

INDIRECT COST

CENTERS FOR MEDICARE & MEDICAID SERVICES

1. Name and Address of Contractor	3. RFP Number
0	0
0
0	4: Proposed Contract Period

2. RESERVED From: 12/31/99

To: 12/31/99

	5. Prior Year	6. Projected	7. Prior Year	8. Projected
DETAIL COSTS	Total	Total Indirect	Medicare	Medicare
	Indirect Costs	Costs	Indirect Costs	Indirect Costs

a. Indirect Labor	$0	$0
b. Indirect Leave	$0	$0
c. Indirect Fringe	$0	$0
d. Rent	$0	$0
e. Storage	$0	$0
f. Utilities	$0	$0
g. Maintenance & Repairs	$0	$0
h. Depreciation	$0	$0
i. Data Processing	$0	$0
j. Equipment Leasing & Rental	$0	$0
k. Office Supplies	$0	$0
l. Reproduction & Printing	$0	$0
m. Telephone	$0	$0
n. Postage & Express Mail	$0	$0
o. Consultants	$0	$0
p. Meeting & Conferences	$0	$0
q. Travel	$0	$0
r. Training	$0	$0
s. Garage & Parking Spaces	$0	$0
t. Dues & Subscriptions	$0	$0
u. Recruiting	$0	$0
v. Temporary Help	$0	$0
w. Continuing Education	$0	$0
x. Legal Fees	$0	$0
y. Accounting/Audit Fees	$0	$0
z. Board of Directors Fees	$0	$0
aa. Insurance	$0	$0
bb. Bank Charges	$0	$0
cc. Other - see attached	$0	$0

dd. ** TOTAL $0 $0

ee. Indirect Cost Rate 0.00% 0.00%

F721 b

INDIRECT COST

CENTERS FOR MEDICARE & MEDICAID SERVICES

1. Name and Address of Contractor	3. RFP Number
0	0
0
0	4: Proposed Contract Period

2. RESERVED From: 12/31/99

To: 12/31/99

	5. Prior Year	6. Projected	7. Prior Year	8. Projected
DETAIL COSTS	Total	Total Indirect	Medicare	Medicare
	Indirect Costs	Costs	Indirect Costs	Indirect Costs

a. Indirect Labor	$0	$0
b. Indirect Leave	$0	$0
c. Indirect Fringe	$0	$0
d. Rent	$0	$0
e. Storage	$0	$0
f. Utilities	$0	$0
g. Maintenance & Repairs	$0	$0
h. Depreciation	$0	$0
i. Data Processing	$0	$0
j. Equipment Leasing & Rental	$0	$0
k. Office Supplies	$0	$0
l. Reproduction & Printing	$0	$0
m. Telephone	$0	$0
n. Postage & Express Mail	$0	$0
o. Consultants	$0	$0
p. Meeting & Conferences	$0	$0
q. Travel	$0	$0
r. Training	$0	$0
s. Garage & Parking Spaces	$0	$0
t. Dues & Subscriptions	$0	$0
u. Recruiting	$0	$0
v. Temporary Help	$0	$0
w. Continuing Education	$0	$0
x. Legal Fees	$0	$0
y. Accounting/Audit Fees	$0	$0
z. Board of Directors Fees	$0	$0
aa. Insurance	$0	$0
bb. Bank Charges	$0	$0
cc. Other - see attached	$0	$0

dd. ** TOTAL $0 $0

ee. Indirect Cost Rate 0.00% 0.00%

F721 c

INDIRECT COST

CENTERS FOR MEDICARE & MEDICAID SERVICES

1. Name and Address of Contractor	3. RFP Number
0	0
0
0	4: Proposed Contract Period

2. RESERVED From: 12/31/99

To: 12/31/99

	5. Prior Year	6. Projected	7. Prior Year	8. Projected
DETAIL COSTS	Total	Total Indirect	Medicare	Medicare
	Indirect Costs	Costs	Indirect Costs	Indirect Costs

a. Indirect Labor	$0	$0
b. Indirect Leave	$0	$0
c. Indirect Fringe	$0	$0
d. Rent	$0	$0
e. Storage	$0	$0
f. Utilities	$0	$0
g. Maintenance & Repairs	$0	$0
h. Depreciation	$0	$0
i. Data Processing	$0	$0
j. Equipment Leasing & Rental	$0	$0
k. Office Supplies	$0	$0
l. Reproduction & Printing	$0	$0
m. Telephone	$0	$0
n. Postage & Express Mail	$0	$0
o. Consultants	$0	$0
p. Meeting & Conferences	$0	$0
q. Travel	$0	$0
r. Training	$0	$0
s. Garage & Parking Spaces	$0	$0
t. Dues & Subscriptions	$0	$0
u. Recruiting	$0	$0
v. Temporary Help	$0	$0
w. Continuing Education	$0	$0
x. Legal Fees	$0	$0
y. Accounting/Audit Fees	$0	$0
z. Board of Directors Fees	$0	$0
aa. Insurance	$0	$0
bb. Bank Charges	$0	$0
cc. Other - see attached	$0	$0

dd. ** TOTAL $0 $0

ee. Indirect Cost Rate 0.00% 0.00%

F721 d

INDIRECT COST

CENTERS FOR MEDICARE & MEDICAID SERVICES

1. Name and Address of Contractor	3. RFP Number
0	0
0
0	4: Proposed Contract Period

2. RESERVED From: 12/31/99

To: 12/31/99

	5. Prior Year	6. Projected	7. Prior Year	8. Projected
DETAIL COSTS	Total	Total Indirect	Medicare	Medicare
	Indirect Costs	Costs	Indirect Costs	Indirect Costs

a. Indirect Labor	$0	$0
b. Indirect Leave	$0	$0
c. Indirect Fringe	$0	$0
d. Rent	$0	$0
e. Storage	$0	$0
f. Utilities	$0	$0
g. Maintenance & Repairs	$0	$0
h. Depreciation	$0	$0
i. Data Processing	$0	$0
j. Equipment Leasing & Rental	$0	$0
k. Office Supplies	$0	$0
l. Reproduction & Printing	$0	$0
m. Telephone	$0	$0
n. Postage & Express Mail	$0	$0
o. Consultants	$0	$0
p. Meeting & Conferences	$0	$0
q. Travel	$0	$0
r. Training	$0	$0
s. Garage & Parking Spaces	$0	$0
t. Dues & Subscriptions	$0	$0
u. Recruiting	$0	$0
v. Temporary Help	$0	$0
w. Continuing Education	$0	$0
x. Legal Fees	$0	$0
y. Accounting/Audit Fees	$0	$0
z. Board of Directors Fees	$0	$0
aa. Insurance	$0	$0
bb. Bank Charges	$0	$0
cc. Other - see attached	$0	$0

dd. ** TOTAL $0 $0

ee. Indirect Cost Rate 0.00% 0.00%

QIOSubconts 1

Physician Reviewer Cost for Beneficiary & Family Centered Care Activities
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. and FCC
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. and FCC
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. and FCC	Benef. and FCC
Reviews	Per Review	Per Year	Hourly Rate	Review Costs	Review Costs

0.0 $0 $0

52. Current	53. Yr-1	54. Yr-1	55. Yr-1	56. Yr-1	57. Yr 1
Phys. Reviewer	Number of	Hours	Hours	Phys. Reviewer	Dev New QIO Act.
Hourly Rate	Reviews	Per Review	Per Year	Hourly Rate	Review Costs

0 $0

58. Yr-2	59. Yr-2	60. Yr-2	61. Yr-2	62. Yr 2
Number of	Hours	Hours	Phys. Reviewer	Dev New QIO Act.
Reviews	Per Review	Per Year	Hourly Rate	Review Costs

0 $0

63. Yr-3	64. Yr-3	65. Yr-3	66. Yr-3	67. Yr 3	68. Total 3 Yr
Number of	Hours	Hours	Phys. Reviewer	Dev New QIO Act.	Dev New QIO Act.
Reviews	Per Review	Per Year	Hourly Rate	Review Costs	Review Costs

0 $0 $0

&11Subcontracts Proposal Quality Improvement Organization 10th SOW Business Proposal &"Arial,Bold"Physician Reviewers and Physician Advisors

Form SC 1 Prepared on:

STAFFING

																TOT DIR/YR	TOT DIR/YR	TOT DIR/YR	TOT DIR/YR		TOT DIR LAB	TOT DIR LAB	TOT DIR LAB	TOT DIR LAB		INDIRECT	INDIRECT	INDIRECT	INDIRECT		INDIR	INDIR	INDIR	INDIR		Total Labor	TOTAL LABOR	TOTAL LABOR	TOTAL LABOR		TOT LABOR	TOT LABOR	TOT LABOR	TOT LABOR		Direct Leave	Direct Leave	Direct Leave	Direct Leave
					4a current	4b current	4c current	4d current		5aProposedYr 1	5bPropYr1	5c Prop Yr 1	5d Prop Yr 1		7.	Prof. Hours	IS hrs	Corp Admin	Support	8. Total	Prof. Labor	IS labor	Corp Admin	Support	9.	Prof. Hours	IS hrs	Corp Admin	Support	10. Total	Prof. Labor	IS labor	Corp Admin	Support	11.	Prof. Hours	IS hrs	Corp Admin	Support	12. Total	Prof. Labor	IS labor	Corp Admin	Support	13.	Prof. Hours	IS hrs	Corp Admin	Support
	1. Staff	2. Position	3. Labor	4. Current	hourly	hourly	hourly	hourly	5. Proposed	hourly	hourly	hourly	hourly	6. Percent	Total Direct Labor	per year	per year	hours per yr	Staff Hrs per	Direct	costs 5yr	$$ 3 year	Labor $ 3 yr	Staff	Indirect Labor	per year	per year	hours per yr	Staff Hrs per	Indirect	costs/yr	$$ per year	Labor $ per yr	Staff	Total Labor	per year	per year	hours per yr	Staff Hrs per		costs/yr	$$ per year	Labor $ per yr	Staff	Direct Leave	per year	per year	hours per yr	Staff Hrs per
	Name	Title	Category	Hourly Rate	professional	IS	Corp Admin	support staff	Hourly Rate	professional	IS	Corp Admin	support staff	Change	Hours	avg	avg	avg	yr, avg	Labor Costs				Labor $$ 5yr	Hours	avg	avg	avg	yr, avg	Labor Costs	avg	avg	avg	Labor $$yr, avg	Hours	avg	avg	avg	yr, avg	Labor Costs	avg	avg	avg	Labor $$yr, avg	Hours	avg	avg	avg	yr, avg
1										$0.00	$0.00	$0.00	$0.00	ERROR:#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
2										$0.00	$0.00	$0.00	$0.00	ERROR:#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
3					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
4					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
5					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
6					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
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17					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
18					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
19					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
20					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
21					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
22					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
23					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
24					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
25					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
26					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
27					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
28					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
29					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
30					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
31					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
32					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
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57					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
58					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
59					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
60					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
61					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
62					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
63					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
64					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
65					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
66					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
67					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
68					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
69					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
70					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
71					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
72					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
73					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
74					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
75					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
76					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
77					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
78					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
79					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
80					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
81					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
82					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
83					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
84					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
85					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
86					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
87					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
88					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
89					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
90					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
91					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
92					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
93					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
94					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
95					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
96					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
97					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
98					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
99					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
100					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
101					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
102					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
103					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
104					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
105					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
106					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
107					$0.00	$0.00	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00	ERROR:#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
Grand Total	N/A	N/A	N/A	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#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
By Category
P=Professional				ERROR:#DIV/0!					ERROR:#DIV/0!					ERROR:#DIV/0!	0.0					$ - 0					0.0					$ - 0					0.0					$ - 0					0.0
I=Info Systems				ERROR:#DIV/0!					ERROR:#DIV/0!					ERROR:#DIV/0!	0.0					$ - 0					0.0					$ - 0					0.0					$ - 0					0.0
C=Corp Mgmt				ERROR:#DIV/0!					ERROR:#DIV/0!					ERROR:#DIV/0!	0.0					$ - 0					0.0					$ - 0					0.0					$ - 0					0.0
S=Support Staff				ERROR:#DIV/0!					ERROR:#DIV/0!					ERROR:#DIV/0!	0.0					$ - 0					0.0					$ - 0					0.0					$ - 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

Averaging
Counts	0	0	0	0	0	0	0	0	0

Staffing Proposal Personnel Loading Chart Quality Improvement Organization 12th SOW Business Proposal &G

Form Staffing Page &P &D

N O T

A P P L I C A B L E

Staff Sum

Labor Category	1. Average	2. Average		4. Total	5. Total	6. Total	7. Total	10. Total	11. Total	12. Total	13. Total	14. Leave as a	15. Total	16. Total
	Current	Proposed	3. Percent	Direct Labor	Direct Labor	Indirect Labor	Indirect Labor	Direct Leave	Direct Leave	Leave	Leave	% of Hours	Labor and Leave	Labor and Leave	17.Total FTE
	Hourly Rate	Hourly Rate	Change	Hours	Costs	Hours	Costs	Hours	Costs	Hours	Costs	Worked	Hours	Costs
Professional	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	0.0	$0	0.0	$0	$ - 0	$0	$ - 0	$0	ERROR:#DIV/0!	0.0	$0	0.00
Information Systems	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	0.0	$0	0.0	$0	$ - 0	$0	$ - 0	$0	ERROR:#DIV/0!	0.0	$0	0.00
Corporate Management	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	0.0	$0	0.0	$0	$ - 0	$0	$ - 0	$0	ERROR:#DIV/0!	0.0	$0	0.00
Support Staff	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	0.0	$0	0.0	$0	$ - 0	$0	$ - 0	$0	ERROR:#DIV/0!	0.0	$0	0.00
Total	ERROR:#DIV/0!	ERROR:#DIV/0!	ERROR:#DIV/0!	$ - 0	$ - 0	$ - 0	$ - 0			$ - 0	$ - 0	ERROR:#DIV/0!	$ - 0	$ - 0	$ - 0

NOT APPLICABLE

Subconts

1.	2.	3.	4.
	Total
Name	Costs	Current Activity	Proposed Activity

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

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

QIO ODC

	OTHER DIRECT COST
	QIN QUALITY IMPROVEMENT ORGANIZATION 12th SOW BUSINESS PROPOSAL
	CENTERS FOR MEDICARE & MEDICAID SERVICES
1. Name and Address of Contractor		3. RFP Number
0		0
0
0		4: Proposed Contract Period

2. RESERVED From: 12/31/99

To: 12/31/99

DETAIL COSTS	5	6	7	8	9	10	11	12	13	14	15	16	Total Projected Medicare - 5yr Other Direct Costs
	Quality Improvement Network	Information Services	Title3	Title4	Title5	Title6	Title7	Title8	Title9	Title10	Title11

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

BFCC Sup Sch

1. Name and Address of QIO Organization:

2. QIO Area (State):

3. Contract Period

ERROR:#REF!

From:

ERROR:#REF!

To:

ERROR:#REF!

4. Quality of Care Reviews Cost Per Case

5. Hospital Based Notice Appeals Cost Per Case

6. Fee-for-Service (FFS) Expedited Appeals Cost Per Case

7. Medicare Advantage (MA) Fast Track Appeals Cost Per Case

8. EMTALA: 5-day Reviews Cost Per Review

9. EMTALA: 60-day Reviews Cost Per Review

10. Higher Weighted DRG Cost Per Case

11. Quality Improvement Interventions (QII)/ Technical Assistance Costs

12. Sanction Activities

13. Collaboration

14. Transparency Through Reporting

15. Other Non-Review Activities

16. 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	$ - 0
2. Information Systems																															0.0	$ - 0
3. Corporate Management																															0.0	$ - 0
4. Support Staff																															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	$0	0.0	$ - 0

b. Leave																															0.0	$ - 0
c. Fringe Benefits																																$ - 0
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	$ - 0

d. SUBCONTRACTS:
1. Physician Reviewers / Phys. Advisors																															0.0	$ - 0
2. Other Consultants																																$ - 0
3. Other Subcontractors																																$ - 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	$0	0.0	$ - 0

e. Travel																																$ - 0
f. Other Direct Costs																																$ - 0
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 $ - 0

h. Pass-thru Costs $0 $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		$ - 0

TOTAL COSTS WITH FEE	$0	$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 BENEFICIARY & FAMILY CENTERED CARE on the form "QIO F719".

Travel Detail Form

TRAVEL DETAIL

QIN QUALITY IMPROVEMENT ORGANIZATION 12th SOW BUSINESS PROPOSAL

CENTERS FOR MEDICARE & MEDICAID SERVICES

1. RFP Number:	2. Name and Address of QIO Organization:				3. QIO Area (State):				4. Contract Period
ERROR:#REF!	ERROR:#REF!					ERROR:#REF!			From:	ERROR:#REF!
	ERROR:#REF!								To:	ERROR:#REF!
	ERROR:#REF!
									5. Mileage Rate:
6. Area	7. Trip Title & Description/Purpose	8. # of Days per Trip	9. # of Nights per Trip	10. # of Travelers per Trip	11. Airfare per Person	12. Departing from:	13. Arriving to:	14. FTR Meals & Inc. Daily Rate	15. FTR Lodging per Night	16. # of Trips	17. Total # of miles per trip	18. # of Rental Cars Per Trip	19. Daily Rental Car Rate	20. Misc. Cost per Person per Trip (includes parking, gas, taxi, etc.)	21. TOTAL	22. Notes
Quality Improvement Network															$0
															$0
															$0
															$0
Information Services															$0
															$0
															$0
															$0
Title3															$0
															$0
															$0
															$0
Title4															$0
															$0
															$0
															$0
Title5															$0
															$0
															$0
															$0
Title6															$0
															$0
															$0
															$0
Title7															$0
															$0
															$0
															$0
Title8															$0
															$0
															$0
															$0
Title9															$0
															$0
															$0
															$0
Title10															$0
															$0
															$0
															$0
Title11															$0
															$0
															$0
															$0
															$0
															$0
															$0
															$0
23. GRAND TOTAL:													$0

** Please note, the totals for these activities DO NOT roll into the TRAVEL line item listed on the forms entitled, "QIO F719" or "QIO ODC".

Key

Cost Elements	Symbol	Groups
		Information Services
Group 1		Quality Improvement Network
Quality Improvement Network	A	Improve Individual Patient Care
		Integrate Care for Populations & Communities
Group 2		Improving Health for Populations & Communities
Information Services	B	General Protocol Requirements
Title3	C	Group 1
Title4	D	Group 2
Title5	E	Group 3
Title6	F	Group 4
		Group 5
Group 3		Group 6
Title7	G	Group 7
		Group 8
Group 4		Group 9
Title8	H	Group 10
Title9	I	Group 11
Title10	J	Group 12
		Group 13
Group 5		Group 14
Title11	K	Group 15
		Group 16
		Titles
		IS
		Beneficiary and Family Centered Care
		CLABSI, CAUTI, SSI, & CDI Hospital Learning Network/Collaborative
		Pressure Ulcers & Restraints Technical Assistance
		Nursing Home Safety Learning Network/Collaborative
		Adverse Drug Events Learning Network/Collaborative
		Quality Reporting & Improvement
		Technical Assistance for Communities
		Prevention Learning Network/Collaborative (excluding Cardiac Care)
		Prevention Technical Assistance
		Cardiac Disease Learning Network & Technical Assistance
		Care Reinvention through Innovation Spread (CRISP) Model
		Title1
		Title2
		Title3
		Title4
		Title5
		Title6
		Title7
		Title8
		Title9
		Title10
		Title11
		Title12

&G image1.png

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