Common use of OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE Clause in Contracts

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). Attachment A-1 Match Reimbursement Certification Form SECTION 1 1 Grantee Name Grantee Name 2 Program MH/CMHG 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter SECTION 2 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 7 Sum (Line 5 + Line 6) $0.00 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! SECTION 3 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 13 Xxxxxxx's Required Match (Line 12 x Line 9) Thru "Period Covered" #DIV/0! #DIV/0! 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! SECTION 4 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) 20 Balance to be Repaid (Line 26 minus Line 27) $0.00 SECTION 5 21 CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all match, outlays and unliquidated obligations are for the purposes set forth in the award documents. Typed or Printed Name and Title Date Submitted Docusign Envelope ID: AFA7D21D-ABA6-4CD7-83B6-FC84E830BBB5 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: AFA7D21D-ABA6-4CD7-83B6-FC84E830BBB5 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization YES N/A 6B Rate Reduction - Emergency Room Use YES N/A 10A Academic Progress - Attendance YES N/A 10B Academic Progress - Behavior YES N/A 10C Academic Progress - Grades YES N/A BHS MATCHING GRANTS FY25 PERFORMANCE MEASURE REPORTING

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). Attachment A-1 Match Reimbursement Certification Form SECTION 1 1 Grantee Name Grantee Name 2 Program MH/CMHG 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter SECTION 2 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 7 Sum (Line 5 + Line 6) $0.00 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! SECTION 3 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 13 Xxxxxxx's Required Match (Line 12 x Line 9) Thru "Period Covered" #DIV/0! #DIV/0! 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! SECTION 4 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) 20 Balance to be Repaid (Line 26 minus Line 27) $0.00 SECTION 5 21 CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all match, outlays and unliquidated obligations are for the purposes set forth in the award documents. Typed or Printed Name and Title Date Submitted 22 Docusign Envelope ID: AFA7D21DE46E8EC8-ABA666B8-4CD7493B-845F-83B6-FC84E830BBB5 CBA1E83E03BD Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: AFA7D21D-ABA6-4CD7-83B6-FC84E830BBB5 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization YES N/A 6B Rate Reduction - Emergency Room Use YES N/A 10A Academic Progress - Attendance YES N/A 10B Academic Progress - Behavior YES N/A 10C Academic Progress - Grades YES N/A BHS MATCHING GRANTS FY25 PERFORMANCE MEASURE REPORTINGREPORTING INSTRUCTIONS 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). Attachment A-1 Match Reimbursement Certification Form SECTION 1 1 Grantee Name Grantee Name 2 Program MH/CMHG 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter SECTION 2 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 7 Sum (Line 5 + Line 6) $0.00 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! SECTION 3 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 13 Xxxxxxx's Required Match (Line 12 x Line 9) Thru "Period Covered" #DIV/0! #DIV/0! 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! SECTION 4 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) 20 Balance to be Repaid (Line 26 minus Line 27) $0.00 SECTION 5 21 CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all match, outlays and unliquidated obligations are for the purposes set forth in the award documents. Typed or Printed Name and Title Date Submitted Docusign Envelope ID: AFA7D21D0B1260BD-5848-ABA6405E-4CD7AE7A-83B6-FC84E830BBB5 FA1C26DEE6F0 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: AFA7D21D0B1260BD-5848-ABA6405E-4CD7AE7A-83B6-FC84E830BBB5 1B Symptom Improvement FA1C26DEE6F0 8A Employment - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization Obtain YES N/A 6B Rate Reduction 8B Employment - Emergency Room Use Maintain YES N/A 10A Academic Progress 9A Housing - Attendance Obtain YES N/A 10B Academic Progress 9B Housing - Behavior YES N/A 10C Academic Progress - Grades Maintain YES N/A BHS MATCHING GRANTS FY25 PERFORMANCE MEASURE REPORTINGREPORTING INSTRUCTIONS 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). Attachment A-1 Match Reimbursement Certification Form SECTION 1 1 Grantee Name Grantee Name 2 Program MH/CMHG 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter SECTION 2 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 7 Sum (Line 5 + Line 6) $0.00 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! SECTION 3 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 13 Xxxxxxx's Required Match (Line 12 x Line 9) Thru "Period Covered" #DIV/0! #DIV/0! 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! SECTION 4 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) 20 Balance to be Repaid (Line 26 minus Line 27) $0.00 SECTION 5 21 CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all match, outlays and unliquidated obligations are for the purposes set forth in the award documents. Typed or Printed Name and Title Date Submitted Docusign Envelope ID: AFA7D21D3986959B-ABA6FB3A-4BFE-4CD7-83B6-FC84E830BBB5 A9FC-853E6176281D Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: AFA7D21D3986959B-ABA6FB3A-4BFE-4CD7-83B6-FC84E830BBB5 A9FC-853E6176281D 1A Symptom Improvement - Depression YES PHQ-9 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization YES N/A 6B Rate Reduction - Emergency Room Use YES N/A PCL-5 10A Academic Progress - Attendance YES N/A 10B Academic Progress - Behavior YES N/A 10C Academic Progress - Grades YES N/A BHS MATCHING GRANTS FY25 PERFORMANCE MEASURE REPORTING

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). Attachment A-1 Match Reimbursement Certification Form SECTION 1 1 Grantee Name Grantee Name 2 Program MH/CMHG 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter SECTION 2 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 7 Sum (Line 5 + Line 6) $0.00 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! SECTION 3 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 13 Xxxxxxx's Required Match (Line 12 x Line 9) Thru "Period Covered" #DIV/0! #DIV/0! 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! SECTION 4 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) 20 Balance to be Repaid (Line 26 minus Line 27) $0.00 SECTION 5 21 CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all match, outlays and unliquidated obligations are for the purposes set forth in the award documents. Typed or Printed Name and Title Date Submitted Docusign Envelope ID: AFA7D21D3598EB6A-6332-ABA64E64-4CD7-83B6-FC84E830BBB5 ACFB-083A68FF2420 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: AFA7D21D-ABA6-4CD7-83B6-FC84E830BBB5 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization YES N/A 6B Rate Reduction - Emergency Room Use YES N/A 10A Academic Progress - Attendance YES N/A 10B Academic Progress - Behavior YES N/A 10C Academic Progress - Grades YES N/A BHS MATCHING GRANTS FY25 PERFORMANCE MEASURE REPORTINGREPORTING INSTRUCTIONS 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). Attachment A-1 Match Reimbursement Certification Form SECTION 1 1 Grantee Name Grantee Name 2 Program MH/CMHG 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter SECTION 2 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 7 Sum (Line 5 + Line 6) $0.00 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! SECTION 3 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 13 Xxxxxxx's Required Match (Line 12 x Line 9) Thru "Period Covered" #DIV/0! #DIV/0! 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! SECTION 4 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) 20 Balance to be Repaid (Line 26 minus Line 27) $0.00 SECTION 5 21 CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all match, outlays and unliquidated obligations are for the purposes set forth in the award documents. Typed or Printed Name and Title Date Submitted Docusign Envelope ID: AFA7D21D6E273622-ABA63A1B-44C9-4CD7-83B6-FC84E830BBB5 AA3C-077881B99D41 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: AFA7D21D-ABA6-4CD7-83B6-FC84E830BBB5 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization YES N/A 6B Rate Reduction - Emergency Room Use YES N/A 10A Academic Progress - Attendance YES N/A 10B Academic Progress - Behavior YES N/A 10C Academic Progress - Grades YES N/A BHS MATCHING GRANTS FY25 PERFORMANCE MEASURE REPORTINGREPORTING INSTRUCTIONS 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). Attachment A-1 Match Reimbursement Certification Form SECTION 1 1 Grantee Name Grantee Name 2 Program MH/CMHG 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter SECTION 2 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 7 Sum (Line 5 + Line 6) $0.00 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! SECTION 3 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 13 Xxxxxxx's Required Match (Line 12 x Line 9) Thru "Period Covered" #DIV/0! #DIV/0! 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! SECTION 4 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) 20 Balance to be Repaid (Line 26 minus Line 27) $0.00 SECTION 5 21 CERTIFICATION: I certify to the best of my knowledge and belief that this report is correct and complete and that all match, outlays and unliquidated obligations are for the purposes set forth in the award documents. Typed or Printed Name and Title Date Submitted Docusign Envelope ID: AFA7D21D9CCA6DF9-ABA690F1-4CD740B7-83B6BC50-FC84E830BBB5 C456F623BE27 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: AFA7D21D-ABA6-4CD7-83B6-FC84E830BBB5 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization YES N/A 6B Rate Reduction - Emergency Room Use YES N/A 10A Academic Progress - Attendance YES N/A 10B Academic Progress - Behavior YES N/A 10C Academic Progress - Grades YES N/A BHS MATCHING GRANTS FY25 PERFORMANCE MEASURE REPORTINGREPORTING INSTRUCTIONS 1 To be completed and submitted as part of Q4 only.