Department of Health 3450000

FORM B

New York State Consultant Services

Contractor's Annual Employment Report

Report Period: April 1, 2020 to March 31 2021

Contracting State Agency Name: New York State Department of Health

Contract Number: CO25147 Agency Business Unit: DOH01

Contract Term: 08/20/2010 to 08/31/2023 Agency Department ID: 12000

Contractor Name: MAXIMUS, Inc.

Contractor Address: 11419 Sunset Hills Road, Reston VA 20190

Description of Services Being Provided: Operate the Enrollment Center and NYS of Health for NYS Health InsurancePrograms

Scope of Contract (Choose one that best fits):

0 Analysis 0 Evaluation 0 Research D Training

O Data Processing Li Computer Programming DOther IT consulting

o Engineering 0 Architect Services Li Surveying EJ Environmental Services

0 Health Services D Mental Health Services

El Accounting Li Auditing Li Paralegal Li Legal X Other Consulting

Number of Number of Hours Amount PayableEmployment Category Employees Worked Under theContract

Business Intelligence Analysts 15-119908 76.07 153,363.30 $8,788,127.35

Compliance Officers 13-1041.00 5.80 11,689.90 $692,934.31

Computer Systems Engineers/Architects 15-1199.02 8.16 16,501.00 $1,216,281.58

Computer User Support Specialists 15-11S1.00 46.50 93,621.10 $4,964,710.28

Customer Service representatives 43-4051.00 1,707.73 3,435,247.60 $113,534,392.43

Data Entry Keyers 43-9021.00 25.50 51,410.50 $1,403,230.84

Database Architects 15-1199.06 6.15 12,343.20 $1,271,485.44

Financial Analysts 13-2051.00 4.13 8,321.70 $471,105.95

Financial Managers 11-3031.00 3.20 6,451.00 $646,388.00

General and Operations Managers 11-1021.00 51.66 104,154.00 $8,098,397.64

Human Resources Managers 11-3121.00 13.94 28,107.85 $2,248,505.79

Human Resources Specialists 13-1071.00 19.14 38,579.70 $2,064,757.73

Information Technology Project Managers 15-1199.09 11.92 23,999.35 $2,895,586.82

Managers, All Other 11-9199.00 12.76 25,722.20 $2,052,899.87

Market Research Analysts and Marketing Specialists 13- 6.22 12,536.50 $684,317.101161.00

Network and Computer Systems Administrators 15-1142.00 18.30 36,887.50 $3,447,232.46

Office and Administrative Support Workers, All Other 43- 20.14 40,611.30 $1,746,317.239199.00

Office Clerks, General 43-9061.00 14.46 29,166.70 $1,223,658.87

Postal Service Mail Sorters, Processors, and Processing 35.04 70,644.90 $1,880,203.04Machine Operators 43-5053.00

Quality Control Analysts 19-4099.01 74.82 150,830.60 $7,358,104.63

Security Guards 33-9032.00 30.56 61,795.65 $1,514,433.15

Software Developers, Applications 15-1132.00 66.36 133,814.91 $11,310,847.77

Software Quality Assurance Engineers and Testers 15- 19.89 40,127.56 $4,045,511.831199.01

Technical Writers 27-3042.00 0.00 4.00 $322.72

Telecommunications Engineering Specialists 15-1143.01 8.31 16,755.70 $1,359,495.29

Training and Development Managers 11-3131.00 9.90 19,952.50 $1,582,028.63

Training and Development Specialists 13-1151.00 63.24 127,498.00 $5,904,547.94

Grand Total • 2,359.92 4,750,138.22 $192,405,824.66

Name of person who prepared this report: Ferdinand Morales

Title: Vice-President, Health East Division Phone #: 518-649-8471

Preparer's Signature:

Date Prepared: 511311 0

(Use additional pages, if necessary) Page 2 of 2

FORM B

New York State Consultant ServicesContractor's Annual Employment Report

Report Period: April 1, 2020 to March 31, 2021

Contracting State Agency Name: _J_nowContract Number: CO27557 Agency Business Unit: DOHOIContract Term: to 10/1/2019 to 9/30/2022 Agency Department ID: 3450000Contractor Name: MAXIMUS Health Services, Inc.Contractor Address: 11419 Sunset hills Road, Reston,VA 20190Description of Services Being Provided: Enrollment Broker /Conflict Free Assessment


o Analysis 0 Evaluation 0 Research 0 TrainingEl Data Processing 0 Computer Programming 0 Other IT consultingo Engineering El Architect Services 0 Surveying El Environmental ServicesZ Health Services 0 Mental Health ServicesO Accounting 0 Auditing El Paralegal 0 Legal El Other Consulting

Number of Number of Amount PayableEmployment Category Employees Hours Worked Under the ContractAdministrative Services Manager 11-

0.77 1,536.50 103,270.433011.00Business Intelligence Analysts 15-1199.08 6.44 12,865.90 957,868.29Computer and Information Systems Mgr. 11- 7.88 15,831.10 1,922828.453021.00Computer Systems Analysts 15-1051.00 26.61 51,234.85 5,063,670.27Computer User Support Specialists 15- 7.45 14,981.50 725,131.231151.00Customer Service representatives 43-

259.01 503,593.31 17,063,290.624051.00Financial Managers 11-3031.00 1.92 3,853.00 437,143.84General and Operations Managers 11- 38.03 76,433.20 6,714,568.511021.00Human Resources Manager 11-3040.00 2.02 4,075.10 362,926.53Human Resources, Training and Labor

2.24 4,507.90 277,352.40Relations Spec. 13-1079.99Inspectors 51-9061.00 54.85 110,343.40 4,700,187.26

Total this page

407.21799,255.76

38,328,237.83

Grand Total 721.95 1,365,328.07 82,589,208.36

Name of person who prepared eport: Wilfred Sathasivam Phone #: 917-228-5611Title: Finance Director

Preparers Signature:____________________________________Date Prepared: 4/7/21

,-


AC 3272-S (Effective 4/12)

FORM B

New York State Consultant Services Contractor’s Annual Employment Report Report Period: April 1, 2020 to March 31, 2021

Contracting State Agency Name: Department of Health Contract Number: C029859 Agency Business Unit: DOH01 Contract Term: 02/01/2015 to 07/31/2021 Agency Department ID: 3450000 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: NYS Medicaid


Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting 0

Employment Category Number of Employees

Number of Hours Worked

Amount Payable Under the Contract

29-11411.00 Registered Nurses 25 27,253.20 $2,181,393.00 15-1121.00 Computer Systems 16 9,949.00 $865,982.00 43-9199.00 Office & Admin 32 31,921.40 $1,869,989.00 11-9199.00 Managers 60 39,845.10 $4,367,819.00 29-1069-00 Physicians and Surgeons 7 4,304.20 $800,775.00 29-1141.00 Registered Nurses (temp) 19 13,245.13 $1,041,655.00 43-9111-00 Statistical Assistants 23 8,785.40 $586,090.00 29-1069-00 Consultants 49 4,715.07 $651,517.00 43-9199.00 Office & Admin 2 100 2,937.00 15-1134-00 Web Developer 10 3,103.90 $239,845.00

Total this page 243 143,222.40 $12,608,002.00 Grand Total 243 143,222.40 $12,608,002.00

Name of person who prepared this report: Naomi Vayner Title: Controller Phone #: 516-326-7767 Preparer's Signature: _______________________________________ Date Prepared: 05/14/2021 (Use additional pages if necessary)

Page 1 of 1


FORM B



Contracting State Agency Name: NYS Department of HealthContract Number: CO30489 Agency Business Unit: DOH01Contract Term: 9/1/2020 to 8/31/2021 Agency Department ID: 12000Contractor Name: NYS Association of County Health OfficialsContractor Address: 1 United Way, Albany, NY 12205Description of Services Being Provided: Description of Services Being Provided: The contractwill implement programs to enhance the knowledge and skills of local health department (LHD)officials and their staff so they can perform their duties in the most effective way possible. Thisis accomplished through: the development and provision of commissioners/directors leadershipprograms; statewide and regional meetings; web-based educational programs; conferencecalls in the areas of general public health, early intervention, family health, and environmentalhealth; information clearinghouse services through content on its website at www.nysacho.org ,its facebook page, and its weekly web digest to LHDs that serves the contract's objectives; andtraining and technical assistance in collaboration with NYSDOH to assist LHDs with informationabout evidence based interventions, help with evaluating programs, facilitating planning andgeneral public health consultation.

Scope of Contract (Choose one that best fits):El Analysis El Evaluation El Research TrainingLI Data Processing El Computer Programming El Other IT consultingLI Engineering El Architect Services El Surveying El Environmental ServicesEl Health Services El Mental Health ServicesEl Accounting El Auditing El Paralegal El Legal El Other Consulting

Number of Number of Amount Payable

Employment Category Employees Hours Worked Under the Contract11-1011.00 Chief Executive 1.00 585.00 $30,772.0011-3131.00 Training & Dev Manager 2.00 1,252.00 $43,659.0013-1151.00 Training & Dev Specialist 3.00 1,433.00 $35,060.0013.1121.00 Event Planner 1.00 594.00 $13,306.0011.3031.00 Financial Manager 1.00 262.00 $5,611.0043-6014.00 Sec & Admin Assistants 1.00 473.00 $9,441.0021.1091.00 Health , Educator 1.00 48.00 $2,577.00

0.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.00

Total this Page 10.00 4,647.00 $140,426.00Grand Total


Name of person who prepared this report: Sarah Ravenhall

Title: Executive Director Phone #: 518-456-7905 ext 108

Preparer's Signature: cfJfjJ R1rx\O! fk QDate Prepared: 04/28/2021

(Use additional pages, if necessary) Page of

FORM B

New York State Consultant Services Contractor's Annual Employment Report


Contracting State Agency Name:

Contract Number: C030954 Agency Business Unit: DOH01


Contractor Name: New York Alliance for Donation (DBA Donate Life NYS) Contractor Address: 185 Jordan Road, Suite 8, Troy, NY 12180

Description of Services Being Provided: Collaborating with the donation and transplant community; facilitating collaboration and education within the New York State donation and transplant community and with other health care stakeholder organizations; increasing public and professional education to increase awareness of the need for organ donation; and enhancing public awareness of the New York State Donate Life Registry (NYSDLR) and the need for donation in New York State through a versatile approach to promoting the NYSDLR in order to increase the number of individuals enrolled in the NYSDLR.


D Analysis D Evaluation D Research D Training

D Data Processing D Computer Programming D Other IT consulting

D Engineering D Architect Services D Surveying D Environmental Services

D Health Services D Mental Health Services

D Accounting D Auditing D Paralegal D Legal � Other Consulting

Employment Category Number of Number of Amount Payable Employees Hours Worked Under the Contract

11-1011.00 Chief Executives 2 707.20 66,655.00

11-2011.00 Advertising & 1 .25 24.64 Promotions Manaaers

11-9199.00 Managers, All Other 2 820.05 41,249.58

13-2011-00 Accountants & Auditors 3 22.80 1,851.07 15-1243.01 Data WarehousingSpecialists 2 44.00 4,361.83

41-3011.00 Advertising Sales3 3.00 166.40 Agents

43-3021.00 Billing & Posting Clerks 2 1.00 23.04 43-3031.00 Bookkeeping,

1 652.40 22,215.38 Accountina & Auditina Clerks43-5053-00 Postal Service MailSorts, Processors & Processing 5 96.00 3,889.69 Machine Operators43-6014.00 Secretaries &

1 242.40 5,177.29 Administrative Assistants51-5111.00 Prepress Technicians 1 4.00 473.19 & Workers51-5112.00 Printing Press

4 94.00 11,321.95 Operators51-5113.00 Print Binding &

5 37.00 3,709.51 Finishina Workers

Total this page 32 2724.10 $ 161,118.57


FORM B


Contracting State Agency Name: Department of Health Contract Number: C031294 Agency Business Unit: DOH01 Contract Term: 01/01/2017 to 12/31/2022 Agency Department ID: 3450467 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: Adult Care Facilities (ACF)


Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting




29-1111.00 Registered Nurses 18 18,411.0 $ 1,145,237.00 11-9199.99 Managers, All Others 1 69.0 $3,919.00

1 987.9 $88,459.00



Page 1 of 1

43-9061.00 Office Clerk, General


FORM B


Contracting State Agency Name: Department of Health Contract Number: C031295 Agency Business Unit: DOH01 Contract Term: 01/01/2017 to 12/31/2022 Agency Department ID: 3450467 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: Nursing Home (NH) and ICF






29-1111.00 Registered Nurses 55 50,617.40 $ 3,277,352.00 11-9111.00 Medical & Health Services Managers 1 9.00 $ 818.00 43-9061.00 Office Clerk, General 1 116.50 $ 6,339.00 15-1051.00 Computer Systems Analysts 1 12.00 $1,718.00 11-9199.99 Managers, All Other 1 106.00 $15,342.00



Page 1 of 1


FORM B


Contracting State Agency Name: Department of Health Contract Number: C031296 Agency Business Unit: DOH01 Contract Term: 01/01/2017 to 12/31/2022 Agency Department ID: 3450467 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: Psy Res Treatment (Psych)






29-1111.00 Registered Nurses 2 696.90 $49,946.00

Total this page 2 696.90 $49,946.00 Grand Total 2 696.90 $49,946.00


Page 1 of 1


FORM B


Contracting State Agency Name: Department of Health Contract Number: C031615 Agency Business Unit: DOH01 Contract Term: 06/01/2016 to 05/31/2021 Agency Department ID: 3450000 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: Program Performance Monitoring and Quality

Improvement in Maternal and Child Health Programs Scope of Contract (Choose one that best fits):





29-1141-00 Registered Nurses 4 1,341.10 $95,256.00 15-1121-00 Computer Systems 3 64.10 $3,473.00 43-9199.00 Office & Admin 2 245.00 $19,737.00 11-9199.00 Managers 6 1,748.40 $194,063.00 29-1069.00 Physicians & Surgeons 43-9111.00 Statistical Assistants

Total this page 19 3,398.60 $312,529.00 Grand Total 19 3,398.60 $312,529.00


Page 1 of 1


FORM B

New York State Consultant Services Contractor’s Annual Employment Report


Contracting State Agency Name: Department of Health Contract Number: C031784 Agency Business Unit: DOH01 Contract Term: 02/01/2008 to 03/01/2022 Agency Department ID: 3450467 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: Hospital Compliance Review






15-1051.00 Computer Systems Analysts 6 83.50 $4,861.00 11-9111.00 Medical & Health Services Managers 11 2,910.50 $194,636.00 43-9061.00 Office Clerk, General 1 7.10 $271.00



Page 1 of 1


FORM B




Department of Health

Contract Number: CO31800

Agency Business Unit: DOH01


Contractor Name: National Institute for Children's Health QUality

Contractor Address: 308 Congress Street, 5th Floor Boston, MA 02210

Description of Services Being Provided: NYS Perinatal Quality Collaborative ConsultantServices


LI Analysis LI Evaluation LI Research LI Training

LI Data Processing LI Computer Programming LI Other IT consulting

LI Engineering LI Architect Services [1 Surveying LI Environmental Services

LI Health Services LI Mental Health Services

LI Accounting LI Auditing LI Paralegal LI Legal Other Consulting

Number of Number of Amount PayableEmployment Category Employees Hours Worked Under the Contract

11.9199.00 Managers, all other 1.00 780.00 $93,600.00

13-1121.00 Meeting, Convention and 1.00 780.00 $70,200.00Event Planners

11-3131.00 Training and Dev Mgrs 1.00 584.00 $81,760.00

29-1069.00 Physicians and Surgeons, 4.00 76.00 $11,400.00all other (Clinical Lead)

27-1024.00 Graphic Designers 1.00 0.00 $2,500.00

29-1069.00 Physicians and Surgeons, 1.00 0.00 $2,500.00all other (Learning Session)

29-1069.00 Physicians and Surgeons,

2.00 6.00 $900.00all other (Ad hoc Clinical Guidance)

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

Total this Page 11.00 2,226.00 $262,860.00

Grand Total __________

Name of person who prepared this report:

Title: UPA;^F-Phone #: '7 31 / -2-73 1


Date Prepared: / 1,3I 2/


FORM B




Department of Health

Contract Number: CO31800



Contractor Name: National Institute for Children's Health QUality

Contractor Address: 308 Congress Street, 5th Floor Boston, MA 02210

Description of Services Being Provided: Implicit Bias Trainning

Scope of Contract (Choose one that best fits):LI Analysis El Evaluation El Research LI Training

El Data Processing LI Computer Programming El Other IT consulting

Lii Engineering [II Architect Services LI Surveying El Environmental Services

El Health Services LI Mental Health Services

El Accounting E Auditing El Paralegal LI Legal Other Consulting


11.9199.00 Managers, all other 2.00 2,604.00 $312,480.0013-1121.00 Meeting, Convention and 2.00 2527.00 $227,430.00Event Planners11-3131.00 Training and Dev Mgrs 2.00 331.00 $46,340.0029-1069.00 Physicians and Surgeons, 1.00 489.00 $68,460.00all other (Clinical Lead)11-3131.00 Training and Dev Mgrs 14.00 0.00 $33,000.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

Total this Page 21.00 5,951.00 $687,710.00

Grand Total

Name of person who prepared this report:

Title: 4I17 Phone #: 07 / 73Preparer's Signature:

Date Prepared:'/ 2 i.) 2I


FORM B New York State Consultant Services

Contractor's Annual Employment Report Report Period: April 1, 2020 to March 31, 2021

Contracting State Agency Name: Department of Health Contract Number: C031882 Agency Business Unit: Contract Term: 3/17/2016 to 3/14/2022 Agency Department ID: Contractor Name: Deloitte Consulting LLP Contractor Address: 111 Washington Ave. Suite 500 Albany, NY 12210

Description of Services Being Provided: Actuarial Services Scope of Contract (Choose one that best fits):

Analysis Evaluation Research Training

Data Processing Computer Programming Other IT consulting

Engineering Architect Services Surveying Environmental Services

Health Services Mental Health Services

Accounting Auditing Paralegal Legal Other Consulting


Number of Hours to Worked


Actuaries 61 50,208.75 $6,806,319.06 Total this page 61 50,208.75 $6,806,319.06

Grand Total 61 50,208.75 $6,806,319.06

Name of person who prepared this report: Mackenzie Hyer Title: Engagement Financial Advisor Phone #: 717-562-5468 Preparer's Signature: Mackenzie Hyer

Date Prepared: 5/10/2021 (Use additional pages, if necessary) Page 1 of ___

FORM B



Contracting State Agency Nam

Contract Number: CO32807 Agency Business Unit: DOH01


Contractor Name: Maximus Health ServicesContractor Address: 1891 Metro Center Dr. Reston, VA.20190Description of Services Being Provided: PASRR


El Analysis LI Evaluation LI Research LI Training

fl Data Processing LI Computer Programming LI Other IT consulting

LI Engineering fl Architect Services LI Surveying LI Environmental Services

LI Health Services Z Mental Health Services

fl Accounting LI Auditing LI Paralegal LI Legal LI Other Consulting

Employment Cate Number of Number of Amount Payable

Employees Hours Worked Under the Contract

Analyst 0.004 7.3 $290.35

Clinical Reviewer 1 0.246 460 $15,947.78

Clinical Reviewer 2 2.085 3898.2 $147,840.27

Clinical Reviewer 3 0.091 170.5 $7,047.28

Clinical Reviewer Lead 0.001 2 $93.75

Manager 0.524 979.5 $44,411.42

Sr. Admin 1.016 1899.9 $50,027.96

Sr. Director 0.005 9 $78.75

Supervisor 0.083 154.6 $15,738.71

LCSW 4 $29,226.04

LMSW 17 $165,991.23

RN 3 $3,208.67

Total this page 28 7596 $480,336.57

Grand Total 28 7596 $480,336.57

Name of person who prepared this report: Shannon Donnelly

;:a::;:: 4 I2#/ Phone #: 629-230-5122

Date Prepared: 5/14/2021


FORM B



Contracting State Agency Name: -Contract Number: CO32807Contract Term: 12/01/2017 to 11130/2022Contractor Name: Maximus Health ServicesContractor Address: 1891 Metro Center Dr. Reston, VA.20190Desciiptoii ol Se[vces being Provided: PASRR

Agency Business Unit: DOHOIAgency Department ID: 3450000

Scope of Contract (Choose one that best fits):LI Analysis LI Evaluation' LI Research TrainingE) Data Processing fl Computer Programming El Other IT consultingLI Engineering LI Architect Services fl Surveying 0 Environmental Services0 Health Services Z Mental Health Serviceso Accounting 1 Auditing El Paralegal LI Legal LI Other Consulting

Employment Category Number of Number ofEmplo I Hours Worked

Amount PayableUnder the Contract

.004Clinical Reviewer 1 1.04Clinical Reviewer 2 1.27Clinical Reviewer 3 .02Clinical Reviewer Lead .03Manager .43Sr. Admin 1.00Sr. Director 09Supervisor .11LCSW 6LMSW 25RN 3

Total this page 38

Grand Total 38Name of person who prepared this report: Tracy HainésTitle: Accounting & Finance SupervisorPreparer's Signature:Date Prepared: 2/4/2021(Use additional pages, if necessary)

7.3 $304.49

1901.5 $69,507.98

2338.50

$93,698.59

28

$1,270.00

55 $2,401.03

781.6

$38,260.19

1832.20 $50,302.46

171.7

$17,195.14

201

$8,812.71$82,954.68

$265,444.73.$29.,000.87

6

.7316.8 $659,152.86

7316.8 $659,152.86

Phone #:,629-230-5171

Page 1 of I


FORM B


Contracting State Agency Name: Department of Health Contract Number: C033227 Agency Business Unit: DOH01 Contract Term: 01/01/2018 to 12/31/2022 Agency Department ID: 3450467 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: DT&C






29-1111.00 Registered Nurses 2 2,625.10 $ 179,907.00 43-9061.00 Office Clerk, General 1 892.50 $32,101.00

Total this page 5 3,517.60 $ 212,008.00 Grand Total 5 3,517.60 $ 212,008.00


Page 1 of 1


FORM B


Contracting State Agency Name: Department of Health Contract Number: C033306 Agency Business Unit: DOH01 Contract Term: 08/31/2017 to 08/30/2021 Agency Department ID: 3450405 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: Vital Access Provider Technical Assistance






43-9061.00 Office Clerk , General 15-1051.00 Computer Systems Analysts 11-9111.00 Medical & Health Services Managers (Based on work performed)

$1,639,863.00

11-9199.99 Managers, All Others 3 1,420.70 $105,313.00


Name of person who prepared this report: Naomi Vayner Title: Controller Phone #: 516-326-7767 Preparer's Signature: _______________________________________ Date Prepared: 05/14/2021

(Use additional pages if necessary) Page 1 of 1

FORM B



Contracting State Agency Name: Contract Number: C#033315 Agency Business Unit: DOH01 Contract Term: 01/01/2018 to 12/31/2022 Agency Department ID: 3450000 Contractor Name: National Center for Healthy Housing Contractor Address: 10320 Little Patuxent Parkway, Suite 200, Columbia, MD 21044 Description of Services Being Provided: Other consulting Scope of Contract (Choose one that best fits):









NCHH Staff* 15-2041.01 – Biostatisticians• Sherry Dixon, Ph.D., NCHH,Biostatistician

1 188.1 $26,188.85

19-2041.00 - Environmental Scientistsand Specialists, Including Health• Amanda Reddy, MS, NCHH ExecutiveDirector• Amy Murphy, MPH, NCHH, LeadTechnical Assistance Provider• Carol Kawecki, NCHH, ProgramManager• Mary Jean Brown, ScD, RN, NCHH,Senior Advisor

4 554.8 $89,215.00

11-3099.00 - Social Scientists andRelated Workers –• Laura Fudala, NCHH, Project Manager• Sarah Goodwin, NCHH, Policy Analyst• Anna Plankey, NCHH, Junior Analyst

3 1,017.1 $76,571.45

11-1011.00 - Chief Executives• Jonathan Wilson, MPP, NCHH CFO,Director of Research• Michelle Harvey, NCHH, COO, Directorof Administration

2 16.5 $2,310.66

27-3031.00 - Public Relations Specialists• Christopher Bloom, NCHH,Communications and Marketing Officer• Jo Miller, GPC, SMS, NCHH, SeniorCommunications Advisor

2 171.3 $23,978.02

Total this page 12 1,947.8 $ 218,263.98

NCHH Contractors 15-1151.00– Computer User Support Specialists • MeWe, Inc./CoInspect**

+Varies; $2,475 monthly user fee for CoInspect database platform $29,700.00

13-1151.00 - Training and Development Specialists • Brigid Riley, MPH, B. E. Riley Consulting

1 60 $7,500.00

11-3099.00 - Social Scientists and Related Workers – • Erin McDowall, NCHH, Intern

1 1.5 $22.50

Total this page 2+ 61.5+ $ 37,222.50

Grand Total 14+ 2,009.3+ $255,486.48 Name of person who prepared this report: Laura Fudala Title: Project Manager Phone #: 443-539-4167

Preparer's Signature: Date Prepared: 5/07/2021 (Use additional pages, if necessary) Page 2 of 2 *NCHH Staff amounts payable under the contract have been calculated using the fully loaded rate including fringe and indirect rates. ** As applicable, the amount payable under the contract to MeWe, Inc./CoInspect has been calculated using both hourly engineering, development, and customization rates as well as monthly user fees that include activities such as user support and database maintenance for the database platform as budgeted in for C#033315 in NCHH’s RFP #17175 response.


FORM B


Contracting State Agency Name: Department of Health Contract Number: C033822 Agency Business Unit: DOH01 Contract Term: 10/1/2019 to 9/30/2024 Agency Department ID: 3450340 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: Epidemiology






29-1069.99 Physicians & Surgeons, All Others 4 6,973.50 $400,195.00 15-1051.00 Computer Systems Analysts 11-9111.00 Medical & Health Services Managers (Based on work performed) 11-9199.99 Managers, All Others 43-9061.00 Office Clerk , General


Name of person who prepared this report: Naomi Vayner Title: Controller Phone #: 516-326-7767 Preparer's Signature: _______________________________________ Date Prepared: 05/14/2021

(Use additional pages if necessary) Page 1 of 1


FORM B



Contracting State Agency Name: NYS Department of HealthContract Number: CO33860 Agency Business Unit: DOH01Contract Term: 1/1/2020 to 12/31/2021 Agency Department ID: 12000Contractor Name: NYS Association of County Health OfficialsContractor Address: 1 United Way, Albany, NY 12205Description of Services Being Provided: Assist the 57 LHDs in meeting their LHD lAP contractdeliverables in improving child, adolescent and adult immunization rates in NYS. NYSACHOwill link the efforts of NYSDOH and LHDs, promote consistent messages statewide, providetraining and collaboration opportunities, and work with the LHDs to strategize new and creativeapproaches to achieve performance targets.

Scope of Contract (Choose one that best fits):LI Analysis fl Evaluation fl Research E Training

LI Data Processing 11 Computer Programming LI Other IT consulting

LI Engineering LI Architect Services LI Surveying LI Environmental Services


LI Accounting LI Auditing fl Paralegal LI Legal LI Other Consulting


11-1011.00 Chief Executive 1.00 340.00 $17,896.00

11-3131.00 Training & 0ev Manager 2.00 1,341.00 $45,098.00

13-1151.00 Training & Dev Specialist 3.00 543.00 $13,580.00

13.1121.00 Event Planner 1.00 599.00 $13,424.00

11.3031.00 Financial Manager 1.00 249.00 $5,323.00

43-6014.00 Sec & Admin Assistants 1.00 400.00 $8,029.00

21.1091.00 Health Educator 1.00 7.00 $376.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

Total this Page 10.00 3,479.00 $103,726.00

Grand Total 10.00 3,479.00 $103,726.00

Name of person who prepared this report: Sarah Ravenhall

Title: Executive Director Phone #: 518-456-7905 x108

Preparer's Signature: TkA.C6J2 ,j-e1rJ1._c_Q4'Date Prepared: 04/26/2021

__________


FORM B



Contracting State Agency Name: NYS Department of Health Contract Number: C035353 Agency Business Unit: DOH01 Contract Term: 07/01/2020 to 06/30/2025 Agency Department ID: 3450000 Contractor Name: KPMG LLP Contractor Address: 515 Broadway Albany NY 12207 Description of Services Being Provided: Independent external financial and programmatic auditing services for DOH Marketplace

Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting

Employment Category

Number of Employees



13-2011.00 Accountants and Auditors 13.00 409.50 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00 0.00 0.00 $0.00

Total this Page 13.00 409.50 $0.00

Grand Total 13.00 409 $0.00

Name of person who prepared this report: Rory Costello Title: Principal Phone #: 212 954 7735 Preparer’s Signature: Date Prepared: 5/10/2021


FORM B New York State Consultant Services

Contractor’s Annual Employment Report Report Period: April 1, 2020 to March 31, 2021

Contracting State Agency Name: Contract Number: C035580 1000017300 Agency Business Unit: DOH01 Contract Term: 05/01/2020 to 10/31/2021 Agency Department ID: 3450000 Contractor Name: New York State Academy of Family Physicians Contractor Address: 16 Sage Estate Ste 202 Albany NY 12204 Description of Services Being Provided: NYSAFP will retain a Family Physician to create an academic detailing program to enhance the capacity of 20 VFC providers in the lower Hudson Valley to communicate with vaccine-hesitant parents. NYSAFP will use the resources its Vaccine & Immunizations Committee, its Education Commission and its Public Health Commission to recruit the Family Physician who will develop and deliver the academic detailing and to assist and support that Family Physician in creating the program including an evaluation component. Scope of Contract (Choose one that best fits):









Chief Executive 1 1785 6000 Administrative Services Manager 2 3418 3000

Total this page 3 5203 $ 9000.00

Grand Total 3 5203 9000

Name of person who prepared this report: Donna C Denley Title: Director of Finance Phone #: 518.489.8945 x2

Preparer's Signature: Date Prepared: 04/12/2021 (Use additional pages, if necessary) Page 1 of 1

FORM B




Contract Number: C035825 Agency Business Unit: DOH01

Contract Term: 04/01/2020 to 03/31/2021 Agency Department ID: 3450000 Contractor Name: New York Alliance for Donation (OBA Donate Life NYS) Contractor Address: 185 Jordan Road, Suite 8, Troy, NY 12180

Description of Services Being Provided: Collaborating with the donation and transplant community; facilitating collaboration and education within the New York State donation and transplant community and with other health care stakeholder organizations; increasing public and professional education to increase awareness of the need for organ donation; and enhancing public awareness of the New York State Donate Life Registry (NYSDLR) and the need for donation in New York State through a versatile approach to promoting the NYSDLR in order to increase the number of individuals enrolled in the NYSDLR.


D Analysis D Evaluation D Research D Training

D Data Processing D Computer Programming D Other IT consulting

D Engineering D Architect Services D Surveying D Environmental Services

D Health Services D Mental Health Services

D Accounting D Auditing D Paralegal D Legal � Other Consulting


11-1011.00 Chief Executives 2 708.20 66,835.00 11-2011.00 Advertising & 1 .75 52.36 Promotions Manaqers

11-9199.00 Managers, All Other 2 2285.20 97,675.89

13-2011-00 Accountants & Auditors 3 113.70 9,233.17

15-1252.00 Software Developers 6 116.00 17,689.55 15-1243.01 Data WarehousingSpecialists 2 6.00 640.27

23-1011.00 Lawyers 1 17.50 8,750.00 41-3011 .00 Advertising Sales 3 7.00 353.60 Agents43-3021.00 Billing & Posting Clerks 2 1.00 48.96 43-3031.00 Bookkeeping, 1 838.80 28,562.63 Accountina & Auditina Clerks43-5053-00 Postal Service MailSorts, Processors & Processing 5 14.00 570.96 Machine Operators43-6014.00 Secretaries &

1 444.40 9,491.70 Administrative Assistants43-9199.00 Office & Administrative

7 1854.00 28,558.40 Support Workers, All Other51-5111.00 Prepress Technicians

1 1.00 69.46 & Workers51-5112.00 Printing Press 4 14.00 1,661.94 Operators

FORM B OSC Use Only:Reporting Code:Category Code:

State Consultant ServicesContractor's Annual Employment Report


Contracting State Agency Name: NYS OGS HBITS/DOH Agency Code: DOH01Contract Number: 1PH65772Contract Term: 11/01/2012 to 06/30/2019Contractor Name: GENESYS Consulting Services, Inc.Contractor Address: I Marcus Blvd, Suite 102, Albany, NY 12205Description of Services Being Provided: Hourly Based IT Services

Scope of Contract (Choose one that best fits):Analysis 7 Evaluation D Research E Training LIIIData Processing fl Computer Programming Z Other IT consulting flEngineering E Architect Services El Surveying El Environmental Services LIIHealth Services [IJ Mental Health Services [IIAccounting E Auditing LI Paralegal LII Legal LI Other Consulting LI

Employment Category Number of Employees Number of Hours Worked [ Amount Payable Underthe Contract

Business Analyst 1 2,008 $150,559.84Project Manager 4 4,984.75 $477,738.44Technical Architect 5 6,574.75 $569,767.84

Total this page 10 1 13,567.5 $1,198,066.12Grand Total 10 1 13,567.5 $1,198,066.12

Name of person who prep red tis report: Cassandra MayPreparer's Signature: CL-. Ti .Title: Financial & Reporting Specialist 0 Phone #: 518-459-9500Date Prepared: 5/3/2021Use additional pages if necessary) Page 1 of I

FORM B OSC Use Only:

Reporting Code:

Category Code:

State Consultant Services


Contracting State Agency Name: NYS DOH Agency Code: 12000

Contract Number: PH65773 Contract Term: 11/01/2012 to 06/30/2019 Contractor Name: IIT Inc Contractor Address: 6 CORNISH COURT, SUITE 101, HUNTINGTON STATION, NY 11746 Description of Services Being Provided: IT Services

Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting


Number of Hours Worked Amount Payable Under

the Contract

15-1121.00 Computer Systems Analysts 4 5239.00 $361,152.80

15-1131.00 Computer Programmers 14 16205.50 $1,346,679.27 15-1142.00 Network and Computer Systems Administrators

1 616.00 $48,473.04

15-1199.09 Information Technology Project Managers

1 0.00 $0.00

Grand Total 20 22060.50 $1,756,305.11

Name of person who prepared this report: Dinesh Gulati Preparer's Signature:___________________________________________________ Title: Managing Director Phone #: 631-254-8600 215 Date Prepared: 4/29/2021

Use additional pages if necessary) Page 1 of 1

FORM B OSC Use Only: Reporting Code: Category Code:

State Consultant Services Contractor’s Annual Employment Report


Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH65776 Contract Term: 11/01/2012 to 06/30/2019 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Project Manager Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting

Employment Category Number of Employees Number of Hours Worked Amount Payable Under the Contract

15-1199.09 4 2,518 $227,598

Total this page 4 2,518 $227,598 Grand Total 4 2,518 $227,598

Name of person who prepared this report: Sanjay Kapalli Preparer's Signature:___________________________________________________ Title: Executive Vice President Phone #: 518-250-4189 Date Prepared: 5/7/2021 Use additional pages if necessary) Page 1 of 1




Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH65776 Contract Term: 11/01/2012 to 06/30/2019 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Specialist Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting


15-1132 1 1,439 $100,629






Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH65776 Contract Term: 11/01/2012 to 06/30/2019 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Technical Architect Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting


15-1199.02 2 744 $68,515

Total this page 2 744 $68,515 Grand Total 2 744 $68,515





Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH65776 Contract Term: 11/01/2012 to 06/30/2019 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Programmer Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting


15-1132 1 16 $880

Total this page 1 16 $880 Grand Total 1 16 $880



FORM B



Contracting State Agency Name: Department of HealthContract Number: PH65780 Agency Business Unit: DOH01Contract Term: 11/1/2012 to 6/30/2019 Agency Department ID: 3450000Contractor Name: MVP Consulting PlusContractor Address: 435 New Karner Road, Suite 202 Albany, NY 12205Description of Services Being Provided: IT Consulting Services

Scope of Contract (Choose one that best fits):E] Analysis LI Evaluation LI Research LI TrainingO Data Processing LI Computer Programming X Other IT consultingEl Engineering LI Architect Services LI Surveying El Environmental ServicesO Health Services LI Mental Health ServicesLI Accounting 0 Auditing LI Paralegal D Legal LI Other Consulting


15-1131.00 1 738 $49,984.75

1 2023.5 $151,620.86

1 1256 $94,112.08

1 1952 $146,263.36

15-1121.00 1 1110 $55,633.20

1 2012 $152,610.20

1 2111 $160,119.35

15-1151.00 1 2111 $184,902.49

15-1199.02 1 2000 $190,360.00

0.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.00

Total this Page 9 15313.5 $ 1,185,606.29Grand Total 9 15313.5 $ 1,185,606.29

Name of person who prepared this report: Stephen MillerTitle: President

Phone #: 518-218-1700

'44^,Zo&—Preparer's Signature:Date Prepared: 4/23/21



FORM B



Contracting State Agency Name: Department of Health

Contract Number: PH 65782 Agency Business Unit: DOH01


Contractor Name: PSI International Inc.

Contractor Address: 11200 Waples Mill Rd, Suite 200 Fairfax, ,VA 22030

Description of Services Being Provided: IT Services










Computer Programmers 6 8,167.75 $520,191.21

Computer Systems Analysts 4 3,368.00 $245,333.90

Computer Systems Architects 5 4,815.75 $424,267.58

Computer User Support Specialists 9 9,146.75 $603,911.92

Database Administrators 2 3,991.25 $306,847.30

IT Project Managers 3 5,365.50 $508,434.78Software Developers, Systems Software 1 336.00 $29,601.60

Software Quality Assurance Testers 6 5,115.50 $300,859.52

Total this Page 36 40,306.50 $2,939,447.81

Grand Total 36 40,306.50 $2,939,447.81

Name of person who prepared this report: Jasmin Bertulfo

Title: Accountant Phone #: 703.621.5849

Preparer’s Signature: ________________________________






Contracting State Agency Name: DOH

Contract Number: PH68607 Agency Business Unit:Contract Term: 07/0112019 to 06/30/2024 Agency Department ID:,Contractor Name: Crossfire Consulting Corp

Contractor Address: 1940 Commerce Street, Yorktown Heights, NY 10598

Description of Services Being Provided: Hourly Based Information Technology

Scope of Contract (Choose one that best fits):El Analysis LI Evaluation El Research 0 TrainingEl Data Processing El Computer Programming 0 Other IT consultingEl Engineering .[jArchitect Services 0 Surveying El Environmental ServicesO Health Services 0 Mental Health ServicesEl Accounting 0 Auditing El Paralegal El Legal 0 Other Consulting

Number of Number of Amount PayableEmployment Category Employees Hours Worked Underthe Contract-

Software Architect 1.00 1852.00 $181,496.00Business Analyst 1.00 1,122.00 $83,028.00

0.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 000 $O:OO0.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000:00 0.00 $0: 000.00 0.00 $0.000.00 0.00 $0.00

Total this Page 2.00 2,974.00 $264,524.00Grand Total 2.00 2,974 $264,524.00

Name of person who prepared this report: Maureen Kruze

Title: Administrator Phone #: 914-302-2900

Preparer's Signature:/'




FORM B



Contracting State Agency Name: NYS DOHContract Number: PH68610 Agency Business Unit:Contract Term: 07/01/2019 to 06/30/2024 Agency Department ID:Contractor Name: Genesys Consulting Services, Inc.Contractor Address: 1 Marcus Blvd, Suite 102, Albany, NY 12205Description of Services Being Provided: Hourly Based IT Services

Scope of Contract (Choose one that best fits):El Analysis El Evaluation El Research El TrainingEl Data Processing LII Computer Programming Z Other IT consultingEl Engineering El Architect Services El Surveying ] Environmental ServicesEl Health Services El Mental Health ServicesEl Accounting El Auditing El Paralegal El Legal El Other Consulting


Business Analyst 1.00 1,979.50 $148,422.91

Database Architect 1.00 218.00 $19,685.40Programmer 2.00 343.75 $26,468.75

Software Architect 4.00 5,453.50 $479,908.00

0.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.00

Total this Page 8.00 7,994.75 $674,485.06

Grand Total 8.00 7,994 $674,485.06

Name of person who prepared this report: Cassandra May

Title: Financial & Reporting pecia1ist Phone #: (518) 459-9500

Preparer's Signature: ( 9..4'.Date Prepared: 05/03/2021 (1



FORM B



Contracting State Agency Name: Department of HealthContract Number: PH68612 Agency Business Unit: DOH01Contract Term: 7/1/2019 to 6/30/2024 Agency Department ID:Contractor Name: JSM Consulting IncContractor Address: 65 Station Road, Cranbury, NJ 08512Description of Services Being Provided: Hourly Based Information Technology

Scope of Contract (Choose one that best fits):E] Analysis D Evaluation 0 Research 0 Training0 Data Processing F1 Computer Programming Il Other IT consulting0 Engineering El Architect Services El Surveying El Environmental ServicesLI Health Services 0 Mental Health Servicesfl Accounting 0 Auditing 0 Paralegal 0 Legal 0 Other Consulting


Employment Category Employees Hours Worked Under the Contract

Software Architect 1.00 2013 $199,266.87

Business Analyst 1.00 928.00 $69,692.800.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 $0.000.00 0.00 - $0.000.00 0.00 $0.000.00 0.00 $0.00

Total this Page 2.00 928.00 $268,959.67Grand Total

Name of person who prepared this report: Vivek ShenoyPhone #: (609) 722-6600, ext.

Title: Sr. VP - Operations 102

Preparer's Signature: A2Date Prepared: 5/10/2021





Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH68613 Contract Term: 07/01/2019 to 06/30/2024 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Tester

Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training






15-1253.00 2 1,322 $79,399

Total this page 2 1,322 $79,399

Grand Total 2 1,322 $79,399





Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH68613 Contract Term: 07/01/2019 to 06/30/2024 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Systems Architect Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting


15-1299.08 3 4,311 $403,079






Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH68613 Contract Term: 07/01/2019 to 06/30/2024 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Software Architect Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting


15-1199.02 3 4,018 $359,611






Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH68613 Contract Term: 07/01/2019 to 06/30/2024 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Project Manager







15-1199.09 2 1,501.25 $112,714

Total this page 2 1,501.25 $112,714

Grand Total 2 1,501.25 $112,714





Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH68613 Contract Term: 07/01/2019 to 06/30/2024 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Programmer Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting


15-1132 4 5,890.25 $404,858

Total this page 4 5,890.25 $404,858 Grand Total 4 5,890.25 $404,858





Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH68613 Contract Term: 07/01/2019 to 06/30/2024 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: IT Specialist







15-1132 2 2,537.75 $177,995

Total this page 2 2,537.75 $177,995

Grand Total 2 2,537.75 $177,995





Contracting State Agency Name: NYS Department of Health Agency Code: Contract Number: PH68613 Contract Term: 07/01/2019 to 06/30/2024 Contractor Name: Knowledge Builders Inc Contractor Address: 1977 Western Avenue; Ste # 1; Albany; NY - 12203 Description of Services Being Provided: Database Architect Scope of Contract (Choose one that best fits): Analysis Evaluation Research Training Data Processing Computer Programming Other IT consulting Engineering Architect Services Surveying Environmental Services Health Services Mental Health Services Accounting Auditing Paralegal Legal Other Consulting


15-1243.00 2 3,060 $239,057




FORM B



Contracting State Agency Name: NYS Department of HealthContract Number: PH68617 Agency Business Unit: DOH01Contract Term: 7/1/2019 to 6/30/2024 Agency Department ID: 3450000Contractor Name: MVP Consulting PlusContractor Address: 435 New Karner Road, Suite 202 Albany, NY 12205Description of Services Being Provided: IT Consulting Services


O Analysis LI Evaluation Research LI Training

LI Data Processing LI Computer Programming X Other IT consulting

LI Engineering LI Architect Services D Surveying LI Environmental Services


O Accounting LI Auditing LI Paralegal LI Legal LI Other Consulting



15-1141.00 1 539.5 $38,255.95

15-1199.01 1 1988.5 $64,447.29

15-1131.00 1 1841.5 $131,630.42

15-1151.00 1 1992 $155,196.72

1 1991.5 $155,157.77

1 960 $74,793.60

1 983.5 $50,945.30

1 296 $23,061.36

15-1121.00 1 1104 $67,642.09

1 772.5 $47,331.08

15-1243.00 1 1826.5 $154,083.54

1 1275 $107,559.00

Total this Page 12 15570.5 $1,070,104.12Grand Total 26 36462 $2,865,907.91

Name of person who prepared this report: Stephen Miller

Title: President Phone #: 518-218-1700





FORM B



Contracting State Agency Name: NYS Department of HealthContract Number: PH68617 Agency Business Unit: DOH01Contract Term: 7/1/2019 to 6/30/2024 Agency Department ID: 3450000Contractor Name: MVP Consulting PlusContractor Address: 435 New Karner Road, Suite 202 Albany, NY 12205Description of Services Being Provided: IT Consulting Services


D Analysis E Evaluation Research D Training

U Data Processing Computer Programming X Other IT consulting

0 Engineering D Architect Services E Surveying fl Environmental Services

O Health Services Mental Health Services

0 Accounting Auditing D Paralegal 0 Legal D Other Consulting



15-1199.09 1 2245 $193,047.561 2061 $177,225.391 1959.75 $168,518.911 1984 $170,604.161 1904 $163,724.961 1174 $100,952.261 1117 $96,050.831 915.75 $78,745.34

15-1199.02 1 2016 $173,174.401 2076.5 $178,371.352 1232 $105,828.801 1262.75 $108,470.231 944 $81,089.60

Total this Page 14 20891.75 $1,795,803.79Grand Total

Name of person who prepared this report: Stephen Miller

Title: President

Phone #: 518-218-1700





FORM B



Contracting State Agency Name: Department of Health

Contract Number: PH68621 Agency Business Unit: DOH01


Contractor Name: PSI International Inc.

Contractor Address: 11200 Waples Mill Rd, Suite 200 Fairfax, ,VA 22030

Description of Services Being Provided: IT Services










Computer Programmers 1 2,008.00 $136,363.28

Computer Systems Analysts 3 4,718.00 $353,189.48

Database Administrators 1 2,047.00 $163,207.31

Database Architects 2 3,928.00 $343,621.44

IT Project Managers 1 1,962.50 $146,971.63

Software Developers, Applications 1 32.00 $2,652.16Software Developers, Systems Software 2 3,119.00 $272,850.12

Software Quality Assurance Testers 1 1,818.00 $111,134.34

Total this Page 12 19,632.50 $1,529,989.76

Grand Total 12 19,632.50 $1,529,989.76

Name of person who prepared this report: Jasmin Bertulfo

Title: Accountant Phone #: 703.621.5849

Preparer’s Signature: ________________________________



AC 3272-S (Effective 4/12) FORM B



Contracting State Agency Name: NYS OGS/NYS Department of Health Contract Number: PH68632 Agency Business Unit: Contract Term: 7/19/2019 to 6/30/2024 Agency Department ID: Contractor Name: Unique Comp, Inc. Contractor Address: 27-08 42nd Road Long Island City, NY 11101 Description of Services Being Provided: IT Staffing Services






15 -1132- 00 Software Developer 1.00 123,911.00 $123,911.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00 0.00 $0.00

Total this Page 1.00 0.00 $ 0.00

Grand Total 1.00 123,911 $123,911.00

Name of person who prepared this report: Diana Tacuri Title: Sr. Resource Manager Phone #: 718-392-5100 Preparer’s Signature: ________________________________ Date Prepared: 05/03/2021


Diana Tacuri

FORM BNew York State Consultant Services

Contractor's Annual Employment ReportReport Period: April 1, 2020 to March 31, 2021

Contracting State Agency Name:Contract Number: PN205AC


Agency Department ID 3450000

Contract Term: 12/1/2015 To 3/15/2025Contractor Name: New York State Technology Enterprise Corporation (NYSTEC)

Contractor Address: 99 Otis Street, 2' Floor, Rome, NY 13441

Description of Services Being Provided: MMIS Operational and Security Support

:ope of Contract (Choose one that best fits):Analysis flEvaluation flResearch [Data Processing ficomputer Programming EOther IT Consulting

Engineering fiArchitect Services flsurveying [Health Services flMental Health Services

Accounting ]Auditing []Paralegal I

Environmental Services

Legal

Consulting

Employment CategoryNumber of Number of hours to Amount PayableEmployees be worked Under the Contract

11-3021.00 Computer and Information Systems Manage 32.00 24,531.00 $ 3,996,514.60

Total this page 32.00 24,531.00 $ 3,996,514.60

Grand Total 32.001 24,531.00 1 $ 3,996,514.60

Name of person who prepared this report: Michael J. Tallman

Title: Contracts Manager Phone #: 315-334-7843 [email protected]

Preparer's Sicinature: ^Ita.Date Prepared: 05-11-2021

(Use additional pages, if necessary)

Page 1 of 1

roSct&



Contracting State Agency Name:Contract Number: PN205AH





Description of Services Being Provided: DOH UAS QC and Transition Support

Analysis

Data Processing

Engineering

Health Services

Accounting

'ose one that best fits):ion DResearch [ter Programming lilOther IT Consulting

t Services surveying [Health Services


Consulting



Total this page 31.00 21,544.50 $ 2,978,885.18

Grand Total 31.00 21,544.50 1 $ 2,978,885.18



Date Prepared: 05-11-2021


Page 1 of 1



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205AR Agency Business Unit: DOH01



Contractor Address: 99 Otis Street, 2 nd Floor, Rome, NY 13441

Description of Services Being Provided: NYPORTS End-User Training and Support

Analysis

Data Processing

Engineering

Health Services

Accounting

'ose one that best fits):ion DResearch Iter Programming El Other IT Consulting

A Services surveying [Health Services


Legal

Consulting


11-3021.00 Computer and Information Systems Manage 5.00 206.00 $ 29,414.48

Total this page 5.00 206.00 $ 29,414.48

Grand Total 5.001 206.00 $ 29,414.48



s Sianature:



Page 1 of 1



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205AS Agency Business Unit: DOH01



Contractor Address: 99 Otis Street, 2nd Floor, Rome, NY 13441

Description of Services Being Provided: NYS DOH NYWIC Help Desk Management and Support

ope of Contract (Choose one that

Analysis DEvaluation [

Data Processing UComputer Programming [

Engineering DArchitect Services [Health Services flMental Health Services

Accounting 1Auditing F

Research IOther IT Consulting


Paralegal

Legal

Consulting


11-3021.00 Computer and Information Systems Manage 7.00 9,947.50 $ 799,125.94

Total this page 7.00 9,947.50 $ 799,125.94

Grand Total 7.001 9,947.50 $ 799,125.94



Sianature:



Page 1 of 1



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205AT Agency Business Unit: DOH01




Description of Services Being Provided: OQPS HIT Healthcare Transformation Support

Analysis

Data Processing

Engineering

Health Services

Accounting

'ose one that b5t tits):ion flResearch [ter Programming I Other IT Consulting

t Services Surveying [Health Services

]Paralegal [


Legal Consulting


11 -3021 .00 Computer and Information Systems Manage 41.00 28,485.00 $ 4,573,366.41

Total this page 41.00 28,485.00 $ 4,573,366.41

Grand Total 41.001 28,485.00 1 $ 4,573,366.41



rers Siqnature:



Page 1 of 1

FORM B

Contractor's Annual Employment ReportReoort Period: Aoril 1. 2020 to March 31. 2021


NYS Dept of HealthContract Number: PN205AU





Description of Services Being Provided: DOH OHIP Advance Planning Document Assistance Phase 3

one that bestAnalysis Li Evaluation

Data Processing [Jcomputer Programming

Engineering flArchitect Services

Health Services _JMental Health Services

Accounting r]Auditing

raining

IT Consulting

Services

Other Consulting



Total this page 18.00 14,203.50 $ 2,231 534.92

Grand Total 18.001 14,203.50 1 $ 2,231 ,534.92


Title: Contracts Manager Phone #: 315-334-7843 mtallman @ nystec.com



Page 1 of 1

Tho3g



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205AV Agency Business Unit: DOH01


Contract Term: 6/17/2019 To 12/31/2021Contractor Name: New York State Technology Enterprise Corporation (NYSTEC)Contractor Address: 99 Otis Street, 2nd Floor, Rome, NY 13441

Description of Services Being Provided: NYS DOH BEI EIS

Analysis

Data Processing

Engineering

Health Services

Accounting

one that best

ter Programming L.JOther IT Consulting

t Services Surveying El Environmental Services

Health Services

Legal Consulting

Employment Category Number of Number of hours to Amount PayableEmployees be worked Under the Contract


Total this page 11.001 8,935.501$ 1,490,132.76Grand Total 11.00 1 8,935.501$ 1,490,132.76





71&6qq



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205AW Agency Business Unit: DOH01




Description of Services Being Provided: NYS DOH EMU Stage 3 and Program Closeout

one that bestAnalysis

Data Processing

Engineering

Health Services

Accounting

ter Programming IJOther IT Consulting

t Services surveying [

Health Services

ronmental Services

Consulting



Total this page 16.00 17,402.75 $ 2,000,149.36

Grand Total 16.00 17,402.75 $ 2,000,149.36





Page 1 of 1

TP&6qJ

FORM B

Contractor's Annual Employment ReporteDort Period: ADril 1. 2020 to March 31. 2021

Contracting State Agency Name: NYS Dept of HealthContract Number: PN205AX Agency Business Unit: DOH01




Description of Services Being Provided: NYS DOH MAPP / MDW PM and QC Services

oneAnalysis

Data Processing

Engineering

Health Services

Accounting

ter Programming IJOther IT Consulting

t Services flsurveying

Health Services

Services

Consulting


11 -3021 .00 Computer and Information Systems Manage 45.00 37,478.75 $ 5,856,939.03

Total this page 45.00 37,478.75 $ 5,856,939.03

Grand Total 45.00 37,478.75 1 $ 5,856,939.03



'*1Date Prepared: 05-11-2021


Page 1 of 1



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205AY Agency Business Unit: DOH01




Description of Services Being Provided: NYS DOH EVV Planning and Procurement

Analysis

Data Processing

Engineering

Health Services

Accounting

cnoose one tnat best tItS)Evaluation El Research

Computer Programming I10ther IT Consulting

Architect Services Surveying

Mental Health Services

Paralegal

Services

Consulting



Total this page 13.00 4,486.25 $ 683,647.51

Grand Total 13.001 4,486.251$ 683,647.51


Title: Contracts Manager

Phone #: 315-334-7843 mtallman @ nystec.com




Page 1 of 1

rror+12



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205BB Agency Business Unit: DOH01




Description of Services Being Provided: NYS DOH WIC Procurement, Project and QM Services

Analysis

Data Processing

Engineering

Health Services

Accounting

'ose one that best fits):ion DResearch [ter Programming IXiOther IT Consulting

A Services Surveying [Health Services

raining


Legal

Consulting



Total this page 2.00 1,936.50 $ 359,646.06

Grand Total 1 2.00 1 1,936.50 $ 359,646.06



Signature:



Page 1 of 1

FORM BNew YOK state uonsuitant 6ervices

Contractor's Annual Employment Reporteoort Period: Aoril 1. 2020 to March 31. 2021

rtg State Agency Name

NYS Dept of HealthNumber: PN205BC





Description of Services Being Provided: NYS DOH OQPS All Payer Database Ongoing QA

ope of Contract (Choose one thaAnalysis DEvaluation

Data Processing UComputer Programming

Engineering DArchitect Services

Health Services UMental Health Services

Accounting r]Auditing

Research

Other IT Consulting

ronmental Services

Consulting



Total this page 40.00 32,298.00 $ 5,260,964.83

Grand Total 40.00 32,298.00 1 $ 5,260,964.83


Title: Contracts Manager Phone #: 315-334-7843 mtallman @ nvstec.com

ure: ^t"Date Prepared: 05-11-2021


Page 1 of 1



me:Agency Business Unit: DOH01




Description of Services Being Provided: NYSDOH Medicaid Children's Transformation QA Program Support

ope of ContractAnalysis 1=11Data Processing

Engineering 11Health Services

Accounting

one that best

ter Programming Mother IT Consulting

t Services flsurveying [

Health Services

Services

Consulting



Total this page 16.00 14,335.50 $ 1,704,273.52

Grand Total 16.001 14,335.50 1 $ 1,704,273.52




(Use additional pages, if necessary) - Page 1 of 1

T3r



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205BH Agency Business Unit: DOH01




Description of Services Being Provided: MLTC Tasking Tool Support and Implementation

ope of Contract (Choose one that best fits):Analysis flEvaluation flResearch fiTraining

Data Processing ]Computer Programming IXiOther IT Consulting

Engineering fiArchitect Services flsurveying flEnvironmental Services

Health Services fiMental Health Services

Accounting [Auditing FlParalegal r]Legal Consulting



Total this page 9.00 3,014.75 $ 465,627.37

Grand Total 9.001 3,014.75 $ 465,627.37



p



Page 1 of 1



Contracting State Agency Name: NYS Dept of HealthContract Number: PN205BI Agency Business Unit: DOH01




Description of Services Being Provided: NYS DOH Hemp Licensing Implementation

ope of ContraciAnalysis ElData Processing UEngineering

Health Services ElAccounting

one that best

Computer Programming IJOther IT Consulting

Architect Services Surveying [

Mental Health Services

Services

Consulting



Total this page 6.00 2,617.00 $ 302,515.12

Grand Total 6.00 1 2,617.00 $ 302,515.12



S



Page 1 of 1

Th-o



State Agency Name: NYS Dept ofmber: PN691##





Description of Services Being Provided: NYSIIS COVID Vaccination QA Project

ope of ContractAnalysis

Data Processing

Engineering I=IHealth Services IDAccounting ni

one that best

ter Programming LJOther IT Consulting

t Services surveying [

Health Services


Consulting


11-3021 .00 Computer and Information Systems Manage 9.00 2,297.75 $ 300,774.72

Total this page 9.00 2,297.75 $ 300,774.72

Grand Total 9.001 2,297.75 $ 300,774.72


Title: Contracts Manager

Phone #: 315-334-7843 [email protected]




Page 1 of 1



ame: NYS Dent of Hr:





Description of Services Being Provided: NYS Immunization Information System (NYSIIS)

ope of Contract (Choose one that best fits):Analysis 11 EvaluationDResearch [Training

Data Processing UComputer Programming IXiOther IT Consulting

Engineering ]Architect Services surveying flEnvironmental Services

Health Services fiMental Health Services

Accounting r]Auditing riParalegal [Legal E]Other Consulting



Total this page 4.00 1,337.00 $ 188,832.18

Grand Total 4.001 1,337.001$ 188,832.18



S



Page 1 of 1

T1rO-5


Contractor's Annual Employment ReportReport Period: April 1 2020 to March 31, 2021

Contracting State Agency Name: NYS Dept of HealthContract Number: PN691AE Agency Business Unit: DOH01




Description of Services Being Provided: DOH Transition of Medicaid Pharmacy Benefit to FFS

oneAnalysis

Data Processing

Engineering

Health Services

Accounting

ter Programming LJother IT Consulting

t Services surveying

Health Services

Services

Consulting



Total this page 4.00 625.00 $ 91,145.16

Grand Total 4.001 625.00 $ 91,145.16





Page 1 of 1


Contractor's Annual Employment ReportReport Period: April 1, 2020 to March 31 2021

ng State Agency Name:

HealthNumber: PN69178AB





Description of Services Being Provided: DOH CACFP System Modernization - Project Management Services

ope of ContractAnalysis 11EData Processing

Engineering

Health Services LIAccounting Eli

'ose one that best fits):ion DResearch [ter Programming jOther IT Consulting

A Services Surveying [Health Services

riparalegal F


Consulting



Total this page 2.00 117.50 $ 22,387.90

Grand Total 2.001 117.50 $ 22,387.90



rers Si



Page 1 of 1

T-8'/

AC 3272-3 (Effective 4/12)

FORM B


Report Period: April 1,2020 to March 31,2021

Contracting State Agency Name: NYS DOH

Contract Number: PR65774 Agency Business Unit:

Contract Term: 0410112020 to 0313112021 Agency Department lD:

Contractor Name: lnfoPeople CorporationContractorAddress: 450 Seventh Avenue, Suite 1106, NY NY 10123

Description of Services Being Provided: lT Staff Augmentation Services

Scope of Contract (Choose one that beet fits):I Analysis I Evaluation f] Research I Training

f] Oata Processing f]Computer Programming E Otfrer lT consulting

fl Engineering I Architect Services I Surveying tr Environmentalservices

I Health Services E Mental Health Services

flAccounting n Auditing I Paralegal I Legat I Ottrer Consutting

Employment CategoryNumber ofEmployees

Number ofHourc Worked


15-1133.00 SoftwareDeveloper/Systems Software 1.00 2,242.40 $243,167.32

0.00 0.00 $0,00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0"00

0.00 0,00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

0.00 0.00 $0.00

Totalthis Page 1.00 2,242.00 $243,167.32

Grand Total 1.00 2,242 $243,167.32

Name of person who prepared this

Title: VP Phone #:646-790-8252


Date Prepared: 510412021


Bemstein

Page 1 of 1

FORM B OSC Use OnIy

Reporting Code:

Category Code:

State Consultant ServicesContractor's Annual Employment Report


Contracting State Agency Name: Department of Health Agency Code: UnknownContract Number: PR65777/PH65777Contract Term: 11/01/2012 to 06/30/2019Contractor Name: Logic House Ltd.Contractor Address: 49950 Jefferson Street, Suite 130-391, Indio, CA 92201Description of Services Being Provided: Various Hourly Based IT Services

Scope of Contract (Choose one that best fits):Analysis Evaluation Research TrainingData Processing Computer Programming Other IT consultingEngineering Architect Services Surveying Environmental ServicesHealth Services Mental Health ServicesAccounting Auditing Paralegal Legal Other Consulting

Amount Payable Under

Employment Category Number of Employees Number of Hours Worked the Contract

Technical Architects 9 21,434.50 $1,693,150.97Specialists 6Programmers 2Business Analysts 2

Total this page 1 19 1 21,434.50 $1,693,150.97

Grand Total 1 19 1 21,434.50 $1,693,150.97

Name of person who prepared this report: Sheila Allen HousePreparer's Signature:Title: President Phone #: 512-689-9650Date Prepared: 04/20/202 1Use additional pages if necessary) Page 1 of 1

FORMB


Report Period; April 1, to March 31,

Contracting State Agency Name: Contract Number: DO l+D/-J35 1,,/0GC,- Agency Business Unit: DOH01 Contract Term: /?i l)f dl/btlo !!11y1 ,;;,,;,3 3,;-,0 OD Agency Department ID: 3450000Contractor Name: �1377'£ ""772t,{J7 LLD / _ Contractor Address: Lf 9 7)//--J S:f-. 1/11 iT ",;13 JVNZ/Jf//C,J< c I Description of Services Being Pro�r;J' f' 1/chf2> ��'f5� Hul-0Scope of Contract (Choose one that best fits):

D Analysis D Evaluation D Research D Training D Data Processing D Computer Programming D Other IT consulting D Engineering D Architect Services D Surveying D Environmental Services D Health Services 12f'.Menta! Health Services D Accounting □

,,

Auditing D Paralegal


"f$,lfl u;,(_j)f'•; (.1 0 ,

Total this page Grand Total D

Name of person who prepared this report: Title: G f?A IJ Tl;£: Preparer's Signature;.--'Q Date Prepared: 10 32Jc)-/ {Use additional pages, if necessary)

D Legal D Other Consulting

Number of Amount Payable Hours Worked Under the Contract

d.00{) 11u. qo1;

0 0 $ 0.00

dOOu .1,/0, 900

Page / of /

FORMB


Report Period: April 1, to March 31,

Contracting State Agency Name: Office of_the State Comptroller

Contract Number: \)0\1 O \- ' 3 'S & 1 o u-<,.. • � ¼5 UUGVAgency Business Unit: DOH01 Contract Term: 1 / 1Sr28 to � I 151 2.3 Agency Department ID: 3450000 Contractor Name: ya. t-, 'Y'Yt � � R--a, i � ContractorAddress: 5� J ��,..J fr , el\..ov\cl_\.'� ( Description ofServ�es Being P\ovided: � \\-.J&� ��-{J&J \,{ � \L CJ

\;- 0 � � Q. Q Q__I U '-\.. . �I


□Analysis D Evaluation D Research D Data Processing D Computer Programming

\

D Training

\I

D Other IT consulting

□

, •• (l

v�J� .,

D l;ngineering D Architect Services D Surveying D Environmental Service , MHealth Services D Mental Health Services D Accounting D Auditing D Paralegal D Legal D Other Consulting

Employment Category Number of Number of Amount F ayable Employees Hours Worked Under the ;ontract

\ \

Total this page 0 0 $ 0.00 Grand Total

Name of person who prepared this report: ·1fA� � '\ BB -a. g_�

s 2( ( Tille r,/P- L � ½

Phone#: ,�\ 4, q Preparer's Signature: Date Prepared: 4 / /31 2o V

()


XXXXXXXXXXXXXXXXXXXXX

FORMB



Contracting State Agency Name: Contract Number: T35623GG Agency Business Unit: DOH01 Contract Term: 04/01/2020 to 03/31/2021 Agency Department ID: 3450000 Contractor Name: Thea Durant Contractor Address: 603 Franklin Street Watertown, NY 13601 Description of Services Being Provided: Mental Health Counseling


D Analysis D Evaluation D Research D Training D Data Processing D Computer Programming D Other IT consulting D Engineering D Architect Services D Surveying D Environmental Services D Health Services X- Mental Health ServicesD Accounting D Auditing D Paralegal D Legal D Other Consulting


21-1014.00 1

Total this page 1 Grand Total 1

Name of person who prepared this report: Thea Bohannon Title: Licensed Mental Health Counselor Preparer's Signature:� ·b� Date Prepared: 04/19/2021 (Use additional pages, if necessary)


40HRS/WEEK $20,000.00

40 hrs./ week $ 20,000.00 40 hrs./ week $20,000.00

Phone#: 3157770751

Page 1 of 1

FORM B

ork State Consultant ServicesContractor'8 Annual Employment Report


Phone #: 518-432-1233 x160

Contracting State Agency Name: NYS Department of Health

Contract Number: T035785 Agency Business Unit DOH01

Contract Term: 0710112021 lo 0613012022 Agency Department lD: 3450000

Contractor Name: Documentation Strategies, lnc.

Contractor Address: 15 Second Avenue, Rensselaer, NY12144Description of Services Being Provided: Project documentiation for COVID-l9 guidance andcommunications, upcoming system releases consisting of modification of role-based user manuals,video-based courses, newsletters, brochures, and other project artifacts for EDRS as well as Coordinateand conduct COVID-19 cause of death training, and role-based instructor-led training sessions for alldata providers of the EDRS.

Scope of Contract (choose one that best fits):

I Analysis n Evaluatlon I Research I Training

n Data Processing E Computer Programming I other lT consutting

E Engineering n Architect Services ! Surveying f] Environmental Services

n Health Services I Mental Health Services

n Accounting n euciting E Paralegal I t-egat X other consulting

Employment Category Number ofEmployo€s

Number ofHours Worked


27-3042.00 - Technical Writers 1 1,510 129,860.00

13-1151.00 - Training andDevelopment Specialists

1 1,455 110,580.00

Total this page 2 2,965 $ 240,440.00

Grand Total 2 2,965 $ 240,440.00


Apr.14.2021 3:43PM canlon-ped i al r i cs No. 7557 P. 2

FORMB


Report Period: April 1 JO'l,b to March 31, ].Jl2J

Contracting State Agency Name: Contract Number: Do\.\, D..1--T35%Z.ti1a-3'-¥:icooo Agency Business Unit: DOH01 Contract Term: S 1'6J.z.ciV,::, to 8 /14/ 2.6Z 3, Agency Department ID: 3450000 Contractor Name: An111 fel:To cc, on.e..Contractor Address: "1-1.p 'JudSDh C;;;,t- Cl\VttDVl NY 136i� .·

U,UVl Description of Services Being Provided: lilYYIIMi:1 ca.re. ��I Corps Prtu:.11°�� nl.AI/ t1,\£.M t- VD"1

Scope of Contract (Choose one that best fits): V

· LJ Analysis D Evaluation U Research LJ Training LJ Data Processing LJ Computer Programming LJ Other IT consulting LJ Engineering U Architect Services U Surveying LJ Environmental Services C!!'.! Health Services D Mental Health ServicesLJ Accounting UAuditing D Paralegal D Legal LJ Other Consulting

Employment Category Number of Number of Amount Payable Employees Hours Worked

NW"�. Vrc;tlf\{101�0J1· I ::},OOI\

Total this page 0 Grand Total

Name of person who prepared this report: .A\'Wt Pbti,1JUJI lJ)u., Title: G{ltJ f, f (/Preparers Signature: � Date Prepared: '1 /1\, 't- i(Use additional pages, If necessary)

0

�.nder the Contract

.., '),-Ii • f\'lD

Page of

$ 0.00

FORMB


Report Period: April 1, 2o to March 31, Z I

Contracting State Agency Name: Contract Number:T3595l.D6q -�OOD Agency Business Unit: DOH01 Contract Term: 8 /1�20 to g- II.!\! 23 Agency Department ID: 3450000 Contractor Name: (Vlc,n:d f+h U z.o"t'\e.. Contractor Address: & Y3CO C,ou.� �ou4-e.. \C\'1 Toaesa N'f Description of Services Being Provided: -p CC\ e..

1

Y IYYiO.Y'l,\ \'i


D Analysis D Evaluation D Research D Training D Data Processing D Computer Programming D Other IT consulting

\""3ui01

D Engineering D Architect Services D Surveying D Environmental Services i)?J Health Services D Mental Health Services D Accounting D Auditing D Paralegal D Legal D Other Consulting


29 - \l7\,0D Nl,l<�e. \ ?D5ttJ $ 21:>,0CO

Tc) ro..c..--\-rt, on c. <

Total this page 0 0 tt2o,ooo �--tt:ttt,

Grand Total -lzo.DOn Name of person who prepared this report: J\/le.,fe.d1+h LVZo� Title:

� H�. /1/1/\ D/1.--Phone#: 315 4�2 -Z.o94 <-0odZ

Preparer's Signature: �� 2.D7 �?\7 l Loui 2 c...e. \ \

Date Prepared:,4 I'S! 202.\

(Use additional pages, if necessary) Page l of J

FORM 8


Report Period: April 1, VJ Z0 to March 31, 2.,02.\

Contracting State Agency Name: Contract Number: l 3 SG\ � q &G Agency Business Unit DOH01 Contract Term: o& /\5 /?Pio to OK JI) J 2.Dd Agency Department ID: 3450000

Con tractor Address: 5 s ID U r\ 0c ! I Y2.D ad. , ( a r+VJ.or_ y;e I N '/ I 3 b � Description of Services Being Provided: p Yi rYlulr'\f [a)({ Heat fh [,erv,.c£J


D Analysis D Evaluation D Research D Training D Data Processing D Computer Programming D Other IT consulting D Engineering D Architect Services D Surveying D Environmental Services Ji! Health Services D Mental Health Services D Accounting D Auditing D Paralegal D Legal D Other Consulting


frimov\ (CA.re\?'vi ?_Coro1 I \,l�i.s 20, (j{)Q. uu

•

Total this page I � \ I \�,, SO $ 0.00

Grand Total 2.,0 J Ol) 0. 0 0 ( . {OY� 00 • Name of person who prepared this rep rt. S�l by M (

Title: (,Q(ltyC{(fV� fnyf1'c,'un /tfJ1JtaJ1i (veJllctv✓) Phone#: 3\5-71\- (o(pQ5 Preparer•s Signature: '-AA/ 'Vlfi • Date Prepared: OS/ 03/ 2..01-- \ (Use additional pages, if necessary) Page of

0

FORM B


Report Period: April 1, to March 31,

Contracting State Agency Name: Contract Number: T036341 Agency Business Unit: DOH01Contract Term: 03/15/2021 to 09/30/2021 Agency Department ID: 3450000Contractor Name: Niagara Falls Memorial MedicalContractor Address: 621 10th Street, Niagara Falls, NY Description of Services Being Provided: Covid-19 Vaccination Staff


D Analysis D Evaluation D Research D TrainingD Data Processing D Computer Programming D Other IT consultingD Engineering D Architect Services D Surveying D Environmental ServicesC8J Health Services D Mental Health ServicesD Accounting D Auditing D Paralegal D Legal D Other Consulting

Employment Category Number of Number of Amount Payable Employees

Medical Evaluation 11Non Clinical 100Pharmacist 12Pharmacy Tech 8Rn Diluter 2RN Floor Lead 4Vaccinator 69

Total this pageGrand Total 206

Name of person who prepared this report: Mark PelsoneTitle: Senior AccountantPreparer's Signature: � �Date Prepared: 05/13/2021(Use additional pages, if necessary)

I

Hours Worked Under the Contract

116 159812030 57647

294 2975185 247249 256989 5279

1397 64258

4059 177957

Phone#: 716-278-4397

Page 2 of 2


FORM B


Contracting State Agency Name: Department of Health Contract Number: 4980-06 Agency Business Unit: DOH01 Contract Term: 04/01/2020 to 03/31/2021 Agency Department ID: 3450000 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: HRI-Ryan White Part B






29-1141-00 Registered Nurses 1 843.00 $79,661.00 15-1121.00 Computer Systems 1 948.00 $53,036.00 43-9199.00 Office & Admin 2 1,492.80 $59,708.00 11-9199.00 Managers 1 10.50 $1,483.00 43-9111.00 Statistical Assistants 1 649.50 $45,814.00



Page 1 of 1


FORM B


Contracting State Agency Name: Department of Health Contract Number: 5840-03 Agency Business Unit: DOH01 Contract Term: 04/01/2020 to 03/31/2021 Agency Department ID: 3450000 Contractor Name: Island Peer Review Organization, Inc. Contractor Address: 1979 Marcus Avenue, Lake Success, NY 11042-1072 Description of Services being Provided: HRI-Discretionary






29-1141-00 Registered Nurses 7 2,143.00 $158,419.00 43-9199.00 Office & Admin 3 1,386.90 $96,429.00 11-9199.00 Managers 6 2,597.00 $258,740.00 43-9111.00 Statistical Assistants 2 494.30 $33,063.00 29-1069.00 Physicians & Surgeons 1 72.00 $10,572.00



Page 1 of 1

FORMB



Contracting State Agency Name: Contract Number: 1100237384 Agency Business Unit: DOH01 Contract Term: 04/01/2020 to 03/31/2021 Agency Department ID: 3450000 Contractor Name: Thea Bohannon Contractor Address: 603 Franklin Street Watertown, NY 13601 Description of Services Being Provided: Mental Health Counseling


D Analysis D Evaluation D Research D Training D Data Processing D Computer Programming D Other IT consulting

D Engineering D Architect Services D Surveying D Environmental Services D Health Services X- Mental Health ServicesD Accounting D Auditing D Paralegal D Legal D Other Consulting


21-1014.00 1

Total this page 1 Grand Total 1

Name of person who prepared this report: Thea Bohannon Title: Licensed Mental Health Counselor Preparers Signature:�� Date Prepared: 04/19/2021 (Use additional pages, if necessary)


40HRS/WEEK $20,000.00

40 hrs./ week $ 20,000.00 40 hrs./ week $20,000.00

Phone#: 3157770751

Page 1 of 1

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