We are spending $158,000 a month more than we will bring in. Here is my plan to close it.

Thirty minutes from me, ninety from you. I want you to argue with this, not agree with it.

Friday 21 August 2026. Every figure comes from the board-approved FY26 budget and our payroll file. If one looks wrong, say so while I am on that slide.

The problem

We spend $544,000 a month. After the grants end we will bring in $387,000.

$544,000
What we spend every month right now.
$387,000
What we will bring in every month once the four grants end.
$158,000
The difference. This is the number the plan has to close.

That is $1.9 million a year. Nothing we spend money on today is big enough to absorb it.

Why the money is going away

Four grants end by 30 September. Together they are worth $1,855,700.

SAMHSA CCBHC
678,000
Crisis DHS 590
577,496
Neonatal HRSA
329,163
HFS Pathways
271,041
WORTH
500,000
Living Rooms
300,000
BCBS School
218,750

Three of those four were always going to end on those dates. They were in the budget the board approved in March. Our grant income drops from $2.87 million to $1.02 million, which is a fall of 65 percent.

What we did when the grants ended

When each grant ended we moved those staff to overhead instead of to billable work.

Who pays each dollar of salaryJanuary to AprilOctober to DecemberChange
A grant pays for it2,595,1951,103,545-1,491,650
Clinical work we bill for924,635924,635no change at all
Overhead, which has no income behind it626,8972,118,547+1,491,650

One and a half million dollars of salary moved from a grant paying for it to nobody paying for it. The amount we bill for did not move by a single dollar.

That is the real problem. Cutting jobs is necessary, but cutting jobs is not what fixes this.

The plan, and the assumptions behind it

Move any slider to test an assumption. The gap updates as you change it.

Our budget assumed clinical income grows 77 percent over last year. If it does not, this changes the answer more than anything else here.
Out of $606,384 of continuing grant salary we could move people onto.
Cards, subscriptions, insurance, cleaning, recruitment.
On top of budget. Fewer missed appointments, billing for more of what we do, more group sessions.
$41,800
Still short each monthThat is $501,598 over a year.
Already doneDay oneWithin 30 days60 to 90 days

Each bar is one of the four things I will walk through next. The nine positions and the two consultants who have already left are fixed, so they are not sliders. If you set clinical income to 80 percent of budget, the monthly gap gets $57,000 worse. That is why that slider is first.

Saving money, 1 of 4

Cutting a grant-funded job still saves money, because we move someone else into that slot.

A grant pays for the work, not for a person. So when we cut someone a grant was paying for, we move someone from overhead into that slot. The grant pays for them instead, and our own costs drop.

$2,118,547
Salary sitting on overhead with no income behind it.
$606,384
Grant salary we can still charge against, in WORTH, Living Rooms and BCBS.

There are three limits on this, so we should not promise more than it can do. The person has to do work that genuinely qualifies under that grant. Each grant caps how much salary we can charge to it without asking permission first. And we have to keep records of who spent time on what.

Saving money, 2 of 4

We are cutting nine positions. Five of them work directly with clients.

That split decides who we tell first and who takes over their work.

  • Where a grant requires a service, we buy it instead of employing someone. WORTH needs video made and we hired a full-time videographer to make it. A contractor can do that and still meet the grant.
  • Marketing has produced nothing in a month, and that work contracts out easily.
  • Two neonatal positions end with a grant that finishes on 31 August whether we act or not.

We are not cutting a service. We are buying it instead of employing someone to do it.

Before any of this happens I need a name against every client. Five of the nine carry a caseload and no document we have records how many clients each one has. That is a query Erin can run, and I want it before we tell anybody.

Saving money, 3 of 4

We can cut $933,500 of spending without cutting a job.

What we spend it onPer yearWhat we spend it onPer year
Jobs we budgeted for and never filled489,250Subscriptions and software54,000
Billing done by an outside firm160,250Computer equipment54,000
Accounting done by an outside firm150,000Insurance, all four policies179,215
Recruitment56,000Cleaning65,000
Other consultants54,000Phone and internet27,000

Be careful with the first line. Not filling a job we budgeted for helps the budget, but it does not put cash in the bank, because that money was never going out in the first place. The amount that actually reaches our bank account is closer to $444,000.

One item I want to raise on its own. We pay $94,800 a year in interest, which means we owe somewhere around $1.2 million. I want to go and talk to that lender before they come and talk to us.

Saving money, 4 of 4

We still need $42,000 a month from clinical work.

I cannot do this part from a spreadsheet. I need Ariel and the clinical team to own it.

  • 34 percent of psychiatry appointments do not happen. Fourteen percent are no-shows and twenty percent are cancelled. Getting a third of those back is real money.
  • We bill for somewhere between a third and a half of what we could be billing for. That gap on its own is bigger than everything else on this slide put together.
  • Case management is being used less than it should be, and staff at every credential level can bill for it.
  • Group sessions earn more per clinician hour than one-to-one sessions. Nobody has worked out what the right mix is.
  • I want to know whether all of our clinicians are credentialed with all of our payers. A clinician who is not credentialed cannot be billed for at all.

The question that actually decides it

Do we still have money on 1 December?

$4,200 is what we had on 19 August.
Leave payout plus unemployment. Ruth is working this out. Leave is frontloaded, so it may be larger than it looks.

This uses the sliders from the previous slide, plus the $77,000 of wind-down money that arrives up front. Savings build up over time: the jobs go on 1 September, expense cuts land over the first month, clinical improvement takes ninety days.

We reach 1 December

This is the part I want you to sit with. Even if we do everything on the last four slides, including the $42,000 a month from clinical work, we still do not reach 1 December on cash. Two things change that. If the SAMHSA replacement lands we finish around $141,000 to the good. If it does not, we need roughly $100,000 of bridge to get there.

So there is a third job alongside cutting costs and billing more: find the bridge, or find out about SAMHSA sooner.

A monthly gap tells us the shape of the problem. This tells us whether we get to the decision.

The new structure

Every service that touches a client moves under Clinical.

How it works today

PsychiatryTherapyCase managementCrisisLiving RoomPathwaysIntakeNeonatalWORTHYogaOverhead

How it would work

Clinical
PsychiatryTherapyCase managementCrisisLiving RoomPathwaysIntake
WORTHOverhead and admin

We should do this even if we were not short of money. Running these as separate departments is why psychiatry patients do not reliably get to therapy and why case management is underused. We wrote that down in the stabilization plan before we counted a single job.

Dates

We announce on 31 August. We decide the agency’s future on 1 December.

DateWhat happens
31 AugThree things on the same day: the new structure, the changes to how services work together, and the expense cuts. If we do the first without the second, the savings never appear and we will have put people out of work for nothing.
1 SeptThe new structure starts.
30 SeptThe SAMHSA grant ends. It is our largest.
Sept to NovWe track cash payroll by payroll. Where we are at sixty days tells us what ninety days will look like, which leaves thirty days to change course.
1 DecWe decide whether to merge, wind down, close, or carry on. If we do the work above, that is a decision we get to make. If we do not, someone else makes it for us.

The time off policy

This is a separate decision on a separate timeline, and it is the only thing here that the board has to approve.

The policy we have now

We give every employee a full year of leave on their first day.

  • Sick leave. Ten days, given in full when someone is hired, rolling over up to four weeks.
  • Personal leave. Five days, given in full.
  • Vacation. Ten days given in full after ninety days, rising to fifteen days at the second anniversary and twenty days at the third.

Someone who leaves in their second month has already been given twelve months of leave. We carry that as money we owe, and we pay it out when they go.

The policy I am proposing

I want to combine vacation and personal leave into one pot people earn as they work.

Years working hereWhat they get todayWhat they would getChange
One to two10 vacation plus 5 personal, so 15 days10 days5 days fewer
Three15 vacation plus 5 personal, so 20 days15 days5 days fewer
Four to five20 vacation plus 5 personal, so 25 days15 days10 days fewer
Six and over20 vacation plus 5 personal, so 25 days20 days5 days fewer
Sick leave10 days10 daysno change

Everyone loses at least a week. People in their fourth and fifth year lose two. I think it is right, but it is not a small change and we should not call it one.

What the change is worth

This saves $64,000 to $85,000 a year. It does not reduce payroll.

What the change doesIf everyone loses five daysHow reliable is that number
Reduces what we owe in unused leave, and what we pay out when someone leaves63,927Reliable, but it only turns into cash when somebody actually leaves.
Frees up clinician days we could bill for68,297I do not believe this one. Our own stabilization plan says several clinicians do not have enough clients to fill the days they already have.
Reduces payroll0We pay salaried staff the same whether they take the day or not.

I am not going to present this as a cost cut, because it is not one. If I did, the first question would be why payroll did not go down, and I would not have a good answer.

The honest reason to do it is that it reduces what we owe and brings us in line with how comparable agencies run their leave. That is a good enough reason on its own.

How it gets approved

The board approves the time off change. Nothing else in this plan needs them.

  • Time off changes the terms of employment for everyone and it lives in the handbook. The handbook already goes to the board in September, so they approve it there.
  • Everything else in this plan is mine to decide and the board’s to be told about. Keeping that line clear protects all of us.
  • That means the time off change cannot start on 31 August with everything else. It comes later, and we should say so plainly rather than letting people work it out for themselves.
  • Two questions go to a lawyer before we announce anything. Whether we are allowed to run a use it or lose it policy in Illinois at all, and whether part-time staff are now owed sick time by law.

One more thing we cannot decide on our own. Pausing the retirement contribution usually needs a formal change to the plan document and written notice to staff. We should ask before we name a date.

Four things to argue with today. Five to answer by Monday.

Argue with me today

  • Where am I cutting too deep? Cut too little and we fail anyway. Cut too much and we break the thing we are trying to save.
  • Who takes over the work on 1 September? Crisis on-call, the phones, and case notes specifically.
  • Is the $42,000 a month from clinical work realistic? If not, tell me today rather than in November.
  • What have I missed?

Answer by Monday

  • Erin. What does the under sixty percent collection figure actually measure? Are all clinicians credentialed with all payers?
  • Ruth. What does day one cost in leave payouts and unemployment? Can the HR subscription answer the employment law questions?
  • Ariel. The psychiatry and clinical changes, how they get implemented, and how people are held to them.
  • Ethan. When do we hear on the SAMHSA application? Is the Living Rooms grant still running after 31 July?
  • Everyone. What did I get wrong today?

Anything we cannot settle today goes on the wall. Every source behind these numbers is in the full working document.