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DocuSign Envelope ID:8E4BA2A0-F8F0-406A-A380-E6C66CCD78B4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 2. AGENCY INFORMATION (Be Very Brief and Concise) <br /> Please provide the following information about your agency (2 pages OR LESS): <br /> a) Years in Operation, Date of Incorporation (Month/Year): Incorporated: 03/1984; 0_perations <br /> began: 06/1990 <br /> b) Agency's Purpose/Mission (no more than a few sentences): <br /> Charles House Association is a private, nonprofit organization whose mission is threefold: <br /> a) Enriching the lives of seniors <br /> b) Supporting families caring for aging family members <br /> c) Representing the community's commitment to its elders <br /> c) Types of Services the Agency Provides (bullet format): <br /> The Charles House Center for Community Eldercare includes: <br /> O Daytime Eldercare Program <br /> O Caregiver Orientation, Resources and Education—CORE Support Program <br /> O The Bradley Program in Learning & Service: opportunities for students and interns to <br /> be introduced to careers in aging and the positive Charles House approach to <br /> working with elders <br /> O Agency Administration, Community Outreach, Management of Eldercare Homes <br /> Charles House operates the pioneering residential care settings—neighborhood eldercare <br /> homes—in the Heritage Hills and the Winmore neighborhoods. <br /> d) Agency's History with Providing These Services: <br /> Since 1990, Charles House has been a leader in developing innovative, highly respected, <br /> services for elders and their caregiving families. Charles House's Daytime Eldercare <br /> Program is exemplary in bringing together community members, caregiving families, elders, <br /> other community resources, funders and donors, to support some of the most frail elders and <br /> the most challenged families in our community. <br /> Since 2011, Charles House has pioneered neighborhood Eldercare Homes as an <br /> innovative model of residential care and end-of-life care. <br /> e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes <br /> in the past year? Is there a new Executive Director?Are there new initiatives?) <br /> Charles House celebrated its 25th Anniversary in October, 2016, with an event at The <br /> Friday Center featuring Jill McCorkle and Clyde Edgerton in conversation with D.G. Martin, <br /> plus musicians Carver, Hicks, Watson & Newberry. <br /> f) Schedule of Positions (For Entire Agency) <br /> • Full Time Equivalent(FTE) staff will be noted as 1.00; half time as .50; quarter time as .25, etc. <br /> • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: <br /> Total Volunteer Hours =Volunteer FTE 2,080 <br /> # of FTE - Full-Time Paid Positions: 19.3 <br /> # of FTE - Paid Part-Time Positions: 8,25 <br /> # of Volunteers: 100+ # of FTE - Volunteers:10 <br /> g) Living Wage <br /> Does this agency pay permanent employees a minimum living wage? (Yes/No) YES <br /> If yes, is this agency an Oran•le Count Livin. Wasle Certified Emslo er? NO <br /> If no, please explain. <br /> Since learning about the living wage determination in Orange County, the board of directors <br /> has been striving to move the entry pay rates to, and above, the living wage determination. <br /> All employees who are eligible for the employer sponsored health plan are at or above the <br /> living wage determination. As the organization moves to achieve 100% living wage <br /> designation, the board of directors will evaluate becoming a certified employer. <br /> Agency Information 1/27/2017 4:52:00 PM, Page 4 of 16 <br />