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HomeMy WebLinkAbout2021-648-E-Aging-A HelpingHandOrange County Outside Agency Performance Agreement Revised 10/2021 Page 1 of 10 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2021, (“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 A Helping Hand, a not-for-profit corporation, located at 1502 West NC Highway 54, Suite 405 , Durham, North Carolina 27707 (“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 Provider agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2021 to June 30, 2022. 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 $5000. 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 $1250. 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: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Orange County Outside Agency Performance Agreement Page 2 of 10 Rev.10/21 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. Termination for Cause. 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. 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 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Orange County Outside Agency Performance Agreement Page 3 of 10 Rev.10/21 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. e. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 6. Responsibilities of the County. Cooperation and Coordination. The County has designated (Janice Tyler) to act as the County's representative with respect to the Project who shall have the authority to render decisions within guidelines established by the County Manager or the County Board of Commissioners and who shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. 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. v. Sexual Misconduct. Sexual Abuse/Molestation Insurance is required when Provider works directly one-on-one with children, elderly or other at-risk populations. 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 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Orange County Outside Agency Performance Agreement Page 4 of 10 Rev.10/21  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  Sexual Misconduct $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. For more information see the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements, (each document is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php.) 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. 8. General Provisions. 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 identified, on the list created by the State Treasurer pursuant to G.S. 147-86.58. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.81. b. 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, which is incorporated herein by reference and can be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php. The County may enforce this provision by an 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. c. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Orange County Outside Agency Performance Agreement Page 5 of 10 Rev.10/21 Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. d. 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 Orange County Living Wage Policy, which is incorporated herein by reference, can be viewed at: http://www.orangecountync.gov/departments/purchasing_division/contracts.php. The County’s living wage is $15.40 per hour. To the extent possible, Orange County recommends that Provider provide a living wage to its employees. e. 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. f. 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. g. 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. h. 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. i. 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. j. 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. k. 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. DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Orange County Outside Agency Performance Agreement Page 6 of 10 Rev.10/21 l. Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, repres entations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. m. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Provider’s Name A Helping Hand Attention: Janice Tyler Attention: Jennifer Ashley P.O. Box 8181 Address: 1502 West NC Highway 54, Suite 405 Hillsborough, NC 27278 Durham, NC 27707 Email: Email: jennifer.ashley@ahelpinghandnc.org n. 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 _____________________________ _______________________ Jennifer Ashley, Executive Director Date For and on behalf of Orange County Government _______________________________ ________________________ Bonnie Hammersley, County Manager Date DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 11/5/2021 11/8/2021 Orange County Outside Agency Performance Agreement Page 7 of 10 Rev.10/21 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Party/Vendor Name: A HelpingHand Party/Vendor Contact Person: Jennifer Ashley Contact Phone: 919-403-5555 Party/Vendor Address: 1502 West NC Highway 54, Suite 405 City Durham State: NC Zip: 27707 Department: Aging Amount: $5000 Purpose: Budget Code(s): 49495050-720085-96002 Vendor # 32018 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 7/1/2021 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: 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: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 11/5/2021 11/6/2021 11/8/2021 11/8/2021 Orange County Outside Agency Performance Agreement Page 8 of 10 Rev.10/21 Exhibit A Provider’s Outside Agency Application DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Orange County Outside Agency Performance Agreement Page 9 of 10 Rev.10/21 Exhibit B Provider’s Revised Scope of Services and Program Budget DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Orange County Outside Agency Performance Agreement Page 10 of 10 Rev.10/21 ATTACHMENT “A” Orange County Certifications – FY 20 - 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 c overed 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 ou r 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: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Executive Director 11/5/2021 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 9/22/2021 (919) 913-1144 (919) 913-1155 10677 A Helping Hand 1502 W Hwy 54 Ste 405 Durham, NC 27707 25895 A 1,000,000 X ETD 0424582 3/1/2019 3/1/2022 500,000 20,000 1,000,000 2,000,000 2,000,000 General Aggregate 1,000,000A X ETA 0424582 3/1/2021 3/1/2022 B General Liability NDO1054177P 9/9/2021 Prof Liab 1,000,000 Orange County Government 200 S. Cameron St P.O. Box 8181 Hillsborough, NC 27278-8181 AHELPIN-01 LPOPE High & Rubish Insurance 6015 Farrington Rd., Ste 101 Chapel Hill, NC 27517 Cincinnati Insurance Companies USLI 9/9/2022 X X X X DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Certified by: _______________________ Title: __________________________ Date: ____________ (Provider’s Signature) EXHIBIT “B” Scope of Services – FY 2021-2022 Outside Agency Performance Agreement Agency Name: A Helping Hand Program Name: Pre-Health Intership Program Funding Award: $5,000 Outline how the agency will spend Orange County’s funding award. Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2022. • Provide escorted Transportation to medical appointments. • Provide trips to the grocery store and companionship. • Train Pre-Health Interns to provide services and gain a better understanding of older adults. 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 Program participants who report they have improved access to health care services. Via survey or client interview 120 Improved scores on physician empathy tests for pre-health interns. Pre and post test 120 Increase numbers of social media posts, articles and awareness campaigns around these issues. 35 posts. 2 published articles Expense Description Amount Partial Salary Volunteer Coordinator (position renamed Director of Community Care) $5,000 Executive Director 10/27/21 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 A Helping Hand Board of Directors Jennifer Ashley, ex officio Executive Director, A Helping Hand Joined Board: July 2014 Scott Bates Certified Public Accountant, C.W. Dunn & Associates., CPAs Joined Board: February 2016 Catherine Bruce Contract Law Attorney, PRA Health Sciences Joined Board: September 2014 Ann Bradford, ex officio Director of Home Care, Carol Woods Retirement Community Joined Board: January 2020 Heather Altman Owner, Harmony Advisors Joined Board: August 2020 Liz Tomajko Vice President of Human Resources & Staff Development, Carol Woods Retirement Community Nathan Boucher Board Chair Durham VA Health System and Duke University Research Scientist, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health System HSR&D Assistant Research Professor, Duke University Sanford School of Public Policy Assistant Professor, Depts. of Population Health Sciences & Medicine (Geriatrics), Duke University School of Medicine Core Faculty, Duke-Margolis Center for Health Policy Senior Fellow, Duke Center for the Study of Aging & Human Dev. Joined Board: January 2020 Josh Ravitz Secretary Nonprofit Consultant Retired Pharmaceutical Scientist, Glaxosmithkline Board Member, Carrboro Human Services Advisory Board Joined Board: November 2019 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 January 8, 2021 Please be advised that A Helping Hand is exempt from the Solid Waste Program Fee, as our offices are located in Durham, NC. Jennifer Ashley Executive Director DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER: $ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD AHELP-1 OP ID: JB 07/21/2020 S. Wolf and Associates, Inc. 2338 W. MorseChicago, IL 60645Polly Kosyla 773-754-0849 Wesco Insurance Company A Helping Hand NC1502 W NC Hwy 54 - #405Durham, NC 27707 XA WWC3476987 07/30/2020 07/30/2021 1,000,000 1,000,000 1,000,000 Proof of Insurance Orange County Government 200 South Cameron Street PO Box 8181 Hillsborough, NC 27278 773-754-0849 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER: $ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 6/19/2020 (919) 913-1144 (919) 913-1155 10677 A Helping Hand 1502 W Hwy 54 Ste 405 Durham, NC 27707 1,000,000A X ETA 0424582 3/1/2020 3/1/2021 Orange County Government 200 S. Cameron St P.O. Box 8181 Hillsborough, NC 27278-8181 AHELPIN-01 ZDIAMOND High & Rubish Insurance6015 Farrington Rd., Ste 101 Chapel Hill, NC 27517 Cincinnati Insurance Companies X X DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER: $ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 9/4/2020 (919) 913-1144 (919) 913-1155 10677 A Helping Hand 1502 W Hwy 54 Ste 405 Durham, NC 27707 25895 A 1,000,000 X ETD 0424582 3/1/2019 3/1/2022 100,000 20,000 1,000,000 2,000,000 2,000,000 1,000,000A X ETA 0424582 3/1/2020 3/1/2021 B Prof Liability NDO1054177O 9/9/2020 1,000,000 Orange County Government 200 S. Cameron St P.O. Box 8181 Hillsborough, NC 27278-8181 AHELPIN-01 ZDIAMOND High & Rubish Insurance6015 Farrington Rd., Ste 101 Chapel Hill, NC 27517 Cincinnati Insurance Companies USLI 9/9/2021 X X X X DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Cover Page P a g e 6 o f 2 3 COVER PAGE Applicant Contact Information A Helping Hand 1502 West NC Highway 54, Suite 405 Durham, NC 27707 1502 West NC Highway 54, Suite 405 Durham, NC 27707 www.ahelpinghandnc.org Executive Director: Jennifer Ashley Telephone Number: 919-403-5555 E-Mail: Jennifer.Ashley@ahelpinghandnc.org Tax ID Number: 56-1923835 Funding Request Please list all Fiscal Year 2022 Human Services (HS) funding requested for all programs and the proposed use of funds (please list program name only) Program Carrboro - HS Chapel Hill - HS Orange County-HS Total Pre-Health Internship Program Operations or Personnel $5,000 Personnel $6,000 Personnel $5,000 Personnel $16,000 Totals $5,000 $6,000 $5,000 $16,000 Briefly explain your proposed use of funds: To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: Executive Director Date Signature: Board Chairperson Date An internship program focused on preparing future practitioners for an increase in the local & national geriatric population. A primary goal of this program is to provide exposure and meaningful interaction that will result in these future professionals viewing older adults as people and not just patients. Additionally, interns who participate in this program develop a more intimate connection to their community and a nuanced understanding of the root causes of their clients conditions. January 10, 2020 January 10, 2020 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Cover Page P a g e 8 o f 2 3 DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON-DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates. YES NO a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? c) Current beneficiaries of the program for which funds are being requested? d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to 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, gender identity/expression, 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 Anti-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. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: Executive Director Date Signature: Board Chairperson Date January 10, 2020 January 10, 2020 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Program information P a g e 9 o f 2 3 AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year): July/1995 2. (no more than a few sentences): A Helping Hand (AHH) is the only nonprofit homecare organization in Orange, Durham and Chatham counties. Founded over 25 years ago, A Helping Hand continues to work with older adults and their families to provide essential services such as escorted medical transportation, in- home assistance and advocacy. 3. Please provide a brief descrip projects and evidence of successful record of meeting proposed budgets and timetables (no more than 100 words). A Helping Hand has been working for over 25 years to improve the quality of life, decrease health disparities and reduce barriers to human services. In addition, we are an active participant in county and statewide aging initiatives as well as a trusted community partner to organizations and companies working within the aging community. Our performance and responsiveness as a service provider has garnered funding, awards, and contractual agreements within the counties that we work and has enabled us to partner Carol Woods on an exciting homecare initiative. 4. Living Wage: Does this agency pay permanent employees a minimum living wage? (Yes / No) No If yes, is this agency an Orange County Living Wage Certified Employer? N0 If no, please briefly explain. A Helping Hand provides living wage salaries for our Administrative Staff. Paid companions are compensated on a scale that starts at $10.00 and increases to $14.00+ based on time with the a base wage of $12.46, which also increases based on time with the agency and merit. Additionally, certain shifts depending on factors including the time of day and length, pay at higher All Companions and CNA eived COVID19 differentials throughout the pandemic, which range from a $1.50 to $4.00 increase in the hourly wage. are also reimbursed .54 per mile for transporting clients. When AHH companions are working with Orange County clients, we pay those companions the living wage rate calculated and required by Orange County. We are a progressive organization that is not only actively working to increase wages within the next 5 years, but also to impact the larger workforce issues in Homecare. Schedule of Positions: # of FTE Full-Time Paid Positions: 5 # of FTE Part-Time Paid Positions: 1.5 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Program information P a g e 1 0 o f 2 3 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: Pre-Health Internship Program Program Primary Contact and Title: Jennifer Ashley, Executive Director Telephone Number: 919-403-5555 E-Mail: Jennifer.ashley@ahelpinghandnc.org 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of Chapel Hill Results Framework, and Orange County BOCC Goals and Priorities, and the target population to benefit from the program. (100 words or less) A Helping Hand has created an innovative approach to address the increased demand for vital services by low income seniors. By utilizing the naturally occurring resource of UNC and Duke pre-health students we formed an internship program that serves two vital purposes: 1) Provide access to healthcare through evidence-based interventions for older adults and adults with disabilities, regardless of their ability to pay. Services include escorted medical transportation, shopping assistance and companionship. These services are provided by pre health interns required to consistently provide a minimum of 10 hours per week of scheduled service to low income older adults. 2) An internship program focused on preparing future practitioners for an increase in the local and national geriatric population. A primary goal of this program is to provide exposure and meaningful interaction that will result in these future professionals viewing older adults as people and not just patients. Additionally, students who participate in this program develop a more intimate connection to their community. DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Program information P a g e 1 1 o f 2 3 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 2019-2020 Actual 2019-20 Projected 2020-21 Projected 2021-22 Gender Men 75 67 50 50 Women 250 222 200 200 Nonbinary/Genderqueer Self-Describe Total 325 289 250 250 Race and Ethnicity Black or African-American 90 85 80 80 American Indian or Alaska Native Asian White 235 204 170 170 Native Hawaiian or other Pacific Islander Two or more races Some other race Total 325 289 250 250 2 Of the above, how many Hispanic/Latino 20 12 15 15 Of the above, how many non-Hispanic/Latino 305 277 233 233 Total 325 289 250 250 Age 0-5 years 6-18 years 19-50 years 51+ years 325 289 250 250 Total 325 289 250 250 Geographic Location Town of Chapel Hill 140 122 110 110 Town of Carrboro 40 36 30 30 Orange County ( Outside of Chapel Hill/Carrboro) 10 8 10 10 Outside of Orange County 135 123 100 100 Total 325 289 250 250 Income Low-income (80% of the Area Median Income and Below) Please see income table in the attachments 325 289 250 Total 325 289 250 250 250 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Program information P a g e 1 2 o f 2 3 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 2019-20 Projected 2020-21 Projected 2021-22 Total Cost of Program $158,580 $155,000 $155,000 Total # of Individuals 289 250 250 Cost Per Individual $548 $620 $620 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: Strategic Objective (please choose one from the Results Framework) Children improve their educational outcomes Residents Increase their livelihood security X Residents improve their health outcomes Intermediate Result (please choose one from the Results Framework) Intermediate Result 3.1: Residents access basic health care services (primary, behavioral, dental) RESULTS Actual 2019-20 Projected 2020-21 Projected 2021-22 Performance Indicators % and # of program participants who report they have improved access to health care services 80%/289 80%/250 80%/250 Improved scores on physician empathy tests for pre-health interns. Pre and post test 80% / 30 interns 80% / 40 interns 80% / 40 interns DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Outside Agencies/Human Services Program information P a g e 1 3 o f 2 3 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. Senior Services Program Goal # 1 Maintain improvements in number of clients who benefit from improved access to health care Performance Measure (How will you accomplish your goal?) % and # of program participants who report they have improved access to health care services. Via survey and client interview Actual Results (Outcome) Ending FY19-20 80%/289 Projected Results (Outcome) Ending FY2021 80%/250 Projected Results (Outcome) Ending FY2022 80%/250 Program Goal # 2 Increase Intern participants understanding and awareness of the struggles older adults face in health care and cultural settings. Performance Measure (How will you accomplish your goal?) Improved scores on physician empathy tests for pre-health interns. Pre and post test Actual Results (Outcome) Ending FY19-20 80%/30 Projected Results (Outcome) Ending FY2021 80%/40 Projected Results (Outcome) Ending FY2022 80%/40 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Outside Agencies/Human Services Program information P a g e 1 4 o f 2 3 Program Goal # 3 Increase awareness of AHH internship program and the challenges older adults face in healthcare and cultural settings. Performance Measure (How will you accomplish your goal?) Increase numbers of social media posts, articles and awareness campaigns around these issues. Actual Results (Outcome) Ending FY19-20 25 targeted social media campaigns on senior issues related to healthcare or cultural bias toward aging. 2 articles published Projected Results (Outcome) Ending FY2021 35 targeted social media campaigns on senior issues related to healthcare or cultural bias toward aging. 2 articles published Projected Results (Outcome) Ending FY2022 35 targeted social media campaigns on senior issues related to healthcare or cultural bias toward aging. 2 articles published DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Program information P a g e 1 5 o f 2 3 Community Impact Award 1. Please describe the impact the proposed programs will have on the target population. Please include specific quantitative and qualitative data in your response. A Helping Hand provides evidence based interventions in its approach to increasing access to healthcare. Our programs provide a consistent and renewable resource of pre-health college students to carry out the tasks that have been identified as having the most impact on the health of low income and isolated seniors. In addition to the overwhelming feedback we receive about health improvement and increased frequency of planned medical visits, our clients have come to rely heavily on our service which is unmatched in its efficacy and execution. Last year alone we were able to provide over 10,000 hours of service focused solely on these interventions. 2. What methods/tools will your organization use to evaluate the proposed effectiveness? Please include specific examples, such as a logic model. Qualitatively, we are able to demonstrate the total number of visits and the task provided. Additionally we conduct client surveys to measure the efficacy of our work and will be adding an empathy scale pre and post test for our incoming interns. We have learned that an understanding of the day to day factors of a patients life contribute greatly to providing effective healthcare and that physician empathy is a major contributor to the outcome of patient health. 3. Please briefly describe how your proposed programs aligns with evidence-based approaches to addressing human service need(s). Hospital systems and government, both local and national, have begun to identify the primary barrier to care in the U.S. One of the largest for older adults is transportation. We provide escorted medical transportation that not only provides a ride, but an advocate who remains with our clients during their visit. Transportation not only impacts the medical visit but trips to the pharmacy and adequate nutrition. As food insecurity grows in this country, A Helping Hand has increased its focus on providing shopping assistance for clients who may need to not only visit a grocery store WHEN they have money but also multiple food banks in order to get the proper nutrition required to maintain their health. 4. Please describe one to three key partnerships/collaborations that add the most value to the success of the proposed programs. We are proud to have recently partnered with Canopy of Carol Woods in order to expand our overall agency service offerings. In addition, we anticipate profound growth in the Caregiving Collaborative as a result of this partnership. Our vision is to expand the internship program to provide quality low or no-cost hands-on care to low income seniors, something that will greatly reduce the cost of care being subsidized countywide DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083 Actual 2019-20 Estimated 2020-21 Projected 2021-22 Percent Change 102,843$ 100,000$ 100,000$ 0% -$ 0 2,250$ 5,000$ 5,000$ 0% -$ -$ 0 5,000$ 6,000$ 6,000$ 0% -$ -$ -$ 0 5,000$ 5,000$ 5,000$ 0% -$ -$ -$ 0 -$ -$ -$ 0 80.00$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 Private Foundation Grants 14,000.00$ 14,000.00$ 14,000.00$ -$ 25,000$ 25,000$ 25,000$ -$ 154,173$ 155,000$ 155,000$ 0% 85,173$ 82,000$ 82,000$ 0% 10,000$ 10,000$ 10,000$ 0% 5,000$ 5,000$ 5,000$ 0% 4,000$ 5,000$ 5,000$ 0% 50,000$ 53,000$ 53,000$ 0% 154,173$ 155,000$ 155,000$ 0% -$ -$ -$ 0 Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. Operating Budget for Specific Program Program Budget PROGRAM REVENUE If you are requesting funds for more than one program, a program budget worksheet should be provided for each program. PROGRAM NAME:Pre-Health Internship Program Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Travel & Training Other Expenses: Federal Government (CDBG/HOME/etc.) Supplies & Equipment Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities SURPLUS/(DEFICIT) FOR PERIOD: Total Program Expenses FY 2021-22 Program Budget DocuSign Envelope ID: 9B1DC55D-94EA-40F5-BA24-B9B5CF170083