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<br />Program information P a g e 1 0 o f 2 2
<br />
<br />Of the above, how many Hispanic/Latino 4,517 4,659 4,857 5,003
<br />Of the above, how many non-Hispanic/Latino 3,532 3,685 3,603 3,712
<br />Total 8,049 8,344 8,460 8,715
<br />Age
<br />0-5 years 791 772 915 942
<br />6-18 years 2,027 2,119 2,094 2,157
<br />19-50 years 3,506 3,668 3,690 3,801
<br />51+ years 1,725 1,785 1,761 1,815
<br />Total 8,049 8,344 8,460 8,715
<br />Geographic Location
<br />Town of Chapel Hill 3,159 3,257 3,304 3,403
<br />Town of Carrboro 1,190 1,259 1,383 1,424
<br />Orange County ( Outside of Chapel Hill/Carrboro) 661 727 955 984
<br />Outside of Orange County 3,039 3,101 2,818 2,904
<br />Total 8,049 8,344 8,460 8,715
<br />Income
<br />Low-income (80% of the Area Median Income and Below) Please see
<br />income table in the attachments ***see note***
<br />Est. 7,400 Est. 7,500 Est. 8,000 Est. 8,100
<br />Total 8,049 8,344 8,460 8,715
<br />1) Piedmont Health’s 2018-19 application was written only for the Carrboro Community Health Center, therefore the table above has
<br />been modified from projected 2018-19 to actual 2017-18, to give actual patient demographics for all 3 Orange County CHC locations
<br />to give reviewers more data about the locations for whom funding is being requested in this application.
<br />***The PHS sliding fee scale is open to all individuals living at or below 200% of poverty, and PHS has income data for those who
<br />choose to apply. Importantly many low-income individuals (including those with Medicaid and Medicare) do not typically supply
<br />PHS income information because their care at PHS is covered by their insurance. 99% of those who applied for our sliding fee scale
<br />in 2018 had documented incomes below 200% of poverty (which is much less than 80% of the median).
<br />8. Cost Per Individual
<br />
<br />This cost per individual must reflect the total program budget divided by the total number of program
<br />individuals in this application.
<br />
<br /> Actual 2018 Projected 2019 Projected 2020
<br />Total Cost of Program $6,267,229 $7,437,645 $7,737,616
<br />Total # of Individuals 8,214 8,460 8,715
<br />Cost Per Individual $762.99 $879.11 $887.85
<br />
<br />9. Performance Indicators
<br />For Chapel Hill and Carrboro applicants:
<br />Please complete the following chart with information about the Strategic Objective, Intermediate Result, and
<br />the Agency Performance Indicator for each program for which you are applying for funding. Please see the
<br />Results Framework in the Attachments section as a reference.
<br />
<br />
<br />
<br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
<br />DocuSign Envelope ID: EEE4BE29-5C31-4220-A7C0-E3D3B4C537B0
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