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SHIP 3 BudgetJuly 20, 2013Minnesota Department of Health

Welcome to the SHIP 3 budget overview. Today we will be reviewing the following items: the Funding Worksheet, the Implementation Budget Form, the Innovative Budget Form and the Planning Budget Form.1SHIP 3 RFP http://www.health.state.mn.us/healthreform/ship/2013rfp/

This is the link to the SHIP 3 RFP. Also highlighted on this slide is the link to the Funding Worksheet and the Budget Forms.2SHIP 3 Funding Worksheet

The funding worksheet is in Excel. The first tab is the funding worksheet.3SHIP 3 Funding Worksheet

COMMUNITY HEALTH BOARD POPULATION Max $1.76/Capita *2011 State Demographer Est AITKIN-ITASCA-KOOCHICHING 74,457 $ 131,044 ANOKA 334,053 $ 587,933 BECKER 32,770 $ 57,675 BENTON 38,558 $ 67,862 BLOOMINGTON 83,671 $ 147,261 BLUE EARTH 64,383 $ 113,314 BROWN-NICOLLET 58,705 $ 103,321 CARLTON-COOK-LAKE-ST.LOUIS 251,673 $ 442,944 CARVER 92,104 $ 162,103 CASS 28,396 $ 49,977 CHISAGO 53,929 $ 94,915 CLAY-WILKIN 66,228 $ 116,561 COTTONWOOD-JACKSON 21,885 $ 38,518 COUNTRYSIDE (BIG STONE-CHIPPEWA-LAC QUI PARLE-SWIFT-YELLOW MEDICINE) 44,775 $ 78,804 CROW WING 62,745 $ 110,431 DAKOTA 401,221 $ 706,149 DODGE-STEELE 56,773 $ 99,920 EDINA 48,262 $ 84,941 FARIBAULT-MARTIN 35,222 $ 61,991

The second tab of the funding worksheet contains Community Health Board (CHB) populations. You will use this information to complete the funding worksheet.4SHIP 3 Funding WorksheetDetermine Number of Community Health Boards (CHB) collaborating- enter number. There is an incentive of $10,000 per CHB, each fiscal year.1 SHIP 3 Funding Worksheet November 1,2013 - June 30, 2015 Applicant: FY14Nov 1, 2013- June 30, 2014 FY15July 1, 2014-June 30, 2015 Total Implementation Base Funding $ 100,000 $ 100,000 $ 200,000 Single Work plan Incentive For two or more CHB's to work together Number of CHB'S included in the application: 2

$ 20,000 $ 20,000 $ 40,000 Per Capita Request Population included in the application:

Implementation per capita amount: $ 1.76

$ - $ - $ - Maximum $1.76 per capita Subtotal $ 120,000 $ 120,000 $ 240,000 Innovative Request for Innovative Approaches

$ - $ - $ - Grand Total $ 120,000 $ 120,000 $ 240,000

The funding worksheet is for implementation grantees only. It will help you determine what your maximum award could be. Step 1 - fill in box number one if your application includes two or more CHBs working together, otherwise you may leave it blank. In the example, two CHBs are working together. Once you put the number of CHBs in box number one, the columns to the right will auto fill, in the example it auto fills with $20,000 each year for 2 CHBs working together. 5SHIP 3 Funding WorksheetTo determine your population count, go to the per capita tab and select the population(s) for the CHB(s). For multi-county CHBs and/or more than one CHB working together, please add the populations together and insert the total.2 SHIP 3 Funding Worksheet November 1,2013 - June 30, 2015 Applicant: FY14Nov 1, 2013- June 30, 2014 FY15July 1, 2014-June 30, 2015 Total Implementation Base Funding $ 100,000 $ 100,000 $ 200,000 Single Work plan Incentive For two or more CHB's to work together Number of CHB'S included in the application: 2

$ 20,000 $ 20,000 $ 40,000 Per Capita Request Population included in the application: 60,000

Implementation per capita amount: $ 1.76

$ 105,600 $ 105,600 $ 211,200 Maximum $1.76 per capita Subtotal $ 225,600 $ 225,600 $ 451,200 Innovative Request for Innovative Approaches

$ - $ - $ - Grand Total $ 225,600 $ 225,600 $ 451,200

Step 2 - on the funding worksheet you will need to determine your population count. Please go to the second tab on the worksheet named Per Capita 6SHIP 3 Funding Worksheet

COMMUNITY HEALTH BOARD POPULATION Max $1.76/Capita *2011 State Demographer Est AITKIN-ITASCA-KOOCHICHING 74,457 $ 131,044 ANOKA 334,053 $ 587,933 BECKER 32,770 $ 57,675 BENTON 38,558 $ 67,862 BLOOMINGTON 83,671 $ 147,261 BLUE EARTH 64,383 $ 113,314 BROWN-NICOLLET 58,705 $ 103,321 CARLTON-COOK-LAKE-ST.LOUIS 251,673 $ 442,944 CARVER 92,104 $ 162,103 CASS 28,396 $ 49,977 CHISAGO 53,929 $ 94,915 CLAY-WILKIN 66,228 $ 116,561 COTTONWOOD-JACKSON 21,885 $ 38,518 COUNTRYSIDE (BIG STONE-CHIPPEWA-LAC QUI PARLE-SWIFT-YELLOW MEDICINE) 44,775 $ 78,804 CROW WING 62,745 $ 110,431 DAKOTA 401,221 $ 706,149 DODGE-STEELE 56,773 $ 99,920 EDINA 48,262 $ 84,941 FARIBAULT-MARTIN 35,222 $ 61,991

Add up your population counts(s), and insert this number into box 2 on the funding worksheet. 7SHIP 3 Funding WorksheetTo determine your population count, go to the per capita tab and select the population(s) for the CHB(s). For multi-county CHBs and/or more than one CHB working together, please add the populations together and insert the total.2 SHIP 3 Funding Worksheet November 1,2013 - June 30, 2015 Applicant: FY14Nov 1, 2013- June 30, 2014 FY15July 1, 2014-June 30, 2015 Total Implementation Base Funding $ 100,000 $ 100,000 $ 200,000 Single Work plan Incentive For two or more CHB's to work together Number of CHB'S included in the application: 2

$ 20,000 $ 20,000 $ 40,000 Per Capita Request Population included in the application: 60,000

Implementation per capita amount: $ 1.76

$ 105,600 $ 105,600 $ 211,200 Maximum $1.76 per capita Subtotal $ 225,600 $ 225,600 $ 451,200 Innovative Request for Innovative Approaches

$ - $ - $ - Grand Total $ 225,600 $ 225,600 $ 451,200

For multi-county CHBs and or more than 1 CHB working together please add the populations together and insert the total.8SHIP 3 Funding WorksheetCreate a budget for work proposed under the cap of $1.76 per capita per fiscal year. If the proposed work will cost less than the cap, adjust the per capita rate accordingly. This is a 20 month budget but caps per fiscal year must be followed.3 SHIP 3 Funding Worksheet November 1,2013 - June 30, 2015 Applicant: FY14Nov 1, 2013- June 30, 2014 FY15July 1, 2014-June 30, 2015 Total Implementation Base Funding $ 100,000 $ 100,000 $ 200,000 Single Work plan Incentive For two or more CHB's to work together Number of CHB'S included in the application: 2

$ 20,000 $ 20,000 $ 40,000 Per Capita Request Population included in the application: 60,000

Implementation per capita amount: $ 1.76

$ 105,600 $ 105,600 $ 211,200 Maximum $1.76 per capita Subtotal $ 225,600 $ 225,600 $ 451,200 Innovative Request for Innovative Approaches

$ - $ - $ - Grand Total $ 225,600 $ 225,600 $ 451,200

Step 3 will be to create a budget for work proposed under the cap of $1.76 per capita for each fiscal year. If the proposed work will cost less than the cap, adjust the per capita rate accordingly. This is a 20 month budget but caps per fiscal year must be followed. 9SHIP 3 Funding WorksheetCreate your budget based on the work proposed, enter total request in box 4. This is a 20 month budget but caps per fiscal year must be followed. 4 SHIP 3 Funding Worksheet November 1,2013 - June 30, 2015 Applicant: FY14Nov 1, 2013- June 30, 2014 FY15July 1, 2014-June 30, 2015 Total Implementation Base Funding $ 100,000 $ 100,000 $ 200,000 Single Work plan Incentive For two or more CHB's to work together Number of CHB'S included in the application: 2

$ 20,000 $ 20,000 $ 40,000 Per Capita Request Population included in the application: 60,000

Implementation per capita amount: $ 1.76

$ 105,600 $ 105,600 $ 211,200 Maximum $1.76 per capita Subtotal $ 225,600 $ 225,600 $ 451,200 Innovative Request for Innovative Approaches $ 40,000

$ 20,000 $ 20,000 $ 40,000 Grand Total $ 245,600 $ 245,600 $ 491,200

Step 4 - if you are an implementation grantee requesting funds for an innovative approach enter your budget based upon the work proposed in box 4. The total request will automatically be divided equally between fiscal years. This is a 20 month budget, but caps per fiscal year must be followed. Your total SHIP 3 budget will then be calculated at the bottom. Verify the request is correct. You will note that you will have your base funding, plus any incentives, and your per capita request, combined with any innovative approach funding totaled at the bottom10SHIP 3 RFP http://www.health.state.mn.us/healthreform/ship/2013rfp/

The budget instructions can be found on the SHIP RFP page. Click on the Implementation Applicant Documents in the table of contents you will find the Budget Narrative Instructions and the Budget narrative. Use this information to help you complete your budget forms. Here you will also find clarity on what type of expense belongs under each of the line items.

11SHIP 3 Implementation Budget FormSHIP 3 Implementation Budget FormStrategy-Specific Budget FormGrantee NameBudget Contact PersonPhoneE-mail addressBudget for November 1, 2013 - June 30, 2015 REQUIRED SELECTIONSLine ItemSCHOOLSCOMMUNITYOVERALLANTICIPATEDADMIN Healthy School FoodActiveSchoolDayTobacco Free LivingHealthy Food in the Community

Childcare

Active LivingBUDGET MATCHEXPENSESSalary and Fringe Benefits0Contractual Services0Travel0Supplies and Equipment0Other0Administrative Costs0Total000000000 REQUIRED SELECTIONS (cont.) OPTIONAL SELECTIONSWORKSITEHEALTH CARETOBACCO CONTEROLLine Item

WorksiteWellness

Community-ClinicalLinkagesAdvance Community Linkages with State and Federal Health Reform Initiatives

Type Strategy Here

Type Strategy Here

Type Strategy Here

Salary and Fringe BenefitsContractual ServicesTravelSupplies and EquipmentOtherAdministrative CostsTotal000000The applicant certifies that SHIP funds will be used to develop new activities, expand or modify current activities that work to reduce obesity and tobacco use, and/or replace discontinued funds from the state, the federal government, or another third party previously used to reduce obesity and tobacco use. The applicant will not voluntarily opt to use SHIP funds to replace federal, state, local, or tribal funding they currently use to reduce tobacco use and exposure or prevent obesity.

The first tab of the SHIP 3 Budget forms is to be completed by SHIP Implementation Grantees. As you complete the costs in your strategic areas the overall budget will auto fill with your totals. Adjust your funding worksheet to match these totals staying under the $1.76 per capita.

12SHIP Innovative Budget FormSHIP 3 Innovative Budget FormGrantee NameBudget Contact PersonPhoneE-mail addressBudget Form for November 1, 2013 - June 30, 2015Line ItemINNOVATIVE STRATEGIESOVERALLANTICIPATEDADMIN Type Strategy hereType Strategy hereType Strategy hereBUDGET MATCHEXPENSESSalary and Fringe Benefits0Contractual Services0Travel0Supplies and Equipment0Other0Administrative Costs0Total000000The applicant certifies that SHIP funds will be used to develop new activities, expand or modify current activities that work to reduce obesity and tobacco use, and/or replace discontinued funds from the state, the federal government, or another third party previously used to reduce obesity and tobacco use. The applicant will not voluntarily opt to use SHIP funds to replace federal, state, local, or tribal funding they currently use to reduce tobacco use and exposure or prevent obesity.

The next tab of the SHIP Budget forms is also only for implementation grantees. This is for your innovative budget. Again the overall budget will auto fill with your totals. Adjust your funding worksheet to match these totals.

13SHIP 3 Budget Form for Planning GranteesSHIP 3 Budget Form for Planning GranteesBUDGET FORMBudget Contact Person's NamePhoneE-mail addressBudget for November 1, 2013 - June 30, 2014Line ItemRequested FundingAnticipated MatchSalary and Fringe BenefitsContractual ServicesTravelSupplies and EquipmentOtherAdministrative CostsTotal00The applicant certifies that SHIP funds will be used to develop new activities, expand or modify current activities that work to reduce obesity and tobacco use, and/or replace discontinued funds from the state, the federal government, or another third party previously used to reduce obesity and tobacco use. The applicant will not voluntarily opt to use SHIP funds to replace federal, state, local, or tribal funding they currently use to reduce tobacco use and exposure or prevent obesity.

The last tab of the SHIP budget forms is for planning grantees to fill in their budget for planning. The cap for planning grantees is $100,000.00. Implementation grantees do not need to complete this form.

14Contacting Minnesota Department of HealthSubmit your questions on the Request for Proposals (RFP) by e-mail to health.makingitbetter@state.mn.us. Individual MDH staff persons are not authorized to respond, and any contact or attempted contact regarding this RFP with any other MDH personnel could result in disqualification.

MDH will post all questions and responses on the website at www.health.state.mn.us/healthreform/ship/2013rfp/ as a resource for all interested parties. The last date to submit questions to MDH is August 23, 2013.

For further questions regarding the RFP or any forms, please send an e-mail to the address listed. Further, all questions and responses regarding the RFP and forms that have already been asked are listed at the site below. Please check there before submitting your questions.15Funding WorksheetSHIP 3 Funding WorksheetNovember 1,2013 - June 30, 2015Applicant:FY14Nov 1, 2013- June 30, 2014FY15July 1, 2014-June 30, 2015TotalImplementationBase Funding$100,000$100,000$200,000Single Work plan IncentiveFor two or more CHB's to work togetherNumber of CHB'S included in the application:0.00.00.0Per Capita RequestPopulation included in the application:Implementation per capita amount:$1.760.00.00.0Maximum $1.76 per capitaSubtotal$100,000$100,000$200,000InnovativeRequest for Innovative Approaches0.00.00.0Grand Total$100,000$100,000$200,000Determine Number of Community Health Boards (CHB) collaborating- enter number. There is an incentive of $10,000 per CHB, each fiscal year.To determine your population count, go to the per capita tab and select the population(s) for the CHB(s). For mulit-county CHBs and/or more than one CHB working together, please add the populations together and insert this populationCreate a budget for work proposed under the cap of $1.76 per capita per fiscal year. If the proposed work will cost less than the cap, adjust the per capita rate accordingly. This is a 20 month budget but caps per fiscal year must be followed.Create your budget based on the work proposed, enter total request in box 4.The availability of funding for Implementation and Innovative grants are based on assumptions made regardingthe applicant pool. The state reserves the right to adjust as necessary.

Per CapitaCOMMUNITY HEALTH BOARDPOPULATIONMax $1.76/Capita*2011 State Demographer EstAITKIN-ITASCA-KOOCHICHING74,457$131,044ANOKA334,053$587,933BECKER32,770$57,675BENTON38,558$67,862BLOOMINGTON83,671$147,261BLUE EARTH64,383$113,314BROWN-NICOLLET58,705$103,321CARLTON-COOK-LAKE-ST.LOUIS251,673$442,944CARVER92,104$162,103CASS28,396$49,977CHISAGO53,929$94,915CLAY-WILKIN66,228$116,561COTTONWOOD-JACKSON21,885$38,518COUNTRYSIDE (BIG STONE-CHIPPEWA-LAC QUI PARLE-SWIFT-YELLOW MEDICINE)44,775$78,804CROW WING62,745$110,431DAKOTA401,221$706,149DODGE-STEELE56,773$99,920EDINA48,262$84,941FARIBAULT-MARTIN35,222$61,991FILLMORE-HOUSTON39,801$70,050FREEBORN31,160$54,842GOODHUE46,168$81,256HENNEPIN607,878$1,069,865HORIZON (DOUGLAS-GRANT-POPE-STEVENS-TRAVERSE)66,408$116,878ISANTI-MILLE LACS64,212$113,013KANABEC-PINE45,817$80,638KANDIYOHI-RENVILLE57,658$101,478LE SUEUR-WASECA46,821$82,405MEEKER-MCLEOD-SIBLEY74,924$131,866MINNEAPOLIS387,873$682,656MORRISON-TODD-WADENA71,744$126,269MOWER39,281$69,135NOBLES-ROCK31,009$54,576NORTH COUNTRY (BELTRAMI-CLEARWATER-HUBBARD-LAKE OF THE WOODS)78,436$138,047OLMSTED145,379$255,867OTTER TAIL57,243$100,748POLK-NORMAN-MAHNOMEN43,789$77,069QUIN COUNTY(KITTSON-MARSHALL-PENNINGTON-RED LAKE-ROSEAU)47,660$83,882RAMSEY510,810$899,026RICE64,717$113,902RICHFIELD35,376$62,262SCOTT131,556$231,539SHERBURNE88,954$156,559STEARNS150,996$265,753SWHHS (LINCOLN-LYON-MURRAY-PIPESTONE-REDWOOD-ROCK)65,921$116,021WABASHA21,589$37,997WASHINGTON240,640$423,526WATONWAN11,197$19,707WINONA51,386$90,439WRIGHT126,033$221,818