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4 EXHIBIT A INDIAN RIVER COUNTY NONPROFIT / QUASI AGENCY REQUEST FOR FUNDING A. Program Cover Page Telephone` 772-569-9788 Fax: 772-569-2088 E -Mail: philip .mhairc.orq I Agree - By checking the "I Agree" box and entering your name below, you certify that information contained in this application accurately reflects the activities of this agency and that the expenditures or portions thereof for which County funds are being requested are not reimbursed by any other source. Name: Philip Cromer Title: CEO Briet description of the Program for wnicn Tunaing is re uestea: The MHA has had an increased need for immediate mental health services and continued follow-up care in response to the COVID-19 pandemic and the unprecedented effects on mental health. Additionally, we are finding more individuals need help but cannot afford it due to the cost of living and other factors, which are a deterrent for people seeking help. The WICC cares for the disadvantaged and vulnerable that would continue to suffer from mental health symptoms and be at risk for the development of more serious concerns if left untreated. Appropriate services are given at the right time which helps to decrease the community's economic burden from higher costs of later intervention. The additional funding requested would allow us to expand our sliding fee schedule and waive fees for those who cannot afford copayments for needed mental health services. An increase in funding is requested to assist underinsured and indigent individuals 300% or below the poverty level to access immediate and ongoing services to support their mental health and well-being. bummary Ke ort Amount requested from Indian River County for 2022/2023: Total Proposed Program budget for 2022/2023: Percent of total Program budget: Current Funding (2021/2022) Dollar increase / (decrease) in request: Percent increase / decrease in request: $30,000.00 $1,257,924.00 2.38% $24,982.00 $5,018.00 20.09% t request increased 5 /o or more bnetly explain wny: The MHA has had an increased need for immediate mental health services and continued follow-up care in response to the COVID-19 pandemic and the unprecedented effects on mental health. Additionally, we are finding more individuals need help but cannot afford it due to the cost of living and other factors, which are a deterrent for people seeking help. The WICC cares for the disadvantaged and vulnerable that would continue to suffer from mental health symptoms and be at risk for the development of more serious concerns if left untreated. Appropriate services are given at the right time' which helps to decrease the community's economic burden from higher costs of later intervention. The additional funding requested would allow us to expand our sliding fee schedule and waive fees for those who cannot afford copayments for.needed mental health services. An increase in funding is requested to assist underinsured and indigent individuals 300% or below the poverty level to access immediate and ongoing services to support their mental health and well-being. The Organization's Board of Directors has approved this application on (date): 04/20/2022 Name of President/Chair of the Board Name of Exec. Director/CEO: Steve Erickson Philip Cromer EXHIBIT A Mental Health Association in Indian Agency: River County Contact Person: Philip Cromer Title: CEO Address: 820 37TH PL Website Address: www.mhairc.org Program Title: MHA Walk -In and Counseling Center Telephone` 772-569-9788 Fax: 772-569-2088 E -Mail: philip .mhairc.orq I Agree - By checking the "I Agree" box and entering your name below, you certify that information contained in this application accurately reflects the activities of this agency and that the expenditures or portions thereof for which County funds are being requested are not reimbursed by any other source. Name: Philip Cromer Title: CEO Briet description of the Program for wnicn Tunaing is re uestea: The MHA has had an increased need for immediate mental health services and continued follow-up care in response to the COVID-19 pandemic and the unprecedented effects on mental health. Additionally, we are finding more individuals need help but cannot afford it due to the cost of living and other factors, which are a deterrent for people seeking help. The WICC cares for the disadvantaged and vulnerable that would continue to suffer from mental health symptoms and be at risk for the development of more serious concerns if left untreated. Appropriate services are given at the right time which helps to decrease the community's economic burden from higher costs of later intervention. The additional funding requested would allow us to expand our sliding fee schedule and waive fees for those who cannot afford copayments for needed mental health services. An increase in funding is requested to assist underinsured and indigent individuals 300% or below the poverty level to access immediate and ongoing services to support their mental health and well-being. bummary Ke ort Amount requested from Indian River County for 2022/2023: Total Proposed Program budget for 2022/2023: Percent of total Program budget: Current Funding (2021/2022) Dollar increase / (decrease) in request: Percent increase / decrease in request: $30,000.00 $1,257,924.00 2.38% $24,982.00 $5,018.00 20.09% t request increased 5 /o or more bnetly explain wny: The MHA has had an increased need for immediate mental health services and continued follow-up care in response to the COVID-19 pandemic and the unprecedented effects on mental health. Additionally, we are finding more individuals need help but cannot afford it due to the cost of living and other factors, which are a deterrent for people seeking help. The WICC cares for the disadvantaged and vulnerable that would continue to suffer from mental health symptoms and be at risk for the development of more serious concerns if left untreated. Appropriate services are given at the right time' which helps to decrease the community's economic burden from higher costs of later intervention. The additional funding requested would allow us to expand our sliding fee schedule and waive fees for those who cannot afford copayments for.needed mental health services. An increase in funding is requested to assist underinsured and indigent individuals 300% or below the poverty level to access immediate and ongoing services to support their mental health and well-being. The Organization's Board of Directors has approved this application on (date): 04/20/2022 Name of President/Chair of the Board Name of Exec. Director/CEO: Steve Erickson Philip Cromer EXHIBIT A