Common use of Financial Status Reports Clause in Contracts

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 $129,055.00 $733,140.00 Fringe Benefits $252,810.00 $54,009.00 $306,819.00 Travel $8,573.00 $0.00 $8,573.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 $134.00 $41,110.00 Contractual $0.00 $0.00 $0.00 Other $9,545.00 $0.00 $9,545.00 Total Direct Costs $915,989.00 $183,198.00 $1,099,187.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 $183,198.00 $1,099,187.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 23,305.00 $129,055.00 3,629.00 $733,140.00 26,934.00 Fringe Benefits $252,810.00 10,720.00 $54,009.00 1,669.00 $306,819.00 12,389.00 Travel $8,573.00 4,043.00 $0.00 1,983.00 $8,573.00 6,026.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 3,041.00 $134.00 1,204.00 $41,110.00 4,245.00 Contractual $0.00 $0.00 $0.00 Other $9,545.00 1,316.00 $0.00 $9,545.00 1,316.00 Total Direct Costs $915,989.00 42,425.00 $183,198.00 8,485.00 $1,099,187.00 50,910.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 42,425.00 $183,198.00 8,485.00 $1,099,187.00 50,910.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 18,918.00 $129,055.00 5,460.00 $733,140.00 24,378.00 Fringe Benefits $252,810.00 16,269.00 $54,009.00 4,259.00 $306,819.00 20,528.00 Travel $8,573.00 1,823.00 $0.00 $8,573.00 1,823.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 $134.00 $41,110.00 Contractual 2,179.00 $0.00 $0.00 2,179.00 Contractual $0.00 Other $9,545.00 8,148.00 $0.00 $9,545.00 8,148.00 Other $1,261.00 $0.00 $1,261.00 Total Direct Costs $915,989.00 48,598.00 $183,198.00 9,719.00 $1,099,187.00 58,317.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 48,598.00 $183,198.00 9,719.00 $1,099,187.00 58,317.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 351,715.00 $129,055.00 0.00 $733,140.00 351,715.00 Fringe Benefits $252,810.00 $54,009.00 $306,819.00 Travel $8,573.00 113,604.00 $0.00 $8,573.00 113,604.00 Travel $0.00 $0.00 $0.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 $134.00 $41,110.00 Contractual 3,965.00 $0.00 $0.00 3,965.00 Contractual $0.00 7,283.00 $770.00 $8,053.00 Other $9,545.00 3,430.00 $0.00 7,300.00 $9,545.00 10,730.00 Total Direct Costs $915,989.00 479,997.00 $183,198.00 8,070.00 $1,099,187.00 488,067.00 Indirect Costs $0.00 $0.00 87,929.00 $0.00 87,929.00 Totals $915,989.00 479,997.00 $183,198.00 95,999.00 $1,099,187.00 575,996.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 181,474.00 $129,055.00 42,708.00 $733,140.00 224,182.00 Fringe Benefits $252,810.00 85,111.00 $54,009.00 17,212.00 $306,819.00 102,323.00 Travel $8,573.00 1,463.00 $0.00 $8,573.00 1,463.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 $134.00 $41,110.00 Contractual 27,331.00 $0.00 $0.00 27,331.00 Contractual $0.00 Other $9,545.00 2,400.00 $0.00 $9,545.00 2,400.00 Other $1,820.00 $0.00 $1,820.00 Total Direct Costs $915,989.00 299,599.00 $183,198.00 59,920.00 $1,099,187.00 359,519.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 299,599.00 $183,198.00 59,920.00 $1,099,187.00 359,519.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 201,168.00 $129,055.00 40,289.00 $733,140.00 241,457.00 Fringe Benefits $252,810.00 75,438.00 $54,009.00 15,269.00 $306,819.00 90,707.00 Travel $8,573.00 $0.00 $8,573.00 0.00 $0.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 0.00 $134.00 0.00 $41,110.00 0.00 Contractual $0.00 $0.00 $0.00 Other $9,545.00 1,183.00 $0.00 $9,545.00 1,183.00 Total Direct Costs $915,989.00 277,789.00 $183,198.00 55,558.00 $1,099,187.00 333,347.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 277,789.00 $183,198.00 55,558.00 $1,099,187.00 333,347.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 77,174.00 $129,055.00 19,282.00 $733,140.00 96,456.00 Fringe Benefits $252,810.00 $54,009.00 $306,819.00 Travel $8,573.00 18,391.00 $0.00 $8,573.00 18,391.00 Travel $0.00 $0.00 $0.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 845.00 $134.00 0.00 $41,110.00 845.00 Contractual $0.00 $0.00 $0.00 Other $9,545.00 0.00 $0.00 $9,545.00 0.00 Total Direct Costs $915,989.00 96,410.00 $183,198.00 19,282.00 $1,099,187.00 115,692.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 96,410.00 $183,198.00 19,282.00 $1,099,187.00 115,692.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 24,374.00 $129,055.00 0.00 $733,140.00 24,374.00 Fringe Benefits $252,810.00 $54,009.00 $306,819.00 Travel $8,573.00 11,212.00 $0.00 $8,573.00 11,212.00 Travel $183.00 $234.00 $417.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 0.00 $134.00 6,260.00 $41,110.00 6,260.00 Contractual $0.00 $0.00 $0.00 Other $9,545.00 $0.00 $9,545.00 660.00 $660.00 Total Direct Costs $915,989.00 35,769.00 $183,198.00 7,154.00 $1,099,187.00 42,923.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 35,769.00 $183,198.00 7,154.00 $1,099,187.00 42,923.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 111,261.00 $129,055.00 36,807.00 $733,140.00 148,068.00 Fringe Benefits $252,810.00 $54,009.00 $306,819.00 Travel $8,573.00 67,951.00 $0.00 $8,573.00 67,951.00 Travel $0.00 $0.00 $0.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 6.00 $134.00 0.00 $41,110.00 6.00 Contractual $4,816.00 $0.00 $4,816.00 Other $0.00 $0.00 $0.00 Other $9,545.00 $0.00 $9,545.00 Total Direct Costs $915,989.00 184,034.00 $183,198.00 36,807.00 $1,099,187.00 220,841.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 184,034.00 $183,198.00 36,807.00 $1,099,187.00 220,841.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 489,051.00 $129,055.00 102,415.00 $733,140.00 591,466.00 Fringe Benefits $252,810.00 203,299.00 $54,009.00 49,337.00 $306,819.00 252,636.00 Travel $8,573.00 2,995.00 $0.00 $8,573.00 2,995.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 $134.00 $41,110.00 Contractual 12,845.00 $0.00 $0.00 12,845.00 Contractual $0.00 Other $9,545.00 41,916.00 $0.00 $9,545.00 41,916.00 Other $8,654.00 $0.00 $8,654.00 Total Direct Costs $915,989.00 758,760.00 $183,198.00 151,752.00 $1,099,187.00 910,512.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 758,760.00 $183,198.00 151,752.00 $1,099,187.00 910,512.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Financial Status Reports. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx (September 1, 2022– August 31, 2023) Budget Categories DSHS Funds Cash Match Category Total Personnel $604,085.00 149,467.00 $129,055.00 34,347.00 $733,140.00 183,814.00 Fringe Benefits $252,810.00 78,994.00 $54,009.00 11,345.00 $306,819.00 90,339.00 Travel $8,573.00 $0.00 $8,573.00 0.00 $0.00 Equipment $0.00 $0.00 $0.00 Supplies $40,976.00 0.00 $134.00 0.00 $41,110.00 0.00 Contractual $0.00 $0.00 $0.00 Other $9,545.00 0.00 $0.00 $9,545.00 0.00 Total Direct Costs $915,989.00 228,461.00 $183,198.00 45,692.00 $1,099,187.00 274,153.00 Indirect Costs $0.00 $0.00 $0.00 Totals $915,989.00 228,461.00 $183,198.00 45,692.00 $1,099,187.00 274,153.00 (Remainder of the page intentionally left blank) Attachment C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.0 Published and Effective – August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS