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DocuSign Envelope ID: 134C4810- 3CA5- 4008- 9E74- 2A07D3AECED8 <br />EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION <br />PROGRAM INFORMATION 2/9/2017 1:51:06 PM Page 21 of 26 <br />Club Nova will keep records and statistics via our member database and <br />progress notes. <br />Club Nova will: <br />• Track the housing security of membership <br />• Track hospitalization and re- hospitalization of members <br />• Survey members, yearly, on housing security, hospitalization, access to <br />healthcare including primary care, dentistry, and supportive care. <br />Previous Year Program Results <br />Club Nova was open 6 days a week, 54 -60 hours per week, and had the <br />necessary assistance to pay the cost of utility bills, staff compensation <br />and benefits (including payroll taxes and insurance), and necessary <br />programming supplies and training. <br />Current Year Estimated Results <br />Club Nova will remain open 6 days a week, 54 -60 hours per week, and <br />will have the necessary assistance to pay the cost of utility bills, staff <br />compensation and benefits (including payroll taxes and insurance), and <br />necessary programming supplies and training. The following are <br />estimated for the year: <br />90% of Club Nova members will report having safe, secure, and <br />affordable housing, with 0% homelessness. <br />80% of Club Nova members will report no re- hospitalization due to <br />psychiatric concerns. <br />100% of Club Nova members will report access to healthcare with 50% <br />reporting access to primary care. <br />Next Year Projected Results <br />Club Nova will remain open 6 days a week, 54 -60 hours per week, and <br />will have the necessary assistance to pay the cost of utility bills, staff <br />compensation and benefits (including payroll taxes and insurance), and <br />necessary programming supplies and training. <br />90% of Club Nova members will report having safe, secure, and <br />affordable housing, with 1% homelessness. <br />80% of Club Nova members will report no re- hospitalization due to <br />psychiatric concerns. <br />100% of Club Nova members will report access to healthcare with 50% <br />reporting access to primary care. <br />5. Program Activity Name <br />Club Nova partners with local food organizations to secure approximately <br />750 pounds of fresh, local produce and meat monthly. Members and <br />staff cook from scratch and address individual dietary needs in our meals. <br />Club Nova members and staff prepare and serve 13 meals per week. <br />Members are be given opportunities to engage in every step of the <br />process, including menu planning, grocery shopping, cooking and <br />cleaning. Club Nova uses its garden as an educational and wellness <br />activity and engages community experts for workshops and trainings <br />related to wellness. <br />Staff work closely with members who have individual goals specifically <br />related to healthy eating and increased wellness to ensure they have the <br />supports needed. <br />Program Goal <br />Club Nova will address food insecurity and diet related disease by <br />providing at least 12,000 healthy, affordable meals, engaging at least <br />80% of membership in Clubhouse meals, and providing education and <br />training related to cooking, nutrition, obtaining and growing food. <br />Performance Measures <br />Club Nova will: <br />• Maintain records of the number of meals served daily. <br />• Maintain daily records of individuals eating at the Clubhouse. <br />• Survey its membership yearly to evaluate the achieved health and food <br />PROGRAM INFORMATION 2/9/2017 1:51:06 PM Page 21 of 26 <br />