STUDENT SERVICE FEE REQUEST FOR 2015-2016FISCAL YEAR 2016

Name of Unit: H0207/ Health CenterFY 2014 FY 2014 FY 2015 FY 2015 FY 2016

Cost Center -note where SFAC Approved Budlet Actual Budget for Approved Bud,et for Projected Actual for Budget Request for

Funding Sources (All) funds to be transferred for 2013-2014 2013-2014 2014-2015 2014-2015 2015-2016Student Service Fees-Base Request (Include any merit ormandated increases) 3049-H0207·10366·NA 1,741,541.00 1,818,388.00 1,741,541.00 1,741,541.00 1,741,541.00

Student Service FeesOne-TIme Allocation-FY2014Student Service Fees One-nme Aliocation·FY2015Student Service FeesOne-TIme Allocation-FY2016Student Service Fees OTFund EquityRolloverDedicated Fees-Base BudgetIncome from all other sourcesl

Faculty/Staff Visits 9,135.00 7,580.00 11,000.00 11,000.00 11,000.00Women's Clinic 122,679.36 47,833.00 150,000.00 51,000.00 51,000.00Physician Visit 126,593.40 137,468.10 150,000.00 150,000.00 150,000.00Orthopedics 11,663.00 13,544.88 12,000.00 15,000.00 15,000.00PsychiatryVisit 39,780.00 44,975.00 40,000.00 46,000.00 46,000.00Visitors 2,345.00 2,680.00 2,345.00 4,000.00 4,000.00Dermatology 10,240.00 0.00 0.00 0.00 0.00Health Insurance Administration Fees 237,775.58 18,359.00 237,775.00 19,000.00 19,000.00Procedures 13,419.00 12,904.00 13,419.00 14,000.00 14,000.00Men's Clinic 7,245.00 9,330.00 8,000.00 11,000.00 11,000.00Nurse Visit 43.00 40.00 500.00 0.00 0.00X-Rays 5,795.00 20,225.00 5,795.00 0.00 0.00LabAnaly'is/Te,t, 254,581.64 351,787.69 275,000.00 360,000.00 360,000.00Treatment Room/OR/ER 2,810.60 100.00 2,810.60 0.00 0.00Clinic RX 73,974.22 166,508.42 75,000.00 170,000.00 170,000.00Miscellaneous/Medical Records Requests 13,997.00 7,046.00 15,000.00 8,000.00 8,000.00Student Financial Collections 10,780.00 7,523.00 10,780.00 11,000.00 11,000.00OVer/Short-ChangeFund "c' 800.00 0.00 800.00 800.00 800.00Dental Clinic 10,220.00 16,062.00 15,000.00 17,000.00 17,000.00

IPrescription/OVer-the-Counter Medicine, 560,000.00 614,589.95 600,000.00 630,000.00 630,000.00Gifts/Donations 0.00 50,000.00IAttendant Care Service, 300,000.00 75,141.87 300,000.00 76,000.00 76,000.00

Funds moved to reserve cost centerCashOVer/Short

Sub-total of Income 3,555,417.80 3,372,085.91 3,716,765.60 3,335,341.00 3,335,341.00

.x-. 0.00 0.00 0.00 0.00 0.0058.96 404.95 0.00 154.00 139.00

'" 0.00 0.00 0.00 0.00 0.000.00 20.24 0.00 0.00 0.00

Sub-total of deductions from Income 58.96 425.19 0.00 154.00 139.00

TOTALINCOME 315551358.84 3137U60.72 3?161765.60 3,335,187.00 3,335,202.00

234,446.56 I Initial, Dept. HeadInitialsCertifying ~~Initial, Completed by tRP

Deductions from IncomeStudent Fee WaiversBadDebt

FY14Fund3049Addition to Fund Equity FR

FY2014 FY 2014 FY 2015 FY 2015 FY 2016Cost Center -nete where SFAC Approved Budset Actual Budget for Approved Budaet for Projected Actual for Budget Request for

Expenses funds tobe transferred for 2013-2014 2013-2014 2014-2015 2014-2015 2015-2016Salorl.. and Wases I Selecton.

Exempt Category Employee Salaries SSF(3049)I Other 14!l'I!D 1,207,067.00 1,402,564.27 1,669,871.18 1,450,000.00 1,550,000.00Non~Exempt Employee Salaries 5SF(3049)I<tllh~1 Both 437,415.00 555,242.81 428,688.00 525,000.00 525,000.00Lump5umWages (Itemize below) SSF(3049)~ Both 120,000.00 0.00 140,000.00 0.00 0.00

Student Workers (NCWS) SSF(3049)I Other I Both 0.00 0.00 0.00 0.00 0.00Student Workers (Graduate Students) SSF(3049)I ~ I Both 0.00 0.00 0.00 0.00 0.00Student leader Stipends SSF(3049)/ Other I Both 0.00 0.00 0.00 0.00 0.00Other Temporary Workers SSF(3049)/ Other I Both 0.00 0.00 0.00 0.00 0.00

Mandated/Merit Increments SSF(3049)/ Other I Both 0.00 0.00 0.00 0.00 0.00EquityAdjustments (SalaryEquity) SSF(3049)I Other / Both 0.00 0.00 0.00 0.00 0.00Overtime SSF(3049)I~ Both 500.00 0.00 500.00 0.00 0.00

TotaI5.larf .. and Waces 1,764,982.00 1,957,807.08 2,239,059.18 1,975,000.00 2,075,000.00

Fringe Benefits Select oneFICA SSF(3049)I Other t<. 19lb) 120,000.00 145,489.23 230,468.40 145,000.00 14S,000.00Insurance SSF(3049)/ Other / !!l: 151.000.00 203,906.24 186,565.08 200,000.00 200,000.00Retirement SSF(3049)/ Other / 0!!J,: 91,000.00 124,930.03 112,310.14 125,000.00 125,000.00Unemployment SSF(3049)/ Other I oth 9,300.00 11,029.26 10,488.90 11,000.00 11,000.00Worker's Compensation SSF(3049)/ Other / !!l: 8,000.00 9,023.91 8,578.81 9,000.00 9,000.00EmployeeBenefits Vacation Pool (.5%benefits eligible

SSF(3049)I Other ~staff) 0.00 0.00 9,218.00 9,218.00longevity SSF(3049)I Other /~ 21,000.00 24,277.96 20,940.00 21,000.00 21,000.00

400,300.00 518,656.63 569,351.33 520,218.00 520,218.00

Other Expenses Select oneInformation Technology Charge (formerly telephone

SSF(3049)~/ Bothexpenses) 17,950.00 24,080.80 17,950.00 24,000.00 24,000.00Postage/Freight SSF(3049)~ Both 420.00 357.62 1,952.92 300.00 0.00Printing-On/OffCampus SSF(3049)1<JJf5!!)I Both 2,300.00 4,756.00 9,436.61 4,000.00 4,000.00OfficeSupplies / Other I Both 17,000.00 17,667.62 17,000.00 15,000.00 15,000.00ClinicSupplies / Other / Both 25,000.00 32,307.09 58,000.00 30,000.00 30,000,00LabAnalysis/X-Rays / Other / Both 125,000.00 130,682.72 170,000.00 120,000,00 120,000.00Equipment/Maintenance/Software/Rental SSF(3049)I«:~I Both 18,000.00 28,982.25 25,000.00 30,000.00 30,000,00Travel ~IntelViewees ~/ Other / Both 0.00 921.44 0.00 3,500.00 0,00Travel- AirfarelOther 5S~ / Other / Both 2,800.00 7,224.42 33,500.00 5,000.00 5,000,00Business Meals S~/Other/Both 8,000.00 1,652.00 5,000.00 1,000.00 1,000.00Credit Card Usage Fee SSF(3049)I<Qi!iDI Both 9,000.00 7,022.91 10,000.00 7,000.00 7,000.00Utilities .'I-I~'" 13,500.00 19,188.25 33,033.45 19,000.00 19,000,00Hazardous Waste Disposal/Gases SSF(3049)/ Both 0.00 1,061.54 1,287.50 1,000.00 1,000,00Cost of Goods Sold SSF(3049)/ / Both 3,300.00 287,631.75 60,000.00 260,000.00 200,000.00Temp Personnel Services SSF(3049) / Both 130,000.00 77,742.00 130,000.00 100,000.00 70,000.00Laundry& CleaningServices S~/ Other /80th 2,700.00 884.15 7,000.00 800.00 800.00Advertising/Promotional Items SSF(3049)I Other / §lml) 2,000.00 9,300.98 5,000.00 9,000.00 8,000,00Employee Uniforms SSF(3049)~ Both 0.00 4,948.96 0.00 500.00 500,00Insurance - Property & Liability SSF(3049)l~ Both 32,000.00 24,070.11 32,000.00 20,000.00 20,000,00Lease- OfficeSpace/Rental SSF(3049)ICJJiDI 80th 0.00 13,278.58 0.00 13,000.00 13,000,00Memberships/Prof Fees/Llcen.. " S~/ Other / Both 2,500.00 9,019.64 15,000.00 5,000.00 5,000.00Reference Materials SSF(3049) /I{}! 'il!J/Both 0.00 550.05 0.00 600.00 600.00Parking S5F(3049) /<Q! tJ)1 Both 7,000.00 7,228.62 20,402,44 7,000,00 7,000.00WorkOrders SSF(3049) /1!Jl ~/Both 0.00 4,483.26 0.00 2,000,00 2,000.00AdminCharge (6% of total expenses) SSF(3049)/ Ot er / ~ 39,000.00 157,954.85 73,201.38 157,000.00 157,000.00

TOI.IOtherExpenses ..;45;;7;':'.;.47;.;0;;..00;.;.__ ..;8;.;72=,99=7'.;.6~1 -,7~Z.;:4'_764.;;.;,;.30 .;8.;.3.;:4'_7~OO;.;.00;;.;;..7;.;3;.;9;:.;,900;.;.;;;.OO;;...

T~al~penses-=a=~2~,6~2~2r~75~2~.00~__ ~3~13~4~9~,46~1.~3~2 ~3~r5~3~3r~1~74_.8~1~~3~,3~2~9r~9~18~.~00~a3~r~33~5~r1~1~8~,00~

Balance (Incom. (es. ~penses) ~9:;:3~2,.::606~.84::;:.__ ...:2~2i1i,1;.;:9;;;9.;;:4;;;0~1~8i:03ro:5;:;9O;:;..;;79:.,,__ ~.-:5r~2.:;:;69;;;.~00~ ...:84~:2!L.:::..

To the best of mv knowldege this report is accurate and reflects the unit's priorities. The figures provided have been checked and verified.(print names & UH affiliation next to all signatures.)Signature of Department Head:

Asst VP, Student Affairs Health and Wellness /Interim Health Center Executive DirectorTitle:Date:

Other AVP required Signatures/dates d~ /cr-d.;)..-(~- FI:;:SO;:::S;Udent AffairsHealthandwellnss

Form completed by:sam~

lastupdated 1017114CertifyingSignature & Date:KimberlyBarrow

Lindsay Barber