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Salary     Base
    Year QEO1 1/
QEO2 1/
Salary Schedule   _______
______2/_____ 3/
Additional Step Advancement __xxxx_ ______ _____
Additional QEO Salary Schedule Cost__xxxx_ ______ ______     Salary Subtotal _______ ______
_____
Longevity (include here if not on salary schedule
    _______ ______ ______
Extended Contracts     ______ ______
_____
Co-Curricular Pay     ______ ______
_____
Extra Duty Pay     ______ ______
_____
Athletic Events     ______ ______
_____
Department Head     _______ ______
_____
Curricular Work     _______ ______
_____
Overload Pay     _______ ______
_____
M-Team     _______ ______
_____
IEP     _______ ______
_____
Supervision     _______ ______
_____
Other _____________________ _______ ______ _____
Total Extra Duty Pay     _______ ______
_____
Summer School     _______ ______
_____
Severance Pay   _______ ______
______
Sick Leave Payout     _______ ______
______
Other ________________ _______ ______ ______
Total Salary Cost _______ ______ ______
_____________
1 The QEO1 and QEO2 salary costs will remain the same as the base year costs for longevity (if not a step), extended contracts, co-curricular pay, extra duty pay, summer school, severance pay, sick leave payout, etc. unless the rate of compensation increases due to an increase in the salary schedule or an additional year of service entitles base year employee(s) to additional compensation.
2 Enter base year salary subtotal.
3 Enter QEO1 salary subtotal.
Fringe Benefit Costs
Credit Reimbursement 4/   ______   _______   _______
Social Security   ______   _______   _______
Retirement   ______   _______   _______
Health Insurance   ______   _______   _______
No.S____ No.F ____
Employer % Contribution
Level S ____ F ____   ______   _______ _______
Dental Insurance   ______   _______ _______
No.S____ No.F ____
Employer % Contribution
Level S ____ F ____   ______   ______ _______
Vision Insurance   ______   _______ _______
No.S____ No.F ____
Employer % Contribution
Level S ____ F ____   ______   ______ _______
Life Insurance   ______   _______ _______
Employer % Contribution
Level ____   ______   ______ _______
Disability Insurance
Employer % Contribution
Level ____   ______   _______ _______
Long-Term Care Insurance
Employer % Contribution
Level ____   ______   _______ _______
Other ______________________   ______   _______ _______
Total Fringe Benefit Cost   _______   _______ _______
Total Salary and Fringe Benefit Cost   _______ _______ _______
QEO1 Increased/decreased salary cost as a percentage of base
Year total salary and fringe benefit cost   _______
QEO1 Increased/decreased fringe benefit cost as a percentage of base Year total salary and fringe benefit cost   _______
QEO2 Increased/decreased salary cost as a percentage of QEO1
total salary and fringe benefit cost   _____
QEO2 Increased/decreased fringe benefit cost as a percentage of
QEO1 total salary and fringe benefit cost   ______
Attach a chart identifying the number of base year employees at each step and lane on any existing salary schedule. We swear that we completed this form in as accurate a manner as possible.
__________________________ _____________
Superintendent/   Date
Business Manager
__________________________ ____________
Treasurer   Date
____________________
4/ The QEO1 and QEO2 credit reimbursement costs will remain the same as the base year costs unless the rate of reimbursement increases due to an increase in the salary schedule.
WISCONSIN EMPLOYMENT RELATIONS COMMISSION QUALIFIED ECONOMIC OFFER
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