A-T-T A CHAA£TkT 2~

State of California Department of Aging AREA PLAN BUDGET AREA PLAN BUDGET SUMMARY - BUDGETED COSTSCDA 122 (Rev 5/2016) Page 1 of 14

TITLE III ADMIN AND TITLE III PROGRAMSDATE: 12/5/16 PSA 25[ ]ORIGINAL[x] REVISION# 1 CONTRACT NO.: AP-1617-25BUDGET PERIOD: July 1, 2016- June 30, 2017

(g) Total Title III

(c) III C-1 Congregate Nutr

III C-2 (e) III D III EAAA DIRECT SERVICE (a) Area Plan Admin

(b) (d) (f)Family CaregiverCOST CATEGORIES Supportive Svcs

_______ 506,701Disease PrevHome Del Nutr

1,962,8520 507,539CASH 948,612 0 01. Personnel0 00ill IN-KIND 0 0 0 0

0CASH2. Staff Travel0IN-KIND(+)

CASH 03. Staff Training0IN-KINDin

11,000 11,000CASH 0 0 0 004. Property / Equipment

m<+) IN-KIND0CASH5. Vendor / Consultant

Agreements 0IN-KINDillCASH 0

6. Food Costs0IN-KINDill

CASH 6,000 7,000 364,063 485,626108,5637. Other Costs

0(+) IN-KINDCASH 0

8. Allocated Costs*0(+) IN-KIND

CASH9.AREA AGENCY DIRECT COSTS

2,459,478948,612 615,264 6,000 7,000 0 882,602

{=) IN-KIND 00 0 0 0 00CASH 183,12194,861 88,260

10. Indirect Costsill IN-KIND 227,823 441,648213,825

1,043,473 615,264 6,000 970,862 2,642,5997,000 011.TOTAL AREA AGENCY COSTS

CASH

227,823 213,825 441,6480 0 0 0(=) IN-KIND

CASH 2,788,682 5,070,171 3,452,183 217,786 720,294 12,249,11612.Subrecipient Contractor Services IN-KIND 517,027 230,882 1,370.871(+) 283,468 339,494 0

1,691,1561,043,473 3,403,946 5,076,171 3,459,183 217,786 14,891,715CASH

13.TOTAL TITLE III227,823 283,468 517,027 444,707 1,812,519339,494 0

(=) IN-KIND14.TOTAL CASH & IN-KIND 1,271,296 3,687,414 5,593,198 3,798,677 217,786 2,135,863 16,704,234

AREA PLAN BUDGET APPROVAL•FOR STATE USE ONLY:

Fiscal Specialist Approval Date DateF iscal Coach Verification

* - Must submit allocation plan with Area Plan Budget

State of CaliforniaDepartment of AgingAREA PLAN BUDGET AREA PLAN BUDGET SUMMARY - BUDGETED COSTSCDA 122 (Rev 5/2016) Page 2 of 14

TITLE III, TITLE VII, AND SPECIAL OMBUDSMAN PROGRAMSCONTRACT NO.: AP-1617-25 DATE: 12/5/16 PSA 25BUDGET PERIOD: July 1, 2016- June 30, 2017 [ ] ORIGINAL ( x ] REVISION # 1

(e) Ombudsman SHF Cit. Pen.

(f) Ombudsman SNFQAF

AAA DIRECT SERVICE (b) VII (c) Total Title III & VII

(d) Ombudsman PHL&C

(g) Total Area Plan

(a) VIICOST CATEGORIES Ombudsman Elder Abuse Prev

CASH 0 0 1,962,8520 1,962,852 0 01. PersonnelIN-KIND 0 0 0 0 0 0 0illCASH 0 0

2. Staff Travel(+) IN-KIND 0 0

CASH 0 03. Staff TrainingIN-KIND 0 0ill

11,000CASH 0 0 00 11,000 04. Property / Equipment

(+) IN-KIND 0 MCASH 0 05. Vendor / Consultant

Agreements IN-KIND 0 0IIICASH 00

6. Food CostsIN-KIND 0 0

485,626CASH 485,6267. Other Costs

IN-KIND(+> 0 0CASH 0 0

8. Allocated Costs*IN-KIND(+) 0 0

2,459,4780 0 2,459,478 0 0 0CASH9.AREA AGENCY

DIRECT COSTS0 0 0 0 0 0 0

IN-KIND(=)CASH 183,121 183,121

10. Indirect Costsill IN-KIND 441,648 441,648

0 2,642,5990 0 0 2,642,599011.TOTAL AREA AGENCY COSTS

CASH

0 0 441,648 0 0 441,6480(=) IN-KIND

CASH 91,346 12,389,82412. Subrecipient Contractor Services

49,362 31,068 260,379 147,574 12,828,845IN-KIND(+) 1,370,871 1,370,871

91,346 49,362 15,032,423 31,068 147.574 15,471,444260,379CASH

13.TOTAL AREA PLAN0 1,812,5190 0 0 0 1,812,519

(=) IN-KIND14.TOTAL CASH & IN-KIND 91,346 49,362 16,844,942 31,068 260,379 147,574 17,283,963* - Must submit allocation plan with Area Plan Budget

State of CaliforniaDepartment of AgingAREA PLAN BUDGET AREA PLAN BUDGET SUMMARY - BUDGETED FUNDINGCDA 122 (Rev 5/2016) Page 3 of 14

TITLE 111, TITLE VII, AND SPECIAL OMBUDSMAN PROGRAMSPSA 25BUDGET PERIOD: July 1, 2016-June 30 2017 [ ] ORIGINAL [ x ] REVISION U 1 'CONTRACT NO.: AP-1617-25 DATE: 12/5/16

(b) III B III C-1 III C-2 (e) HID Disease Prev

III E (g) Total Title III

SECTION A (a) Area Plan Admin

(d) (f)(c)Supportive Svcs Family CaregiverFUNDING SOURCES Congregate Nutr Home Del Nutr

CASH 4,000 191,8971. Program Income 0 123,442 64,455 01,089,4742. NSIP CASH 530,064 559,410

03. Intentionally Blank CASHCASH 0 0 04. Non-Matching 0 0 0

0 0Contributions IN-KIND 0 0 001,162,490704,0765. State Funds CASH 2,105 77,671 378,638

CASH 0 0 88,2606. Matching Contributions

94,861 0 183,1210IN-KIND 227,823 283,468 517,027 339.494 0 444,707 1,812,519

7. Federal Funding 4,044,027 217,786 1,598,896 12,264,733CASH 946,507 3,326,275 2,131 242

5,076,171 217,786 14,891,7151,043,473 3,403,946 3,459.183 1,691,156CASH8.TOTAL TITLE III

FUNDING227,823 283,468 517,027 1,812,519339 494 0 444,707

IN-KIND9. TOTAL CASH & IN-KIND 1,271,296 3,687,414 5,593,198 3,798,677 2,135,863 16,704,234217,786SECTION B

FUNDING SOURCES(h) VII (i) (j) Total

Title III & VII(k) Ombudsman

PH L&C(I) Ombudsman

SHF Cit. Pen.Total

Area PlanVII (m) Ombudsman

SNFQAF(")

Elder Abuse PrevOmbudsman191,89710. Program Income CASH 191 89/

11. NSIP CASH 1,089,4741089474;12. Intentionally Blank CASH 0: o13. Non-Matching

ContributionsCASH 0 0IN-KIND 0C

14. State Funds CASH 1,152,490 31,068 260,379 147,574 1,601,511CASH15. Matching

Contributions183,121 183,121

IN-KIND 1,812,519 1,812,51916. Federal Funding CASH 91,346 49,362 12,405,441 12,405,441

49,36291,346 15,032,423 31,068 147,574260,379 15,471,444CASH17.TOTAL AREA

PLAN FUNDING00 1,812,519 0 0 1,812,5190

IN-KIND18. TOTAL CASH & IN-KIND 91,346 49.362 16,844,942 31,068 260,379 147,574 17,283,963

State of CaliforniaDepartment of AgingAREA PLAN BUDGET

CDA 122 (Rev 5/2016) Page 4 of 14

MATCHING CONTRIBUTIONS & ADEQUATE PROPORTION COMPLIANCE| PSA 25BUDGET PERIOD: July 1, 2016- June 30. 2|[ ] ORIGINAL [ x ] REVISION # 1

SECTION AAREA PLAN ADMINISTRATION MATCHING CONTRIBUTIONS

_______________________________ DATE: 12/5/16SECTION B (may include Public Admin Match from Section A)LOCAL PUBLIC AGENCIES MATCHING CONTRIBUTIONS

CONTRACT NO.: AP-1617-25

Cash Total Cash In-Kind TotalSource In-Kind Source227823 322684City of Los Angeles 94861 227823 322684 City of Los Angeles - Admin Match 94861

471600City of Los Angeles - Program March 4716000000000

94861 227823 TOTAL 566461 227823 794284TOTAL 322684

SECTION CMINIMUM MATCHING REQUIREMENTS COMPLIANCE

(b) Title III B& IIIC pooled

(a) Area Plan Admin

(c) Title IIIE Programs

(d) Total Min MatchingITEM

1. Costs to be Matched 1,269.191 10,557,955 2.131,863 13,959,0092. Required Matching Percentages 25% 10.53% 25%3. Minimum Required Match 317,298 1,111,753 1,962,017532,9664. Match Budgeted (from Page 3) 322,684 532,967 i<« Compare to line 3

<« Compare to Section (3 Total1,132,689 1,988 340

5. Required Local Public Agencies Matching = Line 3 x 25% 490,504

SECTION D ADEQUATE PROPORTION CALCULATION SECTION EPriority Services

(Do not include OTO)FederalShare

ADEQUATE PROPORTION CALCULATION FOR PRIORITY SERVICESBUDGETED BASELINE FUNDS Amount

5. Information & Assistance 796,469 1. Total Supportive Services Federal Share6. Case Management 632,565 {+) 3,326,2757. Assisted Transportation 0 2. Less III B Ombudsman Federal Share8. Transportation 0 (-) 76.2789. Outreach 115,133 3. Less III B One-Time-Only10. Comprehensive Assess. 158,636 242,770(-)11. Health 62,849 Auto-calculated

% of Baseline Funding

AAA Approved Percentage

from Area Flan

4. Equals III B Supportive Services Base Allocation

300722712. Mental Health 0 (=)13, Public Information 0 ' Total Priority Service Federal Share Divided by III B Base (line 4)

A As Approved in the Area Plan____________________________14. Total Access 1,765,652 58.7% 58.515. Personal Care 81,65516. Homemaker 309.21017. Chore 68,211 SECTION F18. Visiting 75,360 OMBUDSMAN MAINTENANCE OF EFFORT CASH FUNDING COMPLIANCE

Title VII OMBI State Special OMB Total OMBI Cash19. Respite Care 0 Title III B OMBI State NIB OMBI20. Alzheimer's Day Care 0 76,278 77,571 439,02191,346 684,31621. Residential Repairs/Mods. 0 Auto-calculated

% of Base*

AAA Approved Percentage

from Area Plan22. Adult Day/Health Care 023. Telephone Reassurance 33,60124. Total In-Home 568037 18.9% 15.525. Legal Assistance 215,000 7.1% 5.5

State of CaliforniaDepartment of AgingAREA PLAN BUDGET

CDA 122 (Rev 5/2016) Page 5 of 14

AREA PLAN BUDGET TRANSFER REQUESTSlCONTRACT NO.: AP-1617-25 | DATE- 12/5/Tfi Ipsa 25BUDGET PERIOD: July 1, 2016- June 30, 2017|[ ] ORIGINAL i x ] REVISION# 1 i

3 Month Allocated Federal Funding Transfers (Approved 3 Month transfers will be included in OTO Amendment)

3 MONTH TRANSFER OF FUNDS REQUEST Transfers allowed in Original Budget only

Federal Funds

JUSTIFICATIONSProvide justification for YTD Transfers of 3 Month Baseline exceeding: 30% between IIIB & MIC or 40% between IIIC-1 & IIIC-2

Current 3 Month Budget Display

Allocations

Must Net Zero New 3 Month Budget Display

AllocationsDecreaseIncreaseJustification:II B Admin 69,607 69,607

II C-1 Admin 90,422 90,422II C-2 Admin 46,235 46,235II B Ombudsman 16,425 16,425II B Program 685,291 685,291II C-1 Program 995,251 995,251II C-2 Program 508,892 508,892II E Admin 30,364 30,364II E Program 335,987 335,987

NSIP C-1 Congr Program 132,516 132,516NSIP C-2 Home Del Program 139,853 139,853

9 Month Allocated Federal Baseline Funding Transfers (9 Month transfers will be processed in the new federal fiscal year, beginning October 1)

9 MONTH TRANSFER OF FUNDS REQUEST Do Not Include OTO

Federal Funds

Current 9 Month Budget Display Baseline Alloc.

Must Net Zero New 9 Month Budget Display Baseline Alloc.

JUSTIFICATIONSProvide justification for YTD Transfers of 9 Month Baseline exceeding: 30% between IIIB & INC or 40% between IIIC-1 & IIIC-2Increase DecreaseJustification:II B Admin 208.819 208,819

II C-1 Admin 271,266 271,266II C-2 Admin 138,704 138,704II B Ombudsman 49.273 49,273II B Program 2,055,874 2,055,874II C-1 Program 2,985,752 2,985.752II C-2 Program 1,526,675 1,526,675I! E Admin 91,090 91,090II E Program 1,004.962 1.004.962NSIP C-1 Congr Program 397.548 397,548NSIP C-2 Home Del Program 419,557 419.557

12 Month Allocated State Funding Transfers (Approved transfers will be included in OTO Amendment)

12 MONTH TRANSFER OF FUNDS REQUESlCurrent 12 MontiBudget Display

Allocations

Must Net Zero New 12 Month Budget Display

Allocations

JUSTIFICATIONSProvide justification for YTD Transfers of 9 Month Baseline exceeding: 30% between IIIB & NIC or 40% between IIIC-1 & IIIC-2State Funds Increase Decrease

State B Ombudsman 0 Justification:State C-1 Admin 0State C-1 Program 0State C-2 Admin 0State C-2 Program 0

AREA PLAN BUDGET

Stale of CaliforniaDepartment of Aging

SCHEDULE OF PAID PERSONNEL COSTSCDA 122 (Rev 5/2016) Page 6 of 14

ADMIN & TITLE III DIRECT PROGRAM SERVICESI DATE: 12/5/16' PSA 25BUDGET PERIOD: July 1, 2016- June 30, 2017 ( ] ORIGINAL [ x ] REVISION# 1 CONTRACT NO.: AP-1617-25

POSITION Annual FTE FTE FTE FTE FTE DirectIII D

FTE FTE Total Title III

Direct Direct FTE Direct DirectCLASSIFICATION Admin % III B % III C-1 III C-2 % III E %Wage Rate % % %

124,501 54.0% 124,501Accountant II/3 230,285 54.0%Accounting Clerk II 60,00064,992 92.0% 60.000 92.0%.ssistant General Manager 163,745 49.0% 80,000 49.0% 98.0% 160,00080,000

61.0% 50,000Auditor I 82,381 50,00061.0%3,401Administrative Clerk 97,178 3,401 3.0%3.0%

Community Program Assistant II/2 29,754 44,754101,513 15.0% 15,000 29.0% 44.0%Community Program Assistant III 75.0% 59,631 100.0% 79,63179.531 25.0% 20,000

Executive Administrative Assistant 75.0% 30,00083,604 75.0% 30,000General Manager 160,000229,161 31.0% 70,000 90,000 31.0%Management Analyst I 20,00082,942 24.0% 24.0% 20,000

25 0% 50.000 47.0%Management Analyst II/4 293,432 5.0% 15,000 74,000 17.0% 139,000Management Assistant/4 190,261 8.0% 15,000 15,0008.0%

Nutritionist 79,845 50,000 63.0% 50,00063.0%Principal Accountant II 107,903 56.0% 60,000 56.0% 60,000Secretary 64,812 64,81277.0% 50,000 23.0% 14,812 100.0%

Social Worker II 97,81197,811 100.0% 100.0% 97,811Social Worker III 115,531 115,531 115,531100.0% 100.0%

Senior Accountant II 96,492 62.0% 60,000 62.0% 60,000Senior Auditor 103,754 58.0% 59,969 59,96958.0%Senior Administrative Clerk/2 120,013 50.0% 60,000 37.0% 44,469 87.0% 104,469Senior Management Analyst I 115,531 52.0% 60,000 48.0% 55,531 100.0% 115,531Senior Management Analyst I 115,531 26.0% 30,000 26.0% 30,000Senior Management Analyst I 115,531 26.0% 30,000 26.0% 30,000Senior Management Analyst I 115,531 26.0% 30,000 52.0% 59,890 78.0% 89,890Senior Management Analyst II 143,128 35.0% 50.741 28.0% 40,000 10,000 70.0%7.0% 100,741Senior Systems Analyst I 97,811 69.0% 67,811 31.0% 30,000 100.0% 97,811

0.0% 00.0% 00.0% 00.0% 00.0% 0

00.0%

0.0% 00.0% 0

507,539948,612 506,701 0 0 1,962,8520,TOTAL SALARIES

0PAYROLL TAXESEMPLOYEEBENEFITS

0

TOTAL PAID PERSONNEL COSTS

948,612 0 507,539506.701 0 1,962,8520

See below for additional personnel lines if needed

AREA PLAN BUDGET

State of CaliforniaDepartment of Aging

SCHEDULE OF PAID PERSONNEL COSTSCDA 122 (Rev 5/2016) Page 7 of 14

TITLE III, TITLE VII, AND SPECIAL OMBUDSMAN DIRECT PROGRAM SERVICESBUDGET PERIOD. July 1,2016- June 30, 2017 [ ] ORIGINAL [ x ] REVISION #1 CONTRACT NO : AP-1617-25 DATE' 12/5/16 PSA 25

POSITION FTE Direct VII Ombi

FTE TotalTitle III & VII

FTE Direct Omb SHF Cit Pen

FTE Direct Omb SNFQAF

TotalFTE%

Annua! FTE Direct VII FTE Direct Omb PH L&C

FTE Total Area PlanCLASSIFICATION Wage Rate % % EAP % %% %

Accountant II/3 230,285 124,501 54.0% 124,50154.0%92 0% 60,000Accounting Clerk II 64,992 92.0% 60,000

Assistant General Manager 160,000163,745 98.0% 98,0%160,000Auditor I 50,000 61.0% 50,00082,381 61.0%

3.0%Administrative Clerk 97,178 3,401 3,4013.0%Community Program Assistant II/2 44.0% 44,754101,513 44.0% 44,754Community Program Assistant III 100.0% 79,63179,631 100.0% 79,631Executive Administrative Assistant 75.0% 30,00083,604 75.0% 30,000General Manager 160,000229,161 31.0% 160,000 31.0%Management Analyst I Management Analyst II/4

20,000 24.0% 20,00082,942 24 0%293,432 47.0% 47.0% 139,000139,000

Management Assistant/4 15,000190,261 8.0% 15,000 8.0%

Nutritionist 79,845 50,000 63.0% 50,00063.0%Principal Accountant II 107,903 56.0% 60,000 56.0% 60,000Secretary 100.0%64,812 100.0% 64,81264,812Social Worker II 97,811 97,811 100.0% 97,811100.0%

Social Worker III 115,531 100.0% 115,531100.0% 115,531Senior Accountant II 96,492 62.0% 60,000 62.0% 60,000Senior Auditor 103,754 58.0% 59,969 58.0% 59,969Senior Administrative Clerk/2 120,013 87.0% 104,469 87.0% 104,469Senior Management Analyst I 115,531 100.0% 115,531 100.0% 115,531Senior Management Analyst I 115,531 26.0% 30,000 26.0% 30,000Senior Management Analyst I 115,531 26.0% 26.0%30,000 30,000Senior Management Analyst I 115,531 78.0% 89,890 78.0% 89,890Senior Management Analyst II 143,128 70.0% 100,741 70.0% 100,741Senior Systems Analyst I 97,811 100.0% 97,811 100.0% 97,8110 0 0.0% 0 0.0% 00 0 0.0% 0 0.0% 00 0 0.0% 0 0.0% 00 0 0.0%0.0% 0 00 0 0.0%0.0% 000 00 0.0% 0 0.0%

0 0 0.0% 0 0.0% 00 0 0.0% 0.0% 00

0 0 1,962,852 0 0 1,962,8520TOTAL SALARIES

00PAYROLL TAXESEMPLOYEE 0rBENEFITSTOTAL PAID PERSONNEL COSTS

1,962,8520 0 01.962,852 0 0

See below for additional personnel lines if needed

State of CaliforniaDepartment of AgingAREA PLAN BUDGET SCHEDULE OF IN-KIND PERSONNEL COSTSCDA 122 (Rev 5/2016) Page 8 of K

ADMIN, TITLE III , TITLE VII, AND SPECIAL OMBUDSMAN DIRECT PROGRAM SERVICESBUDGET PERIOD: July 1, 2016- June 30, 2017 [ ] ORIGINAL [ x ] REVISION # 1 CONTRACT NO AP-1617-25 PSA 25DATE: 12/5/16

POSITION Annual FTE FTE FTE FTE Direct FTE FTE Direct FTEDirect Direct 111 C-2

FTE Direct III D

Total Title IIICLASSIFICATION Wage Rate % Admin % III B % III C-1 % % % III E %

0.0% 00.0% 0

00.0%

0.0% 00.0% 00.0% 00.0% 00.0% 00.0% 00.0% 00.0% 00.0% 00.0% 00.0% 00.0% 0

00.0%

TOTAL SALARIES 0 0 0 0 00 0PAYROLL TAXES 0EMPLOYEE BENEFITS 0TOTAL IN-KIND PERSONNEL COSTS 00 0 0 0 0 0

POSITIONCLASSIFICATION

Annual FTE FTE Direct FTE Direct FTE Total FTE Direct Omb Direct Omb FTE Direct OmbFTE Total TotalWage Rate % VII A % Title III & VIIVII B % % PH L&C SHF Cit Pen % SNFQAF% % Area Plan

0 0 0.0% 0 0.0% 00 0 0.0% 0 00.0%

0 0 0.0% 0 0.0% 00 0 0.0% 0 0.0% 00 0 0.0% 0 00.0%

0 0 0.0% 0 0.0% 00 0 0.0% 0 0.0% 00 0.0% 00 0.0% 00 0 0.0% 0 0.0% 00 0 0.0% 0 0.0% 00 0: 0.0% 0 0.0% 00 0.0%0 0, 0.0% 00 0 0.0% 0 0.0% 00 0 0.0% 0 00.0%

0 0 0.0% 0 0.0% 00 0 0.0% 0 0.0% 0TOTAL SALARIES 0 0 0 o 0 00PAYROLL TAXES 0 0EMPLOYEE BENEFITS 0 0TOTAL IN-KIND PERSONNEL COSTS 0 00 0 0 0 0

State of CaliforniaDepartment of AgingAREA PLAN BUDGET

CDA 122 (Rev 5/2016) Page 9 of 14

SCHEDULE OF DIRECT (III B) SUPPORTIVE SERVICES, OMBUDSMAN AND OTHER SERVICES[CONTRACT NO.: AP-1617-25BUDGET PERIOD: July 1, 2016- June 30, 2017 [ ] ORIGINAL [ x ] REVISION .7 1 DATE: 12/5/16 PSA 25

(a) TotalBudgeted

(b) Non-MatchingContributions____

|(d) In-Kind"

MatchingContributions

(e) (h)ProgramIncome

StateFunds

FederalShare|(g) In-KindSERVICE CATEGORIES Costs (c) Cash (f) Cash

Supportive Services:Personal Care (In-Home)* 0Homemaker (In-Home)* 0Chore (In-Home)* 0Adult Day/Health Care (In-Home)* 0Case Management (Access)" 0Assisted Transportation (Access)* 0Transportation (Access)* 0Legal Assistance* 0Information & Assistance (Access)* 187,573 187,573Outreach (Access)* 40,000 40,000Ombudsman 0

Other Support Services:Program Development 120,000 120,000Coordination 101,691 101,691CARS Data Reporting 76,000 76,000Alzheimer's Day Care (In-Home)* 0Comprehensive Assessment (Access)* 0Health (Access) * 0Mental Health (Access) * 0Public Information (Access)* 0Residential Repairs/Modifications (In-Home)* 0Respite Care (In-Home)* 0Telephone Reassurance (In-Home)* 0Visiting (In-Home)* 0Cash/Material Aid 0Community Education 0Disaster Preparedness Materials Employment

00

Housing 0I nterpretation/T ranslation 0Mobility Management 0Peer Counseling 0Personal Affairs Assistance 0Personal/Home Security 0Registry 0Senior Center Activities 20,000 20,000Emergency Preparedness 70.000 70,000Senior Center Staffing 0Total MB Other Support Services 387,691 0 0 0 0 0 387,6910Total Direct III B 615,264 0 0 615,2640 0 0 0*Denotes Priority Services

State of CaliforniaDepartment of AgingAREA PLAN BUDGET

CDA 122 (Rev 5/2016) Page 10 of 14

SCHEDULE OF SUBRECIPIENT CONTRACTED (HI B) SUPPORTIVE SERVICES, OMBUDSMAN AND OTHER SERVICES[CONTRACT NO.: AP-1617-25BUDGET PERIOD: July 1,2016- June 30, 2017 [ ] ORIGINAL [xj REVISION# 1 DATE: 12/5/16 PSA 25

(a) Total (b) Non-Matching MatchingContributions

|(g) In-Kind"

<h)(e)Contributions Federal

ShareStateFunds

Budgeted ProgramIncome |(d) In-Kind-SERVICE CATEGORIES (f) CashCosts (c) Cash

Supportive Services:9,073 81,655Personal Care (In-Home)* 90,728

34,356 309,210Homemaker (In-Home)* 343,5667,579 68,211Chore (In-Home)* 75,790

Adult Day/Health Care (In-Home)* 0653,343Case Management (Access)* 723,627 70,284

Assisted Transportation (Access)* 0Transportation (Access)* 0Legal Assistance* 259,116 23,889 235,227Information & Assistance (Access)* 75,163 710,073785,236Outreach (Access)* 83,481 8,348 75,133Ombudsman 7,300 76,278161,249 77,671

Other Support Services:Alzheimer's Day Care (In-Home)* 0Comprehensive Assessment (Access)* 176,262 17,626 158,636Health (Access) * 77,332 70,3496,983Mental Health (Access) * 0Public Information (Access)* 0Residenital Repairs/Modifications (In-Home)* 0Respite Care (In-Home)* 0Telephone Reassurance (In-Home)* 37,334 3,733 33,601Visiting (In-Home)* 83733 75,3608,373Cash/Material Aid 0Community Education 0Disaster Preparedness Materials 0Employment 0Housing 0Interpretation/Translation 0Mobility Management 0Peer Counseling 0Personal Affairs Assistance 38,211 34,3903,821Personal/Home Security 0Registry 0Senior Center Activities 136,485 6,940 129,545Emergency Preparedness 0Senior Center Staffing 0Total Contracted IIIB Other Supp Sr/cs 549,357 47,4760 0 0 501,8810 r.

Total Contracted IIIB 3,072,150 0 0 77,6/1 283,468 2,711,0110 0Total Direct IIIB (from Page 9) 615,264615,264 0 0 00 0 0Total III B 3,687,414 0 283,468 3,326,2750 0 77,671 0*Denotes Priority Services

AREA PLAN BUDGET

State of CaliforniaDepartment of Aging

SCHEDULE OF (III C-1 & III C-2) NUTRITION AND (III D) DISEASE PREVENTION & HEALTH PROMOTION PROGRAMS

CDA 122 (Rev 5/2016) Page 11 of 14

[CONTRACT NO AP-1617-25 PSA 25[ ] ORIGINAL [ x ] REVISION# 1BUDGET PERIOD July 1.2015-June 30, 2017 DATE: 12/5/16(a) Total

Budgeted(b) !(c) Non-Matching Matching

Contributions0)(d) (g)

FederalShare

ProgramIncome

IntentionallyBlank

Contributions StateFunds|(f) In-Kind" l(i) In-Kind"NSIP (h) CashSERVICE CATEGORIES Costs (e) Cash

III C-1 Congregate Programs Direct III C-1Congregate Meals 6,0006,000

0Nutrition CounselingNutrition Education 0

0 0 0 6,000Total Direct III C-1 6,000 0 0 0 0 0Subrecipient Contracted III C-1 Services

123,442 495,632 3,845,470Congregate Meals 5,373,246 530 064 378,6380Nutrition Counseling

Nutrition Education 213,952 21,395 192,557Total Contracted III C-1 5,587,198 123,442 530,064 0 378,638 0 517,027 4,038,0270 0Total III C-1 5,593,198 123,442 •0 517,027530.064 0 0 378,638 0 4,044,027III C-2 Home Delivered Programs Direct III C-2Home-Delivered Meals 7,0007,000Nutrition Counseling 0Nutrition Education 0Total Direct III C-2 7,000 0 3 0 7,0000 0 0 0 0Subrecipient Contracted III C-2 ServicesHome-Delivered Meals 3,691,434 64,455 559.410 704,076 329,470 2,034,023Nutrition Counseling 0Nutrition Education 100,243 10,024 90,219Total Contracted III C-2 3,791,677 64,455 559,410 0 0 704,076 0 339,494 2,124,2420Total III C-2 3,798,677 64,455 559,410 0 0 0 704,076 0 339,494 2,131,242III D Disease Prevention & Health Promotion Program Direct III DDis Prev & Health Promotion 0Subrecipient Contracted III D ServicesDisease Prev & Health Promotion 217,786 217,786Total III D 217,786 0 0 Oj. 0 0 217,786

AREA PLAN BUDGET

State of CaliforniaDepartment of Aging

CDA 122 (Rev 5/2016) Page 12 of 14SCHEDULE OF FAMILY CAREGIVER SUPPORT PROGRAM SERVICES (111 E)

| DATE 12/5/16 I PSA 25j 1 ORIGINAL [ x ] REVISION # 1 CONTRACT NO : AP-1617-25E BUDGET PERIOD: July 1,2016- June 30, 2017Matching (h)(a) Total

Budgeted Costs

Non-MatchingContributions

|(d) ln-Kind~

(e)(b)FederalShare

ProgramIncome

StateFunds

Contributions|(g) In-Kind(f) CashCATEGORIES (c) Cash

Direct III E Family Caregivers213,825 562,601Information Services 88,260864,686

225,856Access Assistance 225,85663,411Support Services 63,411

0Respite Care0Supplemental Services

213,825 851,8681,153,953 88,260Total Direct III E Family Caregivers 0 0 0

Direct III E Grandparents10,648Information Services 10,648

Access Assistance 10,61910,6199,467Support Services 9,467

0Respite Care0Supplemental Services

0 30,734Total Direct III E Grandparents 30,734 0 0 00882,6021,184,687 0 88,260 213,825Total Direct III E 0 0

Subrectpient Contracted III E Family Caregiver124,318Information Services 158,868 1,000 33,550

Access Assistance 61,673 185,482248,155 1,000

228,767Support Services 305,832 1,000 76,065Respite Care 125130 31599 93,531Supplemental Services 0Total Contracted III E Family Caregivers 0 202,887 632,098837,985 3,000 00

Subrecipient Contracted 111 E GrandparentsInformation Services 0

84,196Access Assistance 113,191 1,000 27,995Support Services 0Respite Care 0Supplemental Services 0Total Contracted III E Grandparents 27,995 84,196113,191 1,000 0 00Total Subrecipient Contracted III E 0 230,882 716,294951,176 4,000 00

2,135,863 0 444,707 1,598,8964,000 0 88,260Total III E

State of CaliforniaDepartment of AgingAREA PLAN BUDGET

CDA 122 (Rev 5/2016) Page 13 of 14

BUDGETED FEDERAL ONE-TIME-ONLY|[ | ORIGINAL [ x ] REVISION# 1 |DATE: 12/5/16BUDGET PERIOD: July 1, 2016- June ;o, 2017 |psa 25CONTRACT NO: AP-1617-25

Instructions: This is not a separate budget for One-Time-Only. Include OTO costs listed below on all support pages.(a) (c) Home & (d) Innovative(b) (e) (g) (h) Home &

Comm-Based Projects1

(i) Innovative Pilot

Projects*

(f) (J)

Comm-BasedProjects''

BaselineServices

PilotProjects*

BaselineServicesSERVICE CATEGORIES Equipment Total OTO SERVICE CATEGORIES Equipment Total OTO

III B III C-2Personal Care 0 Home-Delivered Meals 332,247 339,2477,000Homemaker 0 Nutrition Counseling 0Chore 0 Nutrition Education 0Adult Day/Health Care 0 NSIP 0Case Management 20,778 20,778 Total III C-2 OTO 332,247 0 0 7,QQQ 339,247Assisted Transportation 0 Home & Innovative

PilotProjects*

Transportation 0 Comm-BasedProjects'

BaselineServicesLegal Assistance 20,22720,227 III D Equipment lotal OTO

Information & Assistance 51,177 101,17750,000 No Longer UsedOutreach N6: Longer: Used0Ombudsman 10,580 10.580 Dis. Prev & Health Prom 8,552 8,552Alzheimer's Day Care 0 Total III D OTO 8,552 0 8,5520 0Comprehensive Assessment 0Health 7,500 7,500 Home &

Comm-Based Projects*

InnovativePilotMental Health 0 Baseline

Public Information 0 III E Family Caregivers EquipmentServices Projects* Total OTOResidendential Repairs/Mods. 0 Information Services 131,947 11,000 258,947116,000Respite Care 0 Access Assistance 0Telephone Reassurance 0 Support Services 0Visiting 0 Respite Care 0Senior Ctr Activities 67,088 87,088 Supplemental Services20,000 0

0 Total Family Caregivers 131,947 11,000 258,9470 116,0000 III E Grandparents0 Information Services 00 Access Assistance 0

CARS Data Reporting 6,000 Support Services6,000 0Total III B OTO 0177,350 0 76,000 253,350 Respite Care 0

Home & Comm-Based

Projects*

Innovative Supplemental Services 0BaselineServices

Pilot Total Grandparents 00 0 0 0(It C-1 Equipment Projects* Total OTO Total III E OTO 131,947 11,000 0 116,000 258,947Congregate Meals 293,438 6,000 299,438 Home &

Comm-Based Projects*

InnovativePilot

Projects’Nutrition Counseling 0 BaselineNutrition Education 0 VII Services Equipment Total OTONSIP 0 Ombudsman (Vila) 8,614 8,614Total III C-1 OTO 293,438 0 0 6,000 299,438 Elder Abuse Prev (VIlb) 1,267 1,267

* Home & Comm-Based Projects and Innovative Pilot Projecls Require Prior Approval Please submit CDA 1031 for all OTO Projects budgeted

AREA PLAN BUDGET

Stale of CaliforniaDepartment of Aging

CDA 122 (Rev 5/2016) Page 14 of 14

SCHEDULE OF PROPERTY/EQUIPMENT TO BE PURCHASEDBUDGET PERIOD; July 1,2016- June 30, 2017 [ ] ORIGINAL [ x ] REVISION # 1 CONTRACT NO.: AP-1617-25 DATE: 12/5/16 PSA 25

(a) (b) (h) (k)(c) (d) (e) (f) (g) (i) (j) (i)

Ombi SHF Cit. Penalty

OmbiSNFQAF

AAA IIIB Supportive Services

III C-1 III C-2 Home Del.

Ill E Family Caregiver

VII Ombi PH L&C

TOTALEquipment

III D VII Elder Abuse Prev.Property / Equipment Description Admin Congregate Disease Prev. Ombudsman

AAA Admin and Direct Service Property / Equipment with per unit purchase price between $500 and $4,9997 Computers at $1,500 each 11,0000 11,000

00000000000

AAA Admin and Direct Service Property / Equipment with per unit purchase price S5.000 or more (requires Departmental approval). Please complete CDA 122P Property Supplement for each item00000000000

TOTAL AAA Admin and Direct Service Property 0 0 0 0 0 11.000 00 0 0 0 11,000

Suhrecioient Contractor Property / Equipment with per unit purchase price $5.000 or more (requires Departmental approval) Please complete CDA 122P Property Supplement for each item0000000000000

Total Contractor Property / Equipment 0 0I.0 0 0 0 0 00 0 0 0