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EXHIBIT A INDIAN RIVER COUNTY NONPROFIT / QUASI AGENCY REQUEST FOR FUNDING A. Program Cover Page Telephone: 772-468-5600 Fax: E -Mail: wwims(aD_nhtcinc.onmicrosoft.com 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: William Wims Title: President / CEO Brief description of the Program for which funding is requested: New Horizons of the Treasure Coast and Okeechobee delivers accessible behavioral and primary health care services to children, adults and families, regardless of finances, to achieve mental and physical wellness, thereby improving the quality of life in local communities. Summary Keport Amount requested from Indian River County for 2023/2024: $377,000.00 Total Proposed Program budget for 2023/2024: $28,346,097.00 Percent of total Program budget: 1.33% Current Funding (2022/2023) $352,554.00 Dollar increase / (decrease) in request: $24,446.00 Percent increase / decrease in request: 6.93% If request increased 5% or more, brietly explain wn : New Horizons of the Treasure Coast (NHTC) is requesting a 6.93% or $24,446 increase to offset the rising cost of healthcare specifically in the MH/SA segment. NHTC is a NFP 501 C3 organization that serves the low income and indigent populations of Indian River County. We are very much a safety net facility that is increasingly dependent on discretionary grants/aids and good will of the Treasure Coast communities. NHTC service offerings continues to grow outpacing our capacity requiring us to grow staff 25% YOY (Vero outpatient location service is no exception). Approximate) 75% of all services offered by NHTC are serving the uninsured or under insured clients. Organization's Board of Directors has approved this application on (date): 05/03/2023 Name of President/Chair of the Board: Name of Exec. Director/CEO: EXHIBIT A Kathryn Hensley William Wims New Horizons of the Treasure Coast Agency: and Okeechobee Contact Person: William Wims Title: President / CEO Address: 4500 W. MidwayRoad Website Address: https://nhtcinc.org/ Program Title: Mental Health and Substance Abuse Telephone: 772-468-5600 Fax: E -Mail: wwims(aD_nhtcinc.onmicrosoft.com 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: William Wims Title: President / CEO Brief description of the Program for which funding is requested: New Horizons of the Treasure Coast and Okeechobee delivers accessible behavioral and primary health care services to children, adults and families, regardless of finances, to achieve mental and physical wellness, thereby improving the quality of life in local communities. Summary Keport Amount requested from Indian River County for 2023/2024: $377,000.00 Total Proposed Program budget for 2023/2024: $28,346,097.00 Percent of total Program budget: 1.33% Current Funding (2022/2023) $352,554.00 Dollar increase / (decrease) in request: $24,446.00 Percent increase / decrease in request: 6.93% If request increased 5% or more, brietly explain wn : New Horizons of the Treasure Coast (NHTC) is requesting a 6.93% or $24,446 increase to offset the rising cost of healthcare specifically in the MH/SA segment. NHTC is a NFP 501 C3 organization that serves the low income and indigent populations of Indian River County. We are very much a safety net facility that is increasingly dependent on discretionary grants/aids and good will of the Treasure Coast communities. NHTC service offerings continues to grow outpacing our capacity requiring us to grow staff 25% YOY (Vero outpatient location service is no exception). Approximate) 75% of all services offered by NHTC are serving the uninsured or under insured clients. Organization's Board of Directors has approved this application on (date): 05/03/2023 Name of President/Chair of the Board: Name of Exec. Director/CEO: EXHIBIT A Kathryn Hensley William Wims