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2008-2009 Funded Personnel <br />Name of Organization: SHARE OUR SELVES <br />Name of Program SOS Free Medical and Dental Clinic <br />NOTE: Please remember that this is only a budget and that reimbursement should be based on actual service. <br />ADMINISTRATIVE STAFF <br />Position Title Annual Annual Total <br />Salary Benefits Compensation <br />CDBG Funds <br />Requested for <br />this position <br />Of this time <br />percent of <br />time serving <br />Santa Ana <br />Maximum <br />Amount of <br />eligible <br />Complensation <br />Of this time <br />percent of <br />time serving <br />Santa Ana <br />Maximum <br />Amount of <br />eligible <br />Complensation <br />Dental Director $ 140,400 <br />$ 21,060 <br />$ 161,460 <br />$ 5,000 <br />25% <br />$ 40,365.00 <br />Physician Assistant $ 87,360 <br />$ 13,104 <br />$ 100,464 <br />$ 5,000 <br />25% $ <br />25,116.00 <br />Total Amount Requested <br />$ - <br />Total Amount Requested <br />$ <br />Must equal amount indicated on Exhbit B <br />PROGRAM STAFF <br />Position Title Annual <br />Salary <br />Annual <br />Benefits <br />Total <br />Compensation <br />CDBG Funds <br />Requested for <br />this position <br />Of this time <br />percent of <br />time serving <br />Santa Ana <br />Maximum <br />Amount of <br />eligible <br />Complensation <br />Dental Director $ 140,400 <br />$ 21,060 <br />$ 161,460 <br />$ 5,000 <br />25% <br />$ 40,365.00 <br />Physician Assistant $ 87,360 <br />$ 13,104 <br />$ 100,464 <br />$ 5,000 <br />25% $ <br />25,116.00 <br />Total Amount Requested <br />$ - <br />Is <br />I <br />$ - <br />$ <br />I <br />$ - <br />Total Amount REguested <br />$ 10,0001 <br />Must equal amount indicated on Exhbit B <br />CONTRACTUAL/PROFESSIONAL SERVICES <br />Type of Service Annual Contract Amount Total <br />Compensation <br />CDBG Funds <br />Requested for <br />this position <br />Of this time Maximum <br />percent of Amount of <br />time serving eligible <br />Santa Ana Complensation <br />Total Amount Requested <br />$ - <br />Must equal amount indicated on Exhbit B <br />***Please note for personnel whose time is not directly traced to serving Santa Ana and instead a percentage is used please <br />confirm the percentage is accurate prior to requesting reimbursement. <br />Exhibit B-1 <br />Page 1 of 1 <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/0! <br />#DIV/O! <br />#DIV/0! <br />#DIV/0! <br />