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Exhibit B—Scope of Services—Fiscal Year 2012-13 <br /> Orange County Outside Agency Performance Agreement Certification <br /> Funded Amount: $10,000 <br /> Agency: Piedmont Health Services, Inc. <br /> Program <br /> Primary Care Home for the Low-Income, Uninsured <br /> Purpose <br /> The funding will be used to support the Piedmont Health Services, Inc. community health center <br /> mission of providing medically indigent residents of Orange County with access to a <br /> comprehensive, sliding-fee primary care home, including medical and dental care (ancillary <br /> health support services are also provided but are not supported by this grant). <br /> Outcomes <br /> Over the project period, to serve over 3,400 residents of Orange County, Chapel Hill or <br /> Carrboro at the Carrboro Community Health Center. The projected FY12 program unit cost is <br /> $165.55 per primary care visit (medical or dental visit). <br /> Program Budget <br /> Description Expense Justification <br /> Personnel - Salaries $10,000 For the current FY,the Carrboro Community <br /> Health Center aims to provide 22,000 <br /> medical visits (including lab) and 4,380 <br /> dental visits to the community. The <br /> requested funds are used to support health <br /> provider salary costs such that we may <br /> maintain the FTE to achieve these visits. <br /> Personnel - FICA and Fringe n/a <br /> Travel/Mileage n/a <br /> Office Supplies n/a <br /> Program Supplies n/a <br /> Advertising n/a <br /> Rent and Utilities n/a <br /> Miscellaneous n/a <br /> Other Expense n/a <br /> Other Expense n/a <br /> Other Expense n/a <br /> 2 <br /> Certified by: Title: CCU Date: ul 3 <br /> �� <br />