Common use of Agreement to Use Electronic Signatures Clause in Contracts

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Amendment to the State of Indiana. I understand that my signing and submitting this Amendment in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment and this affirmation. I understand and agree that by electronically signing and submitting this Amendment in this fashion I am affirming to the truth of the information contained therein. I understand that this Amendment will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Amendment. The parties, having read and understood the foregoing terms of this Amendment, do by their respective signatures dated below agree to the terms thereof. Title:\t1P\resident, Indiana Market Title:\t2M\edicaid director Date:\d51/\12/2021 | 14:39 EDT Date:\d52/\12/2021 | 22:51 EDT Electronically Approved by: Indiana Office of Technology By: (for) ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chief Information Officer Electronically Approved by: Department of Administration By: (for) ▇▇▇▇▇▇ ▇. ▇▇▇▇▇, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, Director Electronically Approved as to Form and Legality by: Office of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Attorney General 1.0 Background 11 2.0 Managed Care Entity- Contractor Requirements 13 2.1 State Licensure 13 2.2 National Committee for Quality Assurance (NCQA) Accreditation 13 2.3 Administrative and Organizational Structure 13 2.4 Staffing 14 2.4.1 Key Staff 14 2.4.2 Staff Positions 20 2.4.3 Training 22 2.4.4 Debarred Individuals 23 2.5 FSSA/OMPP Meeting Requirements 24 2.6 Financial Stability 24 2.6.1 Solvency 24 2.6.2 Insurance 25 2.6.3 Reinsurance 25 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict of Interest 35 2.13 Capitation Related to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 35

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment Agreement by accessing State of Indiana Supplier Portal using the secure password assigned electronic signature tool in Adobe to me and by electronically submitting submit this Amendment Agreement to the State of IndianaIHCDA. I understand that my signing and submitting this Amendment Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Amendment Agreement in this fashion I am affirming to the truth of the information contained thereintherein and my authority to bind the Subgrantee. I also understand that if I decide not to sign this Amendment will not become binding on Agreement electronically I must notify IHCDA so that this Agreement may be re-submitted to me and I may sign it and return it to IHCDA in the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL traditional manner. In Witness Whereof, the Contractor Sub-grantee and the State IHCDA have, through their duly authorized representatives, entered into this AmendmentAgreement. The parties, having read and understood the foregoing terms of this AmendmentAgreement, do by their respective signatures dated below agree to the terms thereof. Title:\t1P\resident, Indiana Market Title:\t2M\edicaid director Date:\d51/\12/2021 | 14:39 EDT Date:\d52/\12/2021 | 22:51 EDT Electronically Approved by«Legal_Name»: Indiana Office Housing and Community Development Authority: Agency’s Legal Name: «Legal_Name» Agency’s Mailing Address: «Contact_Address1» Agency Grant Contact: «Contact_CEO» «Contact_Last_Name» Funding Program: CSBG-D CARES Statutory Information: CARES Act, Public Law 116, 136 (2020) CFDA Number: 93.569 IHCDA Grant Number: «CS_Award_No_» Performance Period: 9/1/2021 – 8/31/2022 Close out Date (45 days following the close of Technology Bythe grant): 10/15/2022 IHCDA Grant Contact: (for) ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chief Information Officer Electronically Approved by: Department of Administration By: (for) ▇▇▇▇▇▇ ▇Community Programs Analyst Any funds that are not expended by August 31, 2022 will be recaptured by IHCDA. ▇▇▇▇▇, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, Director Electronically Approved as to Form and Legality by: Office of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Attorney General 1.0 Background 11 2.0 Managed Care Entity- Contractor Requirements 13 2.1 State Licensure 13 2.2 National Committee for Quality Assurance (NCQA) Accreditation 13 2.3 Administrative and Organizational Structure 13 2.4 Staffing 14 2.4.1 Key Staff 14 2.4.2 Staff Positions 20 2.4.3 Training 22 2.4.4 Debarred Individuals 23 2.5 FSSA/OMPP Meeting Requirements 24 2.6 Financial Stability 24 2.6.1 Solvency 24 2.6.2 Insurance 25 2.6.3 Reinsurance 25 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict of Interest 35 2.13 Capitation Related to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 35Activity Description Amount

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment Agreement by accessing State of Indiana Supplier Portal using the secure password assigned electronic signature tool in Adobe to me and by electronically submitting submit this Amendment Agreement to the State of IndianaIHCDA. I understand that my signing and submitting this Amendment Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Amendment Agreement in this fashion I am affirming to the truth of the information contained thereintherein and my authority to bind the Subgrantee. I also understand that if I decide not to sign this Amendment will not become binding on Agreement electronically I must notify IHCDA so that this Agreement may be re-submitted to me and I may sign it and return it to IHCDA in the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL traditional manner. In Witness Whereof, the Contractor Sub-grantee and the State IHCDA have, through their duly authorized representatives, entered into this AmendmentAgreement. The parties, having read and understood the foregoing terms of this AmendmentAgreement, do by their respective signatures dated below agree to the terms thereof. Title:\t1P\resident«Legal_Name» Indiana Housing and Community Development Authority: Agency’s Legal Name: «Legal_Name» Agency’s Mailing Address: «Contact_Address1» «Contact_Address2»«Contact_City», Indiana Market Title:\t2M\edicaid director Date:\d51/\12/2021 | 14:39 EDT Date:\d52/\12/2021 | 22:51 EDT Electronically Approved by«Contact_State» «Contact_ZIP» Agency Grant Contact: Indiana Office «Contact_CEO» «Contact_Last_Name» Funding Program: CSBG 2022 Statutory Information: 42 U.S.C. § 9901 et. seq CFDA Number: 93.569 IHCDA Grant Number: «CS_Award_No_» Performance Period: 1/1/2022 – 9/30/2023 Close out Date (45 days following the close of Technology Bythe grant): 11/15/2023 IHCDA Grant Contact: (for) ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chief Information Officer Electronically Approved by: Department of Administration By: (for) ▇▇▇▇▇▇ ▇. ▇▇▇▇▇, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, Director Electronically Approved as CSBG Manager Pursuant to Form and Legality by: Office IM No. 61 regarding, CSBG Carryover funds, the Sub-grantee must expend carryover funds during the next federal fiscal year. In order to track the amount of carryover that the Sub- grantee uses, the Sub-grantee must submit a Carryover Report to IHCDA’s Community Programs CSBG Manager by November 15, 2022, which reflects any balance of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇Total Grant Amount not expended as of September 30, 2022. ▇▇▇▇▇▇Any funds that are not expended by September 30, Attorney General 1.0 Background 11 2.0 Managed Care Entity- Contractor Requirements 13 2.1 State Licensure 13 2.2 National Committee for Quality Assurance (NCQA) Accreditation 13 2.3 Administrative and Organizational Structure 13 2.4 Staffing 14 2.4.1 Key Staff 14 2.4.2 Staff Positions 20 2.4.3 Training 22 2.4.4 Debarred Individuals 23 2.5 FSSA/OMPP Meeting Requirements 24 2.6 Financial Stability 24 2.6.1 Solvency 24 2.6.2 Insurance 25 2.6.3 Reinsurance 25 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict of Interest 35 2.13 Capitation Related to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 352023 will be recaptured by IHCDA. Activity Description Amount

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Amendment to the State of Indiana. I understand that my signing and submitting this Amendment in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment and this affirmation. I understand and agree that by electronically signing and submitting this Amendment in this fashion I am affirming to the truth of the information contained therein. I understand that this Amendment will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Amendment. The parties, having read and understood the foregoing terms of this Amendment, do by their respective signatures dated below agree to the terms thereof. By:\s1\ Title:\t1P\resident, Indiana Market Title:\t2M\edicaid Anthem IN Medicaid Title:\t2Me\ dicaid director Date:\d51/\12/2021 Date:\d51/\14/2021 | 14:39 12:58 EDT Date:\d52/\12/2021 Date:\d52/\14/2021 | 22:51 13:21 EDT Electronically Approved by: Indiana Office of Technology By: (for) ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chief Information Officer Electronically Approved by: Department of Administration By: (for) ▇▇▇▇▇▇ ▇. ▇▇▇▇▇, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, Director Electronically Approved as to Form and Legality by: Office of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Attorney General 1.0 Background 11 12 2.0 Managed Care Entity- Contractor Requirements 13 14 2.1 State Licensure 13 14 2.2 National Committee for Quality Assurance (NCQA) Accreditation 13 14 2.3 Administrative and Organizational Structure 13 14 2.4 Staffing 14 15 2.4.1 Key Staff 14 15 2.4.2 Staff Positions 20 21 2.4.3 Training 22 23 2.4.4 Debarred Individuals 23 24 2.5 FSSA/OMPP Meeting Requirements 24 25 2.6 Financial Stability 24 25 2.6.1 Solvency 24 25 2.6.2 Insurance 25 26 2.6.3 Reinsurance 25 26 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict of Interest 35 2.13 Capitation Related to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 3527

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment Agreement by accessing State of Indiana Supplier Portal using the secure password assigned electronic signature tool in Adobe to me and by electronically submitting submit this Amendment Agreement to the State of IndianaIHCDA. I understand that my signing and submitting this Amendment Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Amendment Agreement in this fashion I am affirming to the truth of the information contained thereintherein and my authority to bind the Subgrantee. I also understand that if I decide not to sign this Amendment will not become binding on Agreement electronically I must notify IHCDA so that this Agreement may be re-submitted to me and I may sign it and return it to IHCDA in the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL traditional manner. In Witness Whereof, the Contractor Sub-grantee and the State IHCDA have, through their duly authorized representatives, entered into this AmendmentAgreement. The parties, having read and understood the foregoing terms of this AmendmentAgreement, do by their respective signatures dated below agree to the terms thereof. Title:\t1P\resident«Legal_Name» Indiana Housing and Community Development Authority: Agency’s Legal Name: «Legal_Name» Agency’s Mailing Address: «Contact_Address1» «Contact_Address2»«Contact_City», Indiana Market Title:\t2M\edicaid director Date:\d51/\12/2021 | 14:39 EDT Date:\d52/\12/2021 | 22:51 EDT Electronically Approved by«Contact_State» «Contact_ZIP» Agency Grant Contact: Indiana Office «Contact_CEO» «Contact_Last_Name» Funding Program: CSBG 2020 Statutory Information: 42 U.S.C. § 9901 et. seq CFDA Number: 93.569 IHCDA Grant Number: «CS_Award_No_» Performance Period: 1/1/2021 – 9/30/2022 Close out Date (45 days following the close of Technology Bythe grant): 11/15/2022 IHCDA Grant Contact: (for) ▇▇▇▇▇ ▇. ▇▇▇▇▇▇-May, Chief Information Officer Electronically Approved by: Department Community Programs Analyst Pursuant to IM No. 61 regarding, CSBG Carryover funds, the Sub-grantee must expend carryover funds during the next federal fiscal year. In order to track the amount of Administration By: (for) ▇▇▇▇▇▇ ▇. ▇▇▇▇▇carryover that the Sub- grantee uses, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇the Sub-grantee must submit a Carryover Report to IHCDA’s Community Programs Analyst by November 15, Director Electronically Approved as to Form and Legality by: Office 2021, which reflects any balance of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇Total Grant Amount not expended as of September 30, 2021. ▇▇▇▇▇▇Any funds that are not expended by September 30, Attorney General 1.0 Background 11 2.0 Managed Care Entity- Contractor Requirements 13 2.1 State Licensure 13 2.2 National Committee for Quality Assurance (NCQA) Accreditation 13 2.3 Administrative and Organizational Structure 13 2.4 Staffing 14 2.4.1 Key Staff 14 2.4.2 Staff Positions 20 2.4.3 Training 22 2.4.4 Debarred Individuals 23 2.5 FSSA/OMPP Meeting Requirements 24 2.6 Financial Stability 24 2.6.1 Solvency 24 2.6.2 Insurance 25 2.6.3 Reinsurance 25 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict of Interest 35 2.13 Capitation Related to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 352022 will be recaptured by IHCDA. Activity Description Amount

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment Agreement by accessing State of Indiana Supplier Portal using the secure password assigned electronic signature tool in Adobe to me and by electronically submitting submit this Amendment Agreement to the State of IndianaIHCDA. I understand that my signing and submitting this Amendment Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Amendment Agreement in this fashion I am affirming to the truth of the information contained thereintherein and my authority to bind the Subgrantee. I also understand that if I decide not to sign this Amendment will not become binding on Agreement electronically, I must notify IHCDA so that this Agreement may be re-submitted to me and I may sign it and return it to IHCDA in the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL traditional manner. In Witness Whereof, the Contractor Sub-grantee and the State IHCDA have, through their duly authorized representatives, entered into this AmendmentAgreement. The parties, having read and understood the foregoing terms of this AmendmentAgreement, do by their respective signatures dated below agree to the terms thereof. Title:\t1P\resident«Legal_Name» Indiana Housing and Community Development Authority: Agency’s Legal Name: «Legal_Name» Agency’s Mailing Address: «Contact_Address1» «Contact_Address2»«Contact_City», Indiana Market Title:\t2M\edicaid director Date:\d51/\12/2021 | 14:39 EDT Date:\d52/\12/2021 | 22:51 EDT Electronically Approved by«Contact_State» «Contact_ZIP» «Email» Agency Grant Contact: Indiana Office «Contact_CEO» «Contact_Last_Name» Funding Program: CSBG 2021 Statutory Information: 42 U.S.C. § 9901 et. seq CFDA Number: 93.569 IHCDA Grant Number: «CS_Award_No_» Performance Period: 1/1/2024 – 9/30/2025 Close out Date (45 days following the close of Technology Bythe grant): 11/15/2025 IHCDA Grant Contact: (for) ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chief Information Officer Electronically Approved by: Department of Administration By: (for) ▇▇▇▇▇▇ ▇. ▇▇▇▇▇, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, Director Electronically Approved as CSBG Manager Pursuant to Form and Legality by: Office IM No. 61 regarding, CSBG Carryover funds, the Sub-grantee must expend carryover funds during the next federal fiscal year. In order to track the amount of carryover that the Sub- grantee uses, the Sub-grantee must submit a Carryover Report to IHCDA’s Community Programs Analyst by November 15, 2024, which reflects any balance of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇Total Grant Amount not expended as of September 30, 2024 Any funds that are not expended by September 30, 2025, will be recaptured by IHCDA. ▇▇▇▇▇▇, Attorney General 1.0 Background 11 2.0 Managed Care Entity- Contractor Requirements 13 2.1 State Licensure 13 2.2 National Committee for Quality Assurance (NCQA) Accreditation 13 2.3 Administrative and Organizational Structure 13 2.4 Staffing 14 2.4.1 Key Staff 14 2.4.2 Staff Positions 20 2.4.3 Training 22 2.4.4 Debarred Individuals 23 2.5 FSSA/OMPP Meeting Requirements 24 2.6 Financial Stability 24 2.6.1 Solvency 24 2.6.2 Insurance 25 2.6.3 Reinsurance 25 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict of Interest 35 2.13 Capitation Related to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 35Activity Description Amount

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment Agreement by accessing State of Indiana Supplier Portal using the secure password assigned electronic signature tool in Adobe to me and by electronically submitting submit this Amendment Agreement to the State of IndianaIHCDA. I understand that my signing and submitting this Amendment Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Amendment Agreement in this fashion I am affirming to the truth of the information contained thereintherein and my authority to bind the Sub-recipient. I also understand that if I decide not to sign this Amendment will not become binding on Agreement electronically I must notify IHCDA so that this Agreement may be re-submitted to me and I may sign it and return it to IHCDA in the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL traditional manner. In Witness Whereof, the Contractor The Sub-recipient and the State IHCDA have, through their duly authorized representatives, entered into this AmendmentAgreement. The parties, having parties have read and understood understand the foregoing terms of this Amendment, Agreement and do by their respective signatures dated below hereby agree to the terms thereof. Title:\t1P\resident, City of Lafayette Indiana Market Title:\t2M\edicaid director Date:\d51/\12/2021 | 14:39 EDT Date:\d52/\12/2021 | 22:51 EDT Electronically Approved byHousing and Community Development Authority: Indiana Office Grant Number SC-024-0155-1 CFDA Number 14.267 Agreement Number: SC-024-0155-1 Sub-recipient: City of Technology ByLafayette Funding Source: (for) ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chief Information Officer Electronically Approved by: Department of Administration By: (for) ▇▇▇▇▇▇ ▇. ▇▇▇▇▇, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, Director Electronically Approved as to Form and Legality by: Office Permanent Supportive Housing Rental Assistance The Sub-recipient is bound by the contents of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇Permanent Supportive Housing Rental Assistance application submitted via the Indiana Balance of State Continuum of Care Application, Attorney General 1.0 Background 11 2.0 Managed Care Entity- Contractor Requirements 13 2.1 State Licensure 13 2.2 National Committee for Quality Assurance (NCQA) Accreditation 13 2.3 Administrative PSH Regulations at 24 CFR Part 578, the Administration Manual, PSH Program Memos, and Organizational Structure 13 2.4 Staffing 14 2.4.1 Key Staff 14 2.4.2 Staff Positions 20 2.4.3 Training 22 2.4.4 Debarred Individuals 23 2.5 FSSA/OMPP Meeting Requirements 24 2.6 Financial Stability 24 2.6.1 Solvency 24 2.6.2 Insurance 25 2.6.3 Reinsurance 25 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict of Interest 35 2.13 Capitation Related any other IHCDA policy, directives or memoranda that may be published from time to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 35time.

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Amendment Contract to the State of Indiana. I understand that my signing and submitting this Amendment Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment Contract and this affirmation. I understand and agree that by electronically signing and submitting this Amendment Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Amendment Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/apps/guestidoa/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Amendment. The parties, having read and understood the foregoing terms contractsearch/ Indiana Department of this Amendment, do by their respective signatures dated below agree to the terms thereof. Title:\t1P\resident, Indiana Market Title:\t2M\edicaid director Date:\d51/\12/2021 | 14:39 EDT Date:\d52/\12/2021 | 22:51 EDT Electronically Approved by: Indiana Office of Technology Administration By: (for) ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chief Information Officer CARGILL INCORPORATED By: Title: Customer Care Representative II Title: Vendor Manager Date: 8/9/2022 | 17:03 EDT Date: 8/10/2022 | 07:23 EDT Electronically Approved by: Department of Administration By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇ erda, Commissioner Electronically Approved by: State Budget Agency By: (for) ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, Director Electronically Approved as to Form and Legality by: Office of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇. ▇ ▇▇▇▇▇▇, Attorney General 1.0 Background 11 2.0 Managed Care Entity- Contractor Requirements 13 2.1 This document is an exhibit to the Contract, and is deemed to be attached to and incorporated within the Contract by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Contract shall be resolved by giving precedence and effect to the Contract. INDOT District Salt Type INDOT Early Fill Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Delivered & Loaded) Price Per Ton (Pick Up) 10 - Crawfordsville Untreated Salt INDOT 2,000 $82.35 $90.35 $81.00 INDOT District Salt Type INDOT Seasonal Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Delivered & Loaded) Price Per Ton (Pick Up) 10 - Crawfordsville Untreated Salt INDOT 46,000 $82.35 $90.35 $81.00 20 - Fort ▇▇▇▇▇ Untreated Salt INDOT 65,000 $65.12 $73.12 $60.00 30 - Greenfield Untreated Salt INDOT 71,459 $72.49 $80.49 $72.00 INDOT District Salt Type INDOT Seasonal Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Delivered & Loaded) Price Per Ton (Pick Up) 10 - Crawfordsville Treated Salt INDOT 3,242 $93.11 $101.11 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt INDOT 20 $97.88 $105.88 $97.00 30 - Greenfield Treated Salt INDOT 175 $93.58 $101.58 $93.00 50 - Seymour Treated Salt INDOT 200 $89.94 $97.94 $89.00 60 - Vincennes Treated Salt INDOT 70 $107.76 $115.76 $107.00 INDOT District Salt Type Other State Licensure 13 2.2 National Committee for Quality Assurance Agencies Requested Quantity (NCQATon) Accreditation 13 2.3 Administrative and Organizational Structure 13 2.4 Staffing 14 2.4.1 Key Staff 14 2.4.2 Staff Positions Price Per Ton (Delivered) Price Per Ton (Pick Up) 10 - Crawfordsville Treated Salt DOC-Indiana Women's Prison 40 $93.11 $93.00 10 - Crawfordsville Treated Salt DOC-Plainfield Complex 120 $93.11 $93.00 10 - Crawfordsville Treated Salt DOC-Putnamville Correctional Facility 60 $93.11 $93.00 10 - Crawfordsville Treated Salt DOC-Rockville Correctional Facility 22 $93.11 $93.00 20 2.4.3 Training - Fort ▇▇▇▇▇ Treated Salt DOC - Miami Correctional Facility 20 $97.88 $97.00 30 - Greenfield Treated Salt Richmond State Hospital 75 $93.58 $93.00 30 - Greenfield Treated Salt Indiana State Fair Commission 40 $93.58 $93.00 30 - Greenfield Treated Salt DOC - New Castle Correctional Facility 60 $93.58 $93.00 30 - Greenfield Untreated Salt DOC-Correctional Industrial Facility / IR 80 $72.49 $72.00 50 - Seymour Treated Salt Camp ▇▇▇▇▇▇▇▇▇ 200 $89.94 $89.00 60 - Vincennes Treated Salt DOC-Branchville Correctional Facility 40 $107.76 $107.00 60 - Vincennes Treated Salt DOC-Wabash Valley Correctional Facility 30 $107.76 $107.00 INDOT District Salt Type Customer Name Requested Quantity (Ton) Price Per Ton (Delivered) Price Per Ton (Pick Up) 10 - Crawfordsville Treated Salt Boone County - OneIndiana 1000 $89.51 $89.00 10 - Crawfordsville Treated Salt City of Greencastle Public Works - OneIndiana 450 $89.51 $89.00 10 - Crawfordsville Treated Salt City of Lebanon - OneIndiana 900 $89.51 $89.00 10 - Crawfordsville Treated Salt City of Terre Haute - OneIndiana 700 $89.51 $89.00 10 - Crawfordsville Treated Salt Clay County - OneIndiana 150 $89.51 $89.00 10 - Crawfordsville Treated Salt Clinton County Government - OneIndiana 1000 $89.51 $89.00 10 - Crawfordsville Treated Salt Fountain Co. Highway - OneIndiana 300 $89.51 $89.00 10 - Crawfordsville Treated Salt Hendricks County - OneIndiana 2800 $89.51 $89.00 10 - Crawfordsville Treated Salt Indiana State University - K12Indiana 100 $89.51 $89.00 10 - Crawfordsville Treated Salt Lebanon Comm School Corp - K12Indiana 120 $89.51 $89.00 10 - Crawfordsville Treated Salt Purdue University - OneIndiana 500 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Avon - OneIndiana 1500 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Brownsburg - OneIndiana 1600 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Danville - OneIndiana 400 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Fairview Park - OneIndiana 25 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Otterbein - OneIndiana 80 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Oxford - OneIndiana 20 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Plainfield - OneIndiana 1200 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Shadeland 240 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Veedersburg - OneIndiana 20 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Waynetown - OneIndiana 40 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Whitestown - OneIndiana 1000 $89.51 $89.00 10 - Crawfordsville Treated Salt Town of Williamsport 60 $89.51 $89.00 10 - Crawfordsville Treated Salt Vermillion County - OneIndiana 100 $89.51 $89.00 10 - Crawfordsville Treated Salt Vermillion County - OneIndiana 100 $89.51 $89.00 10 - Crawfordsville Treated Salt Vermillion County - OneIndiana 100 $89.51 $89.00 10 - Crawfordsville Treated Salt Zionsville Community Schools - K12Indiana 230 $89.51 $89.00 20 - Fort ▇▇▇▇▇ Treated Salt City of Angola Clerk - OneIndiana 100 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt City of Bluffton - OneIndiana 500 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt City of ▇▇▇▇▇▇ - OneIndiana 100 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt City of Dunkirk - OneIndiana 80 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt City of East Chicago - OneIndiana 3000 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt City of ▇▇▇▇▇▇▇ - OneIndiana 300 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt City of Ligonier - OneIndiana 100 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt Dekalb County Central Schools - K12Indiana 60 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt Town of ▇▇▇▇▇▇▇▇ 100 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt Town of Millersburg - OneIndiana 80 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt Town of North Manchester - OneIndiana 120 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt Town of Ossian - OneIndiana 60 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt Town of St. ▇▇▇ - OneIndiana 22 2.4.4 Debarred Individuals 23 2.5 FSSA/OMPP Meeting Requirements 24 2.6 Financial Stability 24 2.6.1 Solvency 24 2.6.2 Insurance $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt Town of Topeka - OneIndiana 100 $93.10 $93.00 20 - Fort ▇▇▇▇▇ Treated Salt Town of Winona Lake - OneIndiana 350 $93.10 $93.00 30 - Greenfield Treated Salt City of Alexandria - OneIndiana 175 $89.38 $89.00 30 - Greenfield Treated Salt City of ▇▇▇▇▇▇▇▇ Street - OneIndiana 2400 $89.38 $89.00 30 - Greenfield Treated Salt City of Beech Grove - OneIndiana 800 $89.38 $89.00 30 - Greenfield Treated Salt City of ▇▇▇▇▇▇ - OneIndiana 50 $89.38 $89.00 30 - Greenfield Treated Salt City of Greenfield Street - OneIndiana 1000 $89.38 $89.00 30 - Greenfield Treated Salt City of Indianapolis 3000 $89.38 $89.00 30 - Greenfield Treated Salt City of Indianapolis 8000 $89.38 $89.00 30 - Greenfield Treated Salt City of Indianapolis 7500 $89.38 $89.00 30 - Greenfield Treated Salt City of Indianapolis 3000 $89.38 $89.00 30 - Greenfield Treated Salt City of Indianapolis 3000 $89.38 $89.00 30 - Greenfield Treated Salt City of Indianapolis 3000 $89.38 $89.00 30 - Greenfield Treated Salt City of Indianapolis 7500 $89.38 $89.00 30 - Greenfield Treated Salt City of ▇▇▇▇▇▇▇▇ - OneIndiana 1800 $89.38 $89.00 30 - Greenfield Treated Salt City of New Castle - OneIndiana 1300 $89.38 $89.00 30 - Greenfield Treated Salt City of Richmond Street Dept 1100 $89.38 $89.00 30 - Greenfield Treated Salt City of Shelbyville Street - OneIndiana 590 $89.38 $89.00 30 - Greenfield Treated Salt Hancock County Highway - OneIndiana 1500 $89.38 $89.00 30 - Greenfield Treated Salt Henry County Highway - OneIndiana 800 $89.38 $89.00 30 - Greenfield Treated Salt IUPUI - OneIndiana 650 $89.38 $89.00 30 - Greenfield Treated Salt Jay County Highway - OneIndiana 500 $89.38 $89.00 30 - Greenfield Treated Salt MSD of Decatur Township - K12Indiana 100 $89.38 $89.00 30 - Greenfield Treated Salt MSD of ▇▇▇▇▇▇ Township - OneIndiana 180 $89.38 $89.00 30 - Greenfield Treated Salt MSD of ▇▇▇▇▇ Township - K12Indiana 100 $89.38 $89.00 30 - Greenfield Treated Salt MSD of ▇▇▇▇▇ Township - K12Indiana 100 $89.38 $89.00 30 - Greenfield Treated Salt MSD Washington Township - OneIndiana 450 $89.38 $89.00 30 - Greenfield Treated Salt Rush County Schools - K12Indiana 40 $89.38 $89.00 30 - Greenfield Treated Salt Shelby County Government - OneIndiana 600 $89.38 $89.00 30 - Greenfield Treated Salt Town of Cambridge City - OneIndiana 80 $89.38 $89.00 30 - Greenfield Treated Salt Town of Chesterfield - OneIndiana 80 $89.38 $89.00 30 - Greenfield Treated Salt Town of ▇▇▇▇▇ - OneIndiana 120 $89.38 $89.00 30 - Greenfield Treated Salt Town of Fortville - OneIndiana 160 $89.38 $89.00 30 - Greenfield Treated Salt Town of Fountain City - OneIndiana 50 $89.38 $89.00 30 - Greenfield Treated Salt Town of Frankton - OneIndiana 60 $89.38 $89.00 30 - Greenfield Treated Salt Town of Hagerstown - OneIndiana 80 $89.38 $89.00 30 - Greenfield Treated Salt Town of ▇▇▇▇▇▇▇ - OneIndiana 120 $89.38 $89.00 30 - Greenfield Treated Salt Town of Lapel - OneIndiana 100 $89.38 $89.00 30 - Greenfield Treated Salt Town of McCordsville - OneIndiana 240 $89.38 $89.00 30 - Greenfield Treated Salt Town of Morristown - OneIndiana 100 $89.38 $89.00 30 - Greenfield Treated Salt Town of New Palestine 80 $89.38 $89.00 30 - Greenfield Treated Salt Town of ▇▇▇▇▇▇▇ - OneIndiana 50 $89.38 $89.00 30 - Greenfield Treated Salt Town of Speedway - OneIndiana 400 $89.38 $89.00 30 - Greenfield Treated Salt Town of Summitville - OneIndiana 60 $89.38 $89.00 30 - Greenfield Treated Salt Town of Yorktown - OneIndiana 600 $89.38 $89.00 40 - La Porte Treated Salt Carroll County Highway - OneIndiana 900 $79.46 $79.00 40 - La Porte Treated Salt City of ▇▇▇▇ - OneIndiana 5000 $79.46 $79.00 40 - La Porte Treated Salt City of ▇▇▇▇▇▇▇ - OneIndiana 6700 $79.46 $79.00 40 - La Porte Treated Salt City of Lake Station - OneIndiana 800 $79.46 $79.00 40 - La Porte Treated Salt City of ▇▇▇▇▇▇▇ - OneIndiana 1800 $79.46 $79.00 40 - La Porte Treated Salt City of Mishawaka - OneIndiana 2200 $79.46 $79.00 40 - La Porte Treated Salt City of Monticello - OneIndiana 350 $79.46 $79.00 40 - La Porte Treated Salt City of Rensselaer - OneIndiana 160 $79.46 $79.00 40 - La Porte Treated Salt City of Rochester - OneIndiana 75 $79.46 $79.00 40 - La Porte Treated Salt City of ▇▇▇▇▇▇▇ - OneIndiana 525 $79.46 $79.00 40 - La Porte Treated Salt Fulton County Highway - OneIndiana 650 $79.46 $79.00 40 - La Porte Treated Salt Merrillville Community Schools - K12Indiana 150 $79.46 $79.00 40 - La Porte Treated Salt Newton County - OneIndiana 500 $79.46 $79.00 40 - La Porte Treated Salt Purdue University Northwest 130 $79.46 $79.00 40 - La Porte Treated Salt Town of Bremen - OneIndiana 300 $79.46 $79.00 40 - La Porte Treated Salt Town of Camden - OneIndiana 25 2.6.3 Reinsurance 25 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties $79.46 $79.00 40 - La Porte Treated Salt Town of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality Cedar Lake Public Works - OneIndiana 100 $79.46 $79.00 40 - La Porte Treated Salt Town of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict ▇▇▇▇ - OneIndiana 1000 $79.46 $79.00 40 - La Porte Treated Salt Town of Interest 35 2.13 Capitation Related to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 35Kouts - OneIndiana 50 $79.46 $79.00 40 - La Porte Treated Salt Town Of Long Beach - OneIndiana 500 $79.46 $79.00 40 - La Porte Treated Salt Town of Munster - OneIndiana 3000 $79.46 $79.00 40 - La Porte Treated Salt Town of St ▇▇▇▇ - OneIndiana 2700 $79.46 $79.00 40 - La Porte Treated Salt Town of Trail Creek - OneIndiana 150 $79.46 $79.00 40 - La Porte Treated Salt Town of Westville - OneIndiana 100 $79.46 $79.00 40 - La Porte Treated Salt Town of Winamac - OneIndiana 80 $79.46 $79.00 40 - La Porte Treated Salt Town of Winfield - OneIndiana 850 $79.46 $79.00 40 - La Porte Treated Salt Tri-Creek School Corporation - K12Indiana 120 $79.46 $79.00 40 - La Porte Treated Salt Twin Lakes School Corporation - K12Indiana 75 $79.46 $79.00 50 - Seymour Treated Salt Brown County Government - OneIndiana 800 $91.68 $91.00 50 - Seymour Treated Salt City of Batesville - OneIndiana 150 $91.68 $91.00 50 - Seymour Treated Salt City of Greendale - OneIndiana 350 $91.68 $91.00 50 - Seymour Treated Salt City of Lawrenceburg - OneIndiana 600 $91.68 $91.00 50 - Seymour Treated Salt City of New Albany - OneIndiana 1200 $91.68 $91.00 50 - Seymour Treated Salt City of Rising Sun Government - OneIndiana 200 $91.68 $91.00 50 - ▇▇▇▇▇▇▇ Treated Salt City of Salem - OneIndiana 150 $91.68 $91.00 50 - ▇▇▇▇▇▇▇ Treated Salt City of Seymour - OneIndiana 400 $91.68 $91.00 50 - Seymour Treated Salt ▇▇▇▇▇▇-Sweetwater Conservancy District 150 $91.68 $91.00 50 - Seymour Treated Salt Decatur County Highway - OneIndiana 200 $91.68 $91.00 50 - Seymour Treated Salt Floyd County Road - OneIndiana 2000 $91.68 $91.00 50 - Seymour Treated Salt Franklin County Highway - OneIndiana 1800 $91.68 $91.00 50 - Seymour Treated Salt Harrison County Highway - OneIndiana 2000 $91.68 $91.00 50 - Seymour Treated Salt Jennings County Highway - OneIndiana 800 $91.68 $91.00 50 - Seymour Treated Salt Johnson County Highway Department - OneIndiana 2700 $91.68 $91.00

Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Amendment Agreement by accessing State of Indiana Supplier Portal using the secure password assigned electronic signature tool in Adobe to me and by electronically submitting submit this Amendment Agreement to the State of IndianaIHCDA. I understand that my signing and submitting this Amendment Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Amendment Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Amendment Agreement in this fashion I am affirming to the truth of the information contained thereintherein and my authority to bind the Subgrantee. I also understand that if I decide not to sign this Amendment will not become binding on Agreement electronically I must notify IHCDA so that this Agreement may be re-submitted to me and I may sign it and return it to IHCDA in the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: ▇▇▇▇▇://▇▇.▇▇▇▇.▇▇.▇▇▇/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCT S.GBL traditional manner. In Witness Whereof, the Contractor Sub-grantee and the State IHCDA have, through their duly authorized representatives, entered into this AmendmentAgreement. The parties, having read and understood the foregoing terms of this AmendmentAgreement, do by their respective signatures dated below agree to the terms thereof. Title:\t1P\resident, Indiana Market Title:\t2M\edicaid director Date:\d51/\12/2021 | 14:39 EDT Date:\d52/\12/2021 | 22:51 EDT Electronically Approved by: Indiana Office of Technology «Legal_Name» (Where Applicable) By: (for) ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chief Information Officer Electronically Approved by: Department of Administration Attested By: (for) Printed Name:«Contact_CEO» «Contact_Last_Name» Title: «Contact_CEO_Title» Date: By: Printed Name: S. ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇ Title: Chief of Staff and Chief Operating Officer Date: COMMUNITY SERVICES BLOCK GRANT «Contact_Address2»«Contact_City», Commissioner Electronically Approved by«Contact_State» «Contact_ZIP» Agency Grant Contact: State Budget Agency By«Contact_CEO» «Contact_Last_Name» Funding Program: CSBG 2020 Statutory Information: 42 U.S.C. § 9901 et. seq CFDA Number: 93.569 Performance Period: 1/1/20221 – 9/30/20232 Close out Date (for) 45 days following the close of the grant): 11/15/20232 IHCDA Grant Contact: ▇▇▇▇ ▇▇▇▇▇▇-May, Community Programs Analyst IHCDA Phone and Email: ▇▇▇-▇▇▇-▇▇▇▇, ▇▇▇▇@▇▇▇▇▇.▇▇.▇▇▇ Awarding Official: ▇▇▇▇▇ ▇▇▇▇, Executive Director, ▇▇ ▇. ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇, Director Electronically Approved as to Form and Legality by: Office of the Attorney General By: (for) ▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Attorney General 1.0 Background 11 2.0 Managed Care Entity- Contractor Requirements 13 2.1 State Licensure 13 2.2 National Committee for Quality Assurance ▇▇, ▇▇▇▇▇@▇▇▇▇▇.▇▇.▇▇▇ .1 Administration (NCQANot to Exceed Percentage set forth in Subsection B of Section 4 of Award Agreement) Accreditation 13 2.3 Administrative and Organizational Structure 13 2.4 Staffing 14 2.4.1 Key Staff 14 2.4.2 Staff Positions 20 2.4.3 Training 22 2.4.4 Debarred Individuals 23 2.5 FSSA/OMPP Meeting Requirements 24 2.6 Financial Stability 24 2.6.1 Solvency 24 2.6.2 Insurance 25 2.6.3 Reinsurance 25 2.6.4 Financial Accounting Requirements 26 2.6.5 Reporting Transactions with Parties of Interest 28 2.6.6 Medical Loss Ratio 29 2.6.7 Health Insurance Providers Fee 30 2.7 Subcontracts 31 2.8 Confidentiality of Member Medical Records and Other Information 34 2.9 Internet Quorum (IQ) Inquires 34 2.10 Material Change 34 2.11 Future Program Guidance 34 2.12 Conflict of Interest 35 2.13 Capitation Related to a Vacated Program 35 3.0 HIP Plan Design and Member Eligibility 35 3.1 HIP Plus 35Actual Costs