Governor and Executive Council Agenda item PDF - 2026-03-25 - agenda 21

Meeting Date

2026-03-25

Attachment Kind Label

Agenda item PDF

Attachment Relation

cross_meeting_reference

Agenda Numbers

21

Agency Names

Department Of Transportation

Parent Meeting Title

Governor and Executive Council meeting - 2026-03-25

Lori A, Weaver

CommissloDer

lain N. Watt

Director

STATE OF NEW HAMPSHIRE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

DIVISION OF PUBLIC HEALTH SER VICES

29 HAZEN DRIVE, CONCORD, NH 03301

603.27MSOI 1.800-852-3345 Ext. 4501

Fax: 603-271-4827 TDD Access: 1-800-735-2964

wmv.dhhs.tth.gov

3

November 4,2024

His Excellency, Governor Christopher T. Sununu

and the Honorable Council

State House

Concord, New Hampshire 03301

REQUESTED ACTION

Authorize the Department of Health and Human Services, Division of Public Health

Services, to enter into a contract with Community Action Program Belknap and Merrimack

Counties, Inc. {VC#177203), Concord, NH, in the amount of $448,083 to administer the

Commodity Supplemental Food Program (CSFP) and Senior Farmers' Market Nutrition Program

(SFMNP) services for eligible low-income older adults, with the option to renew for up to four (4)

additional years, effective January 1, 2025, upon Governor and Council approval through June

30. 2026.100% Federal Funds.

Funds are available in the following accounts for State Fiscal Year 2025, and are

anticipated to be available in State Fiscal Year 2026, upon the availability and continued

appropriation of funds in the future operating budget, with the authority to adjust budget line items

within the price limitation and encumbrances between state fiscal years through the Budget Office,

if needed and justified.

05-95-90-902010-74230000 HEALTH AND SOCIAL SERVICES, DEPT OF HEALTH AND

HUMAN SVS, HHS: DIVISION OF PUBLIC HEALTH, BUREAU OF FAMILY HEALTH &

NUTRITION, SENIOR NUTRITION PROGRAMS 100% Federal Funds

State

Fiscal Year

Class /

Account Class Title Job Number Total Amount

2025 074-500589 Contracts for Prog Svc 90006007

(CSFP)

$123,701

2026 074-500589 Contracts for Prog Svc 90006007

(CSFP)

$247,402

Subtotal $371,103

05-95-90-902010-74230000 HEALTH AND SOCIAL SERVICES, DEPT OF HEALTH AND

HUMAN SVS. HHS: DIVISION OF PUBLIC HEALTH, BUREAU OF FAMILY HEALTH &

NUTRITION, SENIOR NUTRITION PROGRAMS 100% Federal Funds

State

Fiscal Year

Class/

Account Class Title Job Number Total Amount

His Excellency, Governor Christopher T. Sununu

and the Honorable Council

2026 074-500589 Contracts for Prog Svc 90006024

(SFMNP Admin)

$6,213

2026 074-500589 Contracts for Prog Svc 90006025

(SFMNP Food)

$70,767

Subtotal $76,980

Total $448,083

EXPLANATION

The purpose of this request is for the Contractor to administer the Commodity

Supplemental Food Program (CSFP) and Senior Farmers' Market Nutrition Program (SFMNP)

services for eligible low-income older adults. The program supports eligible individuals with food

bundles to address food Insecurity and nutritional needs.

The Contractor will conduct outreach and identify eligible applicants, provide nutrition

education, and issue food benefits. The Contractor will distribute monthly or bimonthly CSFP and

SFMNP food bundles to low-income older adults, statewide. Additionally, the Contractor will order

and maintain inventory, provide storage and handling, and distribute all commodities and fresh

produce in compliance with USDA regulations.

Approximately 2,454 individuals will be sen/ed annually.

The Department will monitor services to ensure:

• Supplemental food is provided to a minimum of ninety-five percent (95%) of the

assigned Commodity Supplemental Foods Program caseload through June 30.

2026.

• Farm fresh bundles are provided to a minimum of ninety-five percent (95%) of

the assigned Commodity Supplemental Foods Program caseload through June

30, 2026.

The Department selected-the Contractor through a competitive bid process using a

Request for Proposals (RFP) that was posted on the Department's website from August 28,2024,

through September 30.2024. The Department received one (1) response that was reviewed and

scored by a team of qualified individuals. The Scoring Sheet is attached.

As referenced in Exhibit A, Revisions to Standard Agreement Provisions of the attached

agreement, the parties have the option to extend the agreement for up to four (4) additional years,

contingent upon satisfactory delivery of seryices, available funding, agreement of the parties, and

Govemor and Council approval.

Should the Govemor and Council not authorize this request, food insecure individuals who

meet income and age requirements for the CSFP and SFMNP will not receive services, which

may increase the number of older adults In New Hampshire experiencing food insecurity.

Area served: Statewide

His Excellency, Governor Christopher T. Sununu

and the Honoratile.Council ^

'

Source of Federal Funds: Assistance Listing Number #10.565 and #10.576, FAIN

#244NH814Y8005, #244NH083Y813, and #244NH083Y814

In the event that the Federal Funds become no longer available, General Funds vyill not

be requested to support this program.

Respectfully submitted,

r Lori A. Weaver

Commissioner

The Department of Health and Human Services' Mission is to join communities and families

in providing opportunities for citiecns to achieve health and independence.

New Hampshire Department of Health and Human Services

Division of Finance and Procurement

Bureau of Contracts and Procurement

Scoring Sheet

Project ID# RFP-2025-DPHS-03-COMMO

Project Title Commodity Supplemental Foods Program and Senior Farmers' Market Nutritior) Program

Maximum Points Available Community Action Program Belknap - Merrimack Counties. Inc.

Technical

Knowledge (Q1) 100 ' 90

Experience (Q2) 200 175

Ability (Q3) 300 260

Capacity (Q4) 150 100

Subtotal - Technical 750 625

If a Vendor fail to achieve the minimum Technical score stated, within the RFP, it will receive no further consideration

from the evaluation team and the Vendor's Cost Proposal will remain unopened.

Cost

Vendor Cost 200 200

Vendor Budget Evaluation 50 35

Subtotal • Cost 250 235

TOTAL POINTS 1000 860

TOTAL PROPOSED VENDOR COST $521,957

Reviewer Name

^ iHailey McAlary

^ITara Orchard

3 Kevin Divers

Maureen Brown

Title

Nutrition Service Section Administrator

IcSFP Program Specialist

Administrator II

Nutrition Consultant

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F^9F75B440109 FORM NUMBER P-37 (version 2/23/2023)

Subject: RFP-2025-DPHS-03-COMMO-01 {Commodity Supplemental Foods Program and Senior Farmers*

Notice: This agreement and all of its attachments shall become public upon submission to Governor and

Executive Council for approval. Any information titai is private, confidential or proprietary must

be clearly identified to the agency and agreed to in writing prior to signing the contract.

1.

AGREEMENT

The State of New Hampshire and the Contractor hereby mutually agree as follows:

GENERAL PROVISIONS

rDENTIFlCATION.

I.I Stale Agency Name

New Hampshire Department of Health and Human SerN'ices

1.2 State Agency Address

129 Pleasant Street

Concord, NH 03301-3857

1.3 Contractor Name

Community Action Program Bclknap and Merrimack Counties,

Inc.,

1.4 Contractor Address

2 Industrial Park Drive

Concord, NH 03301

1.5 Contractor Photic

Number

603-225-3295

1.6 Account Unit and Class

74230000 - 074

1.7 Completion Date.

June 30, 2026

1.8 Price Limitation

$448,083

1.9 Contracting Officer for State Agency

Robert W. Moore, Director

1.10 State Agency Telephone Number

(603)271-9631

1.11 Contractor Signature 11/6/2024

> Slgnpd by:

1.12 Name and Title of Contractor Signatory

Michael Tabory Chief Operating Officer

1.13 b^^^??if^^^ignaturc 11/6/2024

Docu5lgn«d by:

(,0.44 Date;

1.14 Name and Title of Slate Agency Signatory

Iain watt Director - DPHS

1.15 Approval by tlic N.H. Department of Administration, Division of Personnel (ifapplicable)

By: Director. On;

1.16 Approval by the Attorney General (Fonn, Substance and Execution) (if applicable)

OpeuStgn^d bjr.

By: On: "/7/2024

1.17 Approval byllicTjOverrior and Executive Council (ifapplicable.)

G&C Item number: G&C Meeting Date:

»

Page I of4

^.— Initial

Ait

Contractor Initials^*

Date^

11/6/2024

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

2. SERVICES TO BE PERFORMED; The Stale of New

Hampshire, acting through the agency identified in block 1.1

("State"), engages contractor identified in block 1.3 ("Contractor")

to perform, and the Contractor shall perform, the work or sale of

goods, or both, identified and more particularly described in the

attached EXHIBIT B which is incorporated herein by reference

("Services").

3. EFFECTIVE DATE/COMPLETION OF SERVICES.

3.1 Notwithstanding any provision of this Agreement to the

contrary, and subject to the approval of the Governor and

Executive Council of the Stale of New Hajiipshire, if applicable,

tltis Agreement, and all obligations of the parties hereunder, shall

become effective on the date llie Governor and Executive Council

approve tliis Agreement, unless no such approval is required, in

which case the Agreement shall become cfTcctive on the date the

Agreement is signed by the State Agency as shown in block 1.13

("EfTeclivc Date").

3.2 If the Connector commeiices the Scr\'iccs prior to the EfTective

Date, all Sen'ices performed by tJie Contractor prior to the"

Effective Date shall be performed at the sole risk of the Contractor,

and in the event that this Agreement docs not become effective, the

State shall have no liability to the Contractor, including withoui

limitation, any obligation to pay the Contractor for any costs

incurred or Services performed.

3.3 Contractor must complete all Services by the Completion Date

specified in block 1.7.

4. CONDITIONAL NATURE OF AGREEMENT.

Notwiilistandihg any provision of this Agreement to tlie contrary,

all obligations of the State hereunder, including, without limitation,

tlic continuance of payments hereunder, are contingent upon the

availability and continued appropriation of funds. In no event shall

the Stale be liable for any payments hereunder in excess of such

available appropriated funds. In the event of a reduction or

termination of appropriated funds by any state or federal legislative

or executive action that reduces, eliminates or otherwise modifies

the appropriation or availability of funding for this Agreement and

the Scope for Services provided in EXHIBIT B, in whole or in part,

the State shall have the right to withhold payment until such funds

become available, if ever, and shall have the right to reduce or

terminate the Services under this Agreement immediately upon

giving the Contractor notice of such reduction or tennination. Tlie

State shall not be required to transfer funds from any other account

or source to the Account identified in block 1.6 in the event funds

in Uiat Account are reduced or unavailable.

5. CONTRACT PRICE/PRICE LIMITATION/ PAYMENT.

5.1 The contract price, method of payment, and terms of payment

are identified and more pariicularly described in EXHIBIT C

which is incorporated herein by reference.

5.2 Notwitlistanding any provision iti tliis Agreement to the

contrary, and notwithstanding unexpected circumstances, in no

event shall the total of all payments autliorized, or actually made

hereunder, exceed the Price Limitation set forth in block 1.8". The

payment by the State of the contract price shall be the only and the

complete reimbursement to the Contractor for all expenses, of

whatever nature incurred by the Contractor in the perfomiance

hereof, and shall be the only and the complete compensation to the

Contractor for the Services.

5.3 The State reserves the right to offset from any amounts

otherwise payable to the Contractor under this Agreement those

liquidated amounts required or pemiiitcd by N.H. RSA 80:7

through RSA 80:7-c or any other provision of law.

5.4 The State's liability under this Agreement shall be limited to

monetary damages not to exceed the total fees paid. The Contractor

agrees that it has an adequate remedy at law for any breach of this

Agreement by tlic State and hereby waives any right to specific

perfomiance or other equitable remedies against the State.

6. COMPLIANCE BY CONTRACTOR WITH LAWS AND

REGULATIONS/EQUAL EMPLOYMENT

OPPORTUNITY.

6.1 In comieciion with Uie perfomiance of the Services, the

Contractor shall comply with all applicable statutes, laws,

regulations, and orders of federal, state, county or municipal

authorities which impose any obligation or duty upon the

Contractor, including, but not limited to, civil rights and equal

employment oppommiiy laws and the Governor's order on Respect

and Civility in the Workplace, Executive order 2020-01. In

addition, if this Agreement is funded in any part by monies of the

United States, the Coimactor shall comply with all federal

executive orders, niles, regulations and statutes, and with any rules,

regulations and guidelines as tlie State or tlie United States issue to

implement these regulations. Tlie Contractor shall also comply

with all applicable intcllecnial property laws.

6.2 During the temi of tliis Agreement, the Contractor shall not

discriminate against employees or applicants for employment

because of age, sex, sexual orientation, race, color, marital status,

physical or menial disability, religious creed, national origin,

gender identity, or gender expression, and will take affirmative

action to prevent such discrimination, unless exempt by state or

federal law. The Contractor shall ensure any subcontractors

comply with these iiondiscrimination requirements.

6.3 No payments or transfers of value by Contractor or its

representatives in connection witli this Agreement have or shall be

made which have the purpose or cfTect of public or commercial

bribery, or acceptance of or acquiescence in extortion, kickbacks,

or other unlawful or improper means of obtaining business.

6.4. The Contractor agrees to permit the State or United Stales

access to any of the Contractor's books, records and accounts for

tlic purpose of ascertaining compliance with this Agreement and

all rules, regulations and orders pertaining to the covenants, tenns

and conditions of this Agreement.

7. PERSONNEL.

7.1 The Conuiictor shall at its own expense provide all personnel

necessary to perfonn the Services. The Contractor warrants that all

personnel engaged in the Services shall be qualified to perform the

Services, and shall be properly licensed and otherwise authorized

to do so under all applicable laws.

7.2 The Contracting Officer specified in block 1.9, or any

successor, shall be tlie State's point of contact pertaining to this

Agreement.

Contractor Initials

Date

Oocusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

8. EVENT OF DEFAULT/REMEDIES.

8.1 Any one or more of the following acts or omissions of ihe

Contractor shall constitute an event of default hcrcunder ("Event

of Default"):

8.1.1 failure to perform the Services satisfactorily or on schedule;

8.1.2 failure to submit any report required hereunder; and/or

8.1.3 failure to perfonn any other covenant, tenn or condition of

this Agreement.

8.2 Upon the occurrence of any Event of Default, the State may

take any one, or more, or all. of the following actions:

8.2.1 give the Contractor a written notice specifying the Event of

Default and requiring it to be remedied within, in the absence of a

greater or lesser specification of time, thirty (30) calendar days

from the date of tlic notice; and if the Event of Default is not timely

cured, tenninate this Agreement, effective two (2) calendar days

after giving the Contractor notice of termmation;

8.2.2 give the Contractor a written notice specifying the Event of

Default and" suspending all payments to be made uiidcr this

Agreement and ordering that the portion of the contract price which

would oilicrwise accrue to the (joniractor during the period from

tlie date of such notice until such time as tlic State determines that

the Contractor has cured the Event of Default shall never be paid

to the Contractor;

8.2.3 give the Contractor a written notice specifying the Event of

Default and set off against any other obligations llic State may owe

to the Contractor any damages the State sufTers by reason of any

Event of Default; and/or

8.2.4 give the Contfaclor a written notice specifying the Event of

Default, treat the Agreement as breached, terminate the Agreement

and pursue any of its remedies at law or in equity, or both.

9. TERMINATION.

9.1 Notwithstanding paragraph 8, the State may, at its sole

discretion, terminate the Agreement for any reason, in whole or in

part, by thirty (30) calendar days written notice to the Contractor

that tltc State is exercising its option loMcmiinate the Agreement.

9.2 In the event of an early tennination of this Agreement for any

reason other than the completion of the Services, the Contractor

shall, at the State's discretion, deliver to the Contracting Officer,

not later than flAccn (15) calendar days after the date of

tennination, a report ('Termination Report") describing in detail

all Services performed, and the contract price earned, to and

including the.date of termination. In addition, at the State's

discretion, the Contractor shall, within fifteen (15) calendar days

of notice of early termination, develop and submit to the State a

transition plan for Ser\'ices under the Agreement.

10. PROPERTY OWNERSHIP/DISCLOSURE.

10.1 As used in Uiis Agreement, the word "Property" shall mean

all data, iiiformation and tltiiigs developed or obtained during the

perfonnaticc of, or acquired or developed by reason of, this

Agreement, including, but not limited to, all studies, reports, files,

formulae, surveys, maps, charts, sound recordings, video

recordings, pictorial reproductions, drawings, atialyses, graphic

representations, computer programs, computer printouts, notes,

letters, memoranda, papers, and documents, all whether finished or

unfinished.

10.2 All data and any Property which has been received from the

State, or purchased with funds provided for that purpose under this

Agreement, shall be the property of the State, and shall be returned

to the State upon demand or upon termination of this Agreement

for any reason.

10.3 Disclosure of data, information and other records shall be

governed by N.H. RSA chapter 91-A and/or other applicable law.

Disclosure requires prior wTittcn approval of the State.

11. CONTRACTOR'S RELATION TO THE STATE. In the

performance of tliis Agreement the Conffacior is in all respects an

independent contractor, and is neither an agent nor an employee of

the State. Neither the Contractor nor any of its officers, employees,

agents or members shall liave authority to bind the State or receive

atiy benefits, workers' compensation or other emoluments

provided by the State to its employees.

12. ASSIGNMENT/DELEGATION/SUBCONTRACTS.

12.1 Contractor shall provide the State written notice at least fifteen

(15) calendar days before any proposed assignment, delegation, or

other transfer of any interest in this Agreement. No such

assignment, delegation, or other transfer shall be effective without

the written consent of the State.

12.2 For purposes of paragraph 12, a Change of Control shall

constitute assignment. "Change of Control" means (a) merger,

consolidation, or a transaction or series of related transactions in

which a third party, together with its affiliates, becomes the direct

or indirect owner of fifty percent (50%) or more of the voting

shares or similar equity interests, or combined voting power of the

Contractor, or (b) the sale of all or substantially all of the assets of

tlie Contractor.

12.3 None of tlic Services shall be subcontracted by tlie Contractor

without prior written notice and consent of the State.

12.4 The State is entitled to copies of all subcontracts and

assignment agreements and shall not be bound by any provisions

contained in a subcontract or an assignment agreement to which it

is not a parly.

13. INDEMNIFICATION. The Contractor shall indemnify,

defend, and hold hamilcss the State, its ofTiccrs, and employees

from and against all actions, claims, damages, demands,

judgments, fines, liabilities, losses, and other expenses, including,

without limitation, reasonable attorneys' fees, arising out of or

relating to this Agreement directly or indirectly arising ftom death,

personal injury, property.damage, intellectual property

infringement, or other claims asserted against Ihe State, its officers,

or employees caused by the acts or omissions of negligence,

reckless or willful misconduct, or fraud by the Contractor, its

employees, agents, or subcontractors. The Stale shall not be liable

for any costs incurred by the Contractor arising under this

paragraph 13. Notwithstanding the foregoing, nothing herein

contained shall be deemed to constitute a waiver of the Slate's

sovereign immunity, which immunity is hereby rescr\'ed to the

State. Tliis covenant in paragraph 13 shall survive the tennination

of this Agreement.

Contractor Initials

Date

-Inttlal

k.t

11/6/2024

Docusign Envelope ID: E033EB7A-33EB-4564.AA6F-69F75B440109

14. INSURANCE.

14.1 The Contractor shall, at its sole expense, obtain and

continuously maintain in force, and shall require any subcontractor

or assignee to obtain and maintain in force, the following

insurance:

14.1.1 commercial general liability insurance against all claims of

bodily injury, death or property damage, in amounts of not less than

$1,000,000 per occurrence and $2,000,000 aggregate or excess;

and

14.1.2 special cause of loss coverage form covering all Property

subject to subparagraph 10.2 herein, in an amount not less titan

80% of the whole replacement value of the Property.

14.2 The policies described in subparagraph 14.1 herein shall boon

policy forms and endorsements approved for use in ilie State of

New Hampshire by the N.H. Dcparuncnt of Insurance, and issued

by insurers licensed in ilic Stale of New Hampshire.

14.3 The Contractor shall furnish to the Contracting Officer

identified in block 1.9, or any successor, a cenificate(s) of

insurance for all insurance required under this Agreement. At the

request of the Contracting Officer, or any successor, the Contractor

shall provide ccrtificatc(s) of insurance for all rcncwal(s) of

insurance required under this Agreement. The certificatc(s) of

insurance and any renewals thereof shall be attached and are

incorporated herein by reference.

15. WORKERS' COMPENSATION.

15.1 By signing this agreement, the Contractor agrees, certifies and

warrants that the Contractor is in compliance with or exempt from,

the requirements of N.H. RSA chapter 281-A ("Workers'

Compensation ").

15.2 To the extent the Contractor is subject to the requirements of

N.H. RSA chapter 281-A, Conuactor shall maintain, and require

any subcontractor or assignee to secure and maintain, payment of

Workers' Compensation in connection with activities which the

person proposes to undertake pursuant to this Agreement. Tlie

Contractor shall furnish the Contracting Officer identified in block

1.9, or any successor, proof of Workers' Compensation in the

manner described in N.H. RSA chapter 281 -A and any applicable

renewal(s) thereof, which shall be attached and are incorporated.

herein by reference. The State shall not be responsible for payment

of any Workers' Compensation premiums or for any other claim or.

benefit for Contractor, or any subcontractor or employee of

Contractor, which might arise under applicable State of New

Hampshire Workers' Compensation laws in connection with the

pcrfonnance of the Services under this Agreement.

16. WAIVER OF BREACH. A Stale's failure to enforce its rights

with respect to any single or continuing breach of this Agreement

shall not act as a waiver of the right of the State to later enforce any

such rights or to enforce any other or any subsequent breach.

17. NOTICE. Any notice by a party hereto to the other party shall

be deemed to have been duly delivered or given at tlie time of

mailing by certified mail, postage prepaid, in a United States Post

Office addressed to the parties at the addresses given in blocks 1.2

and 1.4, herein.

18. AMENDMENT. This Agreement may be amended, waived or

discharged only by an instrument in writing signed by the parties

hereto and only after approval of such amendment, waiver or

discharge by the Governor and Executive Council of the Slate of

New Hampshire imless no such approval is required imder the

circumstances pursuant to State law, rule or policy.

19. CHOICE OF LAW AND FORUM.

19.1 This Agreement shall be govemed, interpreted and constnied

in accordance with the laws of tlie State of New Hampshire except

where tlie Federal supremacy clause requires otherwise. The

wording used in this Agreement is the wording chosen by tlie

parties to express tlieir mutual intent, and no rule of construction

shall be applied against or in favor of any party.

19.2 Any actions arising out of this Agreement, including the

breach or alleged breach thereof, may not be submitted to buiding

arbitration, but must, instead, be brought and maintained in the

Merrimack Coitnly Superior Court of New Hampshire which shall

have exclusive jurisdiction ilicreof. •

20. CONFLICTING TERMS. In the event of a conflict between

the terms of iliis P-37 fomi (as modified in EXHIBIT A) and any

other portion of tliis Agreement including any attachments thereto,

the terms of the P-37 (as modified in EXHIBIT A) shall control.

21. THIRD PARTIES. This Agreement is being entered Into for

the sole benefit of the parties hereto, and notliing herein, express or

implied, is intended to or will confer any legal or equitable right,

benefit, or remedy of any nature upon any other person.

22: HEADINGS. The headings throughout the Agreement arc for

reference purposes only, and the words contained therein shall in

no way be held to explain, modify, amplify or aid in tlie'

interpretation, construction or meaning of the provisions of this

Agreement.

23. SPECIAL PROVISIONS. Additional or modifying

provisions set fortli in the attached EXHIBIT A are incorporated

herein by reference.

24. FURTHER ASSURANCES. The Contractor, along with its

agents and affiliates, shall, at its own cost and expense, execute any

additional documents and tiike such further actions as may be

reasonably required to carry out the provisions of tliis Agreement

and give efTcct to the transactions contemplated hereby.

25. SEVERABILITV. In the event any of the provisions of this

Agreement are held by a court of competent jurisdiction to be

contrary to any state or federal law, the remaining provisions of

this Agreement will remain in full force and effect.

26. ENTIRE AGREEMENT. This Agreement, which may be

executed in a number of counterparts, each of which shall be

deemed an original, constitutes the entire agreement and

understanding between the parties, and supersedes all prior

agreements and understandings with respect to the subject matter

hereof.

Contractor Initial

Date

ll/6/?U?T

Dociisign Envelope ID; E033EB7A-38EB-4564-AA6F-69F756440109

New Hampshire.Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT A

Revisions to Standard Agreement Provisions

1. Revisions to Form P-37, General Provisions

■ 1.1.. Paragraph 3, Subparagraph 3.1, Effective Date/Completion of Services, is

amended as follows:

3.1. Notwithstanding any provision of this Agreement to the contrary, and

subject to the approval of the Governor and Executive Council of the

State of New Hampshire, this Agreement, and all obligations of the

parties hereunder, shall become effective on January 1, 2025 ("Effective

Date").

1.2. Paragraph 3, Effective Date/Completion of Services, is amended by deleting

subparagraph 3.3 in its entirety and replacing it as follows:

3.3. Contractor must complete all Services by the Completion Date specified

in block 1.7. The parties may extend the Agreement for up to four (4)

additional years from the Completion Date, contingent upon satisfactory

delivery of services, available funding, agreement of the parties, and

approval of the Governor and Executive Council.

1.3. Paragraph 12, Assignment/Delegation/Subcontracts, is arnended by adding

subparagraph 12.5 as follows:

12.5. Subcontractors are subject to the same contractual conditions as the

Contractor and the Contractor is responsible to ensure subcontractor

compliance with those conditions. The Contractor shall have written

agreements with all subcontractors, specifying the work to be performed,

and if applicable, a Business Associate Agreement in accordance with

the Health Insurance Portability and Accountability Act. Written

agreements shall specify how corrective action shall be managed. The

Contractor shall manage the subcontractor's performance on an ongoing

basis and take corrective action as necessary. The Contractor shall

annually provide the State with a list of all subcontractors provided for

under this Agreement and notify the State of any inadequate

subcontractor performance.

RFP-202SDPHS-03-COMMO-01 A-1,2 Contractor Initials

Community Action Program Belknap and

Merrimack Counties, Inc. 11/6/2024

Date

7.14.23

Docusign Envelope ID: 6033EB7A-38EB-4564-AA6F^9F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

Scope of Services

1. Statement of Work

1.1 The Contracto

1.2.

r must provide Commodity Supplemental Food Program (CSFP)

and Senior Farmers' Market Nutrition Program (SFMNP) services to eligible

low-income older adults who are at least 60 years of age by: screening for

eligibility: certifying and enrolling eligible participants; issuing food and benefits;

and providing outreach aind education in accordance with USDA requirements.

The Contractor must ensure services are available at the following locations,

which are subject to change upon written approval by the Department:

County Town Location

Belknap Alton Alton Senior Center

Belknap Alton Prospect View Apartments

Belknap Belmont Heritage Terrace Apartments

Belknap Gilford Gilford Knolls

Belknap Laconia Susan Harris Office/Lake Village Apartments

Belknap Laconia Salvation Army

Belknap Laconia Tavern Apartments

Belknap Laconia Sunrise Towers Apartments

Belknap Laconia Northfield Village

Belknap Meredith First Congregational Church

Belknap Tilton New Franklin Apartment

Carroll Ossipee Ossipee Town Hall

Carroll Conway Church of Christ

Carroll Union Greater Wakefield Resource Center

Carroll Wolfeboro First Congregational Church

Cheshire Keene Holly Berry Apartments

Coos Berlin Northern Lights Apartment

Coos Berlin St. Regis Apartments

Coos Berlin Salvation Army

Coos Colebrook Colby Court Apartments

Coos Colebrook Monadnock Congregational Church

Coos Colebrook Monadnock Village

Coos Lancaster All Saints Church

Coos Whitefield Highland House Apartments

Coos Whitefield Mclntyre School Apartments

Coos Whitefield Trinity United Methodist Church

Grafton Ashland Ashland Community Center

Grafton Ashland Common Mans Common

Grafton Bristol Indian River Apartments (—

RFP-2025-DPHS. 03-COMMO-01

Community Action Program Belknap and

Merrimack Counties. Inc

8-2.0

Contractor Initials

Hit

Date

11/6/2024

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F7SB440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers* Market Nutrition

Program

EXHIBIT B

1.3.

Grafton Bristol United Church of Christ

Grafton Bristol Prospect Pines

Grafton Enfield United Methodist Church

Grafton Plymouth Whole Village Family Resource Center

Grafton Plymouth Boulder Point

Grafton Plymouth Pemi Commons

Hillsborough New Ipswich Victoria Woods

Merrimack Boscawen Boscawen Green Apartment

Merrimack Concord Riverside Housing

Merrimack Concord North Ridge Apartments

Merrimack Concord The Hodges Companies (Hillside

Apartments).

Merrimack Concord JFK Apartment

Merrimack Concord Crutchfield Building (Pitman BIdg)

Merrimack Concord Price Haven

Merrimack Concord Freidman Court

Merrimack Concord Briar Pipe Apartments

Merrimack Epsom Meadow Brook Apartments

Merrimack Franklin New Franklin Apartments

Merrimack Penacook * Briar Pipe Apartments

Merrimack Loudon Richard Brown House

Merrimack Pembroke Pembroke Elderly Housing

Merrimack Pittsfield Pittsfield Community Center

Merrimack Suncook Suncook Area Center

Strafford Rochester Rochester Housing Authority

Strafford Rochester Rochester Senior Center"

Strafford Farmington St. Peter's Church

Strafford Dover Niles Senior Center

The Contractor must administer the Commodity Supplemental Food Program

(CSFP) and Senior Farmers' Market Nutrition Program (SFMNP) to the number

of participants as specified by the Department. The Contractor must;

1.3.1. Develop and conduct an Outreach Plan that includes strategies to

provide services to the qualifying individuals, as well as outreach and

education to healthcare professionals and community partners,

Including but not limited to Aging & Disability Resource Center

management and staff, to support enrollment and reduce perceived

barriers. The Outreach Plan must focus on utilizing the Contractor's

network of distribution sites, warehouses, and partnerships with local

agencies to ensure participants receive appropriate access to

nutritious food.

1.3.2. Certify eligible applicants for enrollment in CSFP and SFrWNP' in

RFP-2025-DPHS-03-COMMO-01

Community Action Program Belknap and

Merrimack Counties. Inc

8-2.0

Contractcff^ Initials

Date

Alt

11/6/2024

Docusign Envelope ID: E033EB7A-38EB-4S64-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers* Market Nutrition

Program

EXHIBIT B

accordance with- 7 CFR Part 247 - Commodity Supplemental Food

Program, Part 249 - Senior Farmers' Market Nutrition Program and

Part 250 - Donation of Foods for Use in the United States, its

Territories and Possessions and Areas Under Its Jurisdiction. Any

processes and/or tools utilized by the Contractor for the certification

process are subject to Department approval and must comply with all

applicable federal, state, and Department security and privacy

requirements.

1.3.3. Make eligibility determinations in accordance with applicable federal

and state laws, regulations, orders, guidelines, policies and

procedures, including maintaining an average caseload as

predetermined by the Department from the prior year.

1.3.4. Ensure all applicants are permitted to fill out an application form,

provide information of participant's rights and responsibilities at the

time of certification for enrollment, and provide each applicant of their

right to request a fair hearing in accordance with New Hampshire RSA

126-A:5 and Department regulations..

1.3.5. Provide nutrition education newsletters to participants, which include

but are not limited to direct mail campaigns, media promotions, and

community events.

1.3.6. Distribute CSFP bundles in accordance with 7 CFR Part 247 and Part

250.

1.3.7. Distribute one SFMNP food bundle to each enrolled participant

annually between July and September, throughout the term of the

resulting agreement.

1.3.8. Utilize proxies and volunteers to meet the needs of homebound older

adults who qualify for CSFP and SFMNP, as appropriate.

1.4. The Contractor must order commodities and provide food

storage/warehousing, as appropriate and in accordance with 7 CFR Part 247

and Part 250, which includes, but is not limited to;

1.4.1. Ordering commodities and produce for distribution and maintaining

appropriate levels of inventory for the population to be served for

three months or as directed by the Department.

1.4.2. Accepting food commodities for distribution, which includes but is not

limited to verifying and receiving orders and completing a monthly

CSFP caseload and commodity inventory report.

1.4.3. Providing appropriate refrigeration for up to five (5) days for fresh bulk

produce and safeguarding foods ordered through the USD/^ufflg

RFP-2025-bPHS-03-COMMO-01 IB-2.0 Contractor Initials ^

Community Action Program BelKnap and 11/6/2024

Merrimack Counties. Inc Date

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F7SB440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

handling, storage, and distribution.

1.4.4. Ensuring foods are distinguishable from one another and are labeled

correctly.

1.4.5. Shipping commodities,.fresh fruit, and vegetable bundles to the

certification and/or distribution sites based on packing dates, ensuring

that the oldest commodities and produce are distributed first.

1.4.6. Distributing foods from the USDA in accordance with the approved

food package guide rates.

1.4.7. Distributing foods to eligible recipient agencies in a timely manner, in

optimal condition, and in amounts for which the recipient agencies are

eligible, if applicable.

1.4.8. Ensuring recordkeeping of donated inventory is maintained

separately from recordkeeping of other foods.

1.4.9. Accounting for any loss resulting from improper distribution, storage,

care, or handling of commodities.

1:4.1 (T. Complying with fiscal and operational requirements established by

the Department.

1.5. The Contractor must, in accordance with 7 CFR 247.4(b)(2), maintain and

make participant certification files accessible for audit and review by the

Department for a minimum of three (3) years from the close of the state fiscal

year to which they pertain, or longer if the records are related to unresolved

claims, audits, or investigations.

1.6. The Contractor must work with the Department to produce required program

resources to administer the CSFP and SFMNP in accordance with 7 CFR Part

247 and Part 250 and in a culturally and linguistically appropriate manner,

which includes, but is not limited to:

1.6.1. Participant rights and rules in accordance with 7 CFR 247.12 Rights

and Responsibilities.

1.6.2. Training and nutrition educational materials including but not limited

to printed materials, flyers, and handouts for all program participants.

1.7. The Contractor must comply with all USDA Food and Nutrition Services (FNS)

regulations, policies, instructions, and state policies and procedures for the

CSFP and SFMNP, including but not limited to onsite management evaluations,

program reviews and audits.

1.8. The Contractor must adjust the provision of services, as necessary, to ensure

compliance with changes in the federal regulations governing the CSffi„japd

RFP-2025-DPHS-03-COMMO-01

B-2.0 Contractor Initials ^

Community Action Program Beiknap and 11/6/2024

Merrimadc Counties. Inc Date

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program.

EXHIBIT B

SFMNP that may occur during the contract period.

1.9. The Contractor must allow the Department, the Comptroller General, Office of

Inspector General, the Department of Agriculture, or any of its duly authorized

representatives, to conduct on-site reviews to determine compliance with

Section 2:1.16., ensuring access to information that includes but is not limited

to:

1.9.1. Program operations.

1.9.2. Financial operations.

1.9.3. Storage facilities.

1.10. The Contractor must serve at least 95% of the contracted participant caseloads

enrolled in the programs over the annual contract period.

1.11. The.Contractor must work with the Department to implement policies and

procedures to detect dual participation within the CSFP and SFMNP and

ensure individuals receive the allowable allotment.

1.12. If necessary or required, the Contractor must pursue claims against participants

who resell their food distribution, and/or farmers who over charges or otherwise

does not comply with any agreement with the Contractor.

1.13. The Contractor must maintain adequate accounting and record, keeping

systems to ensure a distinct audit trail, which includes, but is not limited to:

1.,13.1. Accounting ledgers;

1.13.2. Copies of all subcontracts;

1.13.3. Payments;

1.13.4. Enrolled participant demographics including but not limited to name,

address, phone number, race, and ethnicity;.

1.13.5. Participation rates; and

1.13.6. Invoices and correspondence.

1.14. The Contractor must obtain prior approval from the Department before allowing

participation to exceed the caseload assigned by the Department for the CSFP

andSFMNP.

1.15. The Contractor must comply with USDA Office of Civil Rights policies,

including, but not limited to:

1.15.1. Including a non-discrimination statement on all outreach and program

materials.

1.15.2. Ensuring all staff and volunteers not discriminate against participiaots

RFP-2025-DPHS-03-COMMO-01.

8-2.0 Contractw^ Initials k '

Community Action Program Belknap and 11/6/2024

Merrimack Counties. Inc Date

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F7SB440109

New Hampshire Department Of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

based on race, color, national origin, sex (including gender identity

and sexual orientation), disability, age, or reprisal or retaliation for

prior civil rights activity.

1.16. The Contractor must comply with all federal, state, or local requirements

relative to food safety and health, including required health inspections and

procedures for responding to a food recall.

1.17. The Contractor must provide participants with nutrition information and print

materials regarding the availability of health and social service assistance

programs in the individual's service area, which includes, but is not limited to

information regarding:

1.17.1. Supplemental Security Income (SSI) benefits available,through Title

XVI of the Social Security Act;

1.17.2. Medical assistance available through Title XIX of the Social Security

Act, including medical assistance provided to Medicare beneficiaries;

and

1.17.3. The Supplemental Nutrition Assistance Program (SNAP) available to

all elderly applicants, as appropriate.

1.18. The Contractor must \york with organizations, such as NH Senior Center

Network and any faith-based services, on coordination of referrals and,

enrollment initiatives..

1.19. The Contractor must work with the NH Department of Agriculture to recruit,

authorize, and train farmers to provide bulk purchase of authorized produce for

the SFMNP. The Contractor must:

1.19.1. Coordinate with farmers to ensure bulk-purchased bundles of

produce are delivered to CSFP clinic sites.

1.19.2.. Distribute, collect, and approve the farmer applications and

agreements developed by the Departrnent.

1.19.3. Provide orientation and training annually for farmers participating in

the SFMNP.

1.20. Reporting

1.20.1. The Contractor must provide names and addresses for all CSFP

certification, distribution, and storage sites under the jurisdiction of the

local agency to the Department each October for the duration of the

resulting contract period.

1.20.2. The Contractor must provide financial and aggregate data that

contains no personally identifiable information (Pll) to the Dep^gjignt

RFP-2025-DPHS-03-COMMO-01

B-2.0 Contractor Initials

Community Action Program Belknap and 11/6/2024

Merrimack Counties. Inc ' Date

Docusign Envelope 10; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

on the 5lh of each month and as requested, which must include, but

is not limited to:

1.20.2.1. Participation by race and ethnicity;

1.20.2.2. Participation count by service area;

1.20.2.3. Physical inventory count for each warehouse; and

1.20.2.4. Commodities ordered.

1.20.3. The Contractor must develop a Work Plan for all performance

measures, in a format approved by the Department, and submit the

Plan to the Department within thirty (30) business days from the start

of the contract. The Plan will include:

1.20.3.1. Measureable goals to achive the preformance measures;

1.20.3.2. Description of all activities and accompanying tasks to

complete each goal;

1.20.3.3. Timeframes for completion;

1.20.3.4. Identification of the responsible individuals;

1.20.3.5. Quarterly benchmarks; and

1.20.3.6. Deliverables/outputs.

1.20.4. The Contractor must submit a final Annual CSFP and SFMNP

workplan to the Department no later than July 30th of'each year of

the resulting contract period.

1.20.5. The Contractor must provide key data in a format and at a frequency

specified by the Department for the following performance measures:

1.20.5.1. Maintain a minimum of ninety-five percent (95%) of the

assigned contracted participant caseload for CSFP.

1.20.5.2. Maintain a minimum of ninety-five percent (95%) of active

CSFP participants must receive SFMNP bundles.

1.20.6. The Contractor must provide the Department with a delivery schedule

annually and upon any changes to the distribution schedule.

1.20.7. The Contractor may be required to provide other data and.metrics to

the Department in a format specified by the Department, upon request

by the Department.

1.21. Background Checks

RFP-2025-DPHS-034:OMMO-01

B-2.0 Contractor Initials

inhUl

kt

Community Action Program Belknapand,, /c/jrijA

Merrimack Counties, Inc Date

Docustgn Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

1.21.1. Prior to permitting any individual to provide services under this

Agreement, the Contractor must ensure that said individual has

undergone:

1.21.1.1. A criminal background check, at the Contractor's expense, and-

has no convictions for crimes that represent evidence of

behavior that could endanger individuals served under this

Agreement;

1.21.1.2. A name search of the Department's Bureau of Elderly and Adult

Services (SEAS) State Registry, pursuant to RSA 161-F:49, with

results indicating no evidence of behavior that could endanger

individuals served under this Agreement; and

1.21.1.3. A name search of the Department's Division for Children, Youth

and Families (DCYF) Central Registry pursuant to RSA 169-.

C:35, with results indicating no evidence of behavior that could

endanger individuals served under this Agreement.

1.22. Confidential Data

1.22.1. The Contractor must meet all information security and privacy

requirements as, set by the Department and in accordance with the

Department's Information Security Requirements Exhibit as

referenced below.

1.22.2. The Contractor must ensure any individuals involved in delivering

services through this Agreement contract sign an attestation agreeing

to access, view, store, and discuss Confidential Data in accordance

with federal and state laws and regulations and the Department's

Information Security Requirements Exhibit. The Contractor must

ensure said individuals have a justifiable business need to access

confidential data. The Contractor rnust provide attestations upon

Department request.

1.23. Privacy Impact Assessment

1.23.1. Upon request, the Contractor must allow and assist the Department

in conducting a Privacy Impact Assessment (PIA) of its

system(s)/application(s)/web portal(s)/website(s) or Department

system(s)/application(s)/web portal(s)/website(s) hosted by the

Contractor, if Personally Identifiable Information (Pll) is collected,

used, accessed, shared, or stored. To conduct the PIA the Contractor

must provide the Department access to applicable systems and

documentation sufficient to allow the Department to assess, at

minimum, the following:

1.23.1.1. ' How Pll is gathered and stored;

1.23.1.2. Who will have access to Pll;

RFP-2025-DPHS-03^0MMO-01

B-2.0 Contractor Initials

Community Action Program Belknap and 11/6/2024

• Merrimack Counties, Inc Date

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

1.23.1.3. How Pll will be used in the system;

1.23.1.4. How individual consent will be achieved and revoked;

and

1.23.1.5. Privacy practices.

1.23.2. The Department may conduct follow-up PIAs in the event there are

either significant process changes or new technologies impacting the

' collection, processing or storage of.PII.

1.24. Contract End-of-Life Transition Services

1.24.1. General Requirements

1.24.1.1

1.24.1.2.

1.24.1.3.

RFP-2025-DPHS-03-COMMO^1

Community Action Program Belknap and

Merrimack Counties. Inc

If applicable, upon termination or expiration of the

Agreement the parties agree to cooperate in good faith to

effectuate a smooth secure transition of the Services from

the Contractor to the Department and, if applicable, the

Contractor engaged by, the Department to assume the

Services previously performed by the Contractor for this

section, the new Contractor shall be known as

"Recipient"). Ninety (90) days prior to the end-of the

contract or unless otherwise specified by the Department,

the Contractor must begin working with the Department

and if applicable, the hew Recipient to develop a Data

Transition Plan (DTP). The Department shall provide the

DTP template to the Contractor.

The Contractor must use reasonable efforts to assist the

Recipient, in connection with the transition from the

performance of.Services by the Contractor and its End

Users to the performance of such Services. This may

include assistance.with the secure transfer of records

(electronic and hard copy), transition of historical data

(electronic and hard copy), the transition of any such

Service from the hardware, software, network and

telecommunications equipment and internet-related

information technology infrastructure ("Internal IT

Systems") of Contractor to the Internal IT Systems of the

Recipient and cooperation with and assistance to any

third-party consultants engaged by Recipient in

connection with the Transition Services.

If a system, database, hardware, software, and/or

software licenses (Tools) was purchased or cre^d Jo

manage, track, and/or store Department — In

■ft

InlUat

f

in

B-2,0

Contractor Initials

Date

11/6/2024

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

relationship to this contract said Tools will be inventoried

and returned to the Department, along with the inventory

document, once transition of Department Data is

complete.

1.24.1.4. The internal planning of the Transition Services by the

Contractor and its End Users shall be provided to the

Department and if applicable the Recipient in a timely

manner. Any such Transition Services shall be deemed

to be Services for purposes of this Agreement.

1.24.1.5. Should the data Transition extend beyond the end of the

Agreement, the Contractor agrees that the Information

Security Requirements, and if applicable, the

Department's Business Associate Agreement terms and

conditions remain in effect until the Data Transition is

accepted as complete by the Department.

1.24.1.6. In the event where the Contractor has comingled

Department Data and the destruction or Transition of said

data is not feasible, the Department and Contractor will

jointly evaluate regulatory and professional standards for

retention requirements prior to destruction, refer to the

terms and conditions of the.Department's -DHHS

Information Security Requirements Exhibit.

1.24.2. Completion of Transition Services

1.24.2.1. Each service or Transition phase shall be deemed

completed (and the Transition process finalized) at the

end of 15 business days after the product, resulting from

the Service, is delivered to the Department and/or the

Recipient in accordance with the mutually agreed upon

Transition plan, unless within said 15 business day term

the Contractor notifies the Department of an issue

requiring additional time to complete said product.

1.24.2.2. Once all parties agree the data has been migrated the

Contractor will have 30 days to destroy the data per the

terms and conditions of the Department's Information

Security Requirements Exhibit.

1.24.3. Disagreement over Transition Services Results

1.24!3.1. In the event the Department is not satisfied with the

results of the Transition Service, the Department shall' V—InltlaJ

notify the Contractor, in writing, stating the reasdh j|ofpheRFP-2025-DPHS-03-COMMO-01

B-2.0 Contractor Initials

Community Action Program Belknapand 11/6/2024

Menimack Counties, Inc Date

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers* Market Nutrition

Program

EXHIBIT B

lack of satisfaction within 15". business days of the final

product or at any time during the data Transition process.

The Parties shall discuss the actions to be taken to

resolve the disagreement or issue. If an agreement is not

reached, at any time the Department shall be entitled to

initiate actions in accordance with the Agreement.

1.25. Website and Social Media

1.25.1. The Contractor must work with the Department's Communications

Bureau to ensure that.any social media or website designed,

created, or managed on behalf of the Department meets all

Department and NH DolT website and social media requirements

and policies.

1.25.2. The Contractor agrees Protected Health Information (PHI),

Personally Identifiable Information (Pll), or other Confidential

Information solicited either by social media or the website that is

maintained, stored or captured must not be further disclosed unless

expressly provided in the Contract. The solicitation or disclosure of

PHI, Pll, or other Confidential Information is subject to the terms of

the Department's Information Security Requirements Exhibit, the

Business Associate Agreement signed by the parties, and all

applicable Department and federal law, rules, and agreements.

Unless specifically required by the Agreement and unless clear

notice is provided to users of the website or social media, the

Contractor agrees that site visitation must not be tracked, disclosed

or used for website or social media analytics or marketing.

1.25.3. State of New Hampshire's Website Copyright

1.25.3.1. All right, title and interest in the State WWW site, including

copyright to all Data and information, shall remain with the

State.of New Hampshire. The State of New Hampshire

shall also retain all right, title and interest in any user

interfaces and computer instructions embedded within the

WWW pages. All WWW pages and any other Data or

information shall, where applicable, display the State of

New Hampshire's copyright.

2. Exhibits Incorporated

2.1. The Contractor must comply with all Exhibit D Federal Requirements, which

are attached hereto and incorporated by reference herein.

2.2. The Contractor must manage all confidential data related to this Agreejlieflfln

RFP-2025-DPHS-03-COMMO-01. IB-2.0. Contractor Initials ^ ' ■

Community Action Program Belknap and 11/6/2024

Merrimack Counties, Inc Date

Oocusign Envelope ID; E033EB7A-38E8-4S64-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

accordance with the terms of Exhibit E, DHHS Information Security

Requirements.

2.3. The Contractor must use and disclose Protected Health Information, in

compliance with the Standards for Privacy of Individually Identifiable Health

Information (Privacy Rule) (45 CFR Parts 160 and 164) under the Health

Insurance Portability and Accountability Act (HIPAA) of 1996, and in

accordance with the attached Exhibit F, Business Associate Agreement, which

has been executed by the parties.

3. Additional Terms

3.1 Impacts Resulting from Court Orders or Legislative Changes

3.1.1. The Contractor agrees that, to the extent future.state or federal

legislation or court orders may have an impact on the Services

described herein, the State has the right to modify Service priorities

arid expenditure requirements under this Agreement so as to achieve

compliance therewith.

3.2. Federal Civil Rights Laws Compliance:

Appropriate Programs and Services

3.2.1. The Contractor must submit:

Culturally and Linguistically

3.2.1.1

3.2.1.2.

3.2.1.3.

RFP-2025-DPHS-03-COMMO-01

A detailed description of the language assistance

services, within ten (10) days of the Effective Date of the

Agreement, to be provided to ensure meaningful access

to programs and/or services to individuals with limited

English proficiency; individuals who are deaf or have

hearing loss; individuals who are blind or have low

vision; and individuals who have speech challenges.

A written attestation, within 45 days of the Effective Date

of the Agreement and annually thereafter, that all

personnel involved the provision of services to

individuals under this Agreement have completed,

within the last 12 months, the Contractor Required

Training Video on Civil Rights-related Provisions in

DHHS Procurement Processes, which is accessible on

the Department's website

(https://www.dhhs.nh.gov/doing-business-dhhs/civil-

right-compliance-dhhs-vendors); and

The Department's Federal Civil Rights Compliance

Checklist within ten (10) days of the Effective Date of

the Agreement. The Federal Civil Rights Con^pliaace

k.tB-2.0 Contractor Initjals ^

Community Action Program Belknap and

Merrimack Counties. Inc Date

11/6/2024

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers* Market Nutrition

Program

EXHIBIT 8

Checklist must have been completed within the last 12

months and Is accessible on the Department's website. (https://w\vw.dhhs.nh.gov/doing-business-dhhs/civil-

right-compliance-dhhs-vendors).

3.3. Credits and Copyright Ownership

3.3.1. All documents, notices, press releases, research reports and other

materials prepared during or resulting from the performance of the

services of the Agreement must include the following statement, "The

preparation of this (report, document etc.) was financed under an

Contract with the Slate of New Hampshire, Department of Health and

Human Services, with funds provided in part by the State of New

Hampshire and/or such other funding sources as were available or

required, e.g., the United States Department of Health and Human

Services."

3.3.2. All materials produced or-purchased under the Agreement must have

prior approval from the Department before printing, production,

distribution or use.

3.3.3. The Department must retain copyright ownership for any and all

original materials produced, including, but not limited to:

3.3.3.1. Brochures.

3.3.3.2. Resource directories..3.3.3.3. Protocols or guidelines.

3.3.3.4. Posters.

3.3.3.5. -Reports.

3.3.4. The Contractor must not reproduce any materials produced under the

Agreement without prior written approval from the Department.

3.4. Operation of Facilities: Compliance with Laws and Regulations

3.4.1. In the operation of any facilities for providing services, the Contractor

must comply with all laws, orders and regulations of federal, state,

county and municipal authorities and with any direction of any Public

Officer or officers pursuant to laws which must impose an order or

duty upon the contractor with respect to the operation of the facility or

the provision of the services at such facility. If any governmental

license or permit must be required for the operation of the said facility

or the performance of the said services, the Contractor will procure

said license or permit, and will at all times comply with the terms and

conditions of each such license or permit. In connection WiTff'fhe

RFP-2025-DPHS-03-COMMO-01

B-2.0 Contractor Initials

Community Action Program Belknapand

Merrimack Counties. Inc Dale ' '

Docusign Envelope 10: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

foregoing requirements, the Contractor hereby covenants and agrees

that, during the term of this Agreement the facilities must comply with

all rules, orders, regulations, and requirements of the State Office of

the Fire Marshal and the local fire protection agency, and must be in

conformance with local building and zoning codes, by-laws and

regulations.

4. Records

4.1. The Contractor must keep records that include, but are not limited to:

4.1.1. Books, records, documents and other electronic or physical data

evidencing and reflecting all costs and other expenses incurred by the

Contractor in the performance of the Contract, and all income received

or collected by the Contractor.

4.1.2." All records must be maintained in accordance with accounting

procedures and practices, which sufficiently and properly reflect all such

costs and expenses, and which are acceptable to the Department, and

to include, without limitation, all ledgers, books, records, and original

evidence of costs such as purchase requisitions and orders, vouchers,

requisitions for materials, inventories, valuations of in-kind contributions,

labor time cards, payrolls, and other records requested or required by

the Department.

4.1.3. Statistical, enrollment, attendance or visit records for each recipient of

services, which records must include all records of application and

eligibility (including all forms required to determine eligibility for each

such recipient), records regarding the provision of services and all

invoices submitted to the Department to obtain payment for such

services. Forms to be kept on file for three additional years after

participation-include: completed applications, signed participant rights

and rules, client cards or other documentation showing client

participation month by month, participation by site location, and monthly

caseload reports.

4.1.4. All records related to the inventory of USDA foods coming into and out

of the warehouse location. This will include USDA warehouse food

orders, monthly warehousing inventory (FNS-153), food loss records,

and food deliveries to other subcontractors and distribution sites.

4.1.5. Yearly proof of race and ethnic reporting (FNS-191).

4.2. During the term of this Agreement and the period for retention hereunder. the

Department, the United Stales Department of Health and Human Services, and

any of their designated representatives must have access to all reports and

records maintained pursuant to the Agreement for purposes opafflit,RFP-2025-DPHS. 03-COMMO-01 A^TB-2.0 Contractor Initials

Community Action Program Belknapand 11

MerrimackCounties. Inc Date

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market Nutrition

Program

EXHIBIT B

examination, excerpts and transcripts.

4.3. If the Department must disallow any expenses claimed by the Contractor as

costs hereunder; the Department retains the right, at its discretion, to deduct

the amount of such expenses as are disallowed or to recover such sums from

the Contractor.

RFP-2025-DPHS-03-COMMO,-01

B-2.0 Contractor Initials

k-T

Community Action Program Belknapand 11/6/2024

Merrimack Counties. Inc Date

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F.75B440109

New Hampshire Department of Health and Human Services. Commodity Supplemental Foods Program and Senior Farmers' Market

Nutrition Program

EXHIBIT C

Payment Terms

1. This Agreement Is funded by;

1.1. 83% Federal funds, Commodity Supplemental Food. Program, as

awarded on October 4, 2023, by the USDA-FNS, ALN 10.565, FAIN

244NH814Y8005.

1.2. 17% Federal funds, Commodity Supplemental Food Program, as

awarded on January 22, 2024, by the USDA-FNS, ALN 10.576, FAIN

244NH083Y813 and FAIN 244NH083Y814.

2. For the purposes of this Agreement the Department has identified:

2.1. The Contractor as a Subrecipient, in accordance with 2 CFR 200.331.

2.2. The Agreement as NON-R&D, in accordance with 2 CFR §200.332.

3. Payment shall be on a cost reimbursement basis for actual expenditures

incurred in the fulfillment of this Agreement, and shall be in accordance with

the approved line items, as specified in Exhibits C-1 CSFP Admin Funds

Budget through Exhibit C-2 SFMNP Budget.

4. The Contractor shall submit an invoice with supporting documentation to the

Department no later than the fifteenth (15th) working day of the month following

the month in which the services were provided. The Contractor shall ensure

each invoice:

4.1. Includes the Contractor's Vendor Number issued upon registering with

New Hampshire Department of Administrative Services.

4.2. Is subrnitted in a form that is provided by or otherwise acceptable to the

Department.

4.3. Identifies and requests payment for allowable costs incurred in the

previous month.

4.4. Includes supporting documentation of allowable costs with each invoice

that may include, but are not limited to, time sheets, payroll records,

receipts for purchases, and proof of expenditures, as applicable.

4.5. Is completed, dated and returned to the Department with the supporting

documentation for allowable expenses to initiate payment.

4.6. Is assigned an electronic signature, includes supporting documentation,

and is emailed to DPHSContractBillinq@dhhs.nh.qov or mailed to:

Financial Manager

Department of Health and Human Services

129 Pleasant Street G—Initial/U,f

Community Action Program Belknap 11/6/2024

and Merrimack Counties. Inc. Date

Oocusign Envelope ID; E033EB7A-38EB*4&64-AA6F-6gF75B440109

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market

Nutrition Program

EXHIBIT C

5. The Department shall make payments to the Contractor within thirty (30)

calendar days of receipt of each invoice and supporting documentation for

authorized expenses, subsequent to approval of the submitted invoice.

6. The final invoice and supporting documentation for authorized expenses shall,

be due to the Department no later than forty (40) calendar days after the

contract completion date specified in Form P-37, General Provisions Block 1.7

Completion Date.

7. Notwithstanding Paragraph 18 of the General Provisions Form P-37, changes

limited to adjusting amounts within the price limitation and adjusting

encumbrances between State Fiscal Years and budget class lines through the

Budget Office may be made by written agreement of both parties, without

obtaining approval of the Governor and Executive Council, if needed and.

justified.

8. Audits

8.1. The Contractor must email an annual audit to dhhs.act@dhhs.nh.gov if

any of the following conditions exist:

8.1.1. Condition A - The Grantee is subject to a Single Audit pursuant

to 2 CFR Part 200.501 Audit Requirements.

8.1.2. Condition B - The Contractor is subject to audit pursuant to the

requirements of NH RSA 7:28, lll-b.

8.1.3. Condition C - The Contractor is a public company and required

by Security and Exchange Commission (SEC) regulations to

submit an annual financial audit.

8.2. If Condition A exists, the Contractor shall submit an annual Single

Audit performed by an independent Certified Public Accountant (CPA)

to dhhs.act@dhhs.nh,gov within 120 days after the close of the

Contractor's fiscal year, conducted in accordance with the

requirements of 2 CFR Part 200,. Subpart F of the Uniform

Administrative Requirements, Cost "Principles, and Audit

Requirements for Federal awards.

8.2.1. The Contractor shall submit a copy of any Single Audit findings

and any associated corrective action plans. The Contractor

shall submit quarterly progress reports on the status of

implementation of the corrective action plan.

RFP-2025-DPHS-03-COMMO-01

Community Action Program Belknap

and Merrimack Counties, inc.

C-2.1

Contractor Initials

Date

11/6/2024

Docusign Envelope ID: EO33E07A-38EB-4564-AA6F-69F75B44O1O9

New Hampshire Department of Health and Human Services

Commodity Supplemental Foods Program and Senior Farmers' Market

Nutrition Program

EXHIBIT C

8.3. If Condition B or Condition C exists, the Contractor shair submit an

annual financial audit performed by an independent CPA within 120

days after the close of the Contractor's fiscal year.

8.4. Any Contractor that receives an amount equal to or greater than

$250,000 from the Department during a single fiscal year, regardless

of the funding source, may be required, at a minimum, to submit annual

financial audits performed by an independent CPA upon request.

8.5. In addition to. and not in any way in limitation of obligations of the

Agreement, it is understood and agreed by the Contractor that the

Contractor shall be held liable for any state or federal audit exceptions

and shall return to the Department all payments made under the

Agreement to which exception has been taken, or which have been

disallowed because of such an exception..

RFP-2025-DPHS-03-COMMO-01

Community Action Program Selknap

and Merrimack Counties, tnc.

C-2.1

Contractor InKials

(U-t

Date

11/6/2024

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

Exhibit C-1 CSFP Admin Funds Budget

New Hampshire Department of Health and Human Services

Contractor Name: Community Action Program Belknap and Merrimack

Commodity Supplemental Foods Program and

Budget Request for: Senior Farmers Market Nutrition Program

Budget Period: January 2025 to June 30, 2026

Indirect Cost Rate (if applicable) 6^^%

Line Item

D

^, *

SFY 25. (January 1, 2025 -

June 30, 2025)

SFY 26

(July 1. 2025-June 30,

2026)

1. Salary & Wages $34,492 $68,983

2. Fringe Benefits $15,558 $31,115

3. Consultants $750 $1,500

4. Equipment

Indirect cost rate cannot be applied to equipment costs per 2

CFR 200.1 and Appendix IV to 2 CFR 200.

$0 $0

5.(a) Supplies - Educational $0 $0

5.(b) Supplies - Lab $0 $0

5.(c)-Supplies-Pharmacy $0 $0

5.(d) Supplies - Medical $0 $0

5.(e) Supplies - Office $2,579 $5,157

6." Travel $7,520 $15,040

7. Software. $0 $0

8. (a) Other - Marl<eting/Communications $2,000 $4,000

8. (b) Other - Education and Training $0 $0

8. (c) Other - Other (specify below). $0 $0

Occupancy $22,132 $44,704

Telephone $1,011 $2,022

Postage $500 $1,000

Comprehensive Gen. Liab. $3,400 $6,400

Warehouse Supplies $7,500 $15,000

Printing $1,573 $3,145

Other (please specify) $0 $0

9. Subrecipient Contracts $17,073 $34,150

Total Direct Costs $116,088 $232,216

Total Indirect Costs $7,613 $15,186

Subtotals $123,701 $247,402

TOTAL $371,103|

RFP-2025-DPHS-03-COMMO-01

Contractor initials:

-IniUal

Date:.11/6/2024

Docusign Envelope ID: E033E87A-3eEB-4564*AA6F-69F75B440109

Exhibit C-2 SFMNP Budget

New Hampshire Department of Health and Human Services

Contractor Name:

Community Action Program Belknap

and Merrimack Counties, Inc.

Budget Request for:

Commodity Supplemental Foods

Program and Senior Farmers Market

Nutrition Program

Budget PeriodJuly 1, 2025 through June 30, 2026

Indirect Cost Rate (if applicable)0.99%

Line Item Program Cost - Funded by DHHS

1. Salary & Wages $5,000

2. Fringe Benefits $455

3. Consultants $0

4.. Equipment

Indirect cost rate cannot be applied to

equipment costs per 2 CFR 200.1 and'

Appendix IV to 2 CFR 200. $0

5.(a) Supplies - Educational $0

5.(b) Supplies - Lab $0

5.(c) Supplies - Pharmacy $0

5.(d) Supplies - Medical $0

5.(e) Supplies Office $0

6. Travel $0

7. Software $0

8. (a) Other - Marketing/ Communications $0

8. (b) Other - Education and Training $0

8. (c) Other - Other (specify below) $0

Other (please specify) $70,767

Other (please specify) $0

Other (please specify) $0

Other (please specify) $0

9. Subrecipient Contracts $0

Total Direct Costs $76,222

Total Indirect Costs $758

TOTAL $76,980

Contractor Initials;

■Initial

Alt

RFP-2025-DPHS-03-COMMO-01 Date:. 11/6/2024

\

DocusJgn Envelope 10: E033EB7A-38E8-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

SECTION A: CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS

The Contractor Identified in Section 1.3 of the General Provisions agrees to comply with the provisions

of Sections 5151-5160 of the Drug-Free Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle D; 41

U.S.C. 701 et seq.), and further agrees to have the.Contractor's representative, as identified in Sections '

1.11 and 1.12ofthe General Provisionsexecute thefollowingCertification:

ALTERNATIVE I - FOR CONTRACTORS OTHER THAN INDIVIDUALS

US DEPARTMENT OF HEALTH AND HUMAN SERVICES - CONTRACTORS

US DEPARTMENT OF EDUCATION - CONTRACTORS

US DEPARTMENT OF AGRICULTURE - CONTRACTORS

This certification is required by the regulations implementing Sections 5151-5160 of the Drug-Free

Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle D; 41 U.S.C. 701 et seq.). The January 31,

1989 regulations were amended and published as Part II of the May 25,1990 Federal Register (pages

21681-21691), and require certification by contractors (and by inference, sub- contractors), prior to

award, that they will maintain a drug-free workplace. Section 3017.630(c) of the regulation provides that i

a contractor (and by inference, sub-contractors) that Is a State may elect to make one certification to the

Department in each federal fiscal year in lieu of certificates for each Agreement during the federal fiscal |

year covered by the certification. The certificate set out below is a material representation of fact upon '

which reliance Is placed when the agency awards the Agreement. False certification or violation of the

certification shall be grounds for suspension of payments, suspension or termination of Agreements, or '. government wide suspension or debarment. Contractors using this form should send it to: J

Commissioner '

NH Department of Health and Human Services

129 Pleasant Street. >

Concord, NH 03301-6505,

!

1. The Contractor certifies that it will or will continue to provide a drug-free workplace by:

1.1. Publishing a statement notifying employees'that the unlawful manufacture, distribution,

dispensing, possession or use of a controlled substance is prohibited in the Contractor's

workplace and specifying the actions that will be taken against employees for violation of such

prohibition;

1.2. Establishing an ongoing drug-free awareness program to inform employees about

1.2.1. The dangers of drug abuse in the workplace;

1.2.2. The Contractor's policy of maintaining a drug-free workplace;

1.2.3. Any available drug counseling, rehabilitation, and employee assistance programs; and

1.2.4. The penalties that may be imposed upon employees for drug abuse violations occurring !

in the workplace;

1.3. Making it a requirement that each employee to be engaged in the performance of the

Agreement be given a copy of the statement required by paragraph (a);

1.4. Notifying the employee in the statement required by paragraph (a) that, as a condition of

employment under the Agreement, the employee will •

1.4.1. Abide by the terms of the statement; and

1.4.2. Notify the employer in writing of his or her conviction for a violation of a criminal^jjrug 'statute occurring in the workplace no later than five calendar days after suc^onyiction;

v1 6/23 Exhibit D Contractor's Initials ''Federal Requirements Date^^/*^/^^^^

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

1.5. Notifying the agency in writing, within ten calendar days after receiving notice under

subparagraph 1.4.2 from an employee or otherwise receiving actual notice of such conviction.

Employers of convicted employees must provide notice, including position title, to every contract

officer on whose contract activity the convicted employee was working, unless the Federal

agency has designated a central point for the receipt of such notices. Notice shall include the

identification number(s) of each affected Agreement:

1.6. Taking one of the following actions, within 30 calendar days of receiving notice under

subparagraph 1.4.2, with respect to any employee who Is so convicted

1.6.1. Taking appropriate personnel action against such an employee, up to and including

termination, consistent with the requirements of the Rehabilitation Act of 1973, as

amended; or

1.6.2. Requiring such employee to participate satisfactorily in a drug abuse assistance or

rehabilitation program approved for such purposes by a Federal, State, or local health,

law enforcement, or other appropriate agency;

1.7. Making a good faith effort to continue to rnaintain a drug-free workplace through implemientation. of paragraphs,1.1,1.2,1.3, 1.4, 1.5, and 1.6.

2. The Contractor may insert in the space provided below the site(s) for the performance of work done

in connection with the specific Agreement.

Place of Performance (street address, city, county, state, zip code) (list each location)

Check □ if there are workplaces on file that are not identified here.

v16/23 Exhibit D Contractor's Initials

Federal Requirements DateHZH^HHHE

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

SECTION B: CERTIFICATION REGARDING LOBBYING

The Contractor identified in Section 1.3 of the General Provisions agrees to comply with ttie provisions

of Section 319 of Public Law 101-121. Government wide Guidance for New Restrictions oh Lobbying,

and Byrd Anti-Lobbying Amendment (31 U.S.C. 1352). and further agrees to have the Contractor's

representative, as identified in Sections 1.11 and 1.12 of the General Provisions execute the following

Certification:

US DEPARTMENT OF HEALTH AND HUMAN SERVICES - CONTRACTORS

US DEPARTMENT OF EDUCATION - CONTRACTORS

US DEPARTMENT OF AGRICULTURE - CONTRACTORS

Programs (indicate applicable program covered):

•Temporary Assistance to Needy Families under Title IV-A

•Child Support Enforcement Program under Title IV-D

•Social Services Block Grant Program under Title XX

•Medicaid Program under Title XIX"^

•Conimunity Services Block Grant under Title.VI.

•Child Care Development Block Grant under Title IV

The undersigned certifies, to the best of his or her knowledge and belief, that:

1. No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to

any person for influencing or attempting to Influence an officer or employee of any agency, a

Member of Congress, an officer or employee of Congress, or an employee of a Member of

Congress in connection with the awarding of any Federal contract, continuation, renewal,

amendment, or modification of any Federal contract, loan, or cooperative agreement (and by

specific mention sub-contractor).

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for

influencing or attempting to influence an officer or employee of any agency, a Member of Congress,

an officer or employee of Congress, or an employee of a Member of Congress in connection with

this Federal contract, loan, or cooperative agreement (and by specific mention sub- contractor), the

undersigned shall complete and submit Standard Form LLL, (Disclosure Form to Report Lobbying,

in accordance with its instructions, see https://omb.report/icr/201009-0348-022/doc/20388401

3. The undersigned shall require that the language of this certification be included in the award

document for sub-awards at all tiers (including subcontracts, and contracts under grants, loans, and

cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this

transaction was made or entered into. Submission of this certification is a prerequisite for making or

entering into this transaction imposed by Section 1352, Title 31. U.S. Code. Any person who fails to file

the required certification shall be subject to a civil penalty of not less than $10,000 and not more than

$100,000 for each such failure.

Initial

v16/23 Exhibit D Contractor's Initials

Federal Requirements Date5E[^2??E

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D- Federal Requirements

SECTION C: CERTIFICATION REGARDING DEBARMENT. SUSPENSION AND OTHER

RESPONSIBILITY MATTERS

The Contractor identified in Section 1.3 of the General Provisions agrees to comply with the provisions

of Executive Office of the President, Executive Order 12549 and 12689 and 45 CFR Part 76 regarding

Debarment, Suspension, and Other Responsibility Matters, and further agrees to have the Contractor's

representative, as identified in Sections 1.11 and 1.12 of the General Provisions execute the following

Certification:

INSTRUCTIONS FOR CERTIFICATION

1. By signing and submitting this Agreement, the prospective primary participant is providing the

certification set out below.

2. The inability of a person to provide the certification required below will not necessarily result in

denial of participation in this covered transaction. If necessary, the prospective participant shall

submit an explanation of why it cannot provide the certification. The certification or explanation will

be considered in connection with the NH Department of Health and Human Services' (DHHS)

determination whether to enter into this transaction. However, failure of the prospective primary

• participant to furnish a certification or an explanation shall disqualify such person from participation

in this transaction.

3. The certification in this clause is a material representation of fact upon which reliance was placed

when DHHS determined to enter into this transaction. If it is later determined that the prospective

primary participant knowingly rendered an erroneous certification, in addition to other remedies

available to the Federal Government, DHHS may terminate this transaction for cause or default.

4. The prospective primary participant shall provide immediate written notice to the DHHS agency to

whom this Agreement is submitted if at any time the prospective primary participant learns that its

certification was erroneous when submitted or has become erroneous by reason of changed

circumstances.

5. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered

transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and

"voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and

Coverage sections of the rules implementing Executive Order 12549: 45 CFR Part 76. See

https://vww.govinfo.gov/app/details/CFR-2004-title45-vol1/CFR-2004-title45-vol1-part76/context.

6. The prospective primary participant agrees by submitting this Agreement that, should the proposed

covered transaction be entered into, it shall not knowingly enter into any lower tier covered

transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded

from participation in this covered transaction, unless authorized by DHHS.

7. The prospective primary participant further agrees by submitting this proposal that it will include the

clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -

Lower Tier Covered Transactions," provided by DHHS, without modification, in all lower tier covered

transactions and in all solicitations for lower tier covered transactions.'

8. A participant in a covered transaction may rely upon a certification of a prospective participant in a

lower tier covered transaction that it is not debarred, suspended, ineligible, or involuntarily excluded

from the covered transaction, unless it knows that the certification is erroneous. A participant may

decide the method and frequency by which it determines the eligibility of its principals. Each

participant may, but is not required to, check the Nonprocurement List (of excluded parties)

https://www.ecfr.gov/current/title-22/chapter-V/part-513. InlUal

v16/23 Exhibit D Contractor's Initials

Federal Requirements Date^^^TB/TU^

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

9. Nothing contained in the foregoing shall be construed to require establishment of a system of

records in order to render in good faith the certification required by this clause. The knowledge and

information of a participant is not required to exceed that which is normally possessed by a prudent

person in the ordinary course of business dealings.

10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a

covered transaction knowingly enters into a lower tier covered transaction with a person who is

suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in

addition to other remedies available to the Federal government, DHHS may terminate this

transaction for cause or default.

PRIMARY COVERED TRANSACTIONS

11. The prospective primary participant certifies to the best of its knowledge and belief, that it and its

principals:

11.1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or

voluntarily excluded from covered transactions by any Federal department or agency;

11.2. Have not within a three-year period preceding this proposal (Agreement) been convicted of

or had a civil judgment rendered against them for commission of fraud or a criminal offense

in connection with obtaining, attempting to obtain, or performing a public (Federal, State or

local) transaction or a contract under a public transaction; violation of Federal or State

antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or

destruction of records, making false statements, or receiving stolen property;

11.3. Are not presently indicted for otherwise criminally or civilly charged by a governmental entity

(Federal, State or local) with commission of any of the offenses enumerated in paragraph

(l)(b) of this certification; and

11.4. Have not within a three-year period preceding this application/proposal had one or more

public transactions (Federal, State or local) terminated for cause or default.

12. yVhere the prospective primary participant is unable to certify to any of the statements in this

certification, such prospective participant shall attach an explanation to this proposal (contract).

LOWER TIER COVERED TRANSACTIONS

13. By signing and submitting this lower tier proposal (Agreement), the prospective lower tier

participant, as defined in 45 CFR Part 76, certifies to the best of its knowledge and belief that it and

its principals:

13.1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or

voluntarily excluded from participation in this transaction by any federal department or

agency.

13.2. Where the prospective lower tier participarit is unable to certify to any of the above, such

prospective participant shall attach an explanation to this proposal (Agreement).

14. The prospective lower tier participant further agrees by submitting this proposal (Agreement) that it

will include this clause entitled "Certification Regarding, Debarment, Suspension, Ineligibility, and

Voluntary Exclusion - Lower Tier Covered Transactions," without modification in all lower tier covered

transactions and in all solicitations for lower tier covered transactions.

v1 6/23 Exhibit D Contractor's Initials

Federal Requirements Date'^HHZH^E

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

SECTION D: CERTIFICATION OF COMPLIANCE WITH FEDERAL REQUIREMENTS

The Contractor identified in Section 1.3 of the General Provisions agrees by signature of the

Contractor's representative as identified in Sections 1.11 and 1.12 of the General Provisions, to execute

the following certification:

The Contractor will comply, and will require any subcontractors to comply, with any applicable federal

requirements, which may include but are not limited to:

1. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards

(2 CFR 200).

2. The Omnibus Crime Control and Safe Streets Act of 1968 (42 U.S.C. Section 3769d) which

prohibits recipients of federal funding under this statute from discriminating, either in employment

practices or in the delivery of services or benefits, on the basis of race, color, religion, national

origin, and sex. The Act requires certain recipients to produce an Equal Employment Opportunity

Plan;

3. The Juvenile Justice Delinquency Prevention Act of 2002 (42 U.S.C. Section 5672(b)) which adopts

by reference, the civil rights obligations of the Safe Streets Act. Recipients of federal funding under

this statute are prohibited from discriminating, either in employment practices or in the delivery of

services or benefits, on the basis of race, color, religion, national origin, and sex. The Act includes

Equal Employment Opportunity Plan requirements;

4. The Civil Rights Act of 1964 (42 U.S.C. Section 2000d, which prohibits recipients of federal financial

assistance from discriminating on the basis of race, color, or national origin in any program or

activity);

5. The Rehabilitation Act of 1973 (29 U.S.C. Section 794). which prohibits recipients of Federal

financial assistance from discriminating on the basis of disability, in regard to employment and the

delivery of services or benefits, in any program or activity;

6. The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12131-34), which prohibits

discrimination and ensures equal opportunity for persons with disabilities in employment, State and

local government services, public accommodations, commercial facilities, and transportation;

7. The Education Amendments of 1972 (20 U.S.C. Sections 1681, 1683, 1685-86), which prohibits

discrimination on the basis of sex in federally assisted education programs;

8. The Age Discrimination Act of 1975 (42 U.S.C. Sections 6106-07), which prohibits discrimination on

the basis of age in programs or activities receiving Federal financial assistance. It does not include

employment discrimination;

9. 28 C.F.R. pt. 31 (U.S. Department of Justice Regulations - OJJDP Grant Programs); 28 C.F.R. pt.

42 (U.S. Department of Justice Regulations - Nondiscrimination; Equal Employment Opportunity;

Policies and Procedures); Executive Order No. 13279 (equal protection of the laws for faith-based

and community organizations); Executive Order No. 13559, which provide fundamental principles

and policy-making criteria for partnerships with faith-based and neighborhood organizations;

10. 28 C.F.R. pt. 38 (U.S. Department of Justice Regulations - Equal Treatment for Faith-Based

Organizations); and Whistleblower protections 41 U.S.C. §4712 and The Natiorial Defense

Authorization Act (NDAA) for Fiscal Year 2013 (Pub. L. 112-239, enacted January 2, 2013) the Pilot

Program for Enhancement of Contract Employee Whistleblower Protections, which protects

employees against reprisal for certain whistle blowing activities in connection with federal grants

and contracts.

11. The Clean Air Act (42 U.S.C. 7401-7671q.) which seeks to protect human health and the.

environment from emissions that pollute ambient, or outdoor, air. f"" *^ ^ —.

v1 6/23 Exhibit D Contractor's Initials

Federal Requirements DateHZ^??H?E

Oocusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

12. The Clean Water Act (33 U.S.C. 1251-1387) which establishes the basic staicture for regulating

discharges of-pollutants into the waters of the United States and regulating quality standards for

surface waters.

13. Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) (41

U.S.C. 1908) which establishes administrative, contractual, or legal remedies in instances where

contractors violate or breach contract terms, and provide for such sanctions and penalties as

appropriate.

14. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708) which establishes that all

contracts awarded by the non-Federal entity in excess of $100,000 that involve the employment of

rnechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as

supplemented by Department of Labor regulations (29 CFR Part 5).

15. Rights to Inventions Made Under a Contract or Agreement 37 CFR § 401.2 (a) which establishes

the recipient or subrecipient wishes to enter Into a contract with a small business firm or nonprofit

organization regarding the substitution of parties, assignment or performance of experimental,

developmental, or research work under that "funding agreement." the recipient or subrecipient must

comply with the requirements of 37 CFR Part 401, 'Rights to Inventions Made by Nonprofit

Organizations and Srnall Business Firms Under Government Grants, Contracts and Cooperative

Agreements,' and any implementing regulations issued by the awarding agency.

The certificate set out below is a material representation of fact upon which reliance is placed when the

agency awards the Agreement. False certification or violation of the certification shall be grounds for

suspension of payments, suspension or termination of Agreements, or government wide suspension or

debarment.

In the event a Federal or State court or Federal or State administrative agency makes a finding of

discrimination after a due process hearing on the grounds of race, color, religion, national origin, or sex

against a recipient of funds, the recipient will forward a copy of the finding to the Office for Civil Rights,

to the applicable contracting agency or division within the Department of Health and Human Services,

and to the Department of Health and Human Services Office of the Ombudsman.

The Contractor identified in Section 1.3 of the General Provisions agrees by signature of the

Contractor's representative as identified in Sections 1.11 and 1.12 of the General Provisions, to execute

the following certification:

1. By signing and submitting this Agreement, the Contractor agrees to comply with the provisions

indicated above.

v1 6/23 Exhibit D Contractor's Initials

Federal Requirements Date^^^BTTU^

Docusign Envelope ID; E033EB7A-3eEB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

SECTION E: CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE

Public Law 103-227, Part C - Environmental Tobacco Smoke, also known as the Pro-Children Act of

1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned or leased

or contracted for by an entity and used routinely or regulariy for the provision of health, day care,

education, or library services to children under the age of 18, if the services are funded by Federal

programs either directly or through State or local governments, by Federal grant, contract, loan, or loan

guarantee. The law does not apply to children's services provided in private residences, facilities funded

solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug or alcohol

treatment. Failure to comply with the provisions of the law may result In the imposition of a civil

monetary penalty of up to $1000 per day and/or the imposition of an administrative compliance order on

the responsible entity.

The Contractor Identified in Section 1.3 of the General Provisions agrees, by signature of the

Contractor's representative as identified in Section 1.11 and 1.12 of the General Provisions, to execute

the following certification;

1. By signing and submitting this Agreement, the Contractor agrees to make reasonable efforts to

comply with all applicable provisions of Public Law 103-227, Part C, known as the Pro-Children Act. of 1994.

InKtot

•v1 6/23 Exhibit D Contractor's Initials

Federal Requirements Date^^^*^/^"^^

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-6gF75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

SECTtON F: CERTIFICATION REGARDING THE FEDERAL FUNDING ACCOUNTABILITY AND

TRANSPARENCY ACT fFFATA) COMPLIANCE

The Federal Funding Accountability and Transparency Act (FFATA) requires prime awardees of

individual Federal grants equal to or greater than $30,000 and awarded on or after October 1, 2010, to

report on data related to executive compensation and associated first-tier sub-grants of $30,000 or

more. If the initial award is below $30,000 but subsequent grant modifications result in a total award

equal to or over $30,000, the award Is subject to the FFATA reporting requirements, as of the date of

the award.

In accordance with 2 CFR Part 170 (Reporting Subaward and Executive Compensation Information),

the Department of Health and Human Services (DHHS) must report the following information for any

sub award or contract award subject to the FFATA reporting requirements:

1. Name of entity

2. Amount of award

3. Funding agency.

4. NAICS code for contracts / CFDA program number for grants

5. Program source

6. Award title descriptive of the purpose of the funding action

7. Location of the entity

8. Principle place of performance

9. Unique Entity Identifier (SAM UEI; DUNS#)

10. Total compensation and names of the top five executives if:

10.1. More than 80% of annual gross revenues are from the Federal government, and those

revenues are greater than $25M annually and

10.2. Compensation information is not already available through reporting to the SEC.

Prime grant recipients must submit FFATA required data by the end of the month, plus 30

days, in which the award or award amendment is made.

The Contractor identified in Section 1.3 of the General Provisions agrees to comply with the provisions

of The Federal Funding Accountability and Transparency Act, Public Law 109-282 and Public Law 110-

252, and 2 CFR Part 170 (Reporting Subaward and Executive Compensation Information), and further

agrees to have the Contractor's representative,.as identified in Sections 1.11 and 1.12 of the General

Provisions execute the following Certification:

The below named Contractor agrees to provide needed information as outlined above to the NH

Department of Health and Human Services and to comply with all applicable provisions of the Federal

Financial Accountability and Transparency Act.

v1 6/23 Exhibit D Contractor's Initials

Federal Requirements Date^^ZHZHHIE

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit D - Federal Requirements

FORMA

As the Grantee Identified in Section 1.3 of the General Provisions, I certify that the responses to the

below listed questions are true and accurate.

FND1A6MY33D3

1. The UEI (SAM.gov) number for your entity is:

2. In your business or organization's preceding completed fiscal year, did your business or

organization receive (1) 80 percent or more of your annual gross revenue In U.S. federal contracts,

subcontracts, loans, grants, sub-grants, and/or cooperative agreements: and (2) $25,000,000 or

more In annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants,

and/or cooperative agreements?

NO YES

If the answer to #2 above is NO. stop here

If the answer to #2 above is YES, please answer the following:

3. Does the public have access to information about the compensation of the executives in your. business or organization through periodic reports filed under section 13(a) or 15(d) of the Securities

Exchange Act of 1934 (15 U.S.C.78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of

1986?

NO YES

If the answer to #3 above is YES, stop here

If the answer to #3 above is NO, please answer the following:

4. The names and compensation of the five most highly compensated officers in your business or

organization are as follows;

Name:

Name:

Name:

Name:

Name:

Amount:

Amount:

Amount:

Amount:

Amount:

11/6/2024

Date:

v1 6/23

Contractor Name: Communi ty Action Program Belknap-Merrimack County

—8lgn»d by;

C J.y/ y-'7

Nar^f^Tcliael Tabory

Title; chief operating Officer -Initial

Exhibit D

Federal Requirements

Contractor's Initials

DatelV6/2U24

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit E

DHHS Information Security Requirements

A. Definitions

The following terms may be reflected and have the described meaning in this document;

1. "Breach" means the loss of control, compromise, unauthorized disclosure,

unauthorized acquisition, unauthorized access, or any similar term referring to

situations where persons other than authorized users and for an other than authorized

purpose have access or potential access to personally identifiable information,

whether physical or electronic. With regard to Protected Health Information," Breach"

shall have the same meaning as the term "Breach" in section 164.402 of Title 45.

Code of Federal Regulations.

2. "Computer Security Incident" shall have the same meaning "Computer Security

Incident" in section two (2) of NIST Publication 800-61, Computer Security Incident

Handling Guide, National Institute of Standards and technology. U.S. Department of

Commerce.

3. "Confidential Information" or "Confidential Data" means all confidential Information

disclosed by one party to the other such as all medical, health, financial, public

assistance benefits and personal information including without limitation. Substance

Abuse Treatment Records, Case Records, Protected Health Information and

Personally Identifiable Information.

Confidential Information also includes any and all information owned or managed by

the State of NH - created, received from or on behalf of the Department of Health and

Human Services (DHHS) or accessed in the course of performing contracted services

- of which collection, disclosure, protection, and disposition is governed by state or

federal law or regulation. This information includes, but is not limited to Protected

Health Information (PHI), Personal Information (PI), Personal Financial Information

(PFI), Federal Tax Information (FTI), Social Security Numbers (SSN), Payment Card

Industry (PCI), and Or other sensitive and confidential information.

4. "End User" means any person or entity (e.g., contractor, contractor's employee,

business associate, subcontractor, other downstream user, etc.) that receives DHHS

data or derivative data In accordance with the terms of this Contract.

5. "HIPAA" means the Health Insurance Portability and Accountability Act of 1996 and

the regulations promulgated thereunder.

6. "Incident" means an act that potentially violates an explicit or implied security policy,

which includes attempts (either failed or successful) to gain unauthorized access to a

system or its data, unwanted disruption or denial of service, the unauthorized use of

a system for the processing or storage of data; and changes to system hardware,

firmware, or software characteristics without the owner's knowledge, instruction, or

consent. Incidents include the loss of data through theft or device misplacement, loss

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Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F7SB44010g

New Hampshire Department of Health and Human Services

Exhibit E

DHHS Information Security Requirements

or misplacement of hardcopy documents, and misrouting of physical or electronic

mail, all of which may have the potential to put the data at risk of unauthorized access,

use. disclosure, modification or destruction.

7. "Open Wireless Network" means any network or segment of a network that is not

designated by the State of New Hampshire's Department of Information Technology

or delegate as a protected network (designed, tested, and approved, by means of the

State, to transmit) will be considered an open network and not adequately secure for

the transmission of unencrypted PI, PFI, PHI or confidential DHHS data.

8. "Personal Information" (or "PI") means information which can be used to distinguish

or trace an Individual's identity, such as their name, social security number, personal

information as defined in New Hampshire RSA 359-C:19. biorrietric records, etc.,

alone, or when combined with other personal or identifying information which is linked

or linkable to a specific individual, such as date and place of birth, mother's maiden

name, etc.

9. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health

Information at 45 C.F.R. Parts 160 and 164, promulgated under HIPAA by the United

States Department of Health and Human Services.

10. "Protected Health Information" (or "PHI") has the same meaning as provided in the

definition of "Protected Health Information" in the HIPAA Privacy Rule at 45 C.F.R. §

160.103.

11. "Security Rule" shall mean the Security Standards for the Protection of Electronic

Protected Health Information at 45 C.F.R. Part 164, Subpart C. and amendments

thereto.

12. "Unsecured Protected Health Information" means Protected Health Information that is

not secured by a technology standard that renders Protected Health Information

unusable, unreadable, or indecipherable to unauthorized individuals and is developed

or endorsed by a standards developing organization that is accredited by the

American National Standards Institute.

RESPONSIBILITIES OF DHHS AND THE CONTRACTOR

A. Business Use and Disclosure of Confidential Information.

1. The Contractor must not use, disclose, maintain or transmit Confidential Information

except as reasonably necessary as outlined under this Contract. Further, Contractor,

including but not limited to all its directors, officers, employees and agents, must not

use, disclose, maintain or transrfiit PHI in any manner that would constitute a violation

of the Privacy and Security Rule.

Contractor Initials

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Date

Docusign Envelope ID: E033E87A-38E8-4564-AA6F-69F75B440109

Mew Hampshire Department of Health and Human Services

Exhibit E

DHHS Information Security Requirements

2. The Contractor must not disclose any Confidential Information in response to a request

for disclosure on the basis that it is required by law, in response to a subpoena, etc.,

without first notifying. DHHS so that DHHS has an opportunity to consent or object to

the disclosure.

3. If DHHS notifies the Contractor that DHHS has agreed to be bound by additional

restrictions over and above those uses or disclosures or security safeguards of PHI

pursuant to the Privacy and Security Rule, the Contractor- must be bound by such

additional restrictions and must not disclose PHI in violation of such additional

restrictions and must abide by any additional security safeguards.

4. The Contractor agrees that DHHS Data or derivative there from disclosed to an End

User must only be used pursuant to the terms of this Contract.

5. The Contractor agrees DHHS Data obtained under this Contract may not be used for

any other purposes that are not indicated in this Contract.

6. The Contractor agrees to grant access to the data to the authorized representatives of

DHHS.for the purpose of inspecting to confirm compliance with the terms of this

Contract.

II. METHODS OF SECURE TRANSMISSION OF DATA

1. Application Encryption. If End User is transmitting DHHS data containing Confidential

Data between applications, the Contractor attests the applications have been evaluated

by an expert knowledgeable in cyber security and that said application's encryption

capabilities ensure secure transmission via the.internet.

2. Computer Disks and Portable Storage Devices. End User may not use computer disks

or portable storage devices, such as a thumb drive, as a method of transmitting DHHS

data.

3. Encrypted Email. End User may only employ email to transmit Confidential Data if email

is encrvDted and being sent to and being received by email addresses of persons

authorized to receive such information.

4. Encrypted Web Site. If End User is employing the Web to transmit Confidential Data, the

secure socket layers (SSL) must be used and the web site must be secure. SSL encrypts

data transmitted via a Web site.

5. File Hosting Services, also known as File Sharing Sites. End User may not use file hosting

services, such as Dropbox or Google Cloud Storage, to transmit Confidential Data.

6. Ground Mail Service. End User may only transmit Confidential Data via certified ground

mail within the continental U.S. and when sent to a named individual.

7. Laptops and PDA. If End User is employing portable devices to transmit Confidential Data

said devices must be encrypted and password-protected.

-initial

Contractor Initials

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Oa'e

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit E ■

DHHS Information Security Requirements

8. Open Wireless Networks. End User may not transmit Confidential Data via an open

wireless network. End User must employ a virtual private network (VPN) when remotely

transmitting via an open wireless network.

9. Remote User Communicatiori. If End User is employing remote communication to access

or transmit Confidential Data, a virtual private network (VPN) must be installed on the End

User's mobile device(s) or laptop from which information will be transmitted or accessed.

10. SSH File Transfer Protocol (SFTP), also known as Secure File Transfer Protocol. If End

User is. employing an SFTP to transmit Confidential Data. End User will structure the

Folder and access privileges to prevent inappropriate disclosure of information. SFTP

folders and sub-folders used for transmitting Confidential Data will be coded for 24-hour

auto-deletion cycle (i.e. Confidential Data will be deleted every 24 hours).

11. Wireless Devices. If End User is transmitting Confidential Data via wireless devices, all

data must be encrypted to prevent inappropriate disclosure of information.

RETENTION AND DISPOSITION OF IDENTIFIABLE RECORDS

The Contractor will only retain the data and any derivative of the data for the duration of this

Contract. After such time, the Contractor will have 30 days to destroy the data and any

derivative in whatever form it may exist, unless, otherwise required by law or permitted under

this Contract. To this end, the parties must:

A. Retention

1. The Contractor agrees it will not store, transfer or process data collected in

connection with the services rendered under this Contract outside of the United

States. This physical location requirement shall also apply in the implementation of

cloud computing, cloud service or cloud storage capabilities, and includes backup

data and Disaster Recovery locations.

2. The Contractor agrees to ensure proper security monitoring capabilities are in place

to detect potential security events that can impact State of NH systems and/or

Department confidential information for contractor provided systems.

3. The Contractor agrees to provide security awareness and education for its End

Users in support of protecting Department confidential information.

4. The Contractor agrees to retain all electronic and hard copies of Confidential Data

in a secure location and identified in section IV. A.2

5. The Contractor agrees Confidential Data stored in a Cloud must be in a

FedRAMP/HITECH compliant solution and comply with all applicable statutes and

regulations.regarding the privacy and security. All servers and devices must have

currently-supported and hardened operating systems, the latest anti-viral,

antihacker, anti-spam, anti-spyware, and anti-malware utilities. The environment, as

a whole, must have aggressive intrusion-detection and firewall protection.

Contractor Initials

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V5. Last update 10/09/18 11/6/2024

Date

Docusign Envelope ID: E033EB7A-38EB-4S64-AA6F^gF7SB44010g

New Hampshire Department of Health and Human Services

Exhibit E

DHHS information Security Requirements

6. The Contractor agrees to and ensures its complete cooperation with the State's

Chief Information Officer In the detection of any security vulnerability of the hosting

infrastructure.

B. Disposition

1. If the Contractor will maintain any Confidential Information on its systems (or its sub

contractor systems), the Contractor will maintain a documented process for securely

disposing of such data upon request or contract termination; and will obtain written

certification for any State of New Hampshire data destroyed by the Contractor or

any subcontractors as a part of ongoing, emergency, and or disaster recovery

operations. When no longer in use, electronic media containing State of New

Hampshire data shall be rendered unrecoverable via, a secure wipe program in

accordance with industry-accepted standards for secure deletion and media

sanitization, or otherwise physically destroying the media (for example, degaussing)

as described in NISI Special Publication 800-88, Rev 1, Guidelines for Media

Sanitization, National Institute of Standards and Technology, U. S. Department of

Commerce. The Contractor will document and certify in writing at time of the data

destruction, and will provide-written certification to the Department upon request.

The written certification will include all details necessary to demonstrate data has

been properly destroyed and walidated. Where applicable, regulatory and

professional standards for retention requirements will be jointly evaluated by the

State and Contractor prior to destruction.

2. Unless otherwise specified, within thirty (30) days of the termination of this Contract,

Contractor agrees to destroy all hard copies of Confidential Data using a secure

method such as shredding.

3. Unless otherwise specified, within thirty (30) days of the termination of this Contract,

Contractor agrees to completely destroy all electronic Confidential Data by means

of data erasure, also known as secure data wiping.

IV. PROCEDURES FOR SECURITY

A. Contractor agrees to safeguard the DHHS Data received under this Contract, and any

derivative data or files, as follows;

1. The Contractor will maintain proper security controls to protect Department confidential

information collected, processed, managed, and/or stored in the delivery of contracted

services.

2. The Contractor will maintain policies and procedures to protect Department confidential

Information throughout the information lifecycle, where applicable, (from creation,

transformation, use, storage and secure destruction) regardless of the media used.to

store the data (i.e., tape, disk, paper, etc.).

-(nItUI

Contractor Initials

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Date

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human Services

Exhibit E

DHHS Information Security Requirements

3. The Contractor will maintain appropriate authentication and access controls to

contractor systems that collect, transmit, or store Department confidential information

where applicable.

4. The Contractor will ensure proper security monitoring capabilities are in place to detect

potential security events that" can impact State of NH systems and/or Department

confidential information for contractor provided systems.

5. The Contractor will provide regular security awareness and education for its End Users

in support of protecting Department confidential Information.

6. If the Contractor will be sub-contracting any core functions of the engagement

supporting the sen/ices for State of New Hampshire, the Contractor will maintain a

program of an internal process or processes that defines specific security expectations,

and monitoring compliance to security requirements that at a minimum match those for

the Contractor, including breach notification requirements.

7. The Contractor will work with the Department to sign and comply with all applicable

State of New Hampshire and Department system access and authorization policies and

procedures, systems access forms, and computer use agreements as part of obtaining

and maintaining access to any Department system(s). Agreements will be completed

and signed by the Contractor and any applicable sub-contractors prior to system access

being authorized.

8. If the Department determines the Contractor is a Business Associate pursuant to 45

CFR 160.103, the Contractor will execute a HIPAA Business Associate Agreement

(BAA) with the Department and is responsible for maintaining compliance with the

agreement.

9. The Contractor will work with the Department at its request to complete a System

Management Survey. The purpose of the survey is to enable the Department and

Contractor to monitor for any changes in risks, threats, and vulnerabilities that may

occur over the life of the Contractor engagement. The survey will be completed

annually, or an alternate time frame at the Departments discretion with agreement by

the Contractor, or the Department may request the survey be completed when the

scope of the engagement between the Department and the Contractor changes.

10. The Contractor will not store, knowingly or unknowingly, any State of New Hampshire

or Department data offshore or outside the boundaries of the United States unless prior

express written consent is obtained from the Information Security Office leadership

member within the Department.

11. Data Security Breach Liability. In the event of any security breach Contractor shall make

efforts to investigate the causes of the breach, promptly take measures to prevent

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Docusign Envelope ID: EO33E07A-38EB.4564-AA6F-69F75B44O1O9

New Hampshire Department of Health and Human Services

Exhibit E

DHHS Information Security Requirements

future breach and minimize any damage or loss resulting from the breach. The State

shall recover from the Contractor all costs of response and recovery from

the breach, including but not limited to; credit monitoring services, mailing costs and

costs associated with website and telephone call center services necessary due to the

breach.

12. Contractor must, comply with all applicable statutes and regulations regarding the

privacy and security of Confidential Information, and must in all other respects maintain

the privacy and security of PI and PHI at a level and scope that is not less than the level

and scope of requirements applicable to federal agencies, including, but not limited to,

provisions of the Privacy Act of 1974 (5 U.S.C. § 552a). DHHS Privacy Act Regulations

(45 C.F.R. §5b), HIPAA Privacy and Security Rules (45 C.F;R. Parts 160 and 164) that

govern protections for individually identifiable health information, and as applicable

• under State law.

13. Contractor agrees to establish and maintain appropriate administrative, technical, and

physical safeguards to protect the confidentiality of the Confidential Data and to prevent

unauthorized use or access to it. The safeguards must provide a level and scope of

security that Is not less than the level and scope of security requirements established

by the" State of New Hampshire, Department of Information Technology. Refer to

Vendor Resources/Procurement at https://www.nh.gov/doit/vendor/index.htm for the

Department of Information Technology policies, guidelines, standards, and

procurement information relating to vendors.

14. Contractor agrees to maintain a documented breach notification and incident response

process. The Contractor will notify the State's Privacy Officer and the State's Security

Officer of any security breach immediately, at the email addresses provided In Section

VI. This includes a confidential information breach, computer security incident, or

suspected breach which affects or includes any State of New Hampshire systems that

connect to the State of New Hampshire network.

15. Contractor must restrict access to the Confidential Data obtained under this Contract

to only those authorized End Users who need such DHHS Data to perform their official

duties in connection with purposes identified in this Contract.

16. The Contractor must ensure that all End Users:

a. comply >Mth such safeguards as referenced in Section IV A. above, implemented

to protect Confidential Information that is furnished by DHHS under this Contract

from loss, theft or inadvertent disclosure.

b. safeguard this information at all times.

c. ensure that laptops and other electronic devices/media containing PHI. PI. or

PFI are encrypted and password-protected.

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Docusign Envelope ID: E033E87A-38EB-4564-AA6F^9F758440109

New Hampshire Department of Health and Human Services

Exhibit E

DHHS Information Security Requirements

d. send emails containing Confidential Information only if encrypted and being sent

to and being received by email addresses of persons authorized to receive such

information.

e. limit disclosure of the Confidential Information to the extent permitted by law.

f. Confidential Information received under this Contract and individually identifiable

data derived from DHHS Data, must be stored in an area that is physically and

technologically secure from access by unauthorized persons during duty hours

as well as non-duty hours (e.g., door locks, card keys, biometric identifiers, etc.).

g. only authorized End Users may transmit the Confidential Data, including any

derivative files containing personally identifiable information, and in all cases,

such data must be encrypted at all times when in transit, at rest, or when stored

on portable media as required in section IV above.

h. in all other Instances Confidential Data must be maintained, used and disclosed

using appropriate safeguards, as determined by a risk-based assessment of the

circumstances involved.

i. understand that their user credentials (user name and password) must not be

shared with anyone. End Users will keep their credential Information secure.

This applies to credentials used to access the site directly or indirectly through a

third party application.

Contractor is responsible for oversight and compliance of their End Users. DHHS

reserves the right to conduct onsite inspections to monitor compliance with this Contract,

Including the privacy and security requirements provided In herein, HIPAA, and other

applicable laws and Federal regulations until such time the Confidential Data is disposed

of in accordance with this Contract.

V. LOSS REPORTING

The Contractor must notify the State's Privacy Officer and Security Officer of any Security

Incidents and Breaches immediately, at the email addresses provided in Section VI.

The Contractor must further handle and report Incidents and Breaches involving PHI in

accordance with the agency's documented Incident Handling and Breach Notification

procedures and In accordance with 42 C.F.R. §§ 431.300 - 306. In addition to, and

notwithstanding. Contractor's compliance with all applicable obligations and procedures.

Contractor's procedures must also address how the Contractor will:

1. Identify Incidents;

2. Determine if personally identifiable information is involved in Incidents;

3. Report suspected or confirmed Incidents as required in this Exhibit or P-37;

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V5. Last update 10/09/18 11/6/20 24

Oocusign Envelope ID: E033EB7A-38EB-4564-AA6F^9F75B440109

New Hampshire Department of Health and Human Services

Exhibit E

DHHS Information Security Requirements

4. Identify and convene a core response group to determine the risk level of Incidents and

determine risk-based responses to Incidents; and

5. Determine whether Breach notification is required, and, if so, identify appropriate Breach

notification methods, timing, source, and contents from among different options, and

bear costs associated with the Breach notice as well as any mitigation measures.

Incidents and/or Breaches that implicate PI must be addressed and reported, as applicable,

in accordance with NH RSA 359-6:20.

VI. PERSONS TO CONTACT

A. DHHS Privacy Officer:

DHHSPrivacyOfficer@dhhs.nh.gov B.

DHHS Security Officer:

DHHSInformationSecurityOffice@dhhs.nh.gov

Contractor Initials

Ait

V5. Last update 10/09/18 11/6/2024

Date

Docusigh Envelope ID; E033EB7A-38EB-4S64-AA6F-69F75B440109

New Hampshire Department of Health and Human

Exhibit F

BUSINESS ASSOCIATE AGREEMENT

The Contractor identified in Section 1.3 of the General Provisions of the Agreement (Form P-37)

("Agreement"), and any of its agents who receive use or have access to protected health

information (PHI), as defined herein, shall be referred to as the "Business Associate." The State

of New Hampshire, Department of Health and Human Services, "Department" shall be referred

to as the "Covered Entity," The Contractor and the Department are collectively referred to as "the

parties."

The parties agree, to comply with the Health Insurance Portability and Accountability Act, Public

Law 104-191, the Standards for Privacy and Security of Individually Identifiable Health

Information, 45 GFR Parts 160, 162, and 164 (HIPAA), provisions of the HITECH Act, Title XIII,

Subtitle D, Parts 1&2 of the American Recovery and Reinvestment Act of 2009, 42 USC 17934,

et sec., applicable to business associates, and as applicable, to be bound by the provisions of

the Confidentiality of Substance Use Disorder Patient Records, 42 USC s. 290 dd-2.42 CFR Part

2, (Part 2), as any of these laws and regulations may be amended from time to time.

(1) Definitions

a. The following terms shall have the same meaning as defined in HIPAA, the HITECH

Act, and Part 2, as they may be amended from time to time:

"Breach," "Designated Record Set," "Data Aggregation," Designated Record

Set," "Health Care Operations," "HITECH Act," "Individual," "Privacy Rule,"

"Required by law," "Security Rule," and "Secretary."

b. Business Associate Agreement, (BAA) means the Business Associate Agreement

that includes privacy and confidentiality requirerrtents of the Business Associate

working with PHI and as applicable. Part 2 record(s) on behalf of the Covered Entity

under the Agreement.

c. ' "Constructively Identifiable," means there is a reasonable basis to believe that the

information could be used, alone or in combination with other reasonably available

information, by an anticipated recipient to identify an individual who is a subject of

the information.

d. "Protected Health Information" ("PHI") as used in the Agreement and the BAA,

means protected health information defined in HIPAA 45 CFR 160.103, limited to

the information created, received, or used by Business Associate from or on behalf

of Covered Entity, and includes any Part 2 records, if applicable, as defined below.

e. "Part 2 record" means any patient "Record," relating to a "Patient," and "Patient

Identifying Information." as defined in 42 CFR Part 2.11.

f. "Unsecured Protected Health Information" means protected health information that

is not secured by a technology standard that renders protected health information

unusable, unreadable, or indecipherable to unauthorized individuals and is

developed or endorsed by a standards developing organization that is accredited

by the American National Standards Institute.

(2) Business Associate Use and Disclosure of Protected Health Information

a. Business Associate shall not use, disclose, maintain, store, or transmit Protected

Health Information (PHI) except as reasonably necessary to provide the services

outlined under the Agreement. Further, Business Associate, including but-nali

Exhibit F (^V

Contractor Initials ^Business Associate Agreement

11/6/2024

V2.0

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human

Exhibit F

limited to all its directors, officers, employees, and agents, shall protect any PHI as

required by HIPPA and 42 CFR Part 2, and not use, disclose, maintain, store, or

transmit PHI in any manner that would constitute a violation of HIPAA or 42 CFR

Part 2.

b. Business Associate may use or disclose PHI, as applicable:

I. For the proper management arid administration of the Business Associate;

II. As required by law, according to the terms set forth in paragraph c. and d. below;

III. According to the HIPAA minimum necessary standard;

IV. For data aggregation purposes for the health care operations of the Covered

Entity; and. V. Data that is de-identified or aggregated and remains constructively identifiable

may not be used for any purpose outside the performance of the Agreement.

c. To the extent Business Associate is permitted under the BAA or the Agreement to

disclose PHI to any third party or subcontractor prior to making any disclosure, the

Business Associate must obtairi, a business associate agreement or other

agreement with the third party or subcontractor, that complies with HIPAA and

ensures that all requirements and restrictions placed on the Business Associate as

part of this BAA with the Covered Entity, are included ih those business associate

agreements with the third party or subcontractor.

d. The Business Associate shall not, disclose any PHI in response to a request or

demand for disclosure, such as by a subpoena or court order, on the basis that it

is required by law, without first notifying Covered Entity so that Covered Entity can

determine how to best protect the PHI. If Covered Entity objects to the disclosure,

the Business Associate agrees to refrain from disclosing the PHI and shall

cooperate with the Covered Entity in any effort the Covered Entity undertakes to

contest the request for disclosure, subpoena, or other legal process. If applicable

relating to. Part 2 records, the Business Associate shall resist any efforts to access

part 2 records in any judicial proceeding.

(3) Oblioations and Activities of Business Associate

a. Business Associate shall implement appropriate safeguards to prevent

unauthorized use or disclosure of all PHI in accordance with HIPAA Privacy Rule

and Security Rule with regard to electronic PHI, and Part 2, as applicable.

b.. The Business Associate shall immediately notify the Covered Entity's Privacy

Officer at the following email address, DHHSPrivacyOfficer(S)dhhs.nh.gov after the

Business Associate has determined that any use or disclosure not provided for by

its contract, including any known or suspected privacy or security incident or breach

has occurred potentially exposing or compromising the PHI. This includes

inadvertent or accidental uses or disclosures or breaches of unsecured protected

health information.

c. In the event of a breach, the Business Associate shall compjy with the terms of this

Business Associate Agreement, all applicable state and federal laws and

regulations and any additional requirements of the Agreement.

d. The Business Associate shall perform a risk assessment, based on the information

available at the time it becomes aware of any known or suspected priv^ioei

Exhibit F 1Contractor Initials ^ '

Business Associate Agreement

11/6/2024

V2.0

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

New Hampshire Department of Health and Human

Exhibit F

security breach as described above and communicate the risk assessment to the

Covered Entity. The risk assessment shall include, but not be limited to:

I. The nature and extent of the protected health information involved, including the

types of identifiers and the likelihood of re-identification;

II. The unauthorized, person who accessed, used, disclosed, or received the

protected health information;

III. Whether the protected health information was actually acquired or viewed; and

IV. How the risk of loss of confidentiality to the protected health information

has been mitigated.

e. The Business Associate shall complete a risk assessment report at the conclusion

of its incident or breach investigation and provide the findings in a written report to

the Covered Entity as soon as practicable after the conclusion of the Business

Associate's investigation.

f. Business Associate shall make available all of its internal policies and procedures,

books and records relating to the use and disclosure of PHI received from, or

created or received by the Business Associate on behalf of Covered Entity to the

US Secretary of Health and Human Services for purposes of determining the

Business Associate's and the Covered Entity's compliance with HIPAA and the

Privacy and Security Rule, and Part 2, if applicable.

g. Business Associate shall require all of its business associates that receive, use or

have access to PHI under the BAA to agree in writing to adhere to the same

restrictions and conditions on the use and disclosure of PHI contained herein.

h. Within ten (10) business days of receipt of a written request from Covered Entity,

Business Associate shall make available during normal business hours at its offices

all records, books, agreements, policies and procedures relating to the use and

disclosure of PHI to the Covered Entity, for purposes of enabling Covered Entity to

determine Business Associate's compliance vAih the terms of the BAA and the

Agreement.

i. Within ten (10) business days of receiving a written request from Covered Entity,

Business Associate shall provide access to PHI in a Designated Record Set to the

Covered Entity, or as directed by Covered Entity, to an individual in order to meet

the requirements under 45 CFR Section 164.524.

j. Within ten (10) business days of receiving a written request from Covered Entity for.

an amendment of PHI or a record about an Individual contained In a Designated

Record Set, the Business Associate shall make such PHI available to Covered

Entity for amendment and Incorporate any such amendment to enable Covered

Entity to fulfill Its obligations under 45 CFR Section 164.526.

k. Business Associate shall document any disclosures of PHI and Information related

to any disclosures as would be required for Covered Entity to respond to a request

by an individual for an accounting of disclosures of PHI in accordance with 45 CFR

Section 164.528.

I. Within ten (10) business days of receiving a written request from Covered Entity for

a request for an accounting of disclosures of PHI, Business Associate shall make

available to Covered Entity such information as Covered Entity may require to fulfill

its obligations to provide an accounting of disclosures with respect to

Exhibit F

-..... Contractor Initials ^Business Assoaate Agreement

11/6/2024

DateV2.0

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F^9F75B440109

New Hampshire Department of Health and Human

Exhibit F

accordance with 45 CFR Section 164.528.

m. In the event any Individual requests access to, amendment of, or accounting of PHI

directly from the Business Associate, the Business Associate shall within five (5)

business days forward such request to Covered Entity. Covered Entity shall have

the responsibility of responding to forwarded requests. However, if forwarding the

individual's request to Covered Entity would cause Covered Entity or the Business

Associate to violate HIPAA and the Privacy and Security Rule, the Business

Associate shall instead respond to the individual's request as required by such law

and notify Covered Entity of such response as soon as, practicable.

n. Within thirty (30) business days of termination of the-Agreement, for any reason,

the Business Associate shall return or destroy, as specified by Covered Entity, all

PHI received from or created or received by the Business Associate in connection

with the Agreement, and shall not retain any copies or back-ups of such PHI in any

form or platform.

VI. If return or destruction is not feasible, or the disposition of the PHI has been

otherwise agreed to in the Agreement, or if retention is governed by state

or federal law, Business Associate shall continue to extend the protections

of the Agreement, to such PHI and limit further uses and disclosures of such

PHI to those purposes that make the return or destruction infeasible for as

long as the Business Associate maintains such PHI. If Covered Entity, in its

sole discretion, requires that the Business Associate destroy any or all PHI,

the Business Associate shall certify to Covered Entity that the PHI has been

destroyed.

(4) ObliQations of Covered Entity

a. Covered Entity shall post a current version of the Notice of the Privacy Practices

on the Covered Entity's website:

https://www.dhhs.nh.gov/oos/hipaa/publications.htm in accordance with 45 CFR

Section 164.520.

b. Covered Entity shall promptly notify Business Associate of any changes in, or

revocation of permission provided to Covered Entity by individuals whose PHI may

be used or disclosed by Business Associate under this BAA, pursuant to 45 CFR

Section 164.506 or 45 CFR Section 164.508.

c. Covered entity shall promptly notify Business Associate of any restrictions on the

use or disclosure of PHI that Covered Entity has agreed to in accordance with 45

CFR 164.522, to the extent that such restriction may affect Business Associate's

use or disclosure of PHI.

(5) Termination of Agreement for Cause

a. In addition to the Genera! Provisions (P-37) of the Agreement, the Covered Entity

may immediately terminate the Agreement upon Covered Entity's knowledge of a

material breach by Business Associate of the Business Associate Agreement. The

Covered Entity may either immediately terminate the Agreement or provide an

opportunity for Business Associate to cure the alleged breach within a timeframe

specified by Covered Entity.

(6V Miscellaneous

a. Definitions. Laws, and Regulatory References. All laws and regulations

Exhibit F

Contractor Initials

B

Inilfjl

usec

Ai'

usiness Associate Agreement

11/6/2024

V2.0

Docusign Envelope ID: E033EB7A-38EB-45W-AA6F-69F75B440109

New Hampshire Department of Health and Human

Exhibit F. herein, shall refer to those laws and regulations as amended from time to time. A

reference in the Agreement, as amended to include this Business Associate

Agreement, to a Section in HIPAA or 42 Part 2, means the Section as in effect or

as amended.

b. Change in law - Covered Entity and Business Associate agree to take such action

as is necessary from time to time for the Covered Entity and/or Business Associate

to comply with the changes in the requirements of HIPAA, 42 CFR Part 2 other

applicable federal and state law.

c. Data Ownership - The Business Associate-acknowledges that it has no ownership. rights with respect to the PHI provided by or created on behalf of Covered Entity.

d. Interpretation - The parties agree that any ambiguity in the BAA and the

Agreement shall be resolved to permit Covered Entity and the Business Associate

to comply with HIPAA and 42 CFR Part 2.

e. Segregation - If any term or condition of this BAA or the application thereof to any

person(s) or circumstance is held invalid, such invalidity shall not affect other terms

or conditions which can be given effect without the invalid term or condition; to this

end the terms and conditions of this BAA are declared severable.

f. Survival - Provisions in this BAA regarding the use and disclosure of PHI, return

or destruction of PHI, extensions of the protections of the BAA in section (3) g. and

(3) n.l., and the defense and indemnification provisions of the General Provisions

(P-37) of the Agreement, shall survive the termination of the BAA.

IN WITNESS WHEREOF, the parties hereto have duly executed this Business Associate

Agreement.

Department of Health and Human Services community Action Program Belknap^Merrimack County

The State

"OocuSigned by:

X-.i'a u)«.44

— P77tBB8»CBT0ilC

Name of the Contractor

■—signed by:

/ —

^e6tf^4QTlMl7B^Pa■ i

Signature of Authorized Representative Signature of Authorized Representative

Iain watt

Name of Authorized Representative

Michael Tabory

Name of Authorized Representative

Director - DPHS

Title of Authorized Representative

chief operating officer

Title of Authorized Representative

11/6/2024

Date

11/6/2024

Date

Exhibit F

Business Associate Agreement

V2.0

Contractor Initials

(U-t

Date

11/6/2024

DocusJgn Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

State of New Hampshire

Department of State

CERTIFICATE

I, David M. Scanlan, Secretary of State of the State of New Hampshire, do hereby certify that COMMLfNITY ACTION

PROGRAM BELKNAP AND MERRIMACK COLfNTlES, INC. is a New Hampshire Nonprofit Corporation registered

to transact business in New Hampshire on May 28, 1965.1 further certify that all fees and documents required by the Secretary of

Stale's office have been received and is in good standing as far as this office is concerned.

Business ID: 63021

Certificate Number: 0006794263

flf.

5?B&.

5^

IN TESTIMONY WHEREOF,

I hereto set my hand and cause to be affixed

the Seal of the State of New Hampshire,

this 17th day of October A.D. 2024.

David M. Scanlan

Secretary of State

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

COMMUNITY ACTION PROGRAM

BELKNAP-MERRIMACK COUNTIES, INC.

EMPOWERING COMMUNITIES SINCE 19 6 5

CERTIFICATE OF AUTHORITY

1.'Ghristdbher J. Pvies. President. Board of Directors, hereby certify that:

1.1 am a duly elected officer of Co'mrhuhitv Action Prodram BelknapTMerrimack Gbunties. Inc:

2. The following is a true copy of a vote taken at a meeting of the Board of Directors, duly called

and held, on March 14. 2024. at which a quorum of the Directors were present and voting.

VOTED: That Jeanne Agri, Chief Executive Officer/Executive Director, Michael Tabory,

Chief Operating Officer/Deputy Director, Jill Lesmerises, Chief Fiscal Officer, Steven

Gregoire, Budget Analyst, Christopher J. Pyles, Chair, Board of Directors are duly

authorized on behalf of Community. Action. Proararfi Belkhao-Merrimack Gburitles. Inc; to enter

into contracts or agreements with the State of New Hampshire and any of its agencies or

departments and further is authorized to execute any and all documents, agreements and other

instruments, and any amendments, revisions, or modifications thereto, which may in his/her

judgment be desirable or necessary to effect the purpose of this vote.

3.1 hereby certify that said vote has not been amended or repealed and remains in full force and

effect as of the date of the contract/contract amendment to which this certificate is attached. This

authority was valid thirty (30) days prior to and remains valid for thirty (30) days from the date of this

Certificate of Authority.. 1 further certify that it is understood that the State of New Hampshire will

rely on this certificate as evidence that the person(s) listed above currently occupy the position(s)

indicated and that they have full authority to bind the corporation. To the extent that there are any

limits on the authority of any listed individual to bind the corporation in contracts with the State of

New Hampshire, all such limitations are expressly stated herein.

Dated: 17 /& /^ f Signature of Elected Officer

Name:'Christopher J. Ryfes"

Title: President, Bb^d ofCJirectors

Rav. 11/06/2024

Mailing Address P.O. Box 1016, Concord, NH 03302 Administrative Office 8 Old Suncook Road, Concord, NH

Phone: 603 225-3295 | 1 800 856-5525 TTY/TDD 1 800 735-2964 Fax: 603 228-1898

Website: capbm.org

Oocusign Envelope ID; E033EB7A-3eEB-4564-AA6F-69F7SB440109

yXCORCf CERTIFICATE OF LIABILITY INSURANCE DATE (MhUDO/YYYY)

10/02/2024

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES

BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER.

IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the poticy(ie8) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subj^ to the tenms and conditions of the policy, certain policies may require an endorsement. A statement on

this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

Cross Insurance-Manchester

1100 Elm Street

Manchester NH 03101

Stephanie Pefler

(603)669-3218 (603)645^331

AomEss- '"^'^c^certsiScrossagency.com

INSURERtS) AFFORDING COVERAGE NAICS

INSURER A - Selective Insurance Co. of SO 19259

mSURED

Community Action Program Belknap-Merrimack Counties Inc.

P.O. Box 1016

Concord NH 03302

INSURER B; State Health Care c/o Midwest Employers Casua 23612

INSURER C: Pstlsral Ins Co 20281

INSURER 0:

msuRSR e:

INSURER F;

COVERAGES CERTIFICATE NUMBER: 24.25AII lines REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD

INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,

EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR

LTR TYPE OF INSURANCE rrfSDWYD POUCY NUMBER

POUCYEFF

(MM/DD/YYYYI

POUCY EXP

IMMrtlD/YYYYI LIMITS

A

X COMMERCIAL GElNERAL LtABiLITY

£ 1 OCCUR

S 2509940 10/01/2024 10/01/2025

EACH OCCURRENCE, 1,000.000

CLAIMS-MAD

DAMAOE TO RENTED

PREMISES lEa occunencfl) j 1,000.000

MED EXP (Any one peraon), 20.000

PERSONAL S AOV INJURY, 1.000.000

OE a AGGREGATE LIMIT APPLIES PER;

POLICY [3 JECT 13 log

OTHER Frofessional Liability

GENERAL AGGREGATE j 3.000.000

PRODUCTS - COMP/OP AGO, 3,000.000

X Professional Liability S 1,000.000

A

AUTOMOBILE LIABILITY

S 2509940 10/01/2024 10/01/2025

COMBINED SINGLE LIMIT

rEa acddani) $ 1,000.000

X ANY AUTO

HEOULEO

TOS)N.OWNEO

TOS ONLY

BODILY INJURY (Par paiaon) s

OWNED

AUTOS ONLY

HIRED

AUTOS ONLY

SC

Al BODILY INJURY (Par accidani) s

N(.

Al

PROPERTY DAMAGE

rPar arrtdenll S

S

A

X UMBRELLA UAB

EXCESS LIAB

X OCCUR

CLAJMS4MDE S 2509940 10/01/2024 10/01/2025

EACH OCCURRENCE, 5.000,000

AGGREGATE, 5.000.000

OeO X RETENTION } 6 5

8

WORKERS COMPENSATION

AND EMPLOYERS' UABIUTY y, ^

ANY PROPRIETOR/PARTNER/EXECUTIVE rTTl

OFFICER/MEMBER EXCLUDED? " 1

(Mandatory In NH) '

ir yM, descfib* undar

DESCRIPTION OF OPERA'HONS b«l»v

HIA HCKS20240000S47 (3a.) NH 01/01/2024 01/01/2025

V" per OTH-^ STATUTE ER

E.L. EACHACaOENT, 1.000,000

E.L. DISEASE • EA EMPLOYEE, 1.000,000

E.L. DISEASE - POLCY LIMIT J 1.000,000

C

Directors & Officers Liability

J06511302 04/01/2024 04/01/2025

Limit

Deductible

51.000.000

$5,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {ACORD 101. Additional Ramarfcs Setiaduia, may M attaehod H mert »psc« la raquIrM)

Refer to policy for exclusionary endorsements and special provisions.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN. state of New Hampshire; Department of ACCORDANCE WITH THE POUCY PROVISIONS.

Health & Human Services

AUTHORIZED REPRESENTATIVE

129 Pleasant Street

Concord

1

NH 03301

ACORD 25 (2016/03)

O1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

Docusign Envelope ID: E033EB7A-38EB.4564-AA6F-69F75B440109

^ACT/6^

ITO.

O.O

BELKNAP-ME(lRiMACKCOUNTIES.iNC.

C M P'O W C KtNQ -.COW WU N « TI C S'S I K C C.

The Mission of Community Action Program Belknap-Merrimack, Inc.

To assist in reducing poverty, the revitalization of low-income communities, and the empowerment of

low-income families and individuals to reach economic stability.

Docusign Envelope 10; E033EB7A.38EB.4564-AA6F^9F75B440109

Financial Statements

GOMMUNITY ACTION PROGRAIVi

BELKNAP ^ MERRIMAGK COUNTIES. INC

FOR THE YEARS ENDED FEBRUARY 28, 2023 AND 2022

AND

INDEPENDENT AUDITORS' REPORT AND

REPORTS ON GOMPLIANCE AND INTERNAL CONTROLf ■ 4.

Docusign Envelope ID: E033EB7A-38E8-4564-AA6F^9F75B440109

iGQMIVtUNlW-AbtibN PROGRAM BELKNAP -

iGONSOLibATED FINANCIAL sf AtEMENtS ■

'Fb'RTRE YEARS ended FEBRUARY 28. 2Q2'3 AND 2022

TABLE OF CbNTENTS

I

'independent Aud itpcs^^

^ iGqnsqIidated iFihancial. States

jCphs6lidat6d''St^^^ Position -

^.pphsplidated pf Actiyitiep ■

Gdpsdijdated'.Staterfiants'of Fundtioj t V • i- ' • - f. ' •.T J * \

'Cpnspljdated Statejtieriti^

NptpsTtp 6bnsolidaied: FinaWa^

> •». •.'SypplelTipptary Jnfpfrn" *v ' - •

^Schedule'bfExpp^ Awards

CNb1est6Schfedulp:6f-Expdndituresof Federal Awards-

' Jndepepdent^udltprs'Repprtpn Financial RepPrtJin^:■and oqdbrnpllancepod bther'Matteri^Base^^

■"Statemept^r Perfpym^^^ Yn Accordance;;wjth':Governm.Auditing

tStandards.i ".. - '. v

Independent'Auditqre^^^ bomplianceToFEach;:Majpr'Prpgram and

';pn'(Intprnah^^^ ^Gompjiance'Required iby -the-'Uniform

bpidance. ' " *

^Sc|iedure;pf.Flndings/and^

■'i ^.3-

■ X

'4-

■ 9

10-^2!:-23=^4!V...• •>.. 4s

'25-

■3ir32j.

Docusign Envelope ID: E033EB7A-38EB.4564-AA6F^9F75B440109

teone;

&Robetis

• te 'illCO^VAV'

ilNDEPENDENt'AUDITORS' REPORT

Tp Ihe Board!of biredore > -

fCornmunit'y-Action Program:0f;Be{kn'af|ifMefnmg^ -Inc..

iRepbrtron the Audit Of the Financial SCatemerits:

bplnldh

' 'We-'have-audited' thj^iaccpmpahyjh^ lOThsolidated'fipanclal •etatemeptp-pf ObjhrnuhltyvAfe^ 'Pfograhi -of",

Belknap-Memmack;C6 (a;..nonprofit ^Organization); which' bornprise the; consolidated';

i'statenients;\Of flnaQOipl'■ (5o,sif[oh';ys: pf '.Eebfciar^.^28..2023,and 2022,,;and.the, related cOhsfeirdatSdi';■ statements/pf pdi vlhes/fuhctipnal^iexpensMr apd.cayti.fidw

•'nojes'tp- thyppiisplldated i^nancial^statehients. •'.« - f t.' *; "'in; our opinion ^the.oohsplidated' 'finOficlafstalements^presOnf in^all material respects, the 'financial;;

^:ppslti9n.;pf:€ommunity^Adion::PrOgram-pf Bd ayof'F.ebwaiy 2d,;2023:;and'2d22;-and thyphanges;laits':net'assets;^ its-cash.flows for the' yba.rs then ehdedin-aCcordahcy,

iwithyccb.uhtjng principles:geh'efaliya'ccep;fe ■ - -:Bas7s:'fb/'pp/n/on >

' \^e-.c9ydupted 6uryudlt:in;accprdanM accepted in,the Unjted iStates

■of;America;'"and ^the ^standards ^.appjlcable, to' financial.'audits.cphtyney 'in ''$pVe^me/)/ -Audiiin^,

'Stahdarps, Issued by thevComptrpller.General of thb; United States- 'Our.responsibilities under those;

^^Standards'' pre'■ further, ^describedvjn ■ the; AO'dito'rs-j;'Besppnsibllities.'foV 'the Audit, of the ^Financjat'.Statements sectiop of pur repOrt:" We^aryreduired to. be:independeht cf:Cpmmun^^^^ pfVBeiknayMeffirnack GpuntleSiVlhci.enditoirned'dUr.dtfierytW the"

Cry eyant'.P^Ifal 'fiaguirerheMs- rela'ting; to^our;■aud^t■.[ vye-'frelieve. thdt tKte: audit ey'ldenWwd-h'dye^/[is^sbffjcyeot.ahyapprppHatete aucn.f-ppinibrt.s'. '*

Resppny'b/V/t/es of AfanagemenffpriherF/nanc/afStatements., ^ J V... ^............. ^.

• •-IMahagement isi-ifespohsible.'.fqrjth'e preparation; and ^ifair •presentyidh pfl'the cohsojidated 'finahciaj'

•state^ents'Jn.a.ccordance^.v^^ accountlhypririciples;generally-accepted;in;.the United StateypfA^^^.iany.fpf thydesigy,;ilmp|efTlentatip'p^a of Internal cbntfofVeievant to/the,■prepara'ti'on.and;''.fairpresehtatjon oficb.nspiida.ted'h frprn-rriaterjal' misstajyippftt, whbjhpr^'

due'tbfraud,or'error.- • ' ' ' '

date that the dorisojidatedjfinancial^stateipenfs-are

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F^9F75B440109

AuiiJtdrs* Responsihitih'ds^ ihe A u'^lt of the Financtaf Statements

i6M^oBjedives;are tp'6btaih.reas6nable,assuranc^.Bt)dut whetHer.the consdlidat^^^^ statements

if.sj whole ar.e-freeirpm_matefiaj'rTijss^tem^^ error, and to Issue an auditors'"

Yep'ortlhatjncjudes our dpin1bn. R4asonable 'assurariO^^ level of assuranOe but^is hot absolute:'assurance, and thereifpre i/s not. a ' guarantee' that,;an audit, conducted, in accordance, vyitm generally• accepted' auditlhg \standafds\in"dV6.dven7/n^n(.---^w^rf^^ always- detect;a* material.,

^'misstatenient when.it;exists;;irKe.rjsk.pf'^nbt.detect material.misstaleme'nt resulting•from-.fraud Is.

[higher'thari'.for:pnefesultihg from e'rfojr; as fraud hiay'jhyolve cpllusloh, forgery, intehtidnel'omissions,

^misrepreseritations.^or the,override Of intematcpntrol'iMlsstatemehlsare cohsidered^materiafif there is^

-a.substantialjlikelihood thatr'individually^or injthe^aggregate.'they' WoCjId influence the judgment.niade

iby-a reasonable us|r:based.ph the cbhsblldate^

'In ^^rfpnriirig an audit in accordance with'; generally accepted.auditing.standards-arid Goyemmenh

^'Audliing'Standards,'^ey

'Exercise'professional 'jUdgmeiit;arid; majriiairi' prdfesstohal, skepticism' throughout the.audib

Ideritify and'asses>^'^ nsks. bfimateriarmisstatemenb^ the consolidated fihahciaj.statenieh^

iwhettier due to fraud-.or error., and design and perform audit/procedui^esTespohS^^.to-those,'

?isks.';S"uch.'proce'dures include examining,ybh a test.basis,: evidence regarding. the,am'ouhts, and »

^disclosures;in thd "cphs6jidated'fina^^ *' •-- -

• 'Obtain" ah understanding of internal control/eievant-.to the.audit iti ordeV.'to design' audjt-*

'procedures;that are-'approprj.atVimthe'q not for the purpose of expressing:.ah

".opinioji, on the- effectiveness Of *Gom[muhity of Belkha^MeniriiacI^' -Gounties,'!

rnc.'s internarcpntrpK Accordingly,-nb su^^^

' 'Evaluate:the.appropriateness,Of accoun^^ and the reaso'nableness-of significb^

jacco'u'ntihg estimates made' by mahagernent.yas'vyell. as evaluate'i'the'.overall oresentatipn Of.the - •

cqnsplidatedfinancial - -

'Condude.whethej;, in "our,judgment;, there are condjibhs.brevents.-consrderedlh'theaggre

4hat raise^substantial doubt.about. Gommunity,Action Rrdgr^am of Belknap-^^er^lrhack [CoOhtles.., Inc. 's ability to continue as 'a gp|ng coricern.fond reasonable period of time;

rVVe are required to'communicate^ w^ with.goVdrhance regarding, among, other matters;'. fhe:plahned. scope and jiming of the audjt'..Significantyaudk^^^ "and certain internal 'contjol-related ?»

'matters/thatWe'idVht^^^ " ■ '

^puppiement^^

■ipurdudit wasoojiducted fdr thd purpose df-.fOrming an opinronon theoohsojidated financial.stat'emehts^.

j-[as:a. whole:] "Rieoccompanying:^^^^ o'fexpenditures of federal awards; os.required: by.Title. 2- U^S'.,

"Codf o/' Federaf ■2Qb,/Unifdrm fidminlstrative Requirements, Cost PnijcipJes^^^^^^\A'udh 'Requi'^m'erits-^fq/.FederarAwafds,C\^\p^^ of additional analysis Ond is not a.i

Required, part -of fhe.;conVolidated 'financiarystotements.' Such infpfmntlbn 'is \the''^respbjisibility^pf

rnanagemen't tand.Was'.derived; frprn'ond 'relates.directly,tp; the underlying Occpunting and othef records-»

osed to; prepare.,.the'' cbnsplidated ifinahcial etaternents. 'The, information has been subjected'Jto 'the:

- 'auditing pr'o.cedufes.appl[ed:im.audit bTthe'cpnsclidatedrfihanciafstatementSe certain'addition^) -tprbcedures; iocIuding^cbrhpa'hng;a^d 'reepnciling such' Inform directly to the underlying:accouhtlhg ^

and OtberTecords.psedJb 'prepare ttie ■cohsplidaYed.financial staternents or to the cohsbiidated financial-

' itatemerits" themsejveS^'ahd ''pthef' additiphal''procedures In' accordance,- with auditihg.' standards;'

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F^9F75B440109

^generally awepfed'[n..tlie,lJnl|^;§lates. of 'America./Iii our opinion,,'the schedule "of iexpenditUres 6f>■federal awar.ds'-hs Jai/|y\state.d./jn ail • rniiterial respiects/'in',Relation 'tbVthe cphsplidafed 'fiHa

>istayerhe'hts^ " '. " •

>.. j; V ^ ^. -r / ^.... ^,

\ljOthef Repprtih^g Recfuired'by 6^^^ Standards:

• - f ''' t ' ■■ < k

» In.accpfdance'.with ^pvernnieht Auditing'^tahdards^^^^^ also TssUed'pur report dated 'Septemb:er»'

I4v:2023,.-!.6h-,duf considptatioh, of^Cbmrnuhity Actiphif^rog'ram of BelKnap-Merfiniack Couhtips^.Jnc''s'.*

wi 'uui ^icdiii 1^ iLcn i«i ' i.«UMiiui uvci. ill idi ioidi> icpui liny dnu^i^uippiidnuc 'di lu. lUic '

' /"esultsbf thai'testing; and an opNoh -dn the e Comniunity.Action-Prpgra'm'-'

';bf'Be1kha)>MemmaPk-:C6uhties,1nt^^^ finahciaj\repdrtihg'0r6h comfDliance:; That'-^reportlSvari^fntegral part;of. an audit, perforrhed.fh accordance with 'Goyernment]AudiUngi^StandardsV\n ■

>!cdhsiderihg\_c5^^^ -prpg/arn pf;;B.e|knap-Merfimaci<?^ |nc..'s ihterhai cphtrol' oieri.>'finanaal.repPrting andeom^^^

V V

S -!

';bb;/er,,New)Hamp;shife:

•.'September 14; 2023'

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

-X^MUNITY AcfiON PROGRAM BELKNAP - MERrMcK COUNTIES. INcj

vCONSOLIDATEO STATEMENTS OF FINANCIAL POSmON,

■ "" ^FEBRUARY 28; 2023 AND 2022 *

ASS^S.... -..2023: im

J-CURf^NT ASSEtS.

'Cash^;.$,1,7:11,575:$.'-l538,4.485:'

VAccouhts receivable* ' p.027.9,12. *'5.244,621'

invenioiV;.' ^, V ' '^ai.ssg-Prepaid expense's!.'100.225 '.:33.928v

"Iriveslmerits:' ^.128.956 ' T38;793!

""Total cu^'ehVassjBts^' 8.050,237 • 7.d73;753

PROPERTY^

"'Land, buildings and imprwyementft 7,-,627,214 J,360,799

t Equipment, fumjtdre and. vehicles -4.762,49,7' ' "8:335:485^

•^h'strudidalrib^^ *■132.920' -^4.i';40.t. •

tfotalp'ropyrty;. 12*52^.631.J3*745,685

less acwmuiatdd,depreqa(ion ^'6,165.156 > _'!7.528^363: ■:

F^ropertv/riet._:6.357.475 • _*• 6.217'.322>

xdtHER, ASSETS^

^Rightjdfu'se.isset'. • ^..T'3®^'327

•Cash.esqoW'and reservyfund^,77,328; -89.^68

Tehahtvsecurity.depqslts''" -'.^$.247, 9,120'

\bu.eTr6jn rejated party, r6i.348' — - 65.48B'

Totajyther asset| 1,*534.250.164.076 i

■ 76/aL assets':: •$■15.941,962',..$ i3;455..151 '

iDABILiTIESAND^ET ASSETS

■c.uRREfrrUA^jLiTiE^^.:.;1.......~ ' "^Curtent'portibh 6/h'qtes'^p^^ *$' • 237.926' $ ^ 3,14,265. 'Cuirent pdrtlpn'of hghtpf u^^^^^:'46T.162 ^, -/-

line df'i^editV _ - * S 154;356

Accounts'payable. ^I'SSO.iW'', "^SieSS.bSS:

•Acciued.expenj^^. 1,'177,337 ■i,(W6,2Q7-

'Refundabieadvances-f -1817.340' ^1.537,^02/

jtbtaldurterttliabllllies-' -8.244.017"' - • 6;728.279'* • '

'LONSfERMiyABjU'TIES-^,. ^*N"6les payable." lesycunynlp^ph'shi^ 668.146 •MO,489'

iRIghtof,use liabilityHessqurrent'pbriionlhovyn.a^^^^,926.165

lynant se,curity;depgsits ' ' ■8.221 9.120'

lybtal liabilities 9.846;^9 " '.7.631^8/

'NCT.ASSEfs'..... -

' without donorresirictjons •':5i'530:452 5,179,734«.:wilh"'dbhdr';feslricti6ns< -564.961 " •637.529*

Total Vet assets 6.095.413',.:5:817S^»

'■ jOTAL-LtAjlUTIE,S AN^NET.AS_SETS $:i5.941962 $ •'13.455.15i-

-^ee Notes tol^ynsblidateb'Flnancial Statement <-

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

r CONSdupATED STATEMENT. GF ACTIVITIES

'FOR THE YEAR'ENDED FEBRUARY 28. 2023'

Withbut ponor.'

'Restrictiohs

yVlth Donor

-Restrictions 'fbltel '

^REyENijES'AND^p^^^'Grant'awards--

ReritalmCpnie''

•Other funds

In-kind;'

♦United vVay

'IntVrestjncomev.

■Realised loss'pn'^aie of equipme^

i ^56,936;6'63;i40;96i':. 2.804;065

•401.74^;,3,659

■'695.. '(36.538)

^3;i2^293^ ^

~t:56.'936;663;'

'li|d,962,

r'5:926;358.\

-••4dy.748

-.

■.fids'-'

^ (36.53¥);

Total, revenues arid.gther^ ' '60j2'45;'394":3;i22;293:'. ■63;367^6i7-:, NET ASSETS'^RELEASED'FR^

fRESTRICTIONS' " ".3;194.86t -

''Tptai,'.

* -

-■.;63\440.255,(f2,'568)V,63';367.^87'^

' EXpiNSEs-;;

Program.

•.Managefrie/it;,-61,1()1..30'0.-. _'1,988,237

-; 61(101:300,

1:988,23'7.

■ tptal exp^enses ■■63;()89';537 63,689'.537.• - /

CHANGE-IN NET ASSEfS 35d;718 ■(72;568)^ ■278:450.';.NET-ASS'lEtS/BEGlNm; '5.179.734' '■637;529<—■,,—r-=—?- <—: "5^81^263:'

•mi ASSETS^ «»• -H; * '.V t

' $..5.560,452'- $.,:i5.64;^l::.ei. 095.4;l6':S,ee Nptes^to Financial Statements

Oocusign Envelope ID; E033EB7A-38E8-4564-AA6F-69F75B440109

COMMUNITY ACTION PROGf^M COUNTIES.INC.v

I'CdNSdLtbATED.STATEMENT^OF ACTIVITIES

• FORTHE YEAR ENDED.FEBRU'ARY. 28. 2022

'VVIthput.Dpnpr',Wjth:ponor-fc

'Restrictions 'Restrictions VTbtal

<^^ENUESANb:6Tl^Kl SUpPO^

■■ Grant avyards f$. " 36.4$2;0t87' •$' - $.•36,482,0'87

If^ent^iinco'rnei ' ";\135.29.8; n ■'■135.29^'

-qther.funds';....... i'526.432'..i,656;9.84.' L5.17T,416/• Ray.check Rrotectioh-ProgramjLoa'n; Forgiven^ 1^615,427' 5,427^

'iK-kindF. ■ ■ ' ' ' ":;692,'136i ^ •'692.136:-.UnitSd Way 2.123. ?.^23 r

^Interest Ibcome..74.' - ".74

'7.200* -" ' i' ' " ' ' '

JT^ptal reyenues.an^^ 4r36p.777'v;2:650.9'84' ''44,bl1.7§i;-

^NET ASSETS PELEASED FROM ^

RESTRICtldNS^ ' " ' ' 3,062,287;. '(3:662.287)"-

'Iota!.' •■44;423.d64... (41.1j303V,..:44;biiy6:ir

EXPENSES.Rrbgrami.'.Managenient,

40;084;85l;

■11:917,438'

t 40;684;-851.t.. "il. 917.438^.Tdtalexpenses.' ■ 42;002,"289; '. -42,002,289 ■

' CHANGE JNN^^^ s2;420;775'..(411,-303).:2;0q9.472

• -pw ^

^NCT^A*SSEi;S, BEGINNINqQF yEAR.

' NET'ASSEtS;.ENq6F ■

■.2,758:959 ■. l':048,832- -:;j;8oy;79i'

^'5'.■^79,734. ■$. -^637,529;:$ isisiAiea.

'.Seekptes to Cprisd. •8^

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

COMMUNITY ACtlON PROGf^M ^ELKflAP ^ MERRIMACk bOUNTIES:

_ ieONSOUDATEb STATEMENT OF FONCtlONAL EXPENSES

FOR THE YEAR ENDED FEBRUARY 28. 2023 "

'Salaries'and.Wages. ^

^Payrall'^xes^ahd

Traveh ' • •

•dccupancf"

'.Progfam'.services >

^'Oti^e^ cbstsi.

•'Accpuntihg.fee^.'Legal fees.Su'pplies' „.

Postage and shipping'..

'■^Eguipn^ent rental arid rriaintenancej-

Printing andp,ub|icaWpns;

ConYeriences.cpnvarltipns an'd^rneetings

Intaresf - "'7."

'Insurance

^ 'Memberehlp fees

r U.tiljty'and ifiajntenaii^. Computer services' ^-

''Other..'

iDepfeciatibn^ ^;in;kind'

'total/unctipnal;expen>es;/

iPfbbram 'Manaoement- Total'.8.962.376^^.$.841,141 *$ •:9.743.517

'2.422.222 •155,843.. ^578"065

-'233.521' 1.6;30i>: 249,822'

if.36b.924'.133i139,.1>94g63v

44';60T,205'' •- -44;607,205^

se'.ibA'. 1:959!: ■.'68,153>

'24',79*3 268 25,061

289,1 as- 38,955/ i28,14*3

■45766' -■ ■ 45.766^

■■i,540; -

M-.540'-

41,775 ■15:970, '57.745i

f3,B85' ■ •13:885.

'3.991 '39,049^ •43T04O

i3f454^ '307,8'8l •16*2.242'

13,298 10'.283- -'23,581

-139;24T:i 39,247:'71,2-14 - 71,214'

2.298.'9lb •139.465 ■ ',27438,3lr-

32,049' 565,:i36 7^597.185

' 401';748. i-40r.748..::l v.61.101j300-.$^.988;'237:^..'63:089V537

',See Notes^to cbhsolidated Financial 'Statement^'

Docusign Envelope ID: EO33E07A-38EB-4564-AA6F-69F75B44O1O9

'COMMUNITY ACTION PROGRAM BEU<n'aP--M^^^

^CdNSOUIDATEb STATEMENT OF FUNCTIONAL EXPENSES

■ '; i FOR THE Y^'R ENDED FEBRUARY '28. 2022

rani Mariaqement: ' cTotaf

''Salanesand.wage's.. >

«i'Payroll tax^sahd. benefits f

tfraVer

' ■;t)ccupahcy!

'^;Ffpgraml^'eivjces

'Other cbsts:

'%Accbuhtlng'fees....LegaJ fees •

vSuppjies ' ■ •:;po's,tage'a'nd shipping f,

lEquiphient/entaland'maihteh.a^

JP'rinting.ahd publications^.

vG6nferehMs\,OTnyentlpns,ahJi^M^

JnterejsV.^ "

^Insurance.

MMembersKlKfeeS'

^'ptlllty'and niaihtenance't

tepmputer'servlces'.-'

Other " ■

' 'Depiieciatiori '

' (In-kind •

'Total/uhctionai exp^^

$' '»7;961,17V'S■1;180.579. ■$:9;V4Vj56

- ''2.2,96;69b- 228.375'.,2,525:065'

1W;i43 9,648:'. V-2b3.99V^

•-l;-267:982' ■114,41,8'- •1:382.400

'2'5;6;39;'659, _•> '25.639.659;

^74,855:, ■.>4:855'

15,361. 152, M5.'5'13-

f59,844, •■44.534" ■ 204.378 -•

4? ■860: ^?.73;t";58•.591,•

-1 i,l*1 1

28.133.: ^^risge";,

11, l«»;l;55:B29^

13.964' 13".964;

^,29:i87- '26'84.r <5§,028.

124,730.43.85^: •168:586-

1,6.276' -■

k. ^

'16;276'-

88'.7b2. -:i 92.844^^.111'.990 ' iiii99b'

•927;525 '.5.3:61,1 981'rise.

"See'.ijr V *•

•566,151

592,136 5'9'2.136,

'S.:40:084;851' ' ■'1.917;438:;.$-:.L42;0b2.2b9,

^See' Notes' to Consolidated •Financial Statements'^'•'-«w •••i ' • i - •.•• • •, '

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

-gPMMUNlfYAgTig^^.'CONSOUDATED STATEMENTS OF CAiSH FLOWS../for THE-YEARS ended FEBRUARY:28.2023 AND 2022..;CASH FLOWS FROM OPEF^tlNG'ACp

' Change.(ni)et'asVels.. ■ "" "■' " - ■•r^djustmentsitp re^condle cKange jn net esVets to;, ^^et,cash':frol^'op1^"rat^ng activities: ' ' ~.Depreciation, ] ' ^

Paycheck Prptebtion programjoan,forgiveness"

Tnterest.on'deferred financing cpste,-. *

'^'^Realizjedjpss dn.dis^ dfpqui'pmehU

'Decreiase (increase) jh'cuirent'assets:

< Accounts receivable!

■^•jhyerltbry

- Prepaid expenses*..

'DuVfrpm related parfy':

Tenant secufity^deppsits^

Increase/^decrease) In curreni liaBililies/

•'Awpuhjts/payab^ ' ' ' ^

' \Accf^ed.expense^

' Refundable adyances'>

•-Tenant iecurity. deposits;:.'V..•r... - '

'.'NET CASrt PROVIDED BV OPERATING ACTIVITIES' r • - -i •, 'V • V,*. ^.;CASH FLOWSfROM INyESflNG AcflVlTIE^ ^' •<Prdce*eds from^sale of property^v ^ •

'Additipnstp'prbperty. '' "

'Ihvestmerits ' ^ "

» NET CASH USED IN INypStlNG.tash;flows Xr^.m financing: KcTivif ies: t"•'^Net-repayments bn'yrie'cfpre

^Rcpayrnenl ofjdng term'debt"'-

» NET CASH USED IN FINANCING ACTIVITIES.■ f - - « < - •; ■ • " - -iv r- _ '

tNEtjNCREASE IN CASH AND/RESTRICfED CASH ';CASH AND RESTRICTED CASH OF YEAR;CASH ANb RESTRICTEb cASH bXlANCE/EN^;CASH:AND,RESTRICTEb CASH:.

'Chih'

•''Cash escrow and reserve'funds

SUPPLEMENTArDISCLOSURE ORCASH'FLOW INFORMATION:• ^ ••'/". •. w.. r...;,. v.. ' >

' /Cash, paid-^during'^e year fprjnteresl •

2023 ■2022.

s:.278,150^..s. v2;0;C)9'.472.

-597-185.483'

36,538

•-566,-151'

(1:615.427)'

v*483\

17,200);

'f783;291).

".190.857

'(66.297)

--4;'146'"

';873. •

v(1.-H81i812)'

(2j6;q31),

39,'781'. (6'5.488)'

■\2^239):"9i4;597-

'isi.isb

i79,538'

(899)-,

"^2Vl09.823;

t297.2'56 '

•566;86i''•2.239-. e.

':i;54i504, —

■/li37.869

ft 73,876)

-.^•9.837 •.:7'iOQ'

-Yl,lAl;fbl)

"..00:797)

?t7.64.039) A.

dV144,698)'-

''(f54.356)(309; 165)

(225.678).

*(258.743)'::(463.515)-.'(484,421)^

■31>;95d ■^508,750;

M';47l953- ■9B5;2b3\.$ -I'jss.soi fi. 0.473.953'

$ 1.711,575

- -77,328

i '•1.384,485'

- - -.8'9,468:':$.•.1.788,903 '1,.473i951

$ -43,040:.i56;028

' See Notes.to, Cons6|ld.ated'Finan'c}a|.Sta,te^^. 'i' f

Docusign Envelope ID; EO33EB7A-38E0-4564-AA6F-69F75B44O1O9

COMMUNITY ACTION PR^GRA - MERRIMACK COUNTIES..INC.

NOTES TS CONSOLiDATED/fNANGIAL STATEMENTS'

-' FOR THE YEARS ENDED FEBRUARY 28. 2023 AND 2022

1i. CiRGA'NIZATION ANbyUMMARY OF EIGNIFICANt ACCOUNTING POLICIES

■Nature bf Orqanilltion.' ^

Commyhlty/^ction' fJfpgrarri.BelRriap -7 Merrifnack". Go'uhties\ Jinc. (the Orgeriizatiori) is. a m

'New.H0fnpsh1feVnph^.brqapizjatioW-that s^eVbutVltloriai,.health;, living 'and;supp6rt- ♦. needs' of.the/Jow'incorp 'and'elderlypHeh^^ in/the'.twp county ^service 'areas/'as well: as^

'; State,iwjde;^ These ^serv'ibe^ are ^provided vyjth.the ■ financiaksupport bf • yaripus -federal,,.

state, county'and il6bal;brgahiza ' ' ' '' ■ " ■ ' is ' ' ' ■

Prrnclples ofCohsolidatidh

The:-consolidated^'financial^ 'the.abcounts 'of:;dpmmunity 'Action'

'Progra.rih'.:Belkhap-Merrirha.6j<^Cbun^^^ ehtities'-as'CoMhiunftyu

■ Action RrograrnuBelkhap'rMe^^^^^ ■Cbuhties",:jnc:^ha■s,bpth^"an..economic interest:and,1

control-of.the.ehtitie"s:^th7pugh, a majofity ybtihg j.ihtefest;ln their.gbvemlrig bdatd.-Ali.: 'sighificant. ihtercom^ iferhs".:ahdv'transacti^^^^. "h'aVe ■ been> elirpinated •■frojfi^ basic

c6hs6lidated^fihahcia^•statemehts. ' ^

' iSar)"dy;Ledge£jrh1ted

■CAg.BMcdeyeipphie'n^^

jBaslsbf Accbuiitihd'' ^

TfijeracGprnpa^ finahbjal.sta^^ hayb;:beeh'_'preparbd: bh-.lhi;'.accrual'basis";pf;',ac^^^ -in.'abcprciVhce.With 'the accounting, dhncipies,.--gehbrally'

^accepted'ihThe;ljhited,':&tates.bfArn"e^^^ * ••••: • ^:>

' Basis of Presehtatldh' ^.

THe;-consplidated-financial >.Statlrnehti.pf%th

•^ccprdappe'iwjth ':y/§;' generally^accepted;^^^^ 'principle's,'iwhjch:^require,the j'drgahlzatidn'.to ^repqrt'^ regarding;:its financial positipb'iand,.actiyities', accordlng;itqthe>folb^ " ' ■

Ne^aasete W/tbouf:dorior:reiifWcb'ons Include het- assets jhat ar^ndtr.Subject;:tP -:any 'dphbr-jhriposed re'strictiphV anci 'may' b'e.expended"'fbr.;any

jbu^pPse■in.[^e^rfo^fii^g^:the:pr^mary..pb|^net assets, iryiay;be ' bsedj.-af/the'<d^ ibf' the" 'idrganizatiPnIs.

mahagemehtandbParb'otb^ " ^ •

Net:assets 1 with iUonoh restrictidns; include. "net", assets suBject-'to-'

stipujatioris'.imposed'by^ fgrantprs. Some'donof restnctlbhb ire

tempPrary • In; inature.;:..tjip^e'-'restnctjons. yylH. "be imet by actions^bt'the *

0|^93'hi?at'PrtvOfJby|passp^ restrictibns-arepe/petu^in':natuj;e; •whereby.,they,don0if:^&a's*stip.uiated'..the.Tm:perpe'tuity.- ' • '

10

Docusign Envelope ID: E033EB7A.38EB-4564-AA6F-69F75B440109

PROGRAItfl BELKNAP - MERRIMACK iCbUhjTIES- IMC.; N6t^3 TO CQNSOLlbAfED FINANCI^t: FOR THE YEARS ENDED FEBRU^ 2^ 2023 AND 2022

'.p9nor.Testricteid contributions'lare ^re^pilecl.'^as^.Increases, in net-.-assets^.withr'dpnor-

■ restrictions. ' VV^e.n restrictipbp expjre-;nct-appets.'^are reclassjfiecl frprp."net'Assets with:dppbr:fes:tnctjonsVfp;:hetaVsefewithbut;,&9o>ipf.a'ctiyities. * ■" "" ' '' ■" '

thp;6/ganizatjp^^^^^ had net asspt^ with dpnpr fest/igtiohs.pf $564.96 J" andj'$63Z;52? ah■pehrMarY-28.\2P23phd'2.p22v respe^^ ' ' ' •V

V'' ^ •.

Ihcohietaxes

■Coniniuhity.-Ac{ionivRrpgram'"9hBelknap-M^e(;nniack;iCdunti^^^^ 'is-organized: as a*''npnp'r6fit\.cprpPra;ti0h:.a^^ iinCpnpe.'taxes pndCr.iplCrna).Reyenp§>

'Code iSeptipn 50,1 'Revenue Service'has-dCterniihed,the^ t6^:b^^^^

^thVrica*pfiyatV.fpurtda^^^ * ' ' '

The__Organizatlon;in)es; iinformatipn irelp'rnsr iri '.the/ United:StateV and;the/State.:&rNew ■

Harnpsf^ire..The -Organizatipp'Js: subject jto exarninations by tpx;authorities forJhree-'.years:' ' " ^ -.s ^.(fAP- BMC' beyeloprhen 'Cofppratiph: ^the '.Cpfporatiph) is tpxed.-as a ^C" Cpfppratidh-

under the Interhal.Bcven'ue'GodeV'the CprppraboH 'acCounts for deferred, incorne taxes

junderh-the; asset; and.^ljabllity' method..'ih'/aCcprd'ance wjthv Accounting ".Standar^^^^^ t

iC.odlfjcatjpn' Np; 740,;(ASC: 140)/'-AcQbuhtingJ^^ objejctiye-bf this;.impthod ■1s'{to 'pstablishydeferred: liabilities '.for tempdrary^differehfe

between, the: financiahrepdrting basis; and:the'tax baSis- of the/Company's asSets -and.'

liabilities at the enacted; 1ax'rate expeeted;tbhbe in effept when ^such': a'moutits Vrb-

'realized or Settled; iASC J40: also-requires-d^^ and Jiabilities^to^be'shown

fseparately; There'are;hd: defejfed^tax/d liabilities., The.Gorpbratidh'hes.Vha'.

federal net pperajJng.ibss carfyforw at February 28,:2'023'a^^^^ 2d22h.■Sandy/Lejge: hhijted'Parthership is-taxed as" a ■ partnership; ^Fedefaj:.earnings'. Partnerships/are reqUi/ed to'file. ihCorhe tax'retCTrhs-With the/State* bf l^eW.^

^Harhp^hire" and: pay ah InComeTax'At the ^

AcCquntihg; Standard;G.pdificatip*h Np.- 746h(ASG/740), lAccpdrif/ng. fpr^'/hpo Taxes,;eS^e6lished. the-'mlhimurri threshold,,f6r>:'recpgnjzing,. and' '_a system. •fo'^yrneascTrihg; Th'e •

•p^gpnizatjonjs cohSolidaledfinabciarstatem^^

Docusign Envelope ID; EO33E07A-38EB-4564-AA6F-69F75B44O1O9

'fCOMiyiUNITi^ ACTION PROGRAM BELKNAP-MERRIMACK^t c,., ^ • IV '

NOTES TO consolidate^ FINANCIAL STATEMENTS:

FQR THE YEA^ 2023 AND 2027

Prop'ertv-

'"Prppeny.and'epui^ cost^or; jrdqna'ted;;at thp;ap[5ro^^^ ^

aLthP daYe.pf thP.do^ purphased: with i.'diefuiJife/in'exce^s'pf pne^^

iaYld':ex&eding:l5j0007^^^^:uri|e5s;.;a lower thre'shold Is Required"'by'-certain'

dpnding'spurces,. '.Depreciation; isj cpmputed'-on thevstrajght-line' basis over trie estirpated "

tu^sefdl lives of theYeiale^

''Bpijdlhgs;"arid;impr.pvem^^ • "40 years

^ EqUjpni'ent,.furniture and vehicles. iS- IO yeard

-Ose of Estimates., ^ ^

Jha'pjeparatipriYpf-cpnspljd^ ■financial- stalehie^te conforrpityVv/jtri Uriited- StatesY

■ generally.'.accepted accpunting principles reqOires^man maite-estimates'^and '

a'ssumptionsYhaVaffeGrtPrtaih re^ and liabilities arid:di&l6aure'>

prdohtihgenfjassets^andjiabinties' at thedateiof, the/Cohso^^.fi.hahcial; statenients •

and theY/epdrted amounts:pf revenues."arid expenses-during^.the- rPp6rtin*g:rperipd;

t:^ctual,reaultS:coulddiffer.f^^^ ^. ' • / - ' "'I •- -n..

fea'sh and Cash Equivaiehts^ t"FPri purposes-of thedpnsplidated'aYate;mepts;pf cash.fl the/Orgahizatiph:dPpsiders:i

'a|l:1jquid.ipVestrnehtsd,MYchased^.with origihal;(Tiaturitie's, of.three:;hnohth's [ess to-be;•cashdquiyajentsr - ' ^ ' ". ■ ' ~ - ' -.

• adcduntst

^Cdhtributiohs.. v'Ajr contfibufiohs" a're cdnsderedjtp'be ayail^ for jihrestritted. use^unieYs specificaily ^

restncted/by the; doripr'..Amounts /edeived that:are. restricted by the dpndr.fPr future.; period^ pr fpr; spedific;purppses are" reported as.tempbfarily. restricted.of. peffhanentlyd

ires'trictedSupport; d^epending'Pndhepaturedrthe restrictidp., HpweyeY'\if aTestrictiPri' is;fulfilled Jn th'e.same peripd'ln which the' cbntributionisreceivedi the Organization reports •

';the;subpdrt;asu^^ '.

■■'Coritfifaufed'^SerVlces-,,. A-Dpnate'd;ser\/ices are.recpgn|zed:/as cph'tributipns' In accprdance,.wjth/'FASSi AsC -Np.'

''95Q]^iAcc6unting f&r^CghtHbutiori's'-pecei^^^ Made; if:the^sdrVicds"(a)'creatd df, enhance^hbh^financ"ialYass^^^ (b)> require" specialized/skills;.'and' would,'

otherwise be/purchased by^ ' - ' ■ -.

■Volunteers pfpvided..'yai;ipus -seiVicbS/throDghout.Yhe' year; that are': npf-rebpghized 'as"

«-dpntributlprts;ih,.th'e-cpnsotidated^firfanciSljstMements-'slpce the fecogriitioh cfiteri^.under;

\FASBrASCiN6:.9.58:lwere hot met.^ * ' " ■

A2

Docusign Envelope ID: E033EB7A-38E8-4564-AA6F^9F75B440109

1 /COMMUNITY ACTION PROGRAM BELKNAP j-^^MERRIMACK CQUNTIES.MNCa

NOTES to fcbNSOLIDATED FINANO'lAL STAtEMENtS.,

EO'R THEV'^^^ i202l and'2022

jIn-Kind.bonatiohs / NoncashTransactions.... „ «'ponated.-facilities,.seIVic^s^and. areoreflected as - rey,ehue arid 'expanse. In- the;.accompanying statenients,''.If-the= criteria 'for recognition,-is nriet.•'This.VepreientSvthe - estirriajed/fair "value;for the;service," 'supplies; -apd spaee^th'at-'tHe.''brgamzatiprifmight JncuYiundernofmal ■•The-Organlzatiori^jeceiyed,.'i$401,748 and'-'$592i'136/in donated'fac services andlsuppii'es 'for the^years'eridedii

!Fiebrud^y^28V2'Q2■3;an;diFebrda^^^ (See Note,17).'-'^ ' ''

Advertising.,.,

'Tfi'e prgahjzation-^ex^^^^^ -'cpsfS^as; they 'are- ihcurredi total..:a^dyertfs'in^j,^coStstorth'e; years erided;€ebruary;26,.'2bi3.and'Februa(y 28/2P22'tptaled^.$^^^,and.$134/l9'3;;r^^^^...

tlnventorv'

Jnyerit6ry:\p6nsists'dfi^eatheri,zation'Suppljes,-ahdj,w pfocfess ahdNs y.alued":a^

!ldwer pT cpst.'or heffealizable/yalue,.

iRevehUe Recoghitidh...

A'rTidUntsVireG^ ^;grarits/;and ■."bpntracts for specificsdurftps.es^vajre

'generafly,redp'gnized\^ incomectp 'the'eidprit th^at felatedi expehses'artd^cpriditions^^^

tincu/red'- pr met.^G'qndjto '-grants• 'fec^lvetf- pndf.'to• jhe.ppriditipris-'b'elng.';mef^'are'•reported-as. fefundabie:.advances:bohtjtbutfphs\of-cash ah.d othepa^

aV-with dOrior lrestn they are;recejved;with<dorlor limposed "stipbjatiops'that limit

■dhe"'us,e.df;the y6hatedjassets^..'Howeyer:^ restrictiorivis fulfilled, irt-.the 'sape period ip-wh1ch"the'^cPhtributipn;Js'!received';the^^G^^ the,supportjSyyitAdjJtS^^^

rfestrjc.tjpds".' " ' " \

I Program Service Revenue,

iPfografdXseryipe reve.h.ue;iSTepogn!,zed;,.as reyehue, when th

i Rental Reventfe.:..... -

Sandy liedge;(the Partriership)-;denyes revenues' from the ferital.df,%partmeht^ units.;lR;eye.hues'are recognized'0sJhcpmeV.itipntfi'ly,.when-,rents-becorhe'doe...qf^the-apaftment'-Uh to the ies.sees.,The. 'individual" 1e.as§s.<aretpr-a'.lteYm::6f1prie'Ye'ar-"an'd"'are:cancelable;by-toe';tenVnts.'C^ of.the leas.ed. units, js^.;,tradsferred to; the^.lessee iih ah^amount.thatreflects to'e cdrisideratioh-the Partriership'--

rexpebtoto'be^erito in.exchadge fo? toO^'easedi^^^ The, costlricurredltp^pbtain',■ thelease'vvinOepxpehsed^^

Functional Allocation of Expenses

rThe.cqsts^pf pfpVidihgtoeVaViduS.pjogtorns'anjj.olher activities.hayetoq^^ '

'Ihe CpnspJidated'iStateme^^^^ of ■Fug.ctton.arEtosrisesv Acco.'"dirigiycertaih 'cpsts; have;toeen allo'Pated^em jprbgranaiise^ices^nnd:s.upp;orting1" actiyitie.^^^^

Expenses' are'.charged^to^each.^-prbgram.'bas^^:direct-"e'xpenses^Jhcurred

Estimated uffgnbasOdo '

13 ^

Docusign Envelope ID; E033EB7A-38EB-4564-AA6Ft69F75B440109

r^OTEiS TO COlsJSblibAfED FINANCIAL STATEIVIENTS

t6r THE V^RS ENDED FE^ 28.-2023 AND 2022

' Expenje.« Method of allocation

■Wages;and.i6 'fime^ahdeffprt'"

■DepreciatibhV- %A"^ual assets used byjpfqgr^^^^

^;AlJ:b.the''r,experisies_ ■' D.irect;assjghment

■ r ^

'New Accounting Pronouncemehts

"^comperabijity 'among prganjzation'e.ibyvre^^^^ lease assets andlea's'e'iiabjiities' on.'

the^ 'stateriient, of "financial' |6os'itjdh " and /disclosing,key inform'ation ffabput. jleasihg,

^:aVrangVmenfe;for:1esse.es\any'1essW^ of use model\thnV

requires,, all iease&'witfi'a lease term 'ofJrnore than *-12; months,'to recpgnjze^an asset-

representing, itsl'nghtto^use the leaseterni, and. liability" to" mak^^^^, lease"payments to be fecprded,. fhe'Orgahizatipn electedobt to restate^the comparative;

^pe^od^TheJ0f^ga^izati6h'al,sb eleqted' h^ toJreasseSs at adbption (i) e'xpiFed or existing

■cbntrapts to determipe whether they a^^^ orpoh.tain a lease,'(ii)'the leaseolassificatio^^."any''existing leases,'j(iii)'initial direct costs'for existing-'leasesv The ad^optidn bf ''ASU.

' ■■■pf;^;3S7,5:^a^^2022. Results for

the''0rganization''s;his't6rical.accounting;treatrheht.^ not

Ihaye a^material,impact'en theiOrganizatioh'sTesuitsofo'peratibns.ahd

In' September,2020, the;-FAS5jssued ''AdcoUhtlng; iStandards Update > (As.U) No\ ioio^• 07,;Npt-fPr-Pf6fit'Entfties;;(f^ Pfesetftatipn 'and-Piscl6sufes..by'* N6t forfProfit'

^'-Entities^for Contributed; 'tslohfinaVciai'Asset^^ lirite.nded 'toVirnp/ove ^trahspafency''in/^fhe.,

reporting of cbhtnbUted;nonfihancial.assetsi-.also.known;as'giftsUn-kind,\fbp.not-fbr^proflt'.;,pfg,anlzations.jEkampies 6f cpnfnbutedvnbnfihanclal'assets include'fixed'assets sUch^a^• tahd,. buildings,f and 'equipme'li't; Ithe: d'se. Pfrfixed:' assets or "'utilities:; materials;-'and

rsupplies;.;VsUch' as-'food'-or cl6thihg:-.i'ntangib!e''assets:; and repognizedvcbntributed,

"services,'. sThe -;A$U{ < requires V a,A^t, 'for:profit orgahizatioh. fp present: cqntfibuted,nonfinancial.assets;aS'a;s^^ lineUtemrin'the-staterperif of activities.,-apart'frorn.

•4bntrlbutiohs\;pfybash*'br;;ptfier:financial assetsrit^also'requires certain disclqsures'-fof-

'each category;ofdbntnbuted;"hohfinancial-'aseetS'Tecogni2ed/T^ Agency adopted;th'e-

-.-prbyisipns of A^ij.2Q20-;0'7during-20^

fJT;,.iAC'COUNtS re6"eiVa'bLe.

^AccQUntsrjecejyable r at rhe^ arpdunt^n1anagement:■expects to cqllectifrbrfi.

■;6arance.s",butstandihg at",year end>^ that.aje still outstanding;after'manage.meht,'

'had.Used Veasbhable^c^^ ^afe. Wntten off.thrpugh a chargejtb'.theyaJUatiph'

" allpwahce'-and.a;cfedit to accounts feceivab!e;j*The,allowance, for uhcollectlbie; accoUnts-

' 'was',estimated, Wde: zeroat^Februa,iy '2,8^^ ThevOrgariizatidb'hasvhq,. pqllcy-for charging'iin.te.res't^pm^

14

Docusign Envelo[>e ID: E033EB7A-38EB-4564-AA6F-69F75B440109

I, ■

-.-...A. I -.v.,.C. -. %.

- NOTES TO COIslsbLIDATEOflNAliclAL STATEMENTS

f6r THE YEARS ENbEDtEBRUA 28.2023 AND 2022

REFUNDABLE ADVANCES -.

'.OidMi&MCOCiv.BU^.nt duvdnv^/diciieuurucu -.dd.leiunuduic duvdtivca. diiu ^a^''

■;reyebue-inT,Ke:peripd;jn which'the'Telated^iSe'ryices or;^ are pprforrned'or<

incurred..Funds ^recejyed iin -a^^^^ ■oTfgrantpr.bohdjtlpnp beipg met^aggregateld.$1;8lt.,3^Q a'nd:!$i;537f8b2:as of;February..28; 2b23 'and''2022, respectiyely:.LIQUibitYAnd AVAlLABVLjtY^

TheTd|l6wihgrepresehts;the;.0rgahizati.dn's.f!nancia1 asseU as" of,February:28:^"" »•. i 1 Ir.i. - - •

2023 2022

Financial assets at yeaf;end..

'Cash "and^ cash ebuiyaleritSi -undesignatecl'.Accpuhts fepelvable"' '

InyestmentV'"^ ' "

bash; reserves.

/Cash^scfow

J "i,^i..575:. ■

6;'027;912.

128;95.6':

"'74;'847:. *2.481.

$ ^T;384.485

■ '6,244.621''

/i38',-793

t8f;i43::

-.•8:3^5 ►^ f

Tbtal/in'nancialipssets' ^ 7-.945.771.'. ^-6;857.367-'

Less ai^iquhts not availab^b to'iDe^ 'Within..one.yes

' '\Net assets.with-donpr.reX^^^^ " ' '

• Reserve'fundi-

ir^..:564-96r-

74'&i7'

•cv..■6'37-.529'

- -.'781443V

AAmpDhte;npf available witKin;phe year" b39;8Ci8' -718:672:.

fjhanclaj assets'aya to/rtieet general

expenditures pyerThe neid.twelye mohths ■

lit, is '.the prganizationji; goal itp ■maintain'

'"expenses;-whte^ $ 1 b,2pb;bOi9Vand r$6

'^2022; reSpeptiyely./TKe prg^

-7.305:963:

idsets,t6;meet SO'days;710,000, at February

credit: with f$700jOQ,0'.s

'6^38:695

3 of 'Operatihg;-

28.V2C^3;^d"

i0d!^$445,650,'. 5.; RETIREMENT PLAN

Xi

0/gahjzatibri!haS'a;'qUa!ifieH.contrib.utpry;p;ensioh'|Dlan-W^^^

• empl&ye.es'..' the -.cost Vof' the;' plan Js- jchirgeb" to -"prbgrams admiriistefed"\by";4he:-. 'prgamzatiohV^ The expense of Ihe,^ a'nd'2022;

totaled $209/878 ■ahd'$ij^^^

•15

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

ilCOMMUNlrV ACTION PROGRAM BELKNAP - MERRIMACK COUNTIES. INCl

NOISES jd eONSOLIDATED FINANCIAL STATEMENTS.

^ JFQR^THETEARS ENbED FEBRUARY 28. 20^3 AND 2022

6,. OP^R^TiNa LEASES.........

iOri:J,anuafy7 T;^2022rthfe ibr0anizatioh:was,/e^urred. t6^ <

'(Topic^ '542^; As.part.of (implementing 'ASU '2Qi 6-Q2,'"the 'Organizatipn t.evaluated 'purrept';... 'cphtfgptis.'fpvdetermmejw^.rpet the::c"nt(Brla. 6f;a -lease.. The;nght" ofuse' (80^"') '

^rep^eVent'tt;le1^rganization^s^igh\tp■ USB; unde/lying assets for the^I'leasO'jiXbilitiPs. r^presen tp; make leas^e',.fr):)m'' these.leases^^^ ROU/'assets. and: leVse rjiabilit^ all pf^'which; arise-'frorri..

operating leaVes, Were calculated based on the\present value ipf futureJlease payrriehts

finahcial^tatefnehts^acepdnsidered-a^hbh-lease.com^

aTe^.rebqgnized, ■■as.tiposts" aje 'incurred,'' iThe,■ Qfganjzajion.'S'^^bpP^^^ leases^ are^. 'described!belo.W:"' ' ' ^ '

M*. *, ^' ■ Z ^ _

'Facilities bpcupledlby^the'-'OrganlzatiOn for. its..co'mmun'ity;s:e.iYice,.pi;qgrams

vuriderva'rio6b;'pperat(h'g"'iea'ses: Jhfe.\ease..tefmsj;rang ■■yearsV^ Fprtbe'year'erided:2022/'the'arinua! lease expense ifq^

'tbe:leased.,faciliticsvtfa& $586,53^^^

Jh^vapprbximateifuture^minirhum leasq payme^^^ as follows:.

Year; Ended

Februarv!28 ^

• k>. iAmount.

■ioik- -'488,157^

!72625., ", 287^901::2626.' '92;91'T.

2027' ' ■82'd06

2028! ■ 77i5d0'

''Thefeaftef^..477.665'

"ir,5.05i229-%

s impOtedi interest/

' Tptal.ii;i 117;902-

8 1' 387 327'

7,\.^ACCRUED EARNED TIME'

Thd^p'rganizatiqn jiaX'acp^^^ for future-vanhual'.ileaye fime.that its employees;'

i|}ayeVearned. and Yebteb amount ■of $6'91,,684;and,'$S6^^^

'F.ebruaiV', ^8r.,'202j3/andf;^^^^; ■fespebtrvaly; the 'Qrgahizatibn..am'endfed;.the, fpolicy';.; effective.March: 5262,^,\'the; pplicy/alipws

'■'to.tbe^n.ext'fisca|.Veaf;|ip^e^^^ ohly.twpvweeks-.wijl.b^^^

^twpvJ^ek';lialbl]lty1sii'?28'5^^^^ 2'8.V202i^ ' "> ^ *•

16

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109.NOTES'tO GONSbLIDATEb FINANCIAL'STATEMENTS

FORifHE YEARS ENDED FEBRUARY 28. 2023 AND 2022.;8.. BANK LINE OF CREDIT... •.,. ■

Th^-'Grgarifeatidri- has.a $26p;0;0p'rey^plving agrePmenV (the line) with'e,.bank th^f is'due^ph'demand jThej^ interest, payments'^b'^^^^ph' the/Wall ^t?eet: JPufhai: Pdme Sate,(7;75%:-and.at Febfua'ry 28,;2023 anij*'

!'2j^22;'(respectively)'p(us <1%., b'utrnot less than 6%.:per'annuiti. The jine is s|cVred.by->l!

•the 'Orgahization's^as^sets:. was- np- balance, outstanding -.at ■ February.- 2p^*'2p2^^^^

There Was;a;balahce.;bT'|.154(350. putstanPihg ' ' 'V I... ^ ^

Ther:Grgahizatipn/hab>a'reyoiyihg'ijne;:6Lcre^ the-amobnt^/of';'$5t"pb,'0^p0,..yvlth;a/bah1«; that is 'duejPa demahdv^ Jine-bajled^for monthly.^yaria^^ '

-fhte/bit payrnbnts.ba^edp.LIB6RTate;(i2.4i%^ 28,2022/. Thd/linVwal

^se'curedby'ajl.theiQrganizatipri'sTa'ssetsVTh'ere" pulstandingTatFebruaty.

^28,-;202'2'.,The:(ine;was closed'during.theye^rendedEe^^

The.^OrganizatiPn 'enteredyintP ian; additibnal.reyplyipb' line,Pf. Predif agreernenlilthe iine)'

in^the -ampunt,'P,f;.$5PP,pflC)/;.with:a pri;june.:2y..2023:"jfhe<'line cajte

rmpnthly vaTiable'jhierest, paymehts: base'd 'ph 'the VVall Strpet J.c'urna! 'Prinre4Me (7.75°/o >

•atEebruafy. 28^^ 2023)? The.ljne,ii5''secured;.bV all'the.iOrganizatidh'.s.assets.' There'was

'nb;baianee puts^^^^ Fbbruab*^8V2b23^,:c6NCENr^Ti6N6fSlsk^ _,.For "the*^year/ehde^ 2V23', ^apbrOxlmately,;$i8;3^ (29%/.. ahd>

■$32,600,606. ^'(5.1%^^^^^ the prgahlzation's 'revenue- was xeceiyed * ^frorh vthe

■peparttent^ pf'_ health y.;and^y6m, the' ■pepartrbent'''pf/Tjea^^

Xe¥peptiyeiy/' Jhef:fdture. vscale. and': nature, of: the < ■p.rgahlzatibn t is;dependeht' fupon. •'^ntinUed Support from, th^ " '

lio...LPNG'TERM DEBT'

Lpnglterni'debt:porfsisted,.6ft^ bfiFebruary28:

'2023>,';2d22:^;5l;50%Whpte*.payable^'tp-,mbhthly;i.in>Talirhen^^^ prihapaj.ahd..ihterbst' pL

■■$%634'.thrpUgh..Jyiyj^26i9-.--Th ls-^sOpufb.d..by.^propertyb/.thep ' " ' 210,'56p; "S;2lS,228'*♦ 5 •

VJ

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

NOTES Td CpNSbLIDAtED.FINANCIAL StATEMENtS:

'FOR THE'YEAKS ENDEb^ 28.:-2023: AND 2022:

V -»

ik * •-

/

5':75% 'note 'paVabl.e^to-.a^"^i[lna)^claT^'.'^ri.sijtutjorl • in

imontKry' InstallmeHts. for principal;'ar}6. 1hterest^;pT

■ $13.'9j2\th'r6ughJuJ:The;:aptejs

2023 V 2022;

'.prbpe^^lif the/Orgariizatip^'fbr Lakes !Regip

Center- - ■ 73,640.- 9,279'-

3.p6% 'npte';:payabie: fb Jtrie,:CJty \p^'.:CbnP^^ for"

isaSBnoiQ. iirTiproy^erMenis j.in ^rnoniniy *jnsia!imsnis Tor

»pfincipa(:and;iriterest'6f.$74^^^^^ the <

TipiSs IS *sccur6Q py^prppeny^oi ine L/rganizanon top in©"

>agehcy admihistratiyie.bpiid^ '35.:t7f -42,958V

7/00°/o hote;,payable;to,a'ban^

■fbr;priricjpa'l ahdjinteresj of $4',842 thfpugh; May'2b23.

';the' hpte^ is: secured - by, a. first /eal -estate;.rnprtgage"

ahdviassjgnmb^ 'rents and,' leases- on propertyX

M~oca"ted;,i"n Cpneord.;New,Hahipshire^f6r'Early tdead'

Sta^. 65.076 ■ h6,5?2.:00%' 'Paycfeck Prbgrgfm'lpan^^ to ■.a.,bahk^ io;..mbnthjy. ^ihstajlmbhts^y^^ ■■'pfindpbii,:ahd

' in'terest'^ or'$7-51'1 through

vended-^ebVuarySS; •2022; "'?8b;439'•1. ••

"Non-interest bearing, note;payab!e; by' Sandy Ledge,;Limited ii.paft"nershlp) Jd./New •'iHarripshlre* Housing,

t'defe'r/ecl'uhtil June. |]■.;2b34\pr:untiLtKe prbjecLis'sbld,,

' or feflnanceii/br'sOrplui'cash^ iTKe hot'ejs.'Cqilatefaiized by;a"'ifibrtgag'ejon real.estate.':341.922- - ■.345;b5i'.

1 Total Jong^errfi debt ib.efofb uha;rTiprtized deferred

^firfahcipg bpsj: 911,392 t:22b,;557 '. Unarhort.^ed' deferred^fihanGing, cqsts< ■.. !:t5:3i2'6tv.(5.803):

■Less ambunts duelwithih bhe-year'

■906-'072. (237.9261::i,214,754'.

i'(3l4r265). iLpjtg-terhi/pq^. » 6to'46- i

-18V

Docusign Envelope ID: EO33E07A-38EB-4564-AA6F-69F75B44O1O9: COftyflUNITY-ACTION PROGRAflfl BEL-KNAP -MERRIMACK C

'NOTES TO.CONSOLid'ATED FINANCIAL STATEMENTS.FQRTHE YEARS ENbED FEBRUARY 28; 2023 AND 2022

''The'scheduled/maturities'pfjorig-term;^ follows:^

'Year Ending

'FebVuarv 28-' Amouht-

'■2024'' '237,926'

^■2025:' ^ foe,259'.'2d2fe': 27,055;

> ''2027^ 'h3\294\._

■Thereaft'eri;5i6'Q97;

• 1.

11. PAYCHECK-PROTECTrONPROGfUM

' In^AfDrir 2920,, the, Organjzation.TeceiVe ipan proceed^ Jh;. tfre ^ ahriount.vof $,i;935 "S'PP;

/UndeY^'tKe Paych^^ ("PPPt).;: The'RPP/was. es

the Gofonavjfus Aid^ Belief;a,nd.Ec6npm Act (''CARES Adt").>

•On..$e^ternpe.r 14;:?621;-ihe'-Orgahizaticfn re"ceived'partiaJ!forgivenesslih

Y$T,9,15,'427:. The forgiyen 'proce^dsirejjhcjude^^ itl'cpme for thP.vyear/ended'Rebrua 1

•t

10) Y.' 'r

12:, fPROPjER^.^;PfppertyTa'nWeguipmd^^^^ of iFebfuary 28r;2d23:; 202^2.. $. 279:340, ^.279,340::Building-ah9tepi"9v®hi^^^.7,347;,8'74;' ' 'T.dSSl'Msp.■Equipftient-iand yehic^^ j 4;762-,'49,7' ■, 6,'.335,'485;.

CpfistfuctiphilT -■ •132.920'^: '-4^ jpf

' ^. 12;522,63r V13.745,685 ■:LessdpcUrpulatedjd^ -• '6,V65:-156' - zl528:363

f:|PV6p.0f^jah'&;eqUipm 'netT '$ ■ 6.357:475^ '.'$ '■6'^T7:-32'2-tf ' • - », * *

fde"prePiaii6n^;ex^^ for^the;;;9'earS:;e^ded^Fte ^2023 ^andil•202l'to;taie^^;$5^9T^85'ahd,'$.566;T5:t^^^^^ ' ' " 'V

-19-

Oocusign Envelope ID; E033EB7A-38EB-4564-AA6F-69F75B440109

COMMUNITY ACTION PROG ^ MERRIMACK COUNflES^^

WOTES to eONSdUlbATEb FiNA^

iFdR.tHE YEARS'ENDEb FEB^ 28^2023 AND 2022

t?! contingencies:

'The'Organizati9h'receiyes;grantfunding^r6tti yaH^

agreejTfienVothe is^feguireid.tb use'th^ funds vyithin a certain;p.en6d.bnd for'

tu'rpd.ses:jsp;ecifi;e^^^^ laWs/and regulatiphs.^ If exp>nditu?es;'werbtbudd,

!_not;'to;haj:'e^bMP:ni'^'deiin Ppmp laws aridVegu'latiphs.:the.X)rgahizatipn

migliit be'Jequifed, tor repay the";fuh'ds;"No.provisions'bave- beea made 'for thIs'

■.contingency!; because- specific amounts, 'ITany. -haye 'riot •beenrdetennined'br assessed - ■

ras of February, is, * I

14; NET.A^.:Net assets - with'-'donbr ^ feStrictjpnS\are. Oyailabla-'for.the following^. spe6ifi,c -;prpg farfi' ■servicbS'asrofFebrLiary. 28:, ' ";2Q23;:;262Z;NHSoob Paritfy Coaiition.$'■ '663' '$ ' 663^^

iSehiorCehfef;': '>142.251. ■Eider! Service's- 7,3"17^,,'6&,42t'

Ma'fy Gale^ ^ ^ ■•38,130. ■;2^29,:Nfci;RbtaiV;Fp6d*pftailen9®"'. J5,6^!

iS'ummec Feeding.. 20,56^'

rearing iFuhd:'' ':8;79,3''

vAgencyFAP ^ 60,913::27; 307

Agehcy^HeadSia'iJ'.;2l6j604' 2i2;25a;

';^ertcyAFP/Pj:^r{fejorfimunjty'^ ! '': '35b.'dthenPrograrns/, '458i Sobi'

'tpta(betassets;with;'dpn6 $ ■- 564:961 - 637.529'.

'.is:;RELATED party:transactionsr 1 ■

TherCyganjzatlon.serXes-as>the management'ageht-fpr.the,following.'Related Party * *Fuhcti6h:.BeirffonVEfderfy '. ^HUD ■prppei^;**-.. Epsom''Elderiy Hbu'singbjrtc;. HUD Rroper^'.'Altol^'l^obsingtbr i HU b^,Prqp;er;^r"'Pembfpk*e!'Hpusihcjifprfhe^^^ HClD^Pfdpei^?"Newb'gij^EldefiyHb^^ iHUfrProperty'-. Keareerge^ElderJy:!^^ 'HUp^Progerty-

'liRiversjde.iH.ousing.Gp^^^ iHUD;Rrdfeerty-\

t^inj^RLvlrs'e^ ^ffrppeHyrDeyelppni^^.f'dzanam'piace ^ iTransjtiohalSupport^

■^RC'G.-'HOuslng^'Llmi -^Lpw'Income;

' ' ' ■" ■"^■Crpdit'PrpRerty;2"a

Docusign Envelope 10; E033EB7A-38EB-4564-AA6F-69F7S8440109....

iNGTES TO'CONSOLIDATED FINANCIAL STATEMENTS

FOR-THE V^F^S ENDED FEBRUARY 28. 2023 AND 20^2

iThe ^rvires;perforriied by;..the. 0rgantzati6n iiricludeci; marketing, 'accounting^ Jtenant"'

>-selactTon/(fpr ^the'/HUp',prbpe ^HUD" ■cpmpfiari.ce,^(fpr the *'M,U0 properties)^ ^and f

i friaintenan^ ' ^ ^ ^

' The.aniounVdue't^^^ parties'for.ppefa_tihg.actiyrties '(c6jlective1y)Vt:.F^

*28,,'2023.and^20^2.yas..-$268^:$,324,385, respectively,.and! [s -inciude'd ih;-

►accounts receiyaOles. Additional amourits due from related parties at Febru,ary,-2$,'20^3 ';and 2022 were $81 '

FAIR VALlife OF^FINANCIAL INSTRUMENTS-

'Community.-Actiph <PfograrT)'Belk'na"prMerrirn'ack;.Qpunties, inc; hasalso Jhvested

t relating ■tO'itVFlxrit.program jn^cedaih^.The-'falr,value»'o^jthe' tnutu|i) •fcinds-':tptale.d'$^28.95^and '^^38;7?3j■at,Februa^y^28.;■'2623 and7022.^respectiyely

TASG Topic: N9V:825-iO,'Fjnan instfuments. provides a' definition-6? felh Value whjch^

''focu^Svonian exjt:price>Tath.e^ than ah entry pripe, establish'es.;a frarriewpdc In generally^

'.accepted'accpuriting, principles for measunng^fair value which'emphasizesnhat

►a. Jhar1<et:bas^d: nnea not an:.eribty-specific rOeasuremerit,, and' Require

-expanded dlsdosufes'abputfaifyalue Measurei^bhtsJ In accordance.w^:FA$B'ASC;'82^^

Tbe.prgahiisatipb'l^ay "UservalUatio^^^ with* market,^IncomeTaiid^;^

-.Spprpaches^'tp ijiTieaS^^^ value. 'As' a;basis for cphsidering^^^:participarit/.■assumption iri. fair ■ySlule 'measurements,-.FASB\ASC;;820:*es5ab^^^ fair valuS.

' hierarchy.^which prioritiz^^ used ^in measuring:fair yaluesV'The^'hiei^archy gives

'the highest; ipribHty';t6/t,e^^^^ naeasureiribhts and |oyyes,t; prioH^; to! imeasurertiehts.. The three levels of th'eVfa>'value: hterarchy under FA$B' ASC '826':afe.

■ described asfollows':^ ~ ^

Leyel 1 >. loputs'tathe.vajuatjpn:melhodo|ogy.are quoted^prices available in'

active rh'aiiets for identical inyestrnenW^ repofjing date:'

Level:<2 f' Iriputs-.toithe^-valuation.-meihodolpgy are other than -quofed."-ma(1<et

■prices Iri active, rhar^ets. Which are eithetdirectiy or indlfectiy pbservableaSi

■bf theTeporting'iate, and fai/ value;can be delerrniried through'the.'Usedf -

models or other valuatipn'methbdolpgie's^^

■ Level ■Inputslo^the'Valuatipn methodology "are uripbseryable Jhputs in'

situalibriS whe/e.''there^'^^^^ activity for'the^asset pr liabH^^^ ■

and;,the-'repprtrng''entity. makes astirnates and ■ assumptions reJated,to4he;»

pricihg pf thVasSet oc.jiabilityincluding' assurhptlons fegarding^isk-"'

^ At'Fe6tua!V,'^8,^2^ the Orgarlizattop's. inyestrhents werVblassi^ied as 'Level A'

and,wei'ebased/bh^faii^ Value,/

21

Docusign Envelope ID: E033EB7A-38e8-4564-AA6F-69F75B440109.ie6MMUNliT a'gtiqm

NofESTo c6ns6li6ated:financial statements;

FOR THE VeARS ENDED FEBRUARY 28; 2023 AND 2022

Fair Vaiu§ Measurements iisind Significant Observable Inputs (Lever i);

2023;: *202^,Bigihnihg bllarici,,^ftLitO^ '$ - '138;793' -$ ^'i26.9'96.'

vtdtal-gains (josses);. - (9^837)':;1T.797-^:End1ng' baia'nce - rnutuaTfunjds^ S 128.956" £■ •

The/carrying. amo.urit bf;,cash,. curi;ent*assets;.dther^assets,and current 'liaBilities;:dpprpximates fai/uValueTb*ecause;bfthe;sKort matur^^

i7i IN-klNDCONTRIBUTldNS/S.... r -.......The*drgahizali6ri'rebords'lhe'va^ contributions according to'the acboMPtin^^^

pplicfes described; m*^NoteIt '

The 'taij- value of glfts in kind inc!uded bbntribut]ons'-in th'e'firiariclai staten^enTs-and the

cprresporidinj';prpg;rar^ fot fee yeaV erided februgiV 28,> 2023, is as fpirpy/s:^

Vpluoteer'hdurS^.. ^..:.. ^

" iHeadjStart aridiEady He.a^ $.- 117,171

■SC^EP;' ' - ' 88,700

Jierita];syace*' ';146,026^AdVe^tising 15,960.

'*Dbriated goods, 33 891

18. REGLASSIFICATldN:.

- Certain amounts-phd ■•accounts. frorri Vthe.'pri^r ydar finari'dal $tatempnts''l)aye.beeii.lecjasVified.to enhance',the;Gomparabi!ity with ^ current yeai;.-

19. ^SUBSEQUENT EVENTS

' The Orgahlzatipn;has''eVdluate1d;subsequenieveritsrthrou^ 'Septembel44;;2Q23, tK^^

date the"'c6ns6iidated-fihahc1al statenrienti,were'available bd.issued.

Docusign Envelope ID; E033E87A-38EB-4564-AA6F-69F75B440109

■;:suMMMEkrAL'l^

'(See Iricie^

OBCtoIgn Env«op* 10: E033E87A-38eB^Sa4-AAeF-eSF75844010»

CQMMUWITY ACTION PBQGRAM BglkWAP: MCBRtMACtC CQtlMHF«t IMC

' SCHEDULE OF EXKKOaURES OF FEOERAL'ANO NON-FEDERAL'AWARTO

" ' -FOB THE YEAR ENDED FEBRUARY 2«. MM. ' > '

• FEDSlAL CRAKTOR/,'.

PROGRAM inlE ■

US DEPARTMENT OF HEALTH AMD HUMAN SERVKES '=■.HEAD START.CLUSTER

H^SUrt

'CRSSA. H«»cl SM.

ARPA - HMO Start

Low Incbma H«m Ene^'Asiistanc* Program

ARPA-Low.hKcma Hom« Energy Asebtanea Program

Low Incorne Horn Er;ergy Assistance ProgranhSV^'

■ ARPiMjwr Incarne Home Eniei^ AssiittMca Pro^am-SWP'

Lew Inorne VVatM'AssittarM Prcq^

Ponununity Serri^ Blod> Cmra

CV-Cotivnunrty Seniees BlocA Grant -

'Sodat SerVlm ffiodi Gram-Home Detve'rad 8 Cotfgr^ie Meals-

Temporary AsiistarKe for Needy FardBei-Firnny naivwig'. -

Temporary Aisbtarxe'for NeWy Familes-F^V PMrving FPAR-.

r'AGING Cli«TER^

TUeni, Pad S-Sertfdrfransitonation-

Ttte 01, Part C4iorw Oelivei^ Meals-Hbcs.TRia <n, Part C-Home Oaltvertd liieaiS'

Title 01, Part CrCongragata - i-

rm 01. Peri C-Gra6 and Go Meais

NSIR • • - - -. 'CHIi5 6UI£ AND'OEVELpPMHT FUWCLUSTER.Chfld.Cera 4 Oavetdcmem Btodi Grara,,

'ARPA-ChiU Cara 4 Dewlopnent Block Gfarx

Child Cam fAartdslory 4 MaicMng Funds of (he CCDF

m'ECHCAId'CLUSTER-

Medical AacrsttnM Program.

• Medical Asststam Program • Veterars

STLT Health CNpertmertiResoottM to PkMcHealtn or KeaithcaraCriM

' ^Family Ptanrung • Services

'Mslemel. IrtlanL'S Eai^ Childhood Home Vts'ekig Program-

NationalFamttyCsregiwSuppba T« hi. PartE-Service Lhk '

SpeAl Programs 1^ Aging, TMe iv-Sec.Ace.Ur*'Ststa HeeRh IhsurarKe AssistaiSce.Program

Macieare Enrcemant Assittanee Program

US DEPARTMENT OF ACRICULnipE

' Speciai Suppi. Hinritiort Program lor yVontM',Infants 4 CUdrar>.Seniof Farmers Market

'piiid 4'AM Care FoM Progim'

iCWLDNUTRmONCLUSTER-. ^ ^. Suomer,Food Service Program Ew.CMdrwir

ASSISTAHCE USTmO!

•NUMBER

03.600

03 600 >

BS^eoo:-

•PASS THROUGH GRAKTOWS NAME

' BS.sra •- State ol New Harnpeflea,03.668 State'ol New Hamoanira

|93.S68 State crt New Harnpshim

Stale pi New Harnceiiire'

03.490.State ol New H«npshira. 93.^ - State'ol New Hstrpthlra. State of New Hampshira

S3.6OT Staa'ofNawHampsNia'.n.SSS Stab of New Hanpshira

93.558 State of New Hampsrwa

93.044,. iStateofNewHarnpshire

03.045.State of New Hanpahira

93.045' 'iS.tate'oiNewHanpst^

93.045'. State of Mew Hampahm

93.045. State Of New Hampshire

'93.053 'Stsie'of New HampaNrft

93.575 Steta of New Hampst^

93.575 Stale of New Kamoehtta

93.596) Stale of New Hanpsltire. 03.778- State of New HanpishSre. 93.778, Gateways Cornrnvnliy.Services

-93.391. Stats Of Now Hanpsi^

93.217 'Stale Of New Hampsiyra

'93.870 ' Sbte of New Kamoshira-

93.652 > Staa of New Hampshka -;.93.CM8; State of New Hanipshire'

93.324 Staia of New Hanpehire.

93.071.State of New Ksnipthre..10.557' State of Mew HamnNre •

10:576.: Stata of New Kanpshira. 10.556- ''State'of New'Hanpsl^y

i10.559' - State af.NewKanpshlra.'

tPgNTIFYtWC NUMBER 1. 01CH2052-tl3k>r •

OIHETOOOeZS •'

1HE000387ioi-01

CLUSTER TOTAl:

03-«2-52-520010-ieS70o66

02-^:52:s20010'244900d0.

02-52-52-520010-35400006-

a2-52:S2-520010-24490000'^

TOTAL -

02-5242-24520000-

•2001NHC^'3

2001NHCSC3

TOTAL

'0M5-48-I8101042S5'

200tNKTANF

200»HHTAt«F

TOTAL*

l7AANtfr3SS

2l0tNHCMC6-

2tOtNHCMC6

2101NHCMC6

>2101NH'Chrc6

' 1056477. " •.'CLUSTEiR-TOTW.

•NONEPROVIOED: NONE PROVIDED.CLUSTER TOTAL

I90NWPG00040140.

CLUSTER TOTAL

•NH7007000031

' FPHPPA016063-

♦ Xl'0MC33535'

ZOblNHOAFC-CQ.

0OUPO241O2,9OSAO0Ci3<Q-o6'. 2001NHMISH-00

• HWTOTAL ■

V15154NH703W1003 4 50C3

1»4'nH063Y8314

NONEPROyiDED'. _.Wi

'■NONEPROVlbED*

'FEDERAL. -^PASSEOTHROUGH); EXPENDITURES TO SUB-HEbPfEMTS.

4,916,443'

• '82.597

- 347,070

5,346.110

5,383.170,•3,207,214

177,356

-437.212

< 6.204.952

33.094

385.693-

M63,017-

568,710

249

1.211

1,460

■ 151.805

83.419

754.967

143,218

68,237

187,306

1.388.953-

-

247,101

191J32.

-S7.7M'

469 041

104.589'

-

14.256-,. 118.645-

396,344.

43.577,

145.7M

33.468

47,971

20,307.

4,011

'724.991

67.064.

143.641

X*9.T3..Saa NoM te Scl)aiduta7o(Espendtturas of FadenI Awards

- - * 23 •

Oocutign &iv«lep« ID; B»3EB7A-38£B-«Se4V^AeF-68F75B44010e

'PEOeRALCAANTOR/

PftOQHAMTtTli

food"OiSTRieytlpN CLUSTER

Conmodity Food Program'

•Comnxidity Sisotemareai Food.Pnyri

' Enwgsnqr'FoodAssittarKaPtogrsrrW^nanisnUon'

EmerDtncy. FoQO Auiitsnea Program b'

> CQRPORATWN FOR WATIOWAL t COMMUIffri- SgRVICES •

^FOSTER Gl^'DPAREKTS/SENIOR COMPANION CLUSTER

■ Sortlor Companion ProgrBtn'

-US DEPARTMENT OF TRAHSPOWTATIOW

Foimula Qrants fw Rural Aieaa-Concord Transit i

ASSISTANCE UST1N0

ioassa-- PASS THROOCH GRANTORS NAME tPgmiFYlNtS NUMBER

•TRANSR SERVICES PROGRAMS CLUSTER

Enhanead MoMty of Sankn S Ind. W-Pbabibiaa-CAT

Enharrced MoMity of Sartors S ir<d. W/DbabttlUes^iO SWo/wapohaiian.

Ertwneao McMty of Seniors S Ind. WfObablUiaa Voluntoar Offters

1^ DEPARTMENT OF HOUStWO AMD URBAN QgVELOPMEWT

Emargoncy Solutions Gm, CV-Emargenqr Sohriions Grant

Si«ponNe Housing

Continuum of t^ra' Prograrn,.

US DEPARTWEWT <y EffEROY

MJA-WeatNarizatlon Assistanee tot Loa Irwoma Persotrs.WaaOwnzatien'Aasbtanea (or Low'tncbmo Persona

US DEpi/^TMEfh OF LAflOfT'

Sat^ Commurtity Sartlos Emblpyment Piognni

U.S. DEPARTMENT OF TR^SU^

Corwtaviivs Stats M Lo^ Fiscal RaoovaiV Funds

Gmargorcy

Emargeney

Emeigsncy

Emargency

Emargancy

Emargency

Rental Assistanca

Rarrtal Asrirjnca

Raraai Assistance

Renal Assistarwa

Renal Asalstartca

Renal Assittaixe.Program

Piegiani

Program-

Program

Aogrem'

fto^ram

INON-FEOERAL

' NEW HAMPSHIRE PUBUC UTttJTtES COS^ANY

-ElaciTtcat.AssHands Program'^

10S65-' Stato ^ New Hamee'ifea

tO.Stti StsaofMewHamtsnire'

TO.SeSi Sua'crl New Hamosf^

•10.S69; State ot New Hamastiira

«4.0ie'

70.S0O-

».5«

20.5t3<

20.513'

<ia,23i

'14.231

14335,14.25?

81.042

81.042

y7.235

21.027

•21.033

21.023

■.21.023':2t023'

21.023.

<21.023*

■ State of Naw'Hampahira^iepertment of Trensoortation.

' Stm'of N^ HattpsWfe^laearaTWtit of Traraoona'Jo^.Suto^of New HampiWra-Oatwimetn ot TransoortaSon

Menlmaek.County < ' ' ' '

Stau of New Hamptnbe

Stsa of New Hamcanea

Staa of New Hampatrira

Stau of Nmr Hamptliba

Stm of New HampsMra

• Staa of Heir Hampthira

State of Ne«« Hampanin

NHHou^ng

Merriry^ County'

'NH Housing

NH Housing

NHHousirai

NH Housing

NH Housing

ERAP1

ERAP2

204NH8t4Y8005'

f..264NK8l4Y800S>

eirsGciool

B1750000'

CLUSTER TOTAL', USOA.TOTAL

-'leSCANHOOl

elites TOTAL', FEDERAL.,

•eXPENOmiRES

& 452.8411

< 250.749

• 489,781-.

S,851.018,

NH-18-XCM6

NH-18^X043 >

NH-18^X043'

NH^SOCOOI

ICLUSTER TQTAL-

bOT TOTAL

05-»5-42-4230tO-7927.OS«-42-42301CL7927

■TOTAL ' ■ ■

65-aS-43-4230lb7927-in-60(^31

OS^d5<42-423010-7927.102<500731

KLO TOTAL

ti4>4M2aeie.ei=eaw«7*4eear

e«4Mtai».aMeemr4.HTO

006 TOTAL

'10447gi"

DOLTOTAL

SLFRP0145

Cols WaaiNar Finds -,,ERA0012 Mid ERA0435

■■ERA00I2 and ERA0435

ERAE0119

-Ho-jsing SatKty.. ^'treasury totm.

TOTAL-

7.044.396'

8.1*28.857

4

- - - 322.224,S'. 322.224 •

S 'Sj3.473;

82.428 1

28.781

• -64.S5B.175.108

»■ 799.641

S' 105.939

234.484

340 40.1

55.055

125.030

5 521.488

S - 3&ee2

288.813

5 32479S-

S 337.303^

$ '337.303<.5 2.872.852-

22.929

'•15.913,288;

•12.651.588

459.514

14.848;

79.565"

S. 29141.710

s.-."M.01'4.3k'

1.8.... 'iS0.744.79S

• PASSED TKROUGH. 452,841

<33.528

«8 isfbie-

6.337.357

e.337.387>

8.337j57T

'••1,729.270'

Sm Notes to the Schadula of Expandlbvaa of Fedaral Awards-

' 24' '

Docuslgh Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

clQMMUNitV Action p^66RAMEiELkNAP^^

INOtES TO SCHEb OP FEDERAL AWARDS.

' ". FORTHEiYEAR ENDED FEBRUARY 28" 2023

Nptfi BASj^S bfePRESEN^^. ^. v -

" The:acc6rinpahying^^^^^ of, federal* awards ^(the.' Schedule);

iincludes'-;the ife'deral 'award.eetiyity. of Cdm Program'^Bejknap-,MerTirnack'G6ehTes; Jnc. under.programi'pf,theTedefaljgoverhm^e^ the,ye£i.r;'

•fenced'(Febrliafy;'28,;5623. The•'mfpniriatidh nn;'this 'Schedule;is^ preseritedJh'

^ecpfdance: Wilh/.the requifemehts■ of-Title 2- U.S. Qode:ohFedefal,'Reg'uiatiops:

"Paif'200,' yoifQrm.lAdrn^^^^ Cost-Phnpfplei' and\AudJp

[Requfreijielits: [for fiedera/.'Aiyafds' (Uoifprrri ■ Guidancej,. Because dhf-Schedule'

presents pnl/e'Selected portioh^f of Cprpniunity; Action'Pfogrq^

BeiknaprMerrrniack CpuhtiesVlinc;, it'is'lipt ihiehded td:and doe's'inpt preVent the\

fipahclklipositioh^^chang^ net assets,;or 6ashvflpws;^^^ Organjzptiqn.'

■NOTi 2 SUMMARV OF SlGNIFiCANTAb^,, _,

€xpehdifufes^;rdp'prted on the' Schedule are reported;,on dhe-a'c'crual Basis of

accouhtjng. ^SucB'^xpendituVes are'-^recoghize^ -fpilowing the'.cpst/ prihciplesjcpntaioedrin'the 'Ubifbrrn'.Gu types of expenditures e're

allPwableVbr'ace '.liryiited'aS'fo' feinibursement; Negative efT.ountsxshowni'O^^ the-

iSphedule Jrepfeseht ^iadjustrnehts v ^credits ^hiade ■ In' the;hpfmaj dpurse^'pf

business tpjampunts reported ks expe^ -...

NOTES i'NbiRECt costi^te; ^.

Community;Action Pfp Beiknap^Me/.rirnack^.Cbunties. rnc.;has e|ected;tp; pse^'

•the*.tfn-"percent-de iBinimis.'ihdireGt-"Post-rate ■allowed pnder' thevUniforirV

•Guidance.

NQtEf FO'oti cOMMdDITIES AND-^EHICLE^^^, ?;Nonmpnetaiy'-assistance iSi fepo^ Sehe'dule at 'the-ifair yalue.of.comrhoditiesTeceived and:disbursed!

25

Docusign Envelope ID; E033EB7A-38EB.4564-AA6F-69F75B440109

Leom

4i6ve!? •nvciiFebORO.

'NOmiCOfiWAT'......

"iNDERENDENt AUDlfOR^' REPORT OM INTERNAL CONfROL OVER FINA^CiAL

i REPORTING AND. ON.COMPLIANtE AND OTHER MATTERS BASEDTON'

*. AN AUDIT OF FTNANCiAL STATEMENTS PERFORMED /''

IN ACCORDANCE WITH GOVEffWMENT AtyP/r/A/G STANDAR6s

"To tfelBoard of Direc^^^^

^Commun^Actipii'Rrbg'^n^^. ' « • a,W^';haye. audited, in.accordance; vyithThe';,auditing.standards. generajly.accepted:in.the' United;

State$_.6f^America and the standards;;applicable'fe.contained in.'Gpi/emm;e/?f

%Odiiing' Stqhdard^^ issuVd ^by^lhe. Gorqptra of the United.States,-.the.financial-

i'tatemehts tof'Cpmiinum Belknap-Mernmack' ■Counties,;ihc^;(a;'n6hprpfit,. prganjzatiph)', which comprieeThe atateme;ppsltion ss bf f ebruary '28:,:202S^^^^; thb; reibted:- btatenients'^^.fuhclidnaj I'eVpen'ses;. 'and i'cash flbwe, for the/year, theii

• ended, and'the Velated;nbtes.tp.-Uhe'ifinanclarsta^^ have/issued our'repprtbtherep

■dated:%bteniber^^ '

Report on/rtferna/;Coh^^^ Repohih^:

* "* * • •

■\ln'planning and'pei^ofniing' oUn;Va_Udit.bf>the:.;financial'^ ■cphsidered/C.bmmuhih/

VActibnVPrbgram}'!6elknap-Mefnmack''"Cduhfies,-;tnc;ls^ cbn'trpr over ^flnancial■ reporting

i(intefnal',.qoptr6l):"as.-.av!b^:audit\procedures ithat.- are: appropriate':ih.;the'

I circuiristancesTphthe' purpose qf expressing:bur_Ppinion On the financial:etateitrents,'..bu.t; not

/fpr 'the ''purp.dse..pf -expressing'.an Opinion bh the effebtivehess of Cprhrhuhity Action iP.rpgram;. BelkhapTMerrirTiack Gpuntieb, ![nc;'s internal oo'ntrpl. Accordingly, we: do not lexpressyah'

dprnibn on'^the-effectiyen Community.Action "Prograrn Belknap-Mer^^ Gpuhties,-

>lhc.'s-1nternai; control-.' ' • ' '. •.

A deficje'ncylh internal fcohtrpi exists when the design or pperatiph of a control Ooe.s''hot allpw

' 'rinariagemeht pr empjpyees, Jn' the normal tcouree.'pf: performing their assigned functions, To ■

prevent,'h^"'detect'■a^d^coVr■e rhisstaterh.erits,pn^a tihiely basis, A rnatena! weaknes^X'iS; a.

1 deficiency,.ot''a'Comblhatl6n'Of- deficiencies,'Tn:ihfernal cbntrbl, such that there is a%asbnab1e

OPssibijityThat aj imatefi.aj misstatemeht.of.theOntjty's financial.staternenls will.:nqt be prevented,

'Or?detecte;di'arid:cprrected.vbn'-aTim'ely\b'asis.;iA;sighificant'deficienc^^ a deficiency,, br -a

opmbinatlbh'of deficienclesV.ih Ihternal contrbi that is-less severe fhan.^a, material.Weakness, yet

■ iinfiportant enough to merit attent^^^^ by JhbsechargVd/w^ goyemance. '

'■'OUrOqhsjderatibh'-^ ObntrqUWas'* fpf. the^ limited. purpose'described in -.the -firsL

•,'peragrai)h. ofthis- 'seetipn;'and;Was/'n^^^ To' identify all 'deficiencies, in Jnterhaioohtrpl'that might-be matenar^ sighi.fi;caht:deficlencles;'plvqn these llmitations-i during

■puhaudjfwe-did;n6Hdehti{y-'a,Qy\d,efid^^ consider tphemater^^^^

* weaknesses. Hpweye_r: ^rriaterial;.'weakne.ss;e|. 'Or signjficaht deficiencies jriay..exibt;That-.fWere.

hot identified!; ■ ' ' ■ - ■ -. ^ -

yie'-.

Docusign Envelope ID; E033EB7A-38EB-4564-AA6F^9F75B440109

Re/yotibn.Cdm^ OthefMatter's ■

4part;;of bbtaihmg/reasdn^^^ assurance;eibout yytVet^ Community 'Action Prdgram'

Belknap-Merrimdck.Counties', Inc/s^fmancial statertients are'free frprti ma.teriaj'rni'sstaterhent,.we.-,perfomied tests'pf its,cdippliance.with: certain prGyisions-ldf laws,, regulations.,:cPritracts>

'apd/ gfarit agreertients.-i ndhCpmpjianc with' which. could' have.a.direct and rnaterial" effect, on,:

-■tHe:-deter}Tiinatiqh:.otrt statements, ^Rowe'yef.^prpviding..an ■opinion on..compjiance.

with thP^aprovisipns Wa&.hdf.a'n'-pbjectiye.and.accordingly; we'doihqt'-.exjSr'esS;'

r.such/an;ppinipn^'Jhe^^esults'pf.bu^te^^^^ instances 6f noncpmpliance or other

■mattefsjh'at-a%required:tp;fee repbrted,under;;Ubyej77menrA. Purpose of.this'Report

' The. purpose pf this Tepprt is 'soleiy^to describ.e'^t^ se.qpe'of^pur testing of internal,.control and;

<poniplianceand theitesults/jo^^ opinipn.on^the effectiyehesab^^^

•IhelOrgahizatipn'^f internpTcontroto'r.ibh.compliance.■fhis'fepo'rt is an'.integral jDart^of.ah'.audlt-/performed'''in' ^accprdance ' With ■ Goye^ -.Auditing <Stahdards' i\n xbhsiderihg..the:

'Qrganiza.tibri*s.interria|';cpntfGl:Pn,d;c^ th.is,cpmmunieatipfi,'jp.^n^^^^^^,fbra'ny;pthbr„purpp^^ ' 'T- ' "

♦ »

'D6vef,,New Hampshire ■

SepterhberJA, 2023

27>

Docusign Envelope ID: 6033E87A-38EB-4564-AA6F^9F75B440109 '

Leone,

'QOyKK'-WOlfKBORO:.NOimiCONW ■

INDEPENDENT AUDltORS'-REPORT ON COMPLIANCE FOR EACH.

MAJOR.PROGRAM AND ON INTERNAL CONTROL OVER COMPLIANCE:

REQUIRED BYlTHfe UNIFORM.GUiDANCE

'Tbthe'Bd^rd'OfOirectors^,,.. _..

»Cpmmuni"ty Actipii-Program B.ei^hbp^TMbn^ jhc,.

Re/tbrt pri^Cp/rtp^ Each Major Federal Piro^ram

{OfjjnipndnEaCh^^

■yyeihayp audited Cpmmurilty/A^^^^ P;rogram;;SerKhap Counties;;ihcVs:,cortiptiance

'With/the;^pes;W;c6mj3llaiiceyrequi'rdmfents.'described;in'\he

■cbuld.^Have. a directv phd material'-effect on^'each of GommuriitysAcdon 'PTogram-Belkhap--

iMernmack' Cpunties> IriCi's ^majpr'federal prag^ams:if6r the year ended Tebfuary;i8, '2023'.'

'Community Adtlbn Program Beli<:h^,lnc?s fnajpr federal:pr6grams^afe

'identified;ih.the::surpma(y of aud rbs.ujts section of the accpm'panying'.schedule pf finding

an^d questipned costs', ' '. - ■.. ■

• In; pu;^-opinion,. Cofprnuni^^ Countjes; J.nd>^c6mgiied/ Ip all

'material:r"esp_ectsy;With;t'he;types^d^ referred to abovp that'could have;a direct and imaterl^l affect oh,each 6f;its,rhajbHedefai 'prbgram"s for the yean ehded Rebruery -

i28.gd|!3;.' ■ '; ■ "■ ■

Masis fofjppihipn onEach Mayor Pedera/,Program

Vye.'conducted' pur audit- 6f/borhpliance-in.accordance;^with auditing •stahdafdS'.genefally;

accepted jn 'the''.United ^States'of. A^.the-itaridards applicable \t6 Vfinancial 'audits-

cohtained jp GoVemmeh^Aud/d'^'g S/andarda, 'issued^' by 1h"e- Gomptrbller General cf the United •

•States:',-ahd ithe -audltvrequireme^^^^ U;S:-Code.of Federal ■Regulat^^^^

'Vgfe/T"; Adrnm/sfr^^:Cosi"Erincip!.e.$i and Audit Requirements, for Federal

■ Awpid$}'(Unlfbrni.-dtJidahcp)...;0!ur'':rebpcinsibilities under.tho'se startdard^'.'and.-the:-Mhifpita.

^;Sujdance^are,furtherdpspribed in,the'Auditors,'.'R'eipph^jbjlitles. for the. Audit-pf'Cprh'pl'ahce.:$ection.bf,our

t-VVe.are.vrequtrb^^^^ independent cf Community, Abtioh, PTQgram;Belknap7M

gpuntjes^JnQ-and:tb\hieetdijrrdther'ethica -respbrisibllities,.In.aceordan'dB:With "releya'rtt ethical^.requirements ifelatih'g-fe;.our:*ajjM;We belieye/that the' audit'evidence iwe^have;.d6tained ms;

sutfcient. and apprppnate tp;;provife^ bur 'opihipn on cornpjiance for each major

TedejaiVbrogfam.VO,ur-:audit:vdb^ a Jegaj •determlhatipn'!oK^CQmmanl^^ Actiohi;' Prpgram/Beikhap-Merrimack/'C/OU^ with'the, cpmpljahce Tequirernehts

leferreb'.to bbpye'.' ■ ^

\2B'

DocusJgn Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109

<^Resp6ns/b/7/ftes of.Mahagem^

' ' Management isjresponsi^ with the requirements referred td;,ab6ye and ifor 'the '

•, design,.'Jnrjple'meritati^^^^ and maintenance of.effective inte.rnal, control'over compliance with'the '

/'reguirements =ofVlaws, statutes, regulations, rules, andj ■ prbyisions' p^.coritrapjsror ^grants

i• agreernents;.applicable to 'Comjn Actibn program.Bejkriap-Merrimack'. Cpuniies'.'[nC.-s'.«

'federalprpgraiTi.s. ^ ^ - •

V J -

''Auditors* Responsibilities^^^:0ur pbjectives.are;t6 obtain Veafs^^^^ whether material nonc:6mpiiance with-

'the:cpnipliance'requifemehts" referredI'to.ajfe whether due to frauecr-ferrbr.' andr

express.-an opinion bp ■Community Action.Prpgr^ Belknap-Merrimack CountieV, fnc-'s^.rampliance,based oh'our^audityRea'sphaWe/assu^ 'isa.high level of assurance, but is not-

ab'splute aAsurahce^and therefbre;ii\ihpt a gu^^^ audit cohdueted In-accordance •

y-with generally;acc:epteci auditing^stanP '^oyerrirpent AudiUng S'taridards, arid.'the UnifofmV

■ -Guidance will' always; detect material' noncorTipliarice*when it exists..'The riskHpf hot detecting:

materiali 'honc^mplian'cb,.resulting from'-'fraud/ is highe'r than "fpr^ that Yesultiiig/frpm'.erroriVas.

' ''ffaud; may involve'cPllUsion, forgery..Intentiphal orhissiohs, riiisrepresehtatiotie, pr the 'override

/of 'interhai cpntrpl) 'NoncpmpJiahcA-wift the- cornpliance 'requirements, referred; to ■ above \.\S."

cprisi'deTed materiallf'there iA a cpbstaq^^ that, lindivldually/ of-in the^ag'gregate,,''it-''

would; influence'the.'judgrheht;nnade'by.e reasonable'useN^^^ report pn cpmpliarice/abput i

• OpInrhunityV'Action pro iBelkhaqrMerrimack; Counties, Inp.'s;.comgiiance' w'th 'the.

requirernehts of each m^Orfedera^^ ■

- Iri'herfdrrhing-an'agdit-jhiaceprdaricewith^gener starida.l;ciV, 'Gqyernmpnt'^. A.ud///hg;Sfandarc(s,4arjdrthe;iU^^

' Exercise, professiphapjudghient and majrita skepbcism4hrpughout''.the •

audit. ' _ ^ '

■. •' Identify and-assess'the risks^ofimatenal no^^^ whether due, to fraud.or error,, and design\ahd.p;erfom) audit, "procedures fespbh t6;thbse'risks.ySuch;pioceyures;

ihclude fexaminihg,.p'n a/test ■ basis, fevidence -regarding Community Action 'Program^

-,Berkpap-MefriiTiack' Countie^.compliance *.with the.compliance;requirerhehts^. referred to;above and performj^ sUch'bther;p,r6eed.ures/as consjcjered hecessary in;

' the, circumstances;

* ■Obtain:ah ohderslaiiding "bp.Cqrhmunity Action P^^bgram^Belkhap-=Me^^mack^Cbuhties,'

Inc.'s internaj /control.over -cprfipjiance^ relevant to. the audit 'in order i6.,jdesigh:audit

■prbcedU/es'that are;;appropriate in the.circum^ah^^.to test and freppA 00 internal

■bpritVoi mver.cbmpjianbejn^accbrd^^ the^Onifdrm ■Guidance, but.not; for the/purpose of ^expressing 'an ■Opihj.pn on;'the- effectiyeness ^of Commuhity Actiph program

Pelkhpp-Merrimack' Counties'..'Jhc ihtprnal'control/oyer ■c6mpljence:;.Accprdihgly;^ hp.

Vuch bpjnipn\iS'expVeesed.r " - - ■ ■ ■

'^e/are,;'required.to ppmmu^ those'charged witji gpyernahceTegarding,''ampng:pt^^^

' matlers>'the;planhed -'scope 'apd;timlng'.pf;the;audit *;'ah^,'any.significant deficiehcles..and.

hriaterial! weaknesses ihJnteVnarcohtror.dver cbmpliahcejthat wejderitified during the.audit^.29

Docusign Envelope 10; E033EB7A-38EB-4564-AA6F-69F75B440109:Rej^ri6h IniemalCbhtmt/p^^

A deficiency.;inv tntern'aj cdntrol\oyer' 'conipliance "exists.'When:the design - or 6perati6h':6f *a'',cohtf:ol byerdompliahce does'not fallow irnahag^^^ ih'the nprffiai courseibf.iperfdrmlng'theirassign^^^ fgnctiphs, tdjpreyent, or detect'and correct, honcprnpnante;With.a.type of compliance requirement ofa'federal program on; a timely basis. A material.weakne's^in; •. internal.control Over'cornpliariceJis pr -cpmbinatipn of deficiencies,, in'jriternall.. 'tehtrcl-i^oyer ^Tq5)rnpjlarice,;/'s.ud)V |hati ithere.'is:;a: ireasonable ppssibility ^that-,'ipjjtertaj..nphpompiiance;With p.typp; pf;,cprhpllanc^ of. a federal prpgrarn ^"will \n6t W'

■prevented, of detepted 'and pprfeded,■^pAbmely^ A significant-deficiencV in" Jntefnal-i

^,cphtr6! ■ over cPrppiiahce'is. a- 'deiRcie^ -6011161031100 of deficiencies, in, internal-control

■ pyef compliapce vvith'a'^type-of.compjiahpe. requiremeht^of a fed^ prograni^that'is;less seye/e.

i.than'"a imatefjal 'weakness^ia internal cpntrpf^pyer contpliahce, yet important, enough tp meVit'

vattentipn'by.thQsecharged.with gpye^^ ' * '.. bur (^nsideratiPh" Of.'ihtefhaj cphlfpl dyer pprnpliahce 'vyas.fdij the'^lirnited pu/p6se described,'(h

'.the AUdjlors'^Respdnsibilities-fpj t^^ above and wasinptdesl^^^.tP.'iidentify;all.'deficient:interrial.'"c6nVpV\dyer';C^ that:mlght bd 'pfiaterJal

■ 'weaknesses'' of; significant. deficiencies. 'In^. ihter#^ cpntrpV- over- compliance., ■Giydn 'thede;

limitations, dufihg} ouf 'aPdJt^we.^did mot. i'ldentify" any deficjehcies:ln jntefhal;contr6l;:pvei: ''.:cprnpliance;that/we c9risjder-to,\b'e,niateri^ ad defined^ab6ye:<Hpv^evef;, material

oweakne.ssesmf signifidant-d^^^ 'ihterpa'l cbnjjof b^^er co.mplian,ce-fnay;dxi$t^

Abt'be'eltlderitifie'd..• - " ' ' • ': 0'u>faudit was hotrdesigned.for the «purppse of; expfesding. an 'opiniph on the effectivenessiof^

' infernal dontVqf.ovef compiiance.^^pcordingly^ ^ "

' The purpose blthis repprtlpn ihtefnal contfbl.pyef;cofnpllance:is splely.to.descnbe the scope of

o'uf'testirig of jnte'rriai contrdi; over, cdmpliance and the results of thabtesjihg'based.'on the-

vrequifernerits ^ 'Onlfpfirf Gutddpce.vAcc^^ Report is npt-suitable fpr.ahy:6lhef!,:purjppse.,^,/' ^

^ ^Poye^,sNevy,l|Ham"pshlre'

Sepfefnber 14,,2023-

1:30-

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F75B440109;GQMMUNITY ACTiON PRddRA[\/i BEljKNAP.IVIERRIMACK C'QaNTIES. INC.

^SCHEDULE OF FINDINGS AND QUESTIONED COSTS

" 'r FOR THE YEAR ENDED FEBRUARY 28; 2023,

-, - - -., 4.^. -i.. • -

iSUMMARY OF AUDITORS' RESUb^^

1.' The)iuditprs'^ report pk^'resseS-aji- urirrto.Bified. bpipidh-pn whether'.the financial statements,,

■-of 'Gotn^nunity./Actibn-ip BelknaprMernniack", 'Gbunties,,!nc, -were prepared rin^

^accp/dance with'generblly'bcceptbd.^ ' '

■'2.;^ -No'.signiifi:cahb;deficien to vthe^'audit of:the- financial statements.are reportecl ',ini ■

the ihdppendent Aud/fpri' 0epprt [on'-'lnteipal Contrbl-.Oyer Fi'nanciaT

' Complianc^ 'and othprJMatters'-Based, ■'Sfa(emer7fs:'Perfp(?T7ed-,^..Accprp'ahd.e'Witi) Gqy&rnmenrAud^^^^ are;rVp.orted-,

^3:..Wo-Instanpfes-idf ndncBmpllabce material rtort^ie ^inanciali state Actioh'-.• i-'Prpgram Bellijhap^Merrirnacfe.•Counties; Jnc.:,]^;which.would be,Teqgi'red.-fo be reported*.ih <:acc.ord a rice withVGp ybmme'pf

•■4.- No sigriificaht:deficien^ InternalVcbhtroii over. maj6r''federal "award-^prb^^ ^are^

vfep6rted;in the/rtbependenf-AwAfo^^^

On '•(niemaf Oonirdl:'t)ye/jdp'mp!iancG 'f^epujrdij by the^ iJnifofw "Gu/b[aripe. No ■ materfa]^

'^weaknesses e're re.:5: The auditors' report dnVQompllance:f6rrth;e._rriajQr;fed^ for-'CdmmUriity. Apfipn Program.Belknapr^Mer/irnack^ expresses ■ap uiimodified.opinion on all' ■

^ majorprografps.-

f 'f • ' • • ^ ^ - t ' 4, ^

•6; Therewere nb-;audit^findirigS; tRat^ reported in accbrdarice,wlth'2,

•.secti6n^i)'0'5id^' \ d U ' it « -

7: The prpgrame'lested' es-major' programs-include;: U/S.^.Pepartmerit' bf the" Treasury,»

Emergency. RentaL^ssisiance'.Prbgr^ 'Gbrpnavirus State:an^ Local: Fjscali

^,Rec.ovei^,€Linds„ ALN,:2/;02Yi'^.U.S-;;bepaftment '.of"Agriculture and

phTldreni ALNrib. 557s-';U;S..''bep'artr^^^ t^bmari SeivicesTHead Start,.A^^^.Qb-Sbo, 'New^Hlampshire^ ^'Public Utilities'. Com^apy'; Electricar Assistance 'Program, vNON^Federal: " ■ ' - ' ^.

•'5^; Theithreshold.for type A'andIB.programs was^i;822,344.^

••9.' 'C0mmunity\Actipp:'Prbgrar^^^ was.dpte'rrpiped^to notJbe a •

' ^low^risk auditee.- * - ' •;3V

Oocusign Envelope ID; E033EB7A-38E8-4S64-AA6F-69F75844bl09

klNjblNGSli FjNA STATEMEffTS AUbfT-

None.Ai ~ ■

- FINDINGS AND QUEStlbiilEDiQbStS -i^^^ AUDir^" i' ■ ■ *■ ^

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Docusign Envelope ID; E033EB7A-3eEB-4564-AA6F-69F7SB440109

Effective 1/2024

COMMUNITY ACTION PROGRAM

BELKNAP-MERRIMACK COUNTIES, INC. j

EMPOWERING COMMUNITIES SINCE 1965

BOARD OF DIRECTORS

Chris Pyles, Chair

Board member since: 1/14/2021

Sara A. Lewko

Board member since: 2/21/2001

David Croft, Vice Chair

Board member since: 5/13/2021

Dennis Martino

Board member since: 2/24/2005

A. Bruce Carri, Treasurer

Board member since: 3/12/2020

Ashley Reed

Board member since: 5/12/2022

Safiya Wazir, Secretary

Board member since: 11/2/2016

David Siff, Esq.

Board member since: 10/2/2013

Heather Brown

Board member since: 1/15/2009

Tracy Vergason

Board member since: 5/12/2022

Current fiscal year (3/1/24 - 2/28/25) board meetings - 3/14/24, 5/09/24, 9/12/24,11/14/24,1/11/25

klhiCAPBM BOD 10 2023 redacied

Docusign Envelope ID: E033EB7A-38EB-4564-AA6F-69F758440109

Mark Stewart

Work Experience

CSFP Warehouse Manager

Community Action Program Belknap-Merrimack, Counties, Inc.

Concord, NH

April 2023 to Present

• Coordination of delivery, receipt and acceptance of orders and

Inventory of USDA Commodity Supplemental Food shipments.

• Maintain all aspects of the warehouse including organization of

food supplies, ordering of all supplies, general cleanliness, and

overall safety to comply with City of Concord inspection rules.

• Oversee the coordination of and assist with the packaging of

food items including the coordination of assembly line

packaging for storage and distribution.

• Oversee the coordination of daily distribution of food packages

at the main warehouse of off-site tail gate distributions for this

agency or other CSFP contract agencies.

• Coordinate delivery schedule and obtain approval for schedule

and any changes frorri the Director on monthly basis.

• Coordinate ordering of program and warehouse supplies In

consultation with supervisor.

General Manager

Fieldhouse Sports, Inc.

Bow, NH

June 1997 to April 2023

• Managed a team of 12+employees

• Successfully implemented nef policies and procedures to

improve team efficiency

• Met with clients to discuss thit needs

• Responsible for public relations

• Maintained staffing levels

• Managed and trained new hires.

• Developed new programs andltheir implementation.

• Helped build and expand the customer base over the years

with hard work, attention to detail

Self Employed Owner

JZN LTD.

Bow. NH

July 1994 to June 1997

• Hohne Inspection Service, Landscape design and

implementation and minor construction projects.

Subcontracted in topographical tworkwith a septic design

company.