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DocuSign Envelope ID: 717C8AE2- 4D6E- 4E46- A9A7- F4213973D039 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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: 10 <br /># of FTE - Paid Part -Time Positions: 4 (these are Y4 time positions) <br /># of Volunteers: 104 # of FTE - Volunteers: 0 <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 Orange County Living Wage Certified Employer? No <br />If no, please explain. Club Nova Community has strived to give our employees living <br />wages. All our full -time employees are paid above the living wage amount, and in <br />2017 -2018 we reached our goal of paying our 4 part time employees (114 time) for <br />transportation the living wage set in 2017 of $13.15 per hour. However, with the new <br />Living Wage rate for 2018 we now fall short for those 4 part -time employees. With the <br />low Medicaid reimbursement rates and exclusions of services we cannot be <br />reimbursed for, our budget cannot currently handle another increase to the 2018 Living <br />Wage amount for our part -time transportation staff after a 16% increase for 2017 -2018. <br />We will continue to work to gradually increase wages for all staff, with a goal of <br />increased funding to raise staff wages to a living wage across the board. <br />h) Agency Budget <br />i. Is your agency currently receiving and/or requesting other (non -Human <br />Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) <br />government funding? (Yes /No) No. Club Nova is currently working with <br />Orange County, Town of Carrboro, Town of Chapel Hill regarding financial or <br />in -kind support for Club Nova expansion. <br />If yes, please list below: <br />Include aH programs that have funding requests /awards /totals from Carrboro Chapel Hill, <br />and Orange Count governments (other than Human Services). DO NOT include federal <br />funding sources, such as CDBG and HOME. <br />Program <br />FY17 -18 <br />Award <br />FY18 -19 <br />Request <br />Source <br />Ex: Affordable Rental <br />Rehabilitation <br />0 <br />$20,000 <br />Carrboro - Affordable Housing <br />Ex: Agency Administration <br />$15,000 <br />$15,000 <br />Carrboro — Other <br />Ex. Total <br />$15,000 <br />$35,000 <br />Carrboro Total Funding <br />*Add rows or attach additional page, if needed. <br />Agency Information 1/23/2018 1:58 :29 PM P a g e 1 2 o f 3 1 <br />