Appendix K - Hatboro-Horsham School District

GOOD EARTH CHARTER SCHQ4L
Five Year Profarma
FYE 2017-2021
Page
~-5
Assumptions at 100°Io enrolim~nt
s-'~
Five Year Rrafarma Summary X100°Io)
8
9
~0
11
12
~3
~4
Supporting Wc~rksMee#s
ZQ16-2017 -Employee Worksheet
20172018 -Employee 1Nvrksheet
2018-2019 -Employee Wor~sh~et
2019-202 -Employee Wt~rksheet
2~2~-Z021 =Employee WorksheQt
Medical ~ Dental expense assumptions
Charter School Lease Reimbursement assumption
w~
K
1-6
IC
1-T
2919-292D
2019.2020
203f1-2Q21
X020.2027
42
27B
4~
234
191
a7
42
149
a2
706
B4~
8
48
8
41
34
a
8
28
Swaial Ed
8
19
Tom{
50
325
$p
275
225
so
50
17S
~
12S
.
an tR~e Flalboroaiorslfrn School
Ftxt~p is Smad an tRe xhools repCrted eexolhnaM fDr Raqulx Education anE
2017-20'F8
Sehod
RepulsrEd
Spedai Ea
Reg4larEd
Speaal Ed
R~gularEd
Sp~tlN Ed
Regular Ed
Sperm Ed
ReQufarEd
SpadaF Ed
2017-2078
2017-2018
201&2D79
2618-201§
20192026
2019-2020
2D30-421
ZCZO-2047
318
5T
E75
278
+19
326
2sa
.233
42
19i
3~
R~6
f18
27
176
5tudenrt
PoR+lrlion
(M6 for Spedsl Ed.
Pragrom
E~rotFon
Z0162a17
20T8~~~T
Year
Proptam ~irtlede0 w~rofir~rhl
Obi for RepW~r Ed arKl
~,a~r,aas.~e
2.84,004.40 i
1,D06,b72.OB S
2,136,35+1.00 i
789.964:80 S
~,~~,2~II.eO
1.~i,667:~ S
6d5.6~.~ S
2,~1,E47.~
i
5
Page 1
3,732,167.40 i
1 39S e04.48 S
3,127.763.!6
11,736.38
2!,494.29
11,b1Q09
2d,18Z,80
11,433,62
23,824,34
11,194.58
23.234.28
iQ.783.16
2431,10
Annual
Px Pupil
i
3,20d;3BI.DD S
1.184,947.?D S
S
f4]69,326.20
s
S
i
S
i
i
$
S
f
Toms
Amuel
Payment
M the 6 yNr pro/om~s,k is ~asumsC Visa vrNl be 7Q0%arrWlmsnt Uxo~phatR Rhe year, The Tutbtnp r~sera based an Ihs2'D15~76 PDE appmved PDE-363
rents fatued bar each SiM~kt. k fa as~anad tlro rimes wiq mnderalaly Iaosne.0% Tor DoEli ragulx arW epaehl ed atudeMs Mra~ghoi~t Mte tWa Xwrs.
Local Rewmw!- The batfirxlnp b
t
KlntlergarMn sludenia vvpl be b91ed et s had day. 5D students would be 4e billed at halfthe YeBrIY rate for Re9u~rc education and Spiel education.
K
1-S
2018-2019
K
i~
2G~7-241E
?t117-2418
zo~rs•za~~s
K
1-3
ErE~
2016-2617
207$+2Q17
TM sehoW plansio operate a K Ihouph a eehooi. In yew one,tl+e school plain to operele grades K~3, In grade R,tl~e sludeMs will go to
ae~eool Tor ha~rd~rjee~iorn: 2s
in ais mom~np arw 28 aa,den~a ~ aye anan,oion,. ~f predas7 and z,the sdwo~ vrill ne e so
studmds par yade and 25~
In gads3. EecA yaariM &diool will add an ad~Uonsl 50students. Total enroAme~t for K~9 xMl be 450students.
i00li 6KolhnuR
ooaoErutnrcrua~
~sr...~..sor,
H~oraFbrafrem
Ha~oro+lanMm
FN~OrPFIOnhlm
Flalboro~bmham
FlMboro-Honhrm
NlIEOrGH01lhCrtl
Haltiom~HaeeF~em
7~9
a2
797
i2
2~4
12
27E
85'K
84li
~i6
84%
85X
Q4%
85%
28
S
34
S
47
E
48
f59L
18°i
15%
1B'~r
tb9i
1896
f5%
The sdmW plena M obbafn ~e HeaRh care reimbursement The esflamted reknbursemaM b eortservaUvey forecasted at15.000 per year.
5tafie fixidhp [s tarscasUed Por Qre Ch~sr School Lease Relmbursemant. TTro Chutar Sehool Leaae reimEuraerntM vaaa bash on the fortnu#aa
used on the POE-418 end PDE-418.
zosaza2~
Za77-2418
2018-2018
2015-2019
2019-2C2b
2079-2028
Z0~-2021
s
s
5
ear
sa
1.26E
Y~1
~ rs.rts.00
,,.s~s.00
YMr2
~3aso.00
Si.~,e2s
32.00.06
Yar3
~.sao.oa
it oe~.~,
aO.tOG:QD
Ypri
7.d0o.aa
5AG0:06
vMr2
eloo.00
i,~0.~
X~J
,o.oeooG
9,G~O,OG
PoNtlonTltla
1. Clef E7l~CtAfv!OIIfCK
AO~dM1~ii~TMtl1Ms
9..
I~'!T!~lkrt
LL Taediar
S. AAwieTaelrr
T
7. Cemes3ktoremantTeaeher
B.
9.
EG D6lCROr
70.
Ed.
71. C~tMKdtk~11;
12.
13.. AOnk~Oragra/4r~uM
14. CudOtlf01.l Mi~11ED1Nl~ce
StaRhip`and beginning eNniss anrn falbwa M yrr 1:
S+gfhnieg
A+nrp~
Sal
t7
ZD:000
66, 0
~Y1A00,
{6i00U'
46
X0900
id~AdD
sb
~C00
SS.tlOD
3S~OOD..
X3.500
Y~ar2
Nun~rof
Pa~Wons
1.~
6.00
3.00
r.00
O.SC
0.50
2.~
1.09
2.W
1,OQ
t:o0
t.00
1.00
Y~ar'i
Nanb~rof
PosiMon~
t fl4
6.~G0
2.40
1.90
0.50
0.l~
2.90
1.00
?.~
1.00
t.OG.
1.Oa
1..00:
page 2
Yrx3
MumE~rd'
Rositioes
1.00
iD:OG
3',40
1.06
1.00
't.
t.oa
'2.00
t.00
7.W
1.Ob
t.tl0
tA0
2,00
apse nef[x to 6~re ye~Ay~
far Use lotat salary and beneFib bn~akdawn. Amual eialary inaeaaea of 376 per yeW are piarmed.
~~ry aW Ben~lih ~xesna
Rwenw 8ewi~~
Su+d~nt
Fun
The stAaol vr~ nm variousfimdralserS fsrouyhout tl1e Year• The Plan esNmgtes tundrsisilg to be X5.006 Per Yea[.
Student Activity revenue is Torecasted to be revenue neutral. Monier tamed wi be used for frtld bipa. classroom adwRies,fiekf
esrs. ete.
Ogxr reveiwes cansbt of stu~tlent aetfvll~r revenue.fimdroainy,and misr+elWFteous income.
R~rwwsSoue~
r~tlr r Funs
Tine n F
SEA
Ygr4
NmMarof
Posftlon.
1.00
12.00..
iAD
i.li0 '
1.00
1;DQ
vm
3.00
t.(q
3:00
1:00
a.bo
2.00 '
2.OD
rsa1
t ose>oo
S,OOG.00
Ypr4
Yaaya.eo
t2 azs.ri
60,480.00
IDEA funds arc Conmval~rey eatYnakd baseQ on fic Pievbus yesfs apcela!education numbers muRlPAed by S1.2 0 Per adr~enL
Feda~al
Fatlsral Entldernentt~rarKs ~s~skulsteA ata per aNdent rate of3867 per ad~ntfor TMk I and 585.00 persiudentfor TRIe It. Based
an tha student pa~htlon,~e s~ooEiefo~adng Io be SeF~ool~Wi~e vareus Ta~geMd Asaf~eetl.
1'. i'_
sioou ~+ueT~_cx~rE
Ftwv...w.Me~.n.3m:
100 EiwgMmwk
Ygr3
Nun~Ea~of
Fosiiio~s
1,Od
f a:90
i.00
LDG
1.00
1.06
,.ua
2,00
1:00
3.D0
1:170
i.Op
2.00
Z.90
Year5
,asfs.~D
S.OdC.fM
Year S
s3cssa.ao
~z.~z.se
SE.gOpoO
AB 363.80
289,880.20
2.100144.20
263.890.E
9A0.490.80
a90.~
3.A68,Z71.2Q
363.80
283.860.20
144:ZQ
263894.21?
490.80'
2E E6d~2Q
3,46B.Z77.2G
1
6B+t636.18
684638.76
10b.32B.64
105.326:54
.4t
.44
1Q5329.64
105318,68
1.079.618.58 107Y818.56
106828,04
105
64
1 40278:84 1,290,275;84
~9 566:20
6:283.10
12,588;20
6283.10
12.566.20
8:383.7Q
12,596:20
26:332.16
73.~f,6.pg
26332:i$
13.166.08
28.332.1~g
13,169;Q~
26.332.16
.1~
ic.r.u~ ~l
~Z:500
21.00
22.00
t.00
~.OQ
ffi.Oli
t,Otl
37.0
X1.00
2.D0
x.90
X6.00
2.D0
__ 5mg1!
E
S.t77.6T S 75,078.36
3
3S4.OQ
GB1.9Q
58.05
1#7.29
4~.~1
50.2
Tc~dMs t.
5.830.83 f 13,8.74
Ed Services
sue•
u~ilon rid CorMraal~d
s
-
Sates ~nsurane~
iiw~al
SWd~M
d~ LNbiH
snO D60
#
YNrc 1
Ysar7
2~.000
Sl1.OdP
5.000
5:250
5000
b,25C}
OOQ S
Q0.li00
Page 3
YeaR 3
5,x;300
9:St3
5.513
8
S
Year•
55.125
5 788 '
5788
701 :
This Nx~udes L~eneral Liab}i~Y, 8ludent Aaddent. Di~edas and OlFcers k~uai+oie and Welders Co+r~SnseHon irqurence. The school will ensure it
rns~ls lfN Ofstrld's ►aquMwe~eMs. h~awano~ is aaAlm~Md to inaMp appraadrtulNy6% por y~r in pwrtiturt costs,
Ysu6
67 B81
6.Oi8
6.018
?O,OS6
zss~a
zits a~z
zw ese
W []awfeeenem - TfK ror~ta~F DuE9ets E35.000 In ypr ane tw waworf o-ah~,p +br as.mpToyees. In y~aars two mraigh tve. tr,. buapN raeca9t s1s,~a per yex.
Mwranc~
for
732d5
15,000
2a~a
17.364
36,
8t1
4.
Y
Yur6
86550
15.000
2~~2
16538
,729
,4E}3
4
f
1
Yau4
S7.Q0
X7.00
3.00
60.500
15.000
z c~a
16,75Q
330
72
15,000
1
Y~tt3
as are apeseE,, oewpa~ronsl u»rapy, vy~etbleslat. ana
a~ azs s
r
s
;OOG
15,f~0
z,sxs
1
1b,00~
U
Year2
'v0
35.
a,
30
B~.
1
~~
Yur1
so.dr Ea seiwoss - SpseiN EA~61or► s~rtvtors wad ee prsmea~a on a~en s6~raarns TEP. s«,~assso
be4nviorai'~paaNists- Tf~s b not ae ineNnwsemd vr~1! he reWswetl'as Ells IEPS aro ►eeelred.
T~
T
Beu~sat Services
Peohiplonal $wYle~s
~~
This ineduds~ ft1s ups e~ oublds eeYrioe pro+~iders thah fiw a~tldpsted for Via tpoominp +y~ra
E~~q°►
Gceed~R~lHon
Rasa
2016-20'17
5,Of1°~6
2017-2498
5.9D76
ZOf8.20f9
S.W°16
7019•ZEf20
5.Od°k
2~4Z421
5:00%
2021.2022
5.dOw,6
OM1er DeneRt! ansi3b ofUfa fatlowinp: FICA / AAedkare. UrnmpbymsntComp.rM C)Ihar
PSERs!
It~Wwmn!Ran
The CheRr achOoF r~l Ds opting irri0 tAe altsmeM retirement plan.. Based on oompera6le d~ertx xhool0. the xhao~ witl uae a 59L eoMn'butian.
A 17% k~aeesa in ~e f~tth ~d ~Itebea isforecasted in years lwo 9+rayh flue.
Der~i
V'iai0n
3T/tTOisabiNty6l.Ye
AAadkNlDenttl Beneflb
Medical& Dsnlel tienaflb an ~a~latetl byirsnp a LeHgh VNtey Charter ~d~oN's201S2075 ~tatasfior Single and Fa~rdy mcr~d tar projected
3Q'IB~t017 gates.
Part-tkne workers eb no »o,h'e healllr rid darnel baroHts, The ~tlm~t~d ZGtB-2017 yearly yles Ma aslblfours:
7aW~
7oW StaRf
45. Counwlors
1~
lies
Yw 7
ZO,OOD
30.000
2Q;000
78000
Ya~r2
2L}8p0
30.900
30,
81800 S
Year3
21,275
31.827
401000
90.OR6 f
Ypr 4
21.855
32T82
SOOD4
1 83~ 3
22510
33983
G0000
776 5
1reN b
I
ex.
s
f
Ihs Luikfirtg an a daily boss.
,d1aNi.oYbinBb, rapier laesi9,fax Rledfifle, tB180~1
compe,~ers oaalstaoortquaers,na peen ro►m..tlnas4ratian. rrSao mantles.
e~.eoo s
sOG
50 ODQ
1{100D
20~
Ysar2
e~aoo s
500
50.
1000p
2Q OOD
Years
1.583
6 OSa
2.42D
d,84Q
1
f
Yar ~
k itnrorms~ ar system.
tidy bQuipme►rt, e[C.
sz aoo s
2.600
SQ.OdO
10.OG0
20 U00
Y~4
YsR4
1,9~r3
B,8S5
F.8B2
5,324
1 ~4
Yer6
Year5
Ccet[
Costs
/Ymr
ao~
FootMenen~
i.~e
F
........ ~...r.......,~n nm r.:w. hw~M:~ a7w e» w.w a Mer.e~e6.e ltae eer ver:
5
s
~000 5
18f}.00D
2040Q
X5,00 3
Yw1
T2~D OOO S
44.000
~18;oD i
Yawl
Page L
756,90Q 3
516
A0.000
i8.9G Z
Yea►3
793. 0 S
x0.000
18.96 8
5~4
Ypr4
5"K
4Si 000
ZC.Ba
s;roc
2r00
50.00D
70000
20.000
2441
7321
2.928
5858
7
i
833.490
Ye~rS
1'he cf,w~x salao~ perto u~ moeWr uniteIn p.rr on.n ■ p.man.nlre ly h euNt in ~s Hamuro~Florahsm school ~abi~t. n,.rar~lity le pNxx~sd a be"wm r~e~+'.
N~ Yqr one.tl~a aelimeled aquaesioofape'~ 20.000sq 1k st 575.00PK ~4~P~
ode to se~tMie modulars aR totaHnp 5180000. In year lwo. tl~ school wiH ~r
fib Cosh
ace s
26,OOC'
f 000
SG.Wa
30.000.
Y~rrt
Year 1
Yqr3
7 Ofip
1.350
5.000
8.56Q
2 000.
2.200
40pp
400
12,000 f
13,76G f
hkga usetl to complete a daceroom. 7Ms kid~desitems aucA as desks,dwairs.~Nrs;carpets,
M~rkerrnce s4ulpr~wrt ~ndlldls kame uqd of
OKk!equipRlerM h~dlldai.
~Isssroom agitlpm~nt ~naista of a!P dw
CA.~ E~d~.EfbWillO,!!G
Gods
Gaserpom
p1ry0i
AAeIrNa~at
Tae
F
lndu0e~ clarsrcom hXnihxa,oa+~fws,o~fiea tumiMe ~d egiNpmerK kris,
mint
Otead~feu
Totals
7rayll/ Mea1s
ether oulrl~d ~S oonelsl ofeapenmea as~Mad witlf llfescNooltl~et are not d'Kectly atsodatsd wiMi sluderAs: These costs include:
w~loA eead~inn rtr9pdso~ lan+mptus~s ort boaka in me larar9~~a.whkl+ hudts in reEuo~d erPerrcea in'Mls
crY in trw eaAY ya~rs ofths eriart~r hrtn.
Year1
Yar2
Yep3
Y~a4
YES
Books
tS,QOp
15.OW
7Q.000
70.000
10000
Ttlfals
13000
75 OD0
OIL
7p OQQ
70 Utl0
JIaAl~lralws
kf~ruCtlorW
61DEA
ToW CnrrM
These are wpgllas~tera used rt~ a gf~ran s~hoa Year bM s~udsrRs.teachers ar+d office Peraor+nel.
FirsY~Pm~ann201
f00% Enrellrnant
i
r
N M N N M
ra
jr r a
~D V~pp
iR0 ~~
6 Year Proforma
Fecal Year Ending:
Enrollment:
Regular Ed~ation
speaa~ Educatw~
06130/17
176
S
~~
Charter School Lease Reimbursement
Heskh Care Reimbursement
TitlB I
Title II
IDEA
Student Revenue
Fund Raising
---
OBl3~/18
2Y6
06/30/18
2i6
06l30/2D
326
DBl30/21
976
1,585.907 S
601.840
2.136,254 ~
788;865
2.884.094 S
1, 0.622
3.204.381 i
1,1!11,947
8,434
S,OOD
9,D08
5,900
11,681
5,000
17,211
5,000
19,7b5
5,000
116,725
71,975
-
53,35p
71,776
~ 32,400
33,350
12.068
40.800
39,350
12,430
50.4D0
33,350
12.803
58,800
10,0
b~~ _
12,096
4,~
14,575
6,4D0
7,OOD
. __ __
~
$
8;400
5,~_
3,73,181
1,395.899
Total Revenue
S
2,8b3,0a1 ;
S,D87,OY9 S
8,792,436 5
~,624,~B13 ~
b,277,018
Total Persannel Cats
% of Reverie
~
1,183,173 =
48.939E
1,1161,206 S
47.8896
1,800,988 f
52;95Sir
2,391,687' ~
52.93%
~,748,B69
b2.d5Xa
30,OOD
BB,000
75,~b
15,000
2,60D
1S,i100
31,500
69,300
15,000
15,450
2,57b
Y5.750
33.078
72.?66
15,400
15,974
2,653
16,b38
34.729
78.+W3
i5,OD0
16.391
2.732
Contracted Services:
~t
I~Bg~
Su~~ess S~rv~ces
Substitute Servf~es
TBc~►nobgy Sewicea
I~ayra~l Services
~Speael Ed Servicres(Evaluatiomsnd
Prpfessional Development
Sub 7otsl
SI of Raverwe
Insurance
Gef~erel Property8 Liability
Student Accident, and D &0
WOfrGBfS CW11~'~Sa11011
Sub Toisl
xa
COnsumabbe Suppfise
Atlmini~trstive
Instructional
Special Ed ~ IDEA supplies
11.969
'J6,465
eQ,2Z8
75,000
78,883
2,874
soaoo
~s,400
so,soo
eB.sso
~a,z~
35.00D
21S,60D
9.156
i5,~D0U
219,126
1.276
16,004
230,E56
6.19f
1b~000
24a,S~2
5.4"k
151000
246,964
4.84k
25.000
S,~D
5,D00
36,090
1.576
60,OUD
5,2bD
5,250
60,bOD
2.D76
62,500
5,613
5,513
68,62b
1.791
65,126
5,788
b,789
88,70!
7.596
57,881
6,078
6,478
70,O~b
1.SS6
20,000
30,000
20.00D
7`0,000
3.Q96
,2o,6Dp
30,9DD
30,DU0
l7,~i0Q
Z.7%
21,xta
31.827
40000
i3,D45
2.676
21,SSS
32.782
b0.OD0
1046
2.3%
22,510
33.785
80.000
7lE,~76
y.Z+K
Page 6
b Year Proforma
06/30/17
17S
Fecal Year Ending: ~
Enrollment
tlBl30N8
22b
o~a~e
or~or~o
osr~arz~
275
X26
376
/Software
96 of RBv~nuB
tither Overhead hosts
Marketing
Trevel /Meals
Pasla~e
Dues8 Fees
% d Rwarwe
Classroom I Offics
,Sub Total
!6 d R~r~ue
SHB CGats
Building Lease
InIpfGWe1119f1t8
J8~11~181
ut~~ues - E~~~ &cis
Telephone 8 IMemet
Maintenance d. Repairs
Equipment Rental
Sub Total
Ka,~
Student Activities
94#Rtus
16,600
0.8'6
16,D00
0.696
70,000
d.9y6
f0,~0
1.556
70,~p
1.391
1,ODQ
6,000
2,DQ0
4,000
12,4Q0
O.b96
1.250
5;500
3,200
4~4D0
1,360
0.696
1.bb3
B.O50
2,42a
4,840
11,873
0.656
1.853
6,855
2.662
5,324
16,6i1~
d.T46
2,441
7,321
2.928
5,$56
18,647
0,9lS
100,OOD
50,000
30,000
Sb,OpO
10,D00
20,000
60.bDQ
10,000
20.000
50,DOD
10,000
20,000
60,OQD
10,000
20.000
25.OD0
2D6,RDD
8.7'ri6
2.500
8R,b00
2.716
2.600
b1,600
2296
2.SOD
82,6Q0
1.8%
2.500
82,600
1.6li
~b0.000
180,ODD
730,004
7b8,0~
-
793,8UQ
833,49D
+z.000
za,000
2s,2oo
2s,~so
2~,~e3
b0.00D
100.QD0
105,000
110,2bQ
115,763
~,~ie
s,00a
~,Qoa
~,~so
240
7,SOD
6B4,Bp0
21,8%
?b,iD~O
7875
883,!76
3$.296
28.250
8,269
928,D8i
Y~.b96
27,3
86B2
Y74,4T2
21.556
40;p0p
9;11 b
1,034,256
19.671
3,7b0
0.2%
3,750
0.196
8.7b0
O.t96
3,7b0
D.1~76
3,760
0,196
e,~o3
Total Dfsbursa~ents
~
2,3x1,928 ~
2,810,506 ;
3,156,606 S
3,956,893 S
4,399,181
Annual Net Surplus prior to Debt Serv7ce
i
51,158 s
ZTO.SB7 ;
315,831 i
567,8Y2 i
877,838
51.1b8
146,Q38?
b.120
220,581
{140.525)
86,781
918,831
1179.330)
227.781
567,922
{1iD7.8451
597.858
877,838
(219.9591
Interest expense
DebtSeruloe Co~nerape Rego
eginrong Net Surplus after Debt Service
nnual Net Surplus after Deb!Set~vice
eservei~ Cpntingerices
ndlnAFund balance Surplu~(sAartage
PagB 7
GOOD EARTH CHARTER SCHOQL
Employes Summary
06!30!17
Average
.Sala.
Position Title
1. Chief F:~teCutive Officet
2.Academic Teac~ere
'el Ed Teacher
3.
4. S rush /ELL Teacher
5. Music Teacher
6. Ha~dvvoAc 7eac~r
7. Games8 Movement Teacher
8. Classroom Su orl
al Ed ~redor
9. S
1{f.S vial Ed Su port
11. Curriculum S 'alist
12. Mugs$
13. AdminlstretiveAssistant
14.'Custodial f AAaintenance
15. Cnunselnrs
Totrl~
Tut~l StAff R atri
85,000
42.50D
45.00D
45,000
4~,000
40.000
40,OW
33,000
55,ODCf
33>000
42,500
42,5D0
27,50Q
25,D00
42,500
Berelltt
Number of
Positions
Cast of
Medical
Insurance'
Total
Sala
Retlrement
Plan
8.fl0946
1;00 $
6,00
2,00
1.00
0.50
0.6U
3.00
1.Op
2.00
1,00
...1.00
1.OD
1.00
1.D0
65,~U $
255,U00
90,000
45,UQ0
20,Df10
ZD,ODO
66,000
55.E104
66,U00
42,5D0
42,50D
27,500
25,D00
42,500
7, 12 $
48,874
15,825
7,$12
7.812
7,81
15,626
7,812
15,625
7,812.
7,812
7.812
7,$12
7,81
3,250 ~
92,'754
4,5D0
2,250
1,000
1,{100
21.00 ~
7.~.~00
861,4G0 S
171,873 3
4$.'100 S
3,300
2.750
3,300
2,125
2,125
1,78
1,25U
2,125
FICA and
all other
benefits*
Total Cost
~f P,psiiph
8,500 $
25.500
9,000
4,500
2,OD0
2,OD0
6,500
5,500
6,6~Q
4,250 .
4,250
2.750
2,500
4,254
82,5fi2
340,124
119,1.25
58,562
30,812
30,812
91,525.
71,062
91,625
56,687
.56,687
39,437
316,562
58,6$1
8$,200 ~
1,163,173
~m io ee benefit Breakdown
Single
Rate
°Io
Forecasted
Med[cal f Giants) Insurance
Family
Rate
21
22
1 Number of Employees
~ utal Number of Employees r~celvtng Benefits
Hsslth
Den~1
5,177.87
354.00
70%
300
9re ofSipgle En1pl0yeea
4~6 of Family Employees
% of Part lime Employees not receiving Benefits
14
6
20
10090
Total Cost
15,036.38
Bfi1.92
77,443.38
94,429.88
77,443.38
84,429.88
171,873.b6
Toil # of employees
22.0
$
Averngs Gpst
(Including medical, dental,vision &prescription plans.)
Please note this varies greatly depending on Marital status,
number of dependents,and choice of medical plan..
Other Benefits:
FICA/MEDICARE
Unemployment Compensation
Dtlfer
10.0~0°i6
7.65°Ia $
2.~5%
0,10%0
65,943
19,385
862
~
66 200
Cost of Employee 6eneflta
Page 8
7,812,41
GOOD EARTH CHARTER SCHO+DL
employee Summary
OG/3fl118
Position Title
7.43
Average
$ala
1. Chief E~oecutive Officer
2. Academic Teachers
3. S fal ~d fieacher
4. $ nlsh I ELL T~Ac~iar
5. MuBk Te~Cher
8. Hendwol'k TBaCher
7. Games8 Movement Teacher
8. Classroom Su ort
9. 5pecfal Ed Director
10. Sp9Cfel Ed Su
~i
11. Curriculum Specialist
12. Nurse
18. AdminiBtrAtivBA~si~tairt
14. Custodial /Maintenance
16. Cour~aelors
Number of
Positfans
1.~0 S
8.00
B.OD
1.(f0
O.Sb
0.5D
2,00
1.00
2.00
1.00
1.04
1.06
1.OQ
1.00
68,960
43,775
46,860
46,35D
41,200
41,?OD
41,200
33,990
56,850
33,990
43,775
43,775
28,325
25,150
43,775
24.00 3
26.00
Tot#la
Tolal Stiff R u7rio Benetila
Cost of
Medical
Insurance•
Total
Sa1~i
88,95D S
350,200
199,05D
46,35D
2U,800
20,BQ0
67.880
56,650
67,980
13,775
43,776.
28,525
25,75D
93,775
1,021,760
i
11,047 i
88,378
33,142
t 1,047
11,047
11,047
22.095
11,047
.22,095
11,047
11,047
11,047
11,047
11,047
278,783 S
PSERS
Per PDE
5.00°,6
3,348 S
17.510
6,953
2,31@
1,030
1,030
9.399.
2,838
9,399
2,189
2.189
1,16
1,288
2,189
51,085 E
FICA and
all other
benefits*
Total Cost
of Portion
6,895 ;
35,020
13,905
4,635
2,064
Z,O60
6.798
5,885
6,798
4,378
4;578
2,883
7,575
4,378
102,176 i
88,D40
481,1Q8
199,D49
64,35D
3I737
3,737
100,272
76;:105
100,272
61,359
61,889
43,821
40,660
Q1,389
1,4b1,206
Employe Benefit BreAkdown
Single
Rate
96
Forecasted
Medical![3ental Insurance
24
25
Total Number of Endlayers
Total Number of Empiayees receiving Benefits
~h
.~I
8213
425
y6 of Single Employees
X of Family Employees
•~6 of Part Time Employees not recehr ng Benefits
6796
3896
Total Cost
Total.#of Employees
16
9
1p62~8
25
106,208.00
Average Cost
(including medical,dental, vlsipn d~ prescriptbn plans.)
Please Hate this varies greatly depending on Marital status,
number of dependents,end choice of medical plan.
Other Benefits:
fICAlMEDIGARE
Unemployment Companaafion
thher
Family
ttafe
18092
7~1
168974
1fi9,974.00
276,182.00
25
; 11,047.28
10.0096
7.659fo $
2.25%
0.1096
;
Total Cost of E~loyee geneflts
Page 9
78,165
22,980
1,Q22
142,776
G000 EARTH CHARTER SCHOUL
Employee Summary
06/3/18
Position Title
1.03
Average
Sala
1. Chief ExeCut3ve Officer
2:Academic Teachers
3. Special Ed TeflCfier
4. Spanish!ELL "teacher
5. Music Teacher
8. Handwork Teacher
7. Camera6 Movement Teacher
B. CI88sroom Su
9: S
1 Ed Dlreclor
10. Special Ed SuppoR
11. Curriculum SpeCiBfisf
12. Nurse
73. AdminiefrativeAssisterd
14. Custodial/ RAeir~enanoe
1b. COunsebfs
Number of
Positions
68.959
45,088
47,741
47,741
d2,d36
42,A36
42 438
35.010
59,354
35,010
95,D!!b
45,flB8
29,175
26,523
45,D88
Totr)s
Total St~tfR nirin Benefits
Cost of
Medical
Insurance'
Total
Sala
PSF~t.S
Par PDE
S.00'~
FICA and
all other
benefits"
Total Cost
of Portion
1.00 ~
1 D.OD
3:00
1.q0
1.00
1.00
1.Q0
2.00
1.00
2.00
1:00
9.00
2.00
2.00
2.0~
68,958 S
450,883
143,222
47,14/
42,436
42.436
42,436
7QU19
58,356
7U,019
45,bB8
~15,DB6
58,350
53,045
80,177
14.503 S
146,034
43,810
14,803
94,603
14,643
1A,8U3
29,2Q7
1A,603
29,207
94,603
74,6
29„207
2B,2p7
28,207
3,448 ~
22,544
7,161
2,387
2,422
2,122
2122
3,bD1
2,917
3,501
2.264
2,254
2,917
2,852
4,508
6.896 S
4b,088
14,322
4,774
4,2A4
4.244
4,244
7,D02
5,835
7,OD2
4,5 9
4,609
5,83fi
5,305
8,018
93,6
664,548
206,515
.69,605
B3,405
63,4A5
63,A05
108,729
81,705
108,729
66,455
88,455
98,9D9
80,248
132,810
51,00 3
81.00
1,328,247 ¢
4527x4 ¢
66412 S
192,825 S
1980,166
Ewnployee Benefit Breakalawn
Singly
liar
~6
Forecasted
Medkal /Dental Insurance
31
31
Total Number of En~ldysns
Total Number of Employees receiving Bene~+ts
!h
:.,gal
7,456.00
51D.D0
0.35
0.45
°A~ of Single Employees
X of Family ~xnpbyees
'~ of Part Time Empbyses net receiving Benefits
17
14
Average Gost
(Including medical, dental, v~ion 8 prescr9pt~on plans.)
Please Hots this varies greatly depending on Marital status,
number of dependents,and choke of medical plan.
21,710.04
953.00
135,422:00
317,282.00
1.35,422.00
Total Cost
Total # of Employees
Other Benefits:
FICA/MEDICARE
Unemployment Compensation
Other
F~mi1y
Rate
317,282.00
452,704.OD
31
E
10.n0°r~
7.6596 $
22596
0.1096
101.fi11
29,888
1,328
s
132,825
Total Cost of EmplayeQ Benefits
Page 10
14,503.35
GOOD EARTH CHARTER SCHOOL
Employee Summary
Ofi/30/20
1,03
Average
Sala
Position Title
1. Chief Executive Officer
2. Academic Teacher8
I Ed Teac~~er
3.3
4. 3perdshlELLTiaBdle~
6. MusICY~her
6. li~ndwork Teacher
7. Games & Movemerri leacher
8. Ciessroom Su
eCial Ed Dirodor
9.
10. Special Ed
rt
14. Cu~um SpeCia~st
72. Nurse
13. AdministrativeAeeiste~r~t
74. Cust4t~81!M1t8fie►iDe
15. Cou~sabrs .
T01HIs
Total Sfaff R
uir#
Number of
Positions.
7'x,027
46,441
49,773
48,173
43,709
43,709
48,709
38,0
6U,1OQ
36,080
46,441
46,441
30,050
27,318
46,441
i.OD S
12.U0
4.90
1:OU
1,(!0
1.DD
1:OD
2.00
1.00
3.Ob
1.00
1.Ob
2.00
2.0~
2.QR
~S.OG S
95.00
BRneiifs
+Cost of
Medical
Insurance"
Total
Sala
71,02] S
.557,291
198.691
49,178
43,7Q~
43,709
43,709
72.120
BD,10Q
108,180
46,44
4B.MA
80,100
54,536
92,8$2
i,b46,2118
S
P8ERS
Per PDE
5.D0°k
~A and
all other
benefits*
17,822 . ;
211,460
70, 87
17,622
'!'~,62~
17,822
17,632
35,243
17,622
52,585
17;622
17,622
95,243
35,243
33,243
3,551 s
27,85
9,835.
2,458
2,7$5
2,t85
3,1&1 '
3.606
3,005
b,d09
2,322
2,322
3,005
2,732
#,64d
618,T67 ;
77,310 ;
Total Cost
of Postlon
7,103 ~
55.729
19,669
4,917
4,'Jr9
X1,871
4,371
7,212
6,010 '
10,81&
4;644
4.644
8,010
5,484
9,28$
1b~1,$21
S
98,303
852.3A4
296,G87
74,170
67,887
67,887
67,887
118,1b1
x,737
177,27
71,029
71,029
104,558
98.076
142,057
2,394,897
Employee BeaeSt Breal~own
dingle
Rate
°~
Forecasted
Medical / eental Insurance
Total Number of ~rnployees
Total Dumber of Empbyses receiving Benefifs
!th
~er~tal
35
35
8,94?.OiD
612.00
5496
466
96 of Single Emplayecs
°L of Family Err~ployeea
96 0# Part Tires Employees n+ot reasiving Bsne#its
19
16
Average Cost
(Including medical, dental, vision 8 prescription plans.)
Plsaae Hots this varies greatly depending on Marital status,
number of dependen#s,and choke of medical plan.
2fi,052.00
7,144.pp
181,621.00
435,136.00
181,621.00
Total Cost
Total ~ of Employees
Other Benefits:
FICA!ME~CARE
Unemployment Compensation
Other
Family
Rats
435,136.00
616,757.00
35
g
10.0096
7.8596 $
2.2896
0.~09b
178,285
34,79D
1,545
S
15~1,62~
Totat Cost of Employes benefits
Page 91
f7,621.63
GDOD EARTH CHAFiT~it SCM~aI.
Employee Summary
06130!21
1..03
Average
Sala
Position Title
1. Chief Executive t)ffiCBr
2.Acedertdc7e~dters
I ~d 7eaaher
3.
4. S 6lnish /ELI,TeeFher
5. Muafc Tepcfi~
B. HarWwork Teacher
7. Gsmea ~ lNovemen(Teacher
8. Classroom S
9. Special Ed Dirador
10. S ' I Ed
11. Cwriculum 3
Est
12, Nwss
13. AdministretiveA+eslstalM
94. Custodial / AfEainten~ncp
15~ moors".
Totala
Totwl Stafl'R
Number of
Positions
73.158
97.834
54,848
bQ,848
4b,~0
45,020
45,020
37.142
61.903
37,142 '
47,b34
47.834
3U,851
28,138
47,834
1.00 S
74.00
4.00
1.OD
1.00
1.U0
1.00
2.00
1.00
3.Q0
1..00
1.flb
2.00
2.OD
2.OD
3T.00 $
31.00
ulrin Benefits
~~t of
Medical
Msurance'
Total
Sala
73.158 ~
21.766 ;
6.678
304,781
87.066
2D2,592
50,848
29,7 6
+Id,020
21,766
45,020
21,766
45,020
21 788
74,284
43;533
81,903
21,786
111,425
65,299
21,788
47,834
47.834
21,786
43.638
81,803
56,27543,533
95,668
A3.b33
1,688,283 s
8Q6,364 ;
PEERS
Per PDE
5.0 96
FICA and
all other
benaflts*
Total Cost
of Postion
3.658. S
39.484
10,130
2,532
2.251
2,251
2.25
3,714
3,495
5,571
. 2.392
2,392
3, 85
2,'814
4,783
7,91fi S
66.868
2.259
x,065
4.502
4,602
4,502
7.428
6.190
17,143
4,788
4,788
6,190
6,828
B,58i
705,898
1.074,660
320,046
80,012
73,60
73,&40
73,540
128.959
92.856
193,439
78.776
76,778
11x.721
iD8,250
753,551
84,473 5
168 8Y8 S
Z,74B,B83
Employee Benefit Bre~akd+~wo
%
Forecasted
IIA~dicaf 1 C]eratgl Insurance
Total Number of Employees
Total Number of Employes receiving Benefits
+l~
,sl
Family
Rate
10,736.Q0
?34.00
31,2B2.OD
1,373.00
37
37
94 of Single Empbyees
9G. of Family Employees
°~6 of Part Time Employees not receiving Benefits
5196
4996
19
16
Total Cost
Total# of Employees
217,930.OU
587,430.pQ
217,93D,00
Average Cost
(Including rt~dical,dermal, vlsi~ 8 prescription plans.)
Please rotsthis varies greatly depending on AAorifal eteWs,
number of dependents,and chatce of medical plan.
OtherBeneflb:
FICA!MEWCARE
Unemployment Comper~ation
Other
Single
Rate
805,360.00
37
587,430.00
$
10.00°+6
7.6596 ~
2,25°~b
0.1096
Tobsl Cost of Employes Benefits
;
Page 12
129,152
37,8186
1,688
168,826
21,766.49
Avg Health Benefit
Tat~l Employees
Total HeaI~S BenefiEs
;
$
5.22
41.11
Disability ~ Lifoe - Family l year
Qisabilityr $Life -Single!year
8,72' 8Z ~
2Q
'~7d,4'16.38 $
95,584.74
78,831.62
142.29
58.Q5
Vision -Family Bert~fit /year
Yson -Single Benefit!year
Family Benefit extended
Singh Benefit emended
661.92
3~4Aa
Dentail -Family Benefit/year
Dental -Single ~nefitI year
15,076.36 $
5,177,67
$
Health -Single BenefrtJyear
Heater -Family Benefit /year
6
1~4
20
Family Employees
Single Employees
Total fmployee~
FY ending
~'[T
Page 13
11,206.60 $
25
280,165.00 $
172,053.00
108,112.00
60.00
49.Od
171.04
70.QQ
794.00
425.00
6,213.00
18,Q92.00 $
1fi
25
9
14,806.87 y
31
459,013.0 $
321.,180.00
137,$53.00
72.00
59.Q0
X05.00
84.00
953.0
510.00
7,456.00
21,710.OU $
17
31
14
GOOD EARTH CHARTER SCHOOL
Projected Medi~ai Casts
ll'EARS 'I THROUGH 5
FY ending
FY ending
2EF1$
2019
19
3v
16
17,888.77 S
35
625,337.00 $
440,448.00
184,889.00
86.Op
T1 AO
246.00
101.00
1,144.00
612.n0
8,947.0
26~052.Q0 ~
~`Y ending
302.0
19
37
18
22,065.89
37
816,438.00
594,594.00
221,844.0
~ 03.OQ
8x.00
295.00
121.00
1,373.00
734.00
10,736.00
31,262.00
FY ending
2Q21
GOAD EARTH CHARTER SCHOOL
RENT REiMBUR3EMENT CALCULATION
YEARS 11`HROUGH 5
Grades K-6
Yr1
Yr2
Yr 3
Y~ 4
Yr5
125 $
175
225
30d
35D
16p $
160
160
18D
1S0
2U,000
28,000
36,000
48,000
5G,000
Grades 7.12
Yr 1
Yr2
Yr 3
Yr 4
Yr 5
b
0
0
25
25
$
$
~
S
~
22Q
220
220
220
220
Max Relmb.
Gross
'temp Relmb.
Annual Least
Percent
Amount
Enrollment
Yr 1
Yr 3
Yr 3
Yr 4
Yr 5
125
175
225
325
375
Year 1
Total Lease Cost
Liss: Income from other sources
Eligibfe Lease Costs
Reimburseable °~6
Total eligible Amt
Charter School Market Value Aid
Ratio
Total Reimburseable Casts
5,500
5,500
;
20,000
28,000
3fi3OD0
53,500
fi1,500
Year 2
Year 3
300,000
720,000
756,00
793,800
833,A9D
Ysar g
Q.07
(f.0~4
0.05
0.07
~A7
Year 6
300,000
300,000
7%
2U,000
720,000
720,000
496
28,000
756,000
756,000
596
36,000
793,800
793,800
i°~6
53,~aU0
833,490
833,490
7°Jo
61,500
U.3217
0.3217
0.3217
0.32.17
0.3217
6,434 ~
9,008 ~
11,687 ~
17,211 ~
19,786
Page 14
CS
MY Aid
Ratio
0.3217
0.3217
0.3217
0.3217
0.3217
PenSery
PenSery Plan Services, lnc.
LETTER OF INTENT
This Letter of Intent and any attached schedules,amendments, etc.(collectively "Letter") confirm that the employer referenced below
("Employer") wishes and intends to engage PenSery Plan Services, Inc.("PenServ") to provide the services set forth in the attached Schedule
of Estimated Fees and Services ("Schedule").
Employer acknowledges and agrees:
a. Employer must enter into a Services Agreement within sixty("60") days from the Date of Offer specified below, when the offer
expires ("Expiration Date").
b. That PenSery shall begin the initial conversion process once a Services Agreement has been entered into and executed by the
parties.
c. PenSery will not be liable for any consequences and or related costs and or expenses,in the event the Employer does not provide
timely, accurate,and complete data to PenServ.
d.That in the event a Service Agreement has not been executed by or before the Expiration Date,unless agreed upon in writing by
PenSery to provide an extension to this Letter,and the Date of Expiration:(i) the Commitment Fee below, wI11 be non-refundable;
(ii) PenSery will cease to perform further work for the Employer,and shall have no obligation whatsoever to the Employer; and (iii)
the Employer agrees to compensate PenSery for the services rendered under this Letter, beyond the $500 paid in Commitment Fees.
e. PenSery is not a provider of tax, accounting or legal advice.
General.
a. Limitation of Liability. in no event shall either party be liable for loss of profits, revenue,data or use or for any indirect,incidental,
special or consequential damages,however caused,even if advised of the possibility ofsuch damages.
b. Confidentiality. PenSery and the Employer agree that each will keep confidential and not disclose or permit its employees or
representatives to disclose information received from the other or otherwise use such information,except as contemplated under
the Letter, or as maybe authorized by the party whose information is to be disclosed,or as such disclosure maybe required by law.
c. Term and termination.The term of this engagement shall begin on the Date of Offer setforth below,and unless agreed to
otherwise in writing by PenServ,shall expire sixty ("60")days from the Date of Offer, or terminate,as soon as a Services Agreement
has been entered into by the parties, whichever is sooner.
d. Confidentiality and indemnification obligations shall survive the termination or expiration of the Letter.
Commitment Fee: $500.00 (Check payable to PenSery Plan Services, Inc., to be returned with this Letter to the address below.)
Plan Name
Name and 7Yde
Authorized Signature
Effective Date
Accepted: PenSery Plan Services,lnc.
Yvonne C. Kepler Chief Operations Officer
By:
Signature
This Agreement shall expire on:
Attachments:
Plan Questionnaire
Original Fee Proposal
Upon receipt of this Letter of intent along with the Commitment Fee,the Services Agreement and takeover documents will be forwarded to
the Contact indicated above.
For questions or assistance, please contact our Conversion Group
PenSery Plan Services,Inc.
Conversions,Team 75
lOZ Trade Zone Drive
West Columbia,SC 29170
Phone(803)791-4923
PenSery
,STIMATED FEES PER PROPOSAL
Standard Employer Fee Schedule
NonERISA 403(b) Services
PSERs Alternative for Charter Schools
Initial(One Time)
One time Set-up Fee/One time Take-over Fee
(Includes Document Review and Plan Design)
$1,800.00
Annual Base Fee
$ 850.00
s
Non-FRIBA 403(b) Sure
"'
Participant Fees"
Recordkeeping and Compliance
Receive and qualify contributions from all sources,
Reconcile exceptions, track annual contribution and
Maintain records for audit purposes. Review, qualify and
Monitor participant loans, hardship distributions,
Minimum distributions, account transfers.
$40/year/participant
Distribution and Loan Fees
$70 per transaction
Custodial Fee
.06% of assets
Additional Services (Optional)
Internal Compliance Reviews for EmployersNendors
Assistance in Plan corrections
or the Employer. The one*Participant flees and the Custodial fee can be paid by the Participants
ction fees are paid by
timefee and the Base fee however are to be paid by the Employer. Transa
from mutual funds.
Participants. All fees will be reduced by any revenue sharing received
~~-----
~03~b) Plan Q~r~stiohn~ire . --
—
for Ch~~te~r 5c~tool~:iin per~nsy~lv~~hia.
Employer's Name: Good Earth Charter School
800 Welsh
Road
Business Address:
---------___---------.------____
______.__e__~_~~_~
-------_.V___de:
~ State: PA ~
19044
City: Horsham
Employer EIN #: 47-4588510
Phone Number. 215-612-2339
_ _______1_ ---------- ----- - ------ -' - _--_ - — ----~
Contact Person's Name and Title: Thomas Taylor III, CPA, Business Manager
Phone Number: 215-755-7603
Email• ttaxlor~u reotay.com
Who will administer the Plan?
~ A designated Third Party Administrator (please specify): PenSery Plan Services. Inc.
MAN Y` ~ ~A~►r oN'
ti
j When is the plan year? ~ The plan year is the calendar year (most commonly used).
i
❑The plan year is a 12 month period starting on each (month, day)
Current 403(b) Plan ❑Yes (this will be an amendment)
Enter the initial effective date of the Plan:
i
.(This will be on your existing Adoption Agreement)
❑ No (this will be a new 403(b) Plan)
Effective for new hires hired on or after:
IF new hires after the date above were participating in PSERs prior to being hired then such Employees:
D will; or
~ X will not;
have a choice to select either to remain in PSERs or participate in this 403(b) Plan.
How much will employees be permitted to contribute to the plan as a pre-tax salary deferral?
~ The maximum permitted each year by law ($17,500.00 !n 2014)
%(not to exceed the maximum permitted by law)
j
❑ A percentage of pay equal to
Will the plan offer the age 50 catch-up election to allow employees age 50 or older to
~ ❑ No
i ~ Yes
make additional deferrals?
Note: The following option may only be selected by Employers who are: an educational organization; a hospital;
a church related or religious organization described in section 414(e)(B)(ii); a home health services agency; a
health &welfare agency (defined as medical services such as hospice, the prevention of cruelty to children or
an adoption agency, or an agency that provides services to the needy.)
an/mals,
~---~
-T---------~._.._-- -------------Will employees with 15 or more years of service be permitted to make a special catch- ~ ~
Yes
~ ❑ No
~
up contribution of up to $3,000 more per year or $15,000 lifetime? ~T
Will Roth 403(b) post_tax elective deferrals be permitted?
__
❑Yes
~ ❑ No
(Enter the date that
If Roth Deferrals will be permitted, the effective date to allow Roth contributions Is:
Roth contributions may or did begin, even if prior to establishing this plan. Default is 1-1-09 for plans effective
on or before that date.)
Employee Mandatory Contributions:
Employee Mandatory Contributions under the Plan will be required at 5 %.
(PSERs has approved 5%, can be more.)
These Mandatory contributions will apply to Employees hired after the date above.
--
~--
--
These ~~ntlprs are ~i
~ App~oved~VehdBrs`an
hnr~inil fn re~nl~e nnn
idols;
Address
Name of Vendor
i
t
~~cha1~ ~~ ~►il~ b~ ~fih~itted {gyp. ~h~ olloV~(pg V~~ rte'
`~ ~ Q S~ V~
o~~ i~
~blld~i i~ .~i~~do~~'~~ DoE rec~lve':Exc~~nges ar1d~~'f~~rfg' ~~ ,~.~~~~ ,,~dss' t.,~ t`~ ~~~
.. y_. ~__
L6a1~~~~rs~$~I~ ~stribt~ti~~~~_
.- i
Contact Person 1
i
i
-_ -- -------_ — ---------------- - _ —~------~`
Name of Vendor
_ _,_ _— ___.r_
'
A'ddress
ble;
~r ~ ~~~ - ~
t~C~,~1~►1~r
~~r
Phone and Email
Specify the following procedures for Transfer/Exchanges:
(the default shall be $0).
• The minimum amount for Transfers/Exchanges shall be $
• Exchanges will be permitted between all Approved Vendors and from Deselected Vendors unless otherwise
restricted. Please specify any restrictions here:
at any time unless restricted as follows:
• Transfers/Exchanges are permitted
---~—
—
be permitted?
Will hardship withdrawals
_—__--- --.. _---------__ _
Will loans be permitted under the plan?
----__ _-----------_.._
r-----__
j U Yes
__~_
l ❑Yes
~ RI vow
uric c..,.,~..~.e. r...,r.:ti.~f~,,.,~ he .,,~~e +., ~►,~~ .,i~..~
RteuttoH~
~x N o
x No
z
,-;
p No
it res, cnecK the type~s~ or employer contnoutions ~o oe mane:
~ PSERs Alternative Contribution: Employer contributions shall be made only to those Participants who are i
'
', contributing to the Plan Mandatory Employee Contributions and such Employer contributions shall be 5 % of
compensation. (PSERs has approved 5°r6, can be more)
❑ Other (specify the amount of cor+tribution and how it is allocated to participants):
~MPLOYER.CO 'TACT IH~~RIdA7XON
Questionnaire?
Who in your office should we contact fn the event we have questions about the----------
----
—
-----------------
----------
---------i
Name: Thomas Taylor
-----------1
-----—
----------------—~
~ Email: [email protected]
~
'Phone Number: 215-755-7603 ~
—
~_
i
Please name ,the individual who is to receive the completed documents and be responsible to sign the Adoption
Agreement and any other legal forms. ❑Same as above; or
Name: Elaine Powers
'Email: [email protected]
I Phone Number: 215-612-2339
The completed questionnaire should be faxed to:
Plan Document Services at(215)444-9813
or mailed to:
Plan Document Services
c/o PenSery
420 Dresher Road, Suite iG0
Horsham, PA 19044
or emailed to: nlandocuments~uenserv.com
PenSery
NonERISA 403(b)PLAN DOCUMENT
FOR PUBLIC SCHOOLS,COMMUNITY COLLEGES,
AND PUBLIC UNIVERSITIES AND COLLEGES
ADOPTION AGREEMENT
The undersigned Employer hereby adopts a section 403(b) plan in the form ofthe 403(b) plan attached hereto, and agrees that the
following terms, definitions, and elections shall be part ofsuch 403(b)Plan. Where applicable, certain Items have a Default Provision
indicated below the Item number that will apply if no election is made by the Employer.
PART I:(All Employers complete this part.)
EMPLOYER INFORMATION
1 (a)Narne &Address of Employer: Good Earth Charter School, 800 Welsh Road, Horsham PA, 19044
(b)Name of Contact Person: Thomas Taylor, Business Manager
(c) This Plan ❑ is ~ is not a Multiple Employer Plan. If"Yes", name ofthe Plan Sponsor is:
2. Phone: 215-612-2339
3. E1N #(Tax ID number): 47-4588510
4. The Plan shall be administered by:
❑ (a) The Employer;
❑ (b)Jointly with the Vendors;
(c) A designated Administrator (Specify): PenSery Plan Services, Inc.
5. Naine ofPlan: Good Earth Charter Schoo1403(b)Plan
6. Plan Year:
(a)The calendar year; or
❑ (b)The 12-consecutive month period beginning on
7. The Employer has completed and signed this Adoption Agreement in order to:
(a) Establish a new 403(b)plan with an Effective Date of:7/1/2016.
❑ (b) Amend a 403(b)plan previously adopted by the Employer with an initial Effective Date of:
by making a different choice in the Adoption Agreement, with an Effective Date ofthe amendment
of:
8. This Plan shall be governed by the laws ofthe State or Commonwealth of: Pennsylvania.(Enter the name of
the Commonwealth or State where the main office or location ofthe Employer is maintained.)
C`nntrnl 40'~h NonF.RISA dnc f 10/131
y. The Plan shall accept the following contribution types:(check all that apply and complete the corresponding
sections):
Contribution T e
a Pre-Tax Elective Deferrals
b) Post-T~ Roth Elective Deferrals
c Mandato Em to ee Contribution
d) Em to er Nonelective
e Em to er Matchin
Rollovers
( Transfers from other 403 b Plans
Check if
"Yes" Com lete:
~
Items 11-15
❑
Item 16
Item 19
Item 28-29
~
Item 28-29
~
see Items 20-23
~
N/A
10. Forms of benefit payments shall be made pursuant to the Individual Agreements as elected by the Participant
and/or Beneficiary.
PART II:(Complete this Part if Employees may elect to make Elective Deferrals.)
ELIGISILTTY ANI)PARTICIPATION - TLFCTIVE DEFERRALS
1 l.The following Employees shall be eligible under the Plan to make Elective Deferrals(Check(a)or (b)):
(a)
❑ (b)
All Employees ofthe Employer.
All Employees ofthe Employer except the following category (ies):
❑ 1. Nonresident aliens who receive no earned income from the Employer which constitutes income from
sources within the U.S.
❑ 2. Employees who normally work less than 20 hours per week.
❑ 3. Employees who are participants in an eligible deferred compensation plan within the meaning of
section 457 ofthe Code;a 401(k)qualified cash or deferred arrangement ofthe Employer or another
custodial account or annuity described in section 403(b) ofthe Code.
❑ 4. Employees who are students and regularly attend classes at the. Employer institution during the
calendar year.
12. The Entry Date ofa Participant with respect to Elective Deferrals shall be:
❑ (a) On the first day of the next Pay Period beginning after the Employee completes any necessary
applications) and the Salary Reduction Agreement.
❑ (b) On the first day ofthe next month beginning after the Employee completes any necessary applications)
and the Salary Reduction Agreement.
(c) Other (Specify): On the date of hire.
l ontrnl 403h NnnERISA doc f 10!131
3. Employees are permitted to make Elective Deferrals to the Plan as follows:
(a)Elective Deferrals of up to the maximum amount permitted under sections 403(b)and 415 ofthe Code
are permitted.
% ofa Participant's Compensation are permitted.
❑ (b)Elective Deferrals of up to
14. Age 50 Catch-up Contributions:(Choose one.)
(a) shall apply; or
❑ (b) shall not apply.
l 5. The Special Catch-up Contributions after I S years of Service:(Choose one.)
(a) shall not be permitted; or
❑(b) shall be permitted.
16.(a) Roth 403(b) Elective Deferrals:
(i) sha11 not apply.
❑ (ii) shall apply to contributions after
.(Enter December 31,2005 or a later date).
(b)Excess Deferrals will first be corrected from the:
(i)~ regular Pre-tax Elective Deferral Account; or
(ii)~Roth Elective Account.
17. Automatic Enrollment: If an eligible Employee fails to make an affirmative election not to participate in the
Plan with respect to Elective Deferrals, the percentage or amount in Item 18 below:
(a) shall not apply
❑ (b)shall be automatically withheld and contributed to the Plan as an Elective Deferral only for the
following Employees:
;and
❑All Employees hired after:
(i)
❑All Employees hired after:
(ii)
~ ; or
(iii) ❑All Employees effective on:
(iv) ❑Other(specify):
(Caution: An Employer should determine whether automatic enrollment is permitted under the
applicable State taw prior to adopting this provision.)
18. Amount of Automatic Elective Deferral: IfItem 16(b)is elected, the following percentage or amount shall
be automatically deducted from the Employee's compensation and contributed to the Plan as an Elective
Deferral•
(a)N/A, Automatic Enrollment does not apply.
❑(b)
❑ (c)
%,with automatic increases each subsequent Plan Year of
❑ ~d)$
,with automatic increases each subsequent Plan Year of$
❑ (e)$
compensation.
Control 403h NonERISA.dce (10/13)
or
% of
ROLL4~ERITRANSFI,R AND OTHF,R EMPLOYEI:CONTRIBUTION PRnVISI~NS
19. If Mandatory Employee Contributions are elected in Item 9(c) above,complete this Item l 9.
Mandatory Employee Contributions shall be required to be made by the following Employees:
(a) 5% of each eligible Employee's Compensation if such Employee was hired on or after: 8/1/2014;
and
and
❑(b)
% ofeach eligible Employee's Compensation ifsuch Employee was hired on or after:
was a participant in PSERs but after receiving a choice has elected to participate in this Plan.
20. Direct Rollovers: The Plan will accept a Direct Rollover of an Eligible Rollover Distribution from:(Check
each that applies or N/A.)
❑ (a) N/A. The Plan will not accept Direct Rollovers from any plan.
(b) a qualified plan described in section 401(a) or 403(a)of the Code, excluding after-tax employee
contributions.
❑ (c) an annuity contract described in section 403(b)ofthe Code,including after-tax employee
contributions.
(d) an annuity contract described in section 403(b)of the Code, excluding after-tax employee
contributions.
(e) an eligible plan under section 457(b) ofthe Code which is maintained by a state, political
subdivision of a state, or any agency or instrumentality of a state or political subdivision of a state.
21. Participant Rollover Contributions from Other Employer Plans: The Plan will accept a Participant
contribution of an Eligible Rollover Distribution from:(Check each that applies or N/A.)
❑ (a) N/A. The Plan will not accept Rollover Contributions from any employer plan.
(b) a qualified plan described in section 401(a) or 403(a)ofthe Code,excluding after-tax employee
contributions.
(c) an annuity contract described in section 403(b)ofthe Code, excluding after-tax employee
contributions.
(d) an eligible plan under section 457(b) ofthe Code which is maintained by a state, political
subdivision of a state, or any agency or instrumentality of a state or political subdivision of a state.
22. Participant Rollover Contributions from IRAs: The Plan:(Choose one..)
(a) will ❑(b)will not accept a Participant Rollover Contribution ofthe portion ofa distribution from an
individual retirement account or annuity described in section 408(a)or 408(b)ofthe Code that is eligible to
be rolled over and would otherwise be includible in gross income.
23. Effective Date of Direct Rollover and Participant Rollover Contribution Provisions:
Items 20-22 above shall be effective: 1/1/2002(Enter a date no earlier than January 1, 2002.)
l4. Employees ~(a)are ❑(b)are not permitted to make Transfer Contributions to or from this Plan.
25. Employees ~(a) are Q(b)are not permitted to make Exchanges as outlined in the Plan Vendor
Attachrrtent.
C`nntrn140'36N~mRRISA_dnc !10/13)
1
~
tote: Ifelected below,Hardship Distributions and Loans shall only apply to contributions other than the Mandatory
Employee Contributions and the Employer Contributions made on behalf of the Participants who are making
Mandatory Employee Contributions.
26. Hardship Distributions:
❑ (a) shall be permitted; or
(b)shall not be permitted.
27. Pursuant to the Individual Agreements, Loans to Employees:
❑ (a) are;
(b) are not available.
PART III:(Complete this part only if the Employer wishes to make Employer Contributions.)
ELIGIBILITY AND l'ARTICiPATION - EMPL,OYCR CONTRIBUTION
28. Employer Contributions:
❑ (a) shall not be made; or
(b)shall be made.
29. If28(b)is checked, the following type ofEmployer Contributions) shall be made(check all that apply):
❑ (a) Employer Contributions shall be made in accordance with any applicable collective bargaining
agreements or employment contracts as shall be determined from time to time by the Employer.
❑ (b) Employer Post Employment Contributions shall be made.
❑ (c)Employer Matching Contributions shall be made under the following formula:
(d) Other (specify the type ofEmployer Contribution and the method of allocation: Ernplovees hired on
or after 07/01/2016 where such Emvlovees are contributing the Mandatory 5% Employee Contribution, shall
receive an Employer Nonelective Contribution of5% of Compensation.
30. Vesting of Employer Contributions: Each Employee shall:
(a) be 100% immediately vested in the Employer Contributions; or
❑(b)become 100% vested with respect to Employer Contributions after one yeaz ofparticipation in this Plan.
A Participant shall be considered vested on the first day ofthe second year ofactive participation,as provided in
Article XI of the Plan.
AUTHOR1ZCll SIGNATUNI;
The Employer acknowledges that it is an eligible public educational institution under Section 170(b)(1)(A)(ii)ofthe
:ode and is authorized to offer a program under Section 403(b) ofthe Internal Revenue Code.
Signature ofEmployer:
Print Name of Signer:
Contro1403bNonERISA.doc (10/13)
Date:
Title:
PenSery
ESTIMATED FEES PER PROPOSAL
Standard Employer Fee Schedule
NonERISA 403(b)Services
PSERs Alternative for Charter Schools
Initial(One Time)
One time Set-up Fee/One time Take-over Fee
(includes Document Review and Plan Design)
$1,800.00
Annual Base Fee (includes MG Trust as Vendor)
$ 850.00
Annual Fee for PSERs Compliance Review
Census Verification
Separate Accounting for vesting
Tracking sources
Tracking hours and years of service
$ 800.00
s
Non-FRIBA 403(b) Sure
'"
Participant Fees*
Recordkeeping and Compliance
Receive and qualify contributions from all sources,
Reconcile exceptions, track annual contribution and
Maintain records for audit purposes. Review, qualify and
Monitor participant loans, hardship distributions,
Minimum distributions, account transfers.
$40/year/participant
Distribution and Loan Fees
$70 per transaction
Custodial Fee
.10% of assets
Additional Services(Optional)
Internal Compliance Reviews for EmployersNendors
Assistance in Plan corrections
• Fees can be paid by the Participants, the Employer, ar the Vendors)**, if applicable.
Transaction fees are paid by Participants. All fees will be reduced by any revenue sharing
received from mutual funds.
*kSome Vendors will not pay administrative fees.