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DocuSign Envelope ID: EA54395E-EA79-461 B-8A4A-AODF56E9A02D <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): June 1995 <br /> b) Agency's Purpose/Mission (no more than a few sentences): <br /> A Helping Hand (AHH) is the only nonprofit companion care organization in Orange, <br /> Durham and Chatham Counties. Founded over 20 years ago, A Helping Hand continues <br /> to work with older adults and their families to provide essential services such as <br /> escorted medical transportation, in home assistance and advocacy. <br /> c) Types of Services the Agency Provides (bullet format): <br /> • Service Learning Internship Program <br /> • Escorted Medical Transportation <br /> • In Home Assistance <br /> • Shopping Assistance <br /> • Medication Reminders <br /> • Companionship <br /> • Advocacy and Care Coordination <br /> d) Agency's History with Providing These Services: <br /> A Helping Hand has been working for over 20 years to improve the quality of life, <br /> decrease health disparities and reduce barriers to human services. In addition, we are <br /> an active participant in county and statewide aging initiatives as well as a trusted <br /> community partner to organizations and companies working within the aging <br /> community. <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 /> 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 <br /> 2,080 <br /> # of FTE - Full-Time Paid Positions: 4 <br /> # of FTE - Paid Part-Time Positions: 1.4 <br /> #of Volunteers: 80 # of FTE - Volunteers: 2.7 <br /> Agency Information 1/31/2017 3:19:07 PM <br />