HomeMy WebLinkAbout2021-335-Health-Planned Parenthood of South Atlantic-Outside Agency
(«Agencys_Name»)
Orange County Outside Agency Performance Agreement
Revised 7/2018 Page 1 of 9
OUTSIDE AGENCY PERFORMANCE AGREEMENT
THIS AGREEMENT, made and entered into the first day of July 2020, (“Effective Date”) by and between
the County of Orange, a political subdivision of the State of North Carolina, Post Office Box 8181,
Hillsborough, North Carolina, 27278, ("County") and Planned Parenthood South Atlantic, a not-for-profit
corporation, located at 100 South Boylan Avenue, Raleigh, North Carolina 27603 (“Provider”).
WITNESSETH:
WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby
enhance its availability to residents of the County, and said program addresses an important community
human services need, as identified by the Board of Commissioners.
NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set
forth, the County and «Agencys_Name» agree as follows:
1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1,
2020 to June 30, 2021.
2. Scope of Services.
a. Provider will provide services, as outlined in the attached Outside Agency Funding
Application and any amendments or revision thereto which is attached as Exhibit “A” and
incorporated by reference, to the residents of Orange County. The Scope of Services and
the Program Budget may be different from the original application based on County
appropriation; however, any revisions or amendments to this Agreement must be approved
in writing by the County and attached to this Agreement as Exhibit B.
b. The Provider shall be solely responsible for the means, methods, techniques, sequence,
safety program and procedures necessary to properly and fully complete the work set forth
in the Scope of Services.
3. Funding.
a. The County agrees to appropriate for the provision of services described in Exhibit A,
Scope of Services and more particularly described in the Revised Program Budget, the
maximum sum of $20,000.
b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not
used for the purposes stated shall be returned to the County. Any changes in the use of
funds must be authorized in writing by the County prior to any expenditure of the funds by
the Provider. If the funds are expended not in accordance with the Scope of Services, at the
discretion of the County the Provider may be required to repay the funds to the County.
c. The Provider shall be paid in four equal installments in the amount of $5,000. The first
payment is contingent upon receipt of the agency’s performance agreement; the remaining
payments are contingent upon receipt of the request for reimbursement and related
supporting documentation.
d. The County’s obligation to make the quarterly payments is contingent upon receipt of
Progress Reports, which show satisfactory progress toward completion of performance
measures and an accounting of expenditures as detailed in the attached Scope of Services.
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
Orange County Outside Agency Performance Agreement Page 2 of 9
Rev. 1/21
e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21
days after receipt of the Progress Report and Request for Reimbursement or 21 days after
due date of Progress Report whichever is later.
f. The County is not obligated to provide any other support to Provider in this or in
succeeding fiscal years.
4. Agency Reporting.
a. Provider will provide Orange County a Progress Report that includes a fiscal report and
updates on performance measures as outlined in the Scope of Services. Progress Report
dates are: July 1 – December 31; January 1 – March 31 and April 1 - June 30. Reports are
due on January 10, April 10, and July 10 of the program fiscal year.
b. Provider agrees to allow the County to inspect its financial books and records, which
document costs of those services, upon reasonable notice during normal working hours.
5. Termination.
a. In the event of any of the circumstances set forth below (hereinafter referred to as
“default”), the County may immediately terminate this Agreement, in whole or in part, and
from time to time. Notice of termination must be in writing, state the reason or reasons for
the termination, and specify the effective date of the termination:
i. In the event that Provider shall cease to exist as an organization or shall enter
bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all
of its assets, or significantly reduce its services or accessibility to Orange County
residents during the term of this Agreement; or
ii. In the event that Provider shall fail to render a satisfactory accounting as provided
section 4 above, the County may terminate this Agreement and Provider shall
return all payments already made to it by the County for services which have not
been provided or for which no satisfactory accounting has been rendered; or
iii. In the event of any fraudulent representation by the Provider in an invoice or other
verification required to obtain payment under this Agreement or other dishonesty
on a material matter relating to the performance of services under this Agreement.
iv. Nonperformance, incomplete service or performance, or failure to satisfactorily
perform any part of the work identified in the Scope of Services or to comply with
any provision of this Agreement, as determined by the County in its sole discretion.
v. Failure to adhere to the terms of applicable county, state or federal laws,
regulations, or stated public policy.
b. In the event of default by the Provider, the county may elect to terminate this Agreement, in
whole or in part and/or require the Provider to repay the funds within ten (10) business days
from written notice of default. The County may (but shall not be required to) grant the
Provider an opportunity to cure the default without termination of this Agreement. This
clause shall not be interpreted to limit the County’s remedies in law or in equity.
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c. Notwithstanding the foregoing, either party may terminate the agreement at any time
without penalty; provided that written notice of such termination is furnished to the other
party at least 30 days prior to termination. In the event of such termination, any payment
due shall be prorated to the date of termination and any unused funds shall be returned to
the County within 10 days of termination.
d. Any termination of this Agreement for default under this section that is later deemed to be
unjustified shall be deemed a termination for convenience.
6. Insurance.
a. General Requirements. The Provider shall purchase and maintain, during the period of
performance of this Agreement, insurance:
i. Worker’s Compensation. For protection from claims under workers' or workmen's
compensation acts;
ii. Comprehensive General Liability Insurance covering claims arising out of or
relating to bodily injury, including bodily injury, sickness, disease or death of any
of the Consultant's employees or any other person and to real and personal property
including loss of use resulting thereof;
iii. Comprehensive Automobile Liability Insurance, including hired and non-owned
vehicles, if any, covering personal injury or death, and property damage; and
iv. Professional Liability Insurance, covering personal injury, bodily injury and
property damage and claims arising out of or related to the performance under this
Agreement by the Consultant or his agents, consultants and employees.
b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows:
INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE
• Worker's Compensation Limits for Coverage A - Statutory State
NC & Coverage B - Employers Liability
$500,000 each accident, disease policy limit and
disease each employee
• Commercial General $1,000,000 Each Occurrence
Liability $2,000,000 Aggregate
• Automobile Liability $500,000 Combined Single Limit
• Professional Liability $1,000,000 Each Occurrence
$2,000,000 Aggregate
c. All insurance policies (with the exception of Worker's Compensation and Professional
Liability) required under this Agreement shall name the County as an additional insured
party and as a certificate holder. Evidence of such insurance and all correspondence shall
be sent to:
Orange County Risk Manager
Post Office Box 8181
Hillsborough, NC 27278
d. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity
defenses.
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7. Relationship of the Parties. Provider is an independent contractor of the County. Provider
represents that they have or will secure, at his own expense, all personnel required in performing
the services under this Agreement. Such personnel shall not be employees or have any
contractual relationship with the County. All personnel engaged in work under this Agreement
shall be fully qualified and shall be authorized and permitted under federal, state and local law to
perform such services.
8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws,
ordinances, orders and regulations of the federal, state or local governments, as well as their
respective departments, commissions, boards, and officers, which are in effect at the time of
execution of this Agreement or are adopted at any time following execution of this agreement.
9. Subcontract. The County and Provider deem the services provided under this Agreement to be
personal in nature and Provider may not subcontract any rights or duties under this Agreement to
any other party without prior written consent from the County.
10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to
any other party without the prior written consent of the County.
11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all
loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury,
including death or property damage, to any person or persons caused in whole or in part by the
negligence or willful misconduct of the Provider, except to the extent same are caused by the
negligence or willful misconduct of the County. It is the intent of this section to require Provider
to indemnify the County to the extent permitted under North Carolina law. Nothing in this
section is intended to affect or abrogate the County’s sovereign immunity defenses.
12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the
specified services and may be terminated at any time if such funds become unavailable.
13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange
County the parties hereto for themselves, their agents, officials, employees and servants agree not
to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap,
religion, sexual orientation, familial status or veterans status with reference to any activities
carried out by the grantee, no matter how remote. The parties hereto further agree in all respects
to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and
the Orange County Non-discrimination Policy. This provision is enforced by action for specific
performance, injunctive relief, or other remedy as by law provided; this provision shall be
binding on the grantees, the successors and assigns of the parties hereto with reference to the
above subject manner.
14. Living Wage. Orange County is committed to providing its employees with a living wage and
encourages agencies if funds to pursue the same goal. The County’s living wage is $ 14.95 per
hour. To the extent possible, Orange County recommends that Provider provide a living wage to
its employees.
15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the
last known address shall constitute sufficient notice to the County and the Provider. All notices
required and/or made pursuant to this Agreement to be given to the County and the Provides shall
be in writing and mailed to the party addressed as follows:
County: Finance & Administrative Services Provider: Planned Parenthood South
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16. E
n
tire Agreement. This Agreement, including any referenced attachments, constitutes the entire
Agreement between the parties and shall supersede, replace or nullify any and all prior
Agreements of understandings; written or oral, relating to the matters set forth herein, and any
such prior Agreements or understandings shall have no force or affect whatsoever on this
Agreement. The County and Provider have read this Agreement and agree to be bound by all of
its terms, and further agree that this Agreement constitutes the complete and exclusive statement
of the Agreement between the County and Provider.
17. Severability. All clauses found herein shall act independently of each other. If a clause is found
to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It
is understood by the parties hereto that if any part, term or provision of this Agreement is by the
Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United
States, the validity of the remaining portions or provisions shall not be affected, and the rights
and obligations of the parties shall be construed and enforced as if the Agreement did not contain
the particular part, term or provision held to be invalid.
a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of
respective parties hereunder shall be governed by the laws of the State of North Carolina. By
executing this Agreement Provider affirms that Provider and any subcontractors of Provider are
and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General
Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and
has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer
pursuant to G.S. 147-86.58.
18. Signatures. This Agreement together with any amendments or modifications may be executed
electronically. All electronic signatures affixed hereto evidence the intent of the Parties to
comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66.
IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on
the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures
below.
For and on behalf of the Provider
_____________________________ _______________________
Jenny Black, 3UHVLGHQW &(2 Date
For and on behalf of Orange County Government
_______________________________ ________________________
Bonnie Hammersley, County Manager Date
Orange County
Post Office Box 8181
Hillsborough, NC 27278
Atlantic
100 South Boylan Avenue
Raleigh, NC 27603
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
6/28/2021
6/29/2021
Orange County Outside Agency Performance Agreement Page 6 of 9
Rev. 1/21
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Party/Vendor Name: Planned Parenthood of South Atlantic Party/Vendor Contact Person: Jenny Black Contact
Phone: 919-833-7526 x6240 Party/Vendor Address: 100 S. Boylan Ave. City Raleigh State: NC Zip: 27603
Department: Health Amount: $20,000 Purpose: Outside Agency Budget Code(s): 10495050-710013 Vendor #
800040 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New
Renewal Amendment Effective Date 7-1-20 Approved by Board Yes No Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on
this project has not been initiated prior to execution of the agreement:
Department Director’s Signature ________________________________________ Date: ________
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that
was addressed: Turnover in original department generating contract.
Information Technologies
(Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer___________________________________ Date: ________
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney __________________________________________Date: ________
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board __________________________________________Date:_________
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
6/28/2021
6/28/2021
6/29/2021
6/29/2021
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
Outside Agencies/Human Services
Cover Page P a g e 8 o f 21
AGENCY INFORMATION
Please provide the following information about your agency:
1.Date of Incorporation (Month/Year): July 1980
2.Agency’s Purpose/Mission (no more than a few sentences):
The mission of Planned Parenthood South Atlantic (PPSAT) is to provide comprehensive reproductive and sexual
health care services in settings that preserve and protect the individual’s right to privacy and informed decisions;
provide educational programming that fosters a culture of healthy sexuality; and advocate public policies that
advance these rights and expand access to these services.
3.Please provide a brief description of your organization’s past achievements in carrying out similar
projects and evidence of successful record of meeting proposed budgets and timetables (no more than
100 words).
For 39 years, PPSAT has provided high-quality education that reflects the needs of young people, their families,
patients, and local communities. Last year, PPSAT provided sex education to more than 14,000 young people in
settings such as public schools, youth-serving organizations, and health departments. The education team
emphasizes multi-session sex education programs that are evidence-based and proven to meet the needs of the
participants. PPSAT has offered education programs in Orange County for the past 37 years.
4.Living Wage: Does this agency pay permanent employees a minimum living wage? (Yes / No) Yes
If yes, is this agency an Orange County Living Wage Certified Employer? Yes
If no, please briefly explain.
Schedule of Positions: # of FTE – Full-Time Paid Positons: 175 # of FTE – Part-Time Paid Positions: 84
PROGRAM INFORMATION
*Please submit for each program if applying for funding for more than one program.
5. Program Name: Sexual health education and outreach
Program Primary Contact and Title: Daniela Sostaita, Community Health Educator
Telephone Number: 919-869-4786 E-Mail: daniela.sostaita@ppsat.org
6.Please briefly describe the proposed program, including an explanation of how it aligns with the Town
of Chapel Hill and Carrboro’s Results Framework, and Orange County BOCC Goals and Priorities, and the
target population to benefit from the program. (100 words or less)
In the coming year, the community health educator will provide Orange County teens and young adults with
medically accurate, intensive, and balanced sexuality education programs that promote positive sexuality,
healthy behavior, and responsible choices to reduce the rates of unintended pregnancy and sexually transmitted
infections (STIs). This program will ensure a community network of basic human services and infrastructure that
maintains, protects, and promotes the well-being of all Orange County residents, and will help youth develop
age-appropriate skills and demonstrate new healthy lifestyle behaviors around sexual health (Chapel
Hill/Carrboro - Obj. 3, Intermediate Results 3.2).
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
Outside Agencies/Human Services
Cover Page P a g e 9 o f 21
7. Target Population: Please complete the table below with numbers (not percentages) of individuals served
and projected to be served.
Program Target Population Demographics
Projected
2018-19
Actual
2018-19
Projected
2019-20
Projected
2020-21
Gender
Men 90 131 90 100
Women 273 271 260 260
Nonbinary/Genderqueer 15 20
Self-Describe
Total 363 402 365 380
Race and Ethnicity
Black or African-American 75 54 20 50
American Indian or Alaska Native
Asian 50 33 20 30
White 238 271 15 270
Native Hawaiian or other Pacific Islander
Two or more races 11 10 10
Some other race 33 300 20
Total 363 402 365 380
Of the above, how many Hispanic/Latino 90 33 50 50
Of the above, how many non-Hispanic/Latino 273 369 315 330
Total 363 402 365 380
Age
0-5 years
6-18 years 238 340 180 300
19-50 years 134 50 180 70
51+ years 12 10
Total 363 402 365 380
Geographic Location
Town of Chapel Hill 160 220 300 220
Town of Carrboro 100 73 25 70
Orange County ( Outside of Chapel Hill/Carrboro) 40 90
Outside of Orange County 103 109
Total 363 402 365 380
Income
Low-income (80% of the Area Median Income and Below) Please see
income table in the attachments ** **
** **
Total
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
Outside Agencies/Human Services
Cover Page P a g e 10 o f 21
**PPSAT does not collect income information for program participants.
8. Cost Per Individual
This cost per individual must reflect the total program budget divided by the total number of program
individuals in this application.
Actual 2018-19 Projected 2019-20 Projected 2020-21
Total Cost of Program $92,061 $94,475 $96,820
Total # of Individuals 402 365 380
Cost Per Individual $229 $259 $255
9. Performance Indicators
For Chapel Hill and Carrboro applicants:
Please complete the following chart with information about the Strategic Objective, Intermediate Result, and
the Agency Performance Indicator for each program for which you are applying for funding. Please see the
Results Framework in the Attachments section as a reference.
Program Name: Sexual health education and outreach
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
Outside Agencies/Human Services
Cover Page P a g e 11 o f 21
Strategic Objective
(please choose one from the
Results Framework)
Children improve their educational outcomes
Residents Increase their livelihood security
Residents improve their health outcomes
Intermediate Result
(please choose one from the
Results Framework)
3.2 Residents demonstrate new healthy lifestyle behaviors
RESULTS Actual
2018-19
Projected
2019-20
Projected
2020-21
Performance
Indicators
(Please choose at least one
performance indicator to report
on from the Results Framework,
and add additional performance
indicators that you would like to
report to the Towns. Please
insert additional rows as needed,
listing one per row).
% and # of program
participants who
demonstrate new life skills:
Number of adolescents who
participate in multi-session,
evidence-based curricula.
Average increase in
knowledge about pregnancy
and STI prevention.
22 25 30
27% 10% 25%
Number of students reached
by peer educators
272 300 300
Number of parents reached
through parent workshops
15 15 15
Percentage of parents who
report an increased comfort
in talking about sexuality with
their children
75% 75% 75%
Number of participants
reached by single-session
programs
53 15 35
Percentage of individuals
who report an increased
understanding of their risk of
pregnancy or STI transmission
92% 75% 75%
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
Outside Agencies/Human Services
Cover Page P a g e 12 o f 21
Please use the drop down menu below to select which function area best aligns with your agency
and program(s) in which you are requesting funding. Please select only one from the drop down
menu below.
Public Health and Health Education
If you selected other, please tell us what function area best aligns with your organization:
Please indicate three program goals/performance measures below.
A few notes:
If you use percentages, please put the actual number equivalence.
Please ensure your performance measures are outcome based and not outputs.
Program Goal # 1 Adolescents will engage with the program and learn new life
skills
Performance Measure
(How will you accomplish your goal?)
Number of adolescents who participate in multi-session,
evidence-based curricula; average increase in knowledge
about pregnancy and STI prevention.
Actual Results
(Outcome)
Ending FY18-19
22; 27%
Projected Results
(Outcome)
Ending FY2020
25; 10%
Projected Results
(Outcome)
Ending FY2021
30; 25%
Program Goal # 2 Parents will have the skills and information they need to talk
to their children about sexuality
Performance Measure
(How will you accomplish your goal?)
Number of parents reached through parent workshops;
percentage of parents who report an increased comfort in
talking about sexuality with their children
Actual Results
(Outcome)
Ending FY18-19
15; 75%
Projected Results
(Outcome)
15; 75%
_________________
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
Outside Agencies/Human Services
Cover Page P a g e 13 o f 21
Ending FY2020
Projected Results
(Outcome)
Ending FY2021
15; 75%
Program Goal # 3 The educator will engage with community members and
educate them on their sexual health
Performance Measure
(How will you accomplish your goal?)
Number of participants reached by single-session programs;
percentage of individuals who report an increased
understanding of their risk of pregnancy or STI transmission
Actual Results
(Outcome)
Ending FY18-19
53; 92%
Projected Results
(Outcome)
Ending FY2020
15; 75%
Projected Results
(Outcome)
Ending FY2021
35; 75%
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
FY 2018-19 Agency Budget
Agency Budget
Operating Budget for Entire Agency
AGENCY NAME:Planned Parenthood South Atlantic
AGENCY REVENUE
Actual
2018-19
Estimated
2019-20
Projected
2020-21 Percent Change
Private Donations ($ 3,893,332) ($ 8,561,852) ($ 8,818,708) 3%
Agency Generated Revenue (fees)($ 10,211,134) ($ 15,454,914) ($ 15,918,562) 3%
Local Government Grants:
Human Services - Town of Carrboro ($ 1,000) ($ 1,000) ($ 1,000) 0%
Other - Town of Carrboro $ - $ - $ - 0
Human Services - Town of Chapel Hill $ - ($ 2,500) ($ 2,500) 0%
Other - Town of Chapel Hill $ - $ - $ - 0
Human Services - Orange County ($ 16,250) ($ 20,000) ($ 20,000) 0%
Other - Orange County $ - $ - $ - 0
Other - Town of Hillsborough $ - $ - $ - 0
Other Government Grants
Triangle United Way $ - $ - $ - ($- )
State Government $ - ($ 386,500.00) ($ 386,500.00) 0%
Federal Government (CDBG/HOME/etc.)($ 2,323,277.00) $ - $ - ($- )
Private Foundation Grants ($ 5,763,791.00) ($ 1,950,141.00) ($ 1,950,141.00) 0%
Other Revenue ($ 443,580) ($ 278,093) ($ 278,093) ($- )
Total Agency Revenue ($ 22,652,364)($ 26,655,000)($ 27,375,504)3%
AGENCY EXPENSES
Compensation ($ 12,558,737) ($ 15,572,036) ($ 16,039,197) 3%
Rent & Utilities ($ 829,450) ($ 839,631) ($ 839,631) 0%
Supplies & Equipment ($ 3,449,426) ($ 4,233,013) ($ 4,317,673) 2%
Travel & Training ($ 833,678) ($ 1,061,238) ($ 1,082,463) 2%
Other Expenses: ($ 5,360,059) ($ 4,435,904) ($ 4,524,622) 2%
Total Agency Expenses ($ 23,031,350)($ 26,141,822)($ 26,803,586)3%
SURPLUS/(DEFICIT) FOR PERIOD:($ (378,986) ($ 513,178) ($ 571,918) 11%
In FY20 our primary focus is to significantly increase the productivity of our health centers throughout the year while providing safe,
high quality care to our patients. Based on our internal analysis, we believe there is sufficient demand to meet our patient services
goals and make up for the loss of Title X funds. In addtion our new Charlotte facility is now welcoming abortion patients.
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
FY 2018-19 Program Budget
Program Budget
Operating Budget for Program
PROGRAM NAME:Sexual health outreach and education
PROGRAM REVENUE
Actual
2018-19
Estimated
2019-20
Projected
2020-21
Percent
Change
Private Donations ($ - ) ($ - ) ($ - ) 0
Program Generated Revenue ($ - ) ($ - ) ($ - ) 0
Local Government Grants:
Human Services - Town of Carrboro $ - ($ 1,000) ($ 1,000) 0%
Other - Town of Carrboro $ - $ - $ - 0
Human Services - Town of Chapel Hill $ - ($ 2,500) ($ 2,500) 0%
Other - Town of Chapel Hill $ - $ - $ - 0
Human Services - Orange County ($ 16,250) ($ 20,000) ($ 20,000) 0%
Other - Orange County $ - $ - $ - 0
Other - Town of Hillsborough $ - $ - $ - 0
Other Government Grants
Triangle United Way ($ - ) ($ - ) ($ - ) 0
State Government ($ - ) ($ - ) ($ - ) 0
Federal Government (CDBG/HOME/etc.)($ 12,849.00) $ - $ - ($ - )
Private Foundation Grants ($ 43,500.00)($ 45,000.00)($ 45,000.00) $ -
Other Revenue ($ 500) ($ - ) ($ - ) 0
Total Program Revenue ($ 73,099) ($ 68,500) ($ 68,500) 0%
PROGRAM EXPENSES
Compensation ($ 47,184) ($ 47,205) ($ 48,621) 3%
Rent & Utilities ($ 942) ($ 800) ($ 800) 0%
Supplies & Equipment ($ 1,286) ($ 2,220) ($ 2,264) 2%
Travel & Training ($ 7,575) ($ 11,110) ($ 11,332) 2%
Other Expenses: ($ 35,074) ($ 33,140) ($ 33,802) 2%
Total Program Expenses ($ 92,061) ($ 94,475) ($ 96,819) 2%
SURPLUS/(DEFICIT) FOR PERIOD:($ (18,962)($ (25,975)($ (28,319) -9%
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
Certified by: Title: President/CEO Date: 6/25/2021
EXHIBIT “B”
Scope of Services – FY 2021-22
Outside Agency Performance Agreement
Agency Name: Planned Parenthood South Atlantic
Program Name: Sexual Health Education and Outreach
Funding Award: $20,000
Outline how the agency will spend Orange County’s funding award.
Expense Description Amount
Personnel $20,000
Program Services
Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2021.
● PPSAT educator will provide Orange County teens and young adults with medically accurate,
intensive, and balanced sexuality education programs.
● PPSAT’s educator will engage Orange County parents and caregivers in programs that help
families talk more comfortably about sexual health issues.
● PPSAT’s educator will provide science-based community presentations in Orange County
designed for the age and demographics of the audience.
Anticipated Outcomes
The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange
County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants
within that measure’s description or for an earlier performance measure.
Performance Measures Anticipated
Results
Number of adolescents who participate in multi-session, evidence-based curricula; average
increase in knowledge about pregnancy and STI prevention.
30; 25%
Number of students reached by peer educators 300
Number of parents reached through parent workshops; Percentage of parents who report an
increased comfort in talking about sexuality with their children
15; 75%
Number of participants reached by single-session programs; Percentage of individuals who report
an increased understanding of their risk of pregnancy or STI transmission
35; 75%
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
6/28/2021
Orange County Outside Agency Performance Agreement Page 9 of 9
Rev. 1/21
ATTACHMENT “A”
Orange County Certifications – FY 2020-21
Outside Agency Performance Agreement
Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer
I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief
financial officer for my agency with this Agreement and that I will keep it current to the County of Orange.
The list should be in writing with the name, title, residential address; phone and email address and if
possible, fax number.
Officers and Board of Directors
I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and
that we will continue to update the list as changes occur. The list should be in writing, with the name,
physical address, mailing address and if possible, phone, fax and email address.
Budget Submission
I certify that I have provided a budget for the period to be covered by funding Orange County, and that any
substantive changes made to this budget have been in advance authorized in writing by Orange County.
Annual Financial Review
I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget
adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a
separate sheet of paper.
Alignment with Organization’s Mission
I certify that the programs and services for which this funding is requested align with the mission of the
organization.
Intended Purpose
I certify that the funds provided to the agency under the terms of this Agreement will be used for a public
purpose and shall only be used for the purposes intended and any money not used for those purposes will be
promptly returned to Orange County.
Certified by: _______________________ Title: __________________________ Date: ___________
(Provider’s Signature)
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB
President and CEO 6/28/2021
DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB