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DocuSign Envelope ID:71415AD7-DCDD-4CF6-89A9-F93F72D8DC62 XHIBIT 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): May 1981 <br /> b) Agency's Purpose/Mission (no more than a few sentences): <br /> To minister to the urgent needs of citizens of northern Orange County through <br /> the volunteer efforts of diverse congregations and individuals inspired by faith <br /> in God, and to enhance self-sufficiency and awareness of community <br /> resources. <br /> c) Types of Services the Agency Provides (bullet format): <br /> • Meals on Wheels: Provides a nutritious meal, Monday through Friday to <br /> primarily elderly people who are homeboun , alone during lunchtime, <br /> and unable to prepare a nutritious meal themselves due to either <br /> cognitive or physical disability. <br /> • Samaritan Relief Ministry: Provides emergency foo s, utility and rental <br /> payment, and prescription medication payment. <br /> • Thrift Shop: A place where clothing, books, and household items can be <br /> purchased for very low cost and donors are able to make tax <br /> deductable donations. <br /> d) Agency's History with Providing These Services: <br /> OCIM's Meals on Wheels program began in September of 1981. At that time the <br /> program was strictly volunteer run. In October 2001, OCIM hired the first part-time <br /> Meals on Wheels Coordinator. The current Meals on Wheels Coordinator has been <br /> with the program for 11 years. <br /> The Samaritan Relief Ministry, originally called the OCIM loan program, began with a <br /> check book that was kept by the secretary at the First :aptist Church in Hillsborough. <br /> The food pantry and Samaritan Relief Ministry office opened in the mid-1980's. The <br /> current program manager has been with the program for 19 years. <br /> The current Executive Director has been with OCIM for 26 years. <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 /> -A new initiative is being considered to utilize the Cedar Grove Comm pity Center for <br /> Meal on Wheels distribution to the Cedar Grove and Little River communities. <br /> -OCIM uses a certified public accountant to compile its financials each month. <br /> -The Hillsborough Storm Water Fee of$600 was unexpected and unbudgeted. It was a <br /> hardship to an already stressed budget. <br /> ArrPnrii Infnrmafinn 1/ fl/W.)17 4.4R-17 PM P n 1 9 <br />