Attachment G - Line Item Detail Budget Form - Outwood ICF Management & Operations - RFP 729 25_0349.xlsx

XLSX spreadsheet 15 KB Posted

Attached to
Outwood ICF Management & Operations (C5859)
Solicitation number
RFP 729 2500000349 1
Issued by
Harrison County, Kentucky

About this file

Written by GovTribe AI ·

This is a Line Item Detail Budget Form for RFP 729 2500000349, an Outwood Intermediate Care Facility (ICF) Management and Operations contract for a fiscal year ending June 30, 2027. The budget form is designed for submission by vendors bidding on this management and operations contract for the state facility. The document provides a comprehensive template for detailed monthly budget projections across all fiscal year 2027 months from July 2026 through June 2027.

The budget form is structured to capture all personnel costs including salaries and wages by position and full-time equivalency, fringe benefits (health insurance, life insurance, 401k, and FICA), and other personnel costs such as federal and state unemployment taxes, workers compensation, professional licensure fees, and continuing education. Additionally, the form itemizes personal service contracts, operating expenses including utilities, rentals, maintenance and repairs, telecommunications, supplies (drugs/clinical, office/janitorial, food, and miscellaneous), furniture and equipment, travel and training, care and support costs, indirect costs, and a management fee line. All line items are presented with monthly columns allowing vendors to provide detailed cost allocations throughout the contract year, with a total column providing annual budget summaries. The form requires vendor identification information and authorized signature for submission.

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Other files

File Type Posted
No Bid Form - RFP 729 25_0349 - Outwood ICF Management and Operations.docx DOCX document
Attachment F - Budget Summary Cost Proposal - Outwood ICF Management & Operations - RFP 729 25_0349.xlsx XLSX spreadsheet
Attachment D - 2006 Federal Settlement Agreement between the Cabinet and the U.S. Department of Justice.pdf PDF
Attachment B - Outwood Census Demographics.pdf PDF
Attachment A - Strategic Action Plan - August 2006.pdf PDF
Attachment E - Olmstead Plan.pdf PDF
Attachment C - Outwood - Site Map.jpg JPG image
Attachment H - Historical and Mission Vision.docx DOCX document
Final_RFP_729_2500000349_1_SO_FORM.PDF PDF

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FY 2027

RFP 729 2500000349

Outwood ICF Management and Operations Attachment G Line Item Detail Budget Form

For Fiscal Year Ending:June 30, 2027
Jul-26Aug-26Sep-26Oct-26Nov-26Dec-26Jan-27Feb-27Mar-27Apr-27May-27Jun-27Total
PERSONNEL:
Salaries and Wages
List by Position and Full Time Equivalency
EXAMPLE: Medical Director (1 FTE); insert lines as needed$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Total Salaries and Wages$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Fringe Benefits
Health Insurance$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Life Insurance$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
401k$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
FICA$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Other - please specify$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Total Fringe Benefits$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Other Personnel Costs
Federal Unemployment Tax$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
State Unemployment Insurance$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Workers Compensation$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Professional Licensure & Fees$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Professional Continuing Education$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Other - please specify$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Total Other Personnel Costs$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Personal Service Contracts
List by Service/Position & Full Time Equivalency$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
insert lines as needed$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Total Personal Service Contracts$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0

Total Personnel Cost $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0

OPERATING:
Utilities$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Rentals$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Maintenance & Repairs$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Postage and Related Supplies$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Miscellaneous Services$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Telecommunications$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Supplies - Drugs and Clinical$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Supplies - Office, Janitorial & Printing$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Supplies - Food$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Supplies - Miscellaneous$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Furniture and Equipment$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Travel and Training$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Care and Support$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Other - Miscellaneous - please specify$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Indirect Cost$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Total Operating Expense$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0

Management Fee $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0

Total Expenses $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0

Vendor Name:
Address:
Telephone:
Name and Title of Authorized Representative:
Authorized Signature:Date:

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