Common use of INVOICE AND PAYMENT Clause in Contracts

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make available 1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableavailable documentation to show how all program income is allocated and expended during any DSHS and/or federal grantor monitoring visits, and: 1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableavailable documentation to show how all program income is allocated and expended during any DSHS and/or federal grantor monitoring visits, and: 1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract;procedures 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableor 1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mailEmail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract B-2, Budget (i.e., Budget2022); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableavailable documentation to show how all program income is allocated and expended during any DSHS and/or federal grantor monitoring visits, and: 1. Report to the contract manager assigned to the Contract, Contract any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than threethree business days from the date the Grantee has knowledge or reason to believe such activity has taken place.

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableavailable documentation to show how all program income is allocated and expended during any DSHS and/or federal grantor monitoring visits, and: 1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract;, 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableavailable documentation to show how all program income is allocated and expended during any DSHS and/or federal grantor monitoring visits, and: 1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and, 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three

INVOICE AND PAYMENT. A. Grantee shall: A. Request will request payments monthly using the State of Texas Purchase Voucher (“Form B-13”) at that is currently available online and can accessed at: xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all any supporting documentation must will be mailed or submitted to: P.O. Box by fax or electronic mail to the address/number below. Department of State Health Services Claims Processing Unit, MC 1940 X.X. Xxx 149347 Austin, TX 78714Texas 00000-9347 E0000 Fax: (000) 000-mail0000 Email: xxxxxxxx@xxxx.xxxxx.xxx xxxxxxxx@xxxx.xxxxx.xxx, XXXXxxxxxxx@xxxx.xxxxx.xxx, XXX@xxxx.xxxxx.xxx, and xxxxxxxxxxx@xxxx.xxxxx.xxx;your assigned Program Liaison. B. Be Grantee will be paid on a cost reimbursement basis and in accordance with per Attachment B-1 of this Contract (i.e.B-8, Budget); andFY2023 Budget Summary. C. Submit DSHS reserves the right, where allowed by legal authority, to DSHS an annual forecast redirect funds in the event of all program income generated from DSHS funds unanticipated financial shortfalls, and activities. Program income should be expended prior to drawing down or requesting reimbursement from if the HPP Grantee is not meeting the monthly spending percentages/deadlines as determined by DSHS. Grantee must also make available DSHS Contract Management Section will monitor Xxxxxxx’s expenditures on a monthly basis. If expenditures are below that projected in Grantee’s total Contract amount, Xxxxxxx’s budget may be subject to a decrease for the remainder of the Contract term. Positions that remain vacant after ninety (90) days may result in a decrease in funds and/or the elimination of the position. DocuSign Envelope ID: 055DB4DC-BFB3-4FC6-BCFF-C3188E5E252D A T A A T )- K a M M A T A K M T )-9 T TA REVISED HCC-I REVISED HCC-J REVISED HCC-K REVISED EMTF-9 FY19 Project FY19 ALLOCATION TOTAL REVISED HCC-I REVISED HCC-J REVISED HCC-K REVISED EMTF-9 FY20 BASE ALLOCATION TOTAL HCC-I HCC-J HCC-K EMTF-9 FY20 ROUND 1 SUPPLEMENTAL ALLOCATION TOTAL HCC-I HCC-J HCC-K REVISED EMTF-9 FY20 ROUND 2 SUPPLEMENTAL ALLOCATION TOTAL REVISED HCC I REVISED HCC-J REV SED HCC K EMTF-9 FY21 ALLOCATION TOTAL REV SED HCC-I REV SED HCC-J REVISED HCC K REV SED EMTF-9 REVISED EMTF-1 (EMTF RIDER)September 1. Report to the contract manager assigned to the Contract, any knowledge of debarment2021 August 31, suspected fraud2022 FY22 ALLOCAT ON TOTAL HCC I HCC-J HCC-K EMTF-9 EMTF-1 (EMTF R DER) September 1, program abuse2022 - June 30, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three2023 FY23 ALLOCATION TOTAL ERSONNE $ 267 964 $ 125 616 $ 84 991 $ 70 393 $ 51 356 $ - $ 332,356 $ 127 761 $ 90 360 $ 72 922 $ 61 792 $ 352,835 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 126 916 $ 87 303 $ 73 681 $ 61 853 $ 349,753 $ 97 209 $ 95 540 $ 80 828 $ 72 645 $ - $ 346,222 $ 109,571 $ 103,180 $ 86,802 $ 78 451 $ - $ 378,004 $ 2 027 134 RINGE BENE I S $ 69 671 $ 30 967 $ 22 555 $ 17 598 $ 13 353 $ - $ 84,473 $ 33 218 $ 23 494 $ 18 960 $ 16 066 $ 91,738 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 32 998 $ 22 699 $ 19 157 $ 16 082 $ 90,936 $ 25 274 $ 24 840 $ 18 590 $ 17 435 $ - $ 86,139 $ 28,488 $ 26,827 $ 19,964 $ 18 828 $ - $ 94,107 $ 517 064 RAVE $ 38 362 $ 14 800 $ 10 470 $ 9 023 $ 7 630 $ - $ 41,923 $ 14 222 $ 17 677 $ 10 677 $ 5 370 $ 47,946 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 4 553 $ 11 163 $ 5 907 $ 3 690 $ 25,313 $ 3 285 $ 4 920 $ 2 940 $ 3 655 $ 4 425 $ 19,225 $ 12,658 $ 10,006 $ 6,068 $ 585 $ 12,113 $ 41,430 $ 214 199 EQUI M EN $ - $ - $ - $ - $ - $ - $ - $ 8 144 $ 4 979 $ - $ 4 327 $ 17,450 $ - $ - $ - $ - $ - $ - $ - $ - $ 15 000 $ 15,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 13 500 $ 13,500 $ - $ - $ - $ - $ - $ - $ 45 950 SU IES $ 10 889 $ 2 755 $ 773 $ 800 $ 1 250 $ - $ 5,578 $ 22 074 $ 4 482 $ 100 $ 1 500 $ 28,156 $ 19 081 $ 2 754 $ 2 000 $ 9 700 $ 33,535 $ - $ - $ - $ 20 616 $ 20,616 $ 2 000 $ 750 $ 894 $ 1 500 $ 5,144 $ 6 250 $ 1 000 $ 3 500 $ 3 000 $ 34 850 $ 48,600 $ 1,500 $ 500 $ 400 $ 394 $ 19,767 $ 22,561 $ 175 079 CON RAC UA $ 120 484 $ - $ 14 791 $ - $ 13 890 $ - $ 28,681 $ - $ - $ - $ - $ - $ 10 000 $ - $ - $ - $ 10,000 $ 147 731 $ 90 411 $ 76 019 $ 25 200 $ 339,361 $ 18 496 $ 8 773 $ - $ - $ 27,269 $ 77 300 $ 6 600 $ 600 $ - $ - $ 84,500 $ 50,631 $ - $ - $ - $ - $ 50,631 $ 660 926 O HER $ 185 323 $ 100 614 $ 38 056 $ 40 012 $ 21 711 $ 15 000 $ 215,393 $ 54 827 $ 20 978 $ 31 930 $ 16 791 $ 124,526 $ 13 000 $ 23 000 $ 19 654 $ 7 624 $ 63,278 $ - $ - $ - $ - $ - $ 71 045 $ 26 005 $ 32 102 $ 22 927 $ 152,079 $ 47 370 $ 24 042 $ 25 383 $ 8 931 $ 72 225 $ 177,951 $ 53,160 $ 16,241 $ 18,502 $ 7,131 $ 93,120 $ 188,154 $ 1 106 704 D REC COS S $ 692 693 $ 274 752 $ 171 636 $ 137 826 $ 109 190 $ 15 000 $ 708,404 $ 260 246 $ 161 970 $ 134 589 $ 105 846 $ 662,651 $ 42 081 $ 25 754 $ 21 654 $ 17 324 $ 106,813 $ 147 731 $ 90 411 $ 76 019 $ 60 816 $ 374,977 $ 256 008 $ 156 693 $ 131 741 $ 106 052 $ 650,494 $ 256 688 $ 156 942 $ 131 841 $ 105 666 $ 125 000 $ 776,137 $ 256,008 $ 156,754 $ 131,736 $ 105 389 $ 125,000 $ 774,887 $ 4 747 056 NDIREC COS S $ 139 048 $ 57 343 $ 31 605 $ 26 843 $ 22 546 $ - $ 138,337 $ 59 763 $ 33 874 $ 30 080 $ 25 890 $ 149,607 $ - $ - $ 64 001 $ 39 151 $ 32 928 $ 25 684 $ 161,764 $ 63 321 $ 38 902 $ 32 828 $ 26 070 $ - $ 161,121 $ 64,001 $ 39,090 $ 32,933 $ 26,347 $ - $ 162,371 $ 912 248 T TA $ 831 741 $332,095 $203,241 $164,669 $ 131 736 $ 15,000 $ 846,741 $320,009 $195,844 $164,669 $131,736 $ 812,258 $ 42,081 $ 25,754 $ 21,654 $ 17,324 $ 106,813 $ 147 731 $ 90,411 $ 76,019 $ 60,816 $ 374,977 $320,009 $195,844 $164,669 $131,736 $ 812,258 $ 320 009 $ 195 844 $ 164 669 $ 131 736 $ 125 000 $ 937,258 $ 320,009 $ 195,844 $ 164,669 $ 131 736 $ 125,000 $ 937,258 $ 5,659,304

INVOICE AND PAYMENT. A. Grantee shall: A. Request will request payments monthly using the State of Texas Purchase Voucher (“Form B-13”) at that is currently available online and can accessed at: xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all any supporting documentation must will be mailed or submitted to: P.O. Box by fax or electronic mail to the address/number below. Department of State Health Services Claims Processing Unit, MC 1940 X.X. Xxx 149347 Austin, TX 78714Texas 00000-9347 E0000 Fax: (000) 000-mail0000 Email: xxxxxxxx@xxxx.xxxxx.xxx xxxxxxxx@xxxx.xxxxx.xxx, XXXXxxxxxxx@xxxx.xxxxx.xxx, XXX@xxxx.xxxxx.xxx, and xxxxxxxxxxx@xxxx.xxxxx.xxx;your assigned Program Liaison. B. Be Grantee will be paid on a cost reimbursement basis and in accordance with per Attachment B-1 of this Contract (i.e.B-9, Budget); andFY2023 Budget Summary. C. Submit DSHS reserves the right, where allowed by legal authority, to DSHS an annual forecast redirect funds in the event of all program income generated from DSHS funds unanticipated financial shortfalls, and activities. Program income should be expended prior to drawing down or requesting reimbursement from if the HPP Grantee is not meeting the monthly spending percentages/deadlines as determined by DSHS. Grantee must also make available DSHS Contract Management Section will monitor Xxxxxxx’s expenditures on a monthly basis. If expenditures are below that projected in Grantee’s total Contract amount, Xxxxxxx’s budget may be subject to a decrease for the remainder of the Contract term. Positions that remain vacant after ninety (90) days may result in a decrease in funds and/or the elimination of the position. DocuSign Envelope ID: 15DF1CAE-16AF-454D-BE5D-C8F4230E62B6 A T A A T )-T V a M M A T A K M T ) - T TA REVISED HCC T REVISED HCC-U REVISED HCC-V REVISED EMTF-11 FY19 ALLOCAT ON TOTAL REVISED HCC-T REVISED HCC-U REVISED HCC-V EMTF-11 ACT VE SHOOTER SYMPOSIUM PROJECT FY20 BASE ALLOCATION TOTAL HCC T HCC U REVISED HCC-V EMTF-11 FY20 ROUND 1 SUPPLEMENTAL ALLOCATION TOTAL HCC-T HCC-U HCC-V EMTF-11 FY20 ROUND 2 SUPPLEMENTAL ALLOCATION TOTAL REVISED HCC-T REV SED HCC-U REVISED HCC-V REVISED EMTF-11 FY21 ALLOCATION TOTAL REVISED HCC-T REVISED HCC-U REVISED HCC-V REV SED EMTF-11 REVISED EMTF-11 (EMTF RIDER) September 1. Report to the contract manager assigned to the Contract, any knowledge of debarment2021 - August 31, suspected fraud2022 FY22 ALLOCAT ON TOTAL HCC-T HCC-U HCC-V EMTF-11 EMTF-11 (EMTF RIDER) September 1, program abuse2022 - August 31, possible illegal expenditures2023 FY23 ALLOCATION TOTAL ERSONNE $ 370 760 $ 78,651 $ 77,500 $ 1 8,3 8 $ 71,701 $ 376,200 $ 78,816 $ 75,223 $ 185, unlawful activity83 $ 73,2 2 $ - $ 412,764 $ - $ 28,50 $ 35,517 $ 1 ,257 $ 78,278 $ - $ - $ - $ - $ - $ 83,008 $ 75,652 $ 18 ,058 $ 95 907 $ 438,625 $ 96,088 $ 115,085 $ 2 8 552 $ 98, or violation of financial laws5 $ - $ 558,170 $ 96,088 $ 115,085 $ 262,644 $ 98,445 $ - $ 572,262 $ 2,807,059 RINGE BENE I S $ 122 352 $ 12, rules29 $ 10,52 $ 2 ,535 $ 11,698 $ 59,186 $ 17,3 0 $ 18,05 $ 36,655 $ 1 ,815 $ - $ 86,864 $ - $ 6,311 $ 7,81 $ 3,065 $ 17,190 $ - $ - $ - $ - $ - $ 19,092 $ 17, policies00 $ 2,333 $ 22 059 $ 100,884 $ 11,290 $ 13,695 $ 31,193 $ 17,228 $ - $ 73 406 $ 11,290 $ 13,695 $ 32,962 $ 17,228 $ - $ 75,175 $ 535,057 RAVE $ 73 394 $ 11,60 $ 15,866 $ 1 ,350 $ 25, and procedures related to performance under this Contract; 2. Make such report no later than three (79 $ 67,299 $ 11,987 $ 1 ,317 $ 12,899 $ 22,769 $ - $ 61,972 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 700 $ 1,500 $ 1,680 $ 2,630 $ 6,510 $ 5,270 $ 6,093 $ 6 935 $ 9,950 $ - $ 28 248 $ 11,532 $ 19,545 $ 25,900 $ - $ 15,531 $ 72,508 $ 309,931 EQUI M EN $ - $ 6, 11 $ - $ 6,411 $ - $ - $ 15,000 $ - $ - $ 15,000 $ - $ - $ - $ - $ - $ - $ 6 ,892 $ 1 6,007 $ 59,990 $ 270,889 $ 15,1 1 $ 8,2 9 $ 1 1,607 $ - $ 204,997 $ 2 ,162 $ 21,550 $ 73 739 $ 6,113 $ 96,6 $ 222 208 $ - $ - $ 51,094 $ - $ - $ 51,094 $ 770,599 SU IES $ 24 000 $ 7,27 $ 23,103 $ - $ 30,377 $ 200 $ 1,000 $ 866 $ ,0 2 $ - $ 6,108 $ 171 $ - $ 67 $ 2 $ 240 $ - $ - $ - $ - $ 6, 11 $ 8, 00 $ 58, 37 $ ,060 $ 77,308 $ - $ - $ - $ - $ 7,007 $ 7 007 $ - $ - $ - $ 255 $ - $ 255 $ 1 5,295 CON RAC UA $ 259 886 $ 3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee76 $ 37, subgrantee or agent of Grantee60 $ 276,027 $ - $ 356,963 $ 2 ,055 $ 28,001 $ 201,261 $ - $ - $ 253,317 $ 21, or any other person83 $ - $ 23,765 $ - $ 45,248 $ 76,019 $ 7,330 $ 79,5 3 $ - $ 202,892 $ 13,15 $ 18,600 $ - $ - $ 31,754 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 1,150,060 O HER $ 183 573 $ 11,115 $ 83,880 $ 23,220 $ 22,858 $ 141,073 $ 23,080 $ 83,521 $ 1,206 $ 16,868 $ 28,000 $ 192,675 $ - $ - $ - $ - $ - $ - $ 10,000 $ 10,23 $ 826 $ 21,060 $ 6,008 $ 5 ,952 $ 32,628 $ 7,080 $ 100,668 $ 6,859 $ 55,380 $ 90 32 $ - $ 21,3 9 $ 173 912 $ 24,759 $ 63,478 $ 78,143 $ - $ 109,469 $ 275,849 $ 1,088,810 D REC COS S $ 1,033 965 $ 157,275 $ 232,50 $ 515,99 $ 131,736 $ 1,037,509 $ 155, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three78 $ 220,116 $ 93,370 $ 131,736 $ 28,000 $ 1,028,700 $ 21,65 $ 3 ,815 $ 67,163 $ 17,32 $ 140,956 $ 76,019 $ 122,222 $ 235,78 $ 60,816 $ 494,841 $ 1 3,51 $ 22 ,753 $ 60 7 3 $ 131,736 $ 960,746 $ 1 3,669 $ 211,803 $ 50 7 3 $ 131,736 $ 125,000 $ 1,062 951 $ 143,669 $ 211,803 $ 450,743 $ 115,928 $ 125,000 $ 1,047,143 $ 6,806,811 NDIREC COS S $ 67 225 $ 7,39 $ 2,2 8 $ 1 ,039 $ - $ 63,681 $ 9,191 $ ,637 $ 17,373 $ - $ - $ 71,201 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 21,155 $ 0,000 $ 50,000 $ - $ 111,155 $ 21,000 $ 52,950 $ 60 000 $ - $ - $ 133 950 $ 21,000 $ 52,950 $ 60,000 $ 15,808 $ - $ 149,758 $ 596,970 T TA $ 1,101,190 $164,669 $274,752 $530,033 $ 131,736 $ 1,101,190 $164,669 $264,753 $510,743 $131,736 $ 28,000 $ 1,099,901 $21,654 $34,815 $ 67,163 $17,324 $ 140,956 $76,019 $122,222 $235,784 $60,816 $ 494,841 $164,669 $264,753 $510 743 $131,736 $ 1,071,901 $ 164,669 $ 264,753 $ 510 743 $ 131,736 $ 125,000 $ 1,196 901 $ 164,669 $ 264,753 $ 510,743 $ 131,736 $ 125,000 $ 1,196,901 $ 7,403,781

INVOICE AND PAYMENT. 1. System Agency will reimburse Grantee shall:actual, allocable, and eligible costs incurred to complete activities outlined in this Statement of Work. Reimbursement is subject to funding limitations found in 45 CFR Part 96. A. Request payments 2. Grantee shall request monthly reimbursement, solely for Contract activities on or before the 15th day of the month after the month of service (e.g., September submission due October 15th) using the State of Texas Purchase Voucher (Form B-13) 4116), which is incorporated by reference and can be downloaded at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtmxxxxx://xxx.xxxxx.xxx/laws-regulations/forms/4000- 3. All invoice requests not received based on the schedule noted above in Section VIII.2, are considered late and will require justification from the Grantee for the late submission. 4. Xxxxxxx’s monthly State of Texas Purchase Voucher Support Form (VSF) 4116 must include: i. Name, address, and acceptable supporting documentation for reimbursement telephone number of Grantee; ii. HHSC contract number or purchase order number; iii. Identification of services provided; iv. Dates on which services were provided; v. The total amount of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget)request; and C. Submit to DSHS an annual forecast vi. Supporting documentation, which includes: 1. A copy of all program income generated from DSHS Xxxxxxx’s General Xxxxxx proving expenditure of funds and activitiesby cost category; and 2. Program income should be expended prior to drawing down Any other documentation required by this Contract or requesting reimbursement from DSHSotherwise requested by System Agency. 5. Grantee must also make available 1. Report submit monthly reimbursement requests to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policiesXXXX_XX@xxxx.xxxxx.xx.xx, and procedures related copy XXXxxxxxxxx@xxxx.xxxxx.xx.xx and System Agency’s designated Contract manager. System Agency recommends using the following naming convention on the subject line of all monthly reimbursement requests: “Invoice Submission: El Paso MHMR d/b/a Emergence Health Network, HHS001375500008, [Invoice Number], [Invoice Amount], [Service Month].” 6. All Contract costs must be individually identifiable, verifiable, and necessary to performance under satisfy the requirements of this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three.

INVOICE AND PAYMENT. A. Grantee shall: A. Request payments will request payment monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSFB- 13) and acceptable supporting documentation for reimbursement of the required services/deliverables. The Grantee is required will submit the Financial Status Report (FSR-269A). Vouchers, supporting documentation, and Financial Status Reports should be mailed or emailed to identify expenditures by budget category the addresses below. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx X.X. Xxx 000000 Xxxxxx, XX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx B-13s and funding code. Voucher and all supporting documentation must should be submitted sent to: P.O. Box 149347 Austin, TX 78714-9347 E-mailxxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx. FSRs should be sent to: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx;XXXXxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx. B. Be paid on a cost reimbursement basis Subject to submission of required and appropriate documentation, and in accordance with applicable law and governing regulations, Grantee will be reimbursed monthly and in accordance with Attachment B-1 B, Budget. DocuSign Envelope ID: B9E2ADB8-82A0-43C9-A5FC-D4BFDA9AAFF8 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this Contract collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (i.e.0348-0040), Budget); and C. Submit to DSHS an annual forecast Xxxxxxxxxx, XX 00000. As the duly authorized representative of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availablethe applicant, I certify that the applicant: 1. Report Has the legal authority to apply for Federal assistance and the contract manager assigned institutional, managerial and financial capability (including funds sufficient to pay the Contractnon-Federal share of project cost) to ensure proper planning, any knowledge management and completion of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under the project described in this Contract;application. 2. Make such report no later than three (3) working days from Will give the date awarding agency, the Grantee has knowledge Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or reason documents related to believe such activity has taken place;the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Report any credible evidence Will establish safeguards to prohibit employees from using their positions for a purpose that a principal, employee, subgrantee constitutes or agent presents the appearance of Grantee, personal or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, organizational conflict of interest, bribery, gratuity, or similar misconduct involving those funds; andpersonal gain. 4. Make this report Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.§§1681- 1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U. S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, (j) the requirements of any other nondiscrimination statute(s) which may apply to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx application. 7. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply, as applicable, with provisions of the HHS Office Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than threeemployees whose principal employment activities are funded in whole or in part with Federal funds.

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly Contractor will request payments, at least monthly, using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding codexxxx://xxx.xxxx.xxxxx.xxx/grants/forms/b13form.doc. Voucher and all any supporting documentation must will be mailed or submitted to: by fax or submitted by electronic mail to the address/number below. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 7871400000-9347 E0000 Fax: (000) 000-mail0000 Email to: xxxxxxxx@xxxx.xxxxx.xxx AND xxxxxxxxxxx@xxxx.xxxxx.xxx with copies to the Assigned Contract Manager and xxxxxxxxxxx@xxxx.xxxxx.xxx;GEN-FEE program contact. B. Be Vouchers will be submitted as aggregate activity reports with a State of Texas voucher and will not refer to or identify individual clients. Contractor will submit requests for reimbursement or payment within thirty (30) calendar days following the end of the month covered by the voucher or within sixty (60) days in cases of potentially Medicaid eligible individuals who are denied eligibility by the Health and Human Services Commission. All vouchers will be submitted within forty-five (45) days of each fiscal year end. C. Contractor will be paid on a cost reimbursement fee for service basis and with the current schedule of allowable services and rates as referenced in accordance with Attachment B-1 the most current Title V Genetic Fee-for-Service Policies and Procedures Manual xxxxx://xxx.xxxx.xxxxx.xxx/genetics/contract.shtm. DocuSign Envelope ID: In this document, the terms Respondent, Contractor, Applicant, and Vendor, when referring to the following affirmations (whether framed as certifications, representations, warranties, or in other terms) refer to Respondent, and the affirmations apply to all Respondents regardless of this Contract their business form (i.e.e.g., Budgetindividual, partnership, corporation); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableRespondent affirms, without exception, as follows: 1. Report Respondent represents and warrants that all certifications, representations, warranties, and other provisions in this Affirmations and Solicitation Acceptance apply to Respondent and all of Respondent's principals, officers, directors, shareholders, partners, owners, agents, employees, subcontractors, independent contractors, and any other representatives who may provide services under, who have a financial interest in, or otherwise are interested in this Solicitation or any contract resulting from this Solicitation. 2. Respondent represents and warrants that all statements and information provided to HHSC and DSHS are current, complete, and accurate. This includes all statements and information in this Solicitation Response. 3. Respondent understands that HHSC and DSHS will comply with the Texas Public Information Act (Chapter 552 of the Texas Government Code) as interpreted by judicial rulings and opinions of the Attorney General of the State of Texas. Information, documentation, and other material prepared and submitted in connection with this Solicitation or any resulting contract may be subject to public disclosure pursuant to the Texas Public Information Act. In accordance with Section 2252.907 of the Texas Government Code, Respondent is required to make any information created or exchanged with the State pursuant to the contract, and not otherwise excepted from disclosure under the Texas Public Information Act, available in a format that is accessible by the public at no additional charge to the State. 4. Respondent represents and warrants that it will comply with the requirements of Section 552.372(a) of the Texas Government Code. Except as provided by Section 552.374(c) of the Texas Government Code, the requirements of Subchapter J (Additional Provisions Related to Contracting Information), Chapter 552 of the Government Code, may apply to the contract manager assigned and the Respondent agrees that the contract can be terminated if the Respondent knowingly or intentionally fails to comply with a requirement of that subchapter. 5. Respondent acknowledges its obligation to specifically identify information it contends to be confidential or proprietary and, if Respondent designated substantial portions of its Solicitation Response or its entire Solicitation Response as confidential or proprietary, the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related Solicitation Response is subject to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than threebeing disqualified.

INVOICE AND PAYMENT. A. Grantee shall: A. Request will request payments monthly using the State of Texas Purchase Voucher (“Form B-13”) at that is currently available online and can accessed at: xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all any supporting documentation must will be mailed or submitted toby fax or electronic mail to the address/number below. Department of State Health Services Claims Processing Unit, MC 1940 X.X. Xxx 000000 Xxxxxx, Xxxxx 00000-0000 Fax: P.O. Box 149347 Austin(000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx XXXXxxxxxxx@xxxx.xxxxx.xxx, XXX@xxxx.xxxxx.xxx, and xxxxxxxxxxx@xxxx.xxxxx.xxx;your assigned Program Liaison. B. Be Grantee will be paid on a cost reimbursement basis and as set forth in accordance with Attachment B-1 of this Contract (i.e.ATTACHMENT B-7, Budget); andREVISED FIRST, SECOND, THIRD, THIRD SUPPLEMENTAL ROUND 1, THIRD SUPPLEMENTAL ROUND 2, FOURTH AND FIFTH TERM BUDGET SUMMARY. C. Submit DSHS reserves the right, where allowed by legal authority, to DSHS an annual forecast redirect funds in the event of all program income generated from DSHS funds unanticipated financial shortfalls, and activities. Program income should be expended prior to drawing down or requesting reimbursement from if the HPP Grantee is not meeting the monthly spending percentages/deadlines as determined by DSHS. Grantee must also make available 1DSHS Contract Management Section will monitor Grantee’s expenditures on a monthly basis. Report If expenditures are below that projected in Grantee’s total Contract amount, Grantee’s budget may be subject to a decrease for the contract manager assigned to remainder of the Contract, any knowledge Contract term. Positions that remain vacant after ninety (90) days may result in a decrease in funds and/or the elimination of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, the position. DocuSign Envelope ID: 9DAB9D70-9C25-475D-BE25-DC0D4BEC3F6E HEAL HCARE COALI IONS (HC C ) I K and procedures related to performance under this Contract; 2. Make such report no later than three EM ER GEN C Y M EDICAL ASK F ORCE (3EM F ) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three9 O A L R EV ISED HCC I R EV ISED HCC R EV ISED HCC K R EV ISED EM F 9 FY 19 Pro ject F Y 19 ALLOCA ION O A L R EV ISED HCC I R EV ISED HCC R EV ISED HCC K R EV ISED EM F 9 F Y 2 0 B A SE ALLOCA ION O A L HCC I HCC HCC K EM F 9 FY20 ROUND 1 SUPPLEMENTAL ALLOCATION TOTAL HCC I HCC HCC K R EV ISED EM F 9 FY20 ROUND 2 SUPPLEMENTAL ALLOCATION TOTAL R EV ISED HCC I R EV ISED HCC R EV ISED HCC K EM F 9 FY 2 1 ALLOCA ION O A L HCC I HCC HCC K EM F 9 F Y 22 ALLOCA ION O A L PERSONNEL $ 267,964 $ 125 616 $ 84 991 $ 70 393 $ 51 356 $ - $ 332,356 $ 127 761 $ 90 360 $ 72 922 $ 61 792 $ 352,835 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 126 916 $ 87 303 $ 73 681 $ 61 853 $ 349,753 $ 107 001 $ 96 358 $ 81 646 $ 73 425 $ 358,430 $ 1 661 338 FRINGE BENEFITS $ 69,671 $ 30 967 $ 22 555 $ 17 598 $ 13 353 $ - $ 84,473 $ 33 218 $ 23 494 $ 18 960 $ 16 066 $ 91,738 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 32 998 $ 22 699 $ 19 157 $ 16 082 $ 90,936 $ 27 820 $ 25 053 $ 21 228 $ 19 091 $ 93,192 $ 430 010 TRAVEL $ 38,362 $ 14 800 $ 10 470 $ 9 023 $ 7 630 $ - $ 41,923 $ 14 222 $ 17 677 $ 10 677 $ 5 370 $ 47,946 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 4 553 $ 11 163 $ 5 907 $ 3 690 $ 25,313 $ 5 012 $ 4 881 $ 2 340 $ - $ 12,233 $ 165 777 EQUIPM ENT $ - $ - $ - $ - $ - $ - $ - $ 8 144 $ 4 979 $ - $ 4 327 $ 17,450 $ - $ - $ - $ - $ - $ - $ - $ - $ 15 000 $ 15,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ 32 450 SUPPLIES $ 10,889 $ 2 755 $ 773 $ 800 $ 1 250 $ - $ 5,578 $ 22 074 $ 4 482 $ 100 $ 1 500 $ 28,156 $ 19 081 $ 2 754 $ 2 000 $ 9 700 $ 33,535 $ - $ - $ - $ 20 616 $ 20,616 $ 2 000 $ 750 $ 894 $ 1 500 $ 5,144 $ 1 000 $ 500 $ 500 $ 200 $ 2,200 $ 106 118 CONTRACTUAL $ 120,484 $ - $ 14 791 $ - $ 13 890 $ - $ 28,681 $ - $ - $ - $ - $ - $ 10 000 $ - $ - $ - $ 10,000 $ 147 731 $ 90 411 $ 76 019 $ 25 200 $ 339,361 $ 18 496 $ 8 773 $ - $ - $ 27,269 $ 27 445 $ 16 800 $ 5 099 $ - $ 49,344 $ 575 139 OTHER $ 185,323 $ 100 614 $ 38 056 $ 40 012 $ 21 711 $ 15 000 $ 215,393 $ 54 827 $ 20 978 $ 31 930 $ 16 791 $ 124,526 $ 13 000 $ 23 000 $ 19 654 $ 7 624 $ 63,278 $ - $ - $ - $ - $ - $ 71 045 $ 26 005 $ 32 102 $ 22 927 $ 152,079 $ 88 410 $ 13 350 $ 21 028 $ 12 950 $ 135,738 $ 876 337 DIRECT COSTS $ 692,693 $ 274 752 $ 171 636 $ 137 826 $ 109 190 $ 15 000 $ 708,404 $ 260 246 $ 161 970 $ 134 589 $ 105 846 $ 662,651 $ 42 081 $ 25 754 $ 21 654 $ 17 324 $ 106,813 $ 147 731 $ 90 411 $ 76 019 $ 60 816 $ 374,977 $ 256 008 $ 156 693 $ 131 741 $ 106 052 $ 650,494 $ 256 688 $ 156 942 $ 131 841 $ 105 666 $ 651,137 $ 3 847 169 INDIRECT COSTS $ 139,048 $ 57 343 $ 31 605 $ 26 843 $ 22 546 $ - $ 138,337 $ 59 763 $ 33 874 $ 30 080 $ 25 890 $ 149,607 $ - $ - $ 64 001 $ 39 151 $ 32 928 $ 25 684 $ 161,764 $ 63 321 $ 38 902 $ 32 828 $ 26 070 $ 161,121 $ 749 877 O A L $ 831,741 $332,095 $203,241 $164,669 $ 131,736 $ 15,000 $ 846,741 $320,009 $195,844 $164,669 $131,736 $ 812,258 $ 42,081 $ 25,754 $ 21,654 $ 17,324 $ 106,813 $ 147,731 $ 90,411 $ 76,019 $ 60,816 $ 374,977 $320,009 $195,844 $164,669 $131,736 $ 812,258 $ 320 009 $ 195 844 $ 164 669 $ 131 736 $ 812,258 $ 4,597,046

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box X.X. Xxx 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableavailable documentation to show how all program income is allocated and expended during any 1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three

INVOICE AND PAYMENT. Grantee shall: A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx; B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make availableavailable documentation to show how all program income is allocated and expended during any 1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract; 2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place; 3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and 4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three