RFP Application Template-Post(DOC).docx

ROWAN COUNTY

HIGH IMPACT OPIOID ABATEMENT STRATEGIES

Funding Proposal Application Form

Applicant Agency: General Information

(check one) ☐ Government/ Public Authority

As a separate Excel file, submit a completed Budget Worksheet.

1. Proposal Summary (no more than 250 words, required but not scored) Provide a brief overview of the planned project. Summary must include a purpose statement describing how your application will address the needs of people who use drugs in the community with particular considerations for historically marginalized populations.

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2. Project Narrative A. Assessment of Community Need (16 points, suggested page limit: 1 ½ pages)

· List the geographic area to be served by the proposed project and the overdose burden in that area.

· Provide any pertinent and/or necessary information as it relates to the need for this work in your community. Identify any gaps in services you intend to address by identifying and/or defining current programs/providers.

· Describe the needs of the priority population that this proposal will serve and how those needs were determined (e.g., focus groups, survey, patient engagement).

NOTE: Provide citations/reference sources for any included community demographic or health status data. Current and relevant data is available at:

https://www.ncdhhs.gov/opioid-and-substance-use-action-plan-data-dashboard https://nc211.org/data/ https://medicaid.ncdhhs.gov/reports/dashboards#annual

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B. Project Description and Program Sustainability (28 points, suggested page limit: 3 pages)

· Clearly identify which implementation strategy from the NC MOA’s Option A list of eligible strategies are included in the proposal, including the number (e.g., “Strategy 6: Early Intervention”). Only one eligible strategy may be selected for each proposal.

· Describe the proposed project in detail including its expected impact on preventing opioid overdose, increasing access and linkages to care for the most marginalized and underserved populations, and building local infrastructure to respond to the opioid overdose crisis.

· Explain how you will engage or have already engaged the priority population in developing this proposed project.

· Detail how this project will advance your organization’s goals.

· Include timelines for project implementation with specific program objectives as they relate to performance measures and budget (e.g., hiring staff or subcontractors, purchasing supplies, establishing policies and protocols, enrolling participants, etc.) including who is responsible for associated activities.

· Explain how the project will increase the capacity of your organization or your community over time to address opioid use disorder. Note that applications must describe how they will plan for enhancements, improvements, or increases achieved during the project year to be sustained past the funding secured during the project period.

· Describe obstacles that may affect your organization’s ability to sustain this program after the project cycle and potential solutions to identified challenges.

· Detail any other funding sources that will be used towards this project.

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C. Equity Impact (8 points, suggested page limit: ¾ page)

· Describe how the proposed project addresses health inequities and reaches historically marginalized populations. Additionally, describe how the proposed project addresses the needs of the uninsured and underinsured. Finally, describe how the proposed project will address social determinants of health (transportation, housing, employment, etc.) directly or through collaboration with other agencies.

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D. Organizational Readiness (20 points, suggested page limit: 2 pages)

· Describe the capacity of the fiscal agent/organization that will take total responsibility for the fiscal, reporting, and grant-related compliance requirements to manage grants and comply with financial and monitoring requirements.

· If applicable, identify any proposed subcontractors and their role on the proposed project. If the specific subcontractor is not yet identified, describe how the subcontractor will be selected.

· Provide specific examples of the organization’s or partnership/collaboration of multiple organizations’ capacity to deliver information in a culturally humble, sensitive, and appropriate manner. The applicant must demonstrate an understanding of issues specifically affecting people who use drugs (PWUD) and/or other intersecting historically marginalized populations. A successful applicant will have staff and/or volunteers with diverse backgrounds who are sensitive to drug user health issues.

· If applicable, provide specific examples of how any identified subcontractors demonstrate these capacities.

· Describe your organizations or partnership/collaboration of multiple organizations’ history promoting the health and dignity of individuals and communities impacted by drug use or your plans to incorporate this mission into your core activities and how your organization will be delivering program activities in a culturally appropriate manner.

· If applicable, provide specific examples of how any identified subcontractors demonstrate these capacities.

· If applicable, highlight if your organization or partnership/collaboration of multiple organizations and/or any proposed subcontractors serve the following prioritized groups:

· Those experiencing homelessness and housing instability,

· Black, Indigenous, and People of Color (BIPOC),

· Federal or NC recognized tribal communities, and/or

· Those transitioning from correctional settings to the community.

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E. Evidence of Collaborations/Partnerships (16 points, suggested page limit: 1 ¼ pages)

· Describe how you will collaborate on this project or initiative with other relevant organizations in your community and how this project will improve collaboration between local stakeholders and/or engage new ones.

· Describe how you will verify that projects or services are not being duplicated in the community and with the population served.

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F. Performance Measures and Program Evaluation (12 points, suggested page limit: 1 page)

· Detail how you will evaluate your project.

· Describe how you will engage the priority population in the design and implementation of the evaluation of this project.

· Recipients providing direct services will be required to report client-level data on elements including but not limited to demographic characteristics, substance use, diagnosis(es), services received, and types of medications for opioid use disorder received. Explain how you will capture this data. (See https://nctopps.ncdmh.net/dev/gettingstartedwithnctopps.asp for a suggested tool.)

· Explain how you will monitor the project and capture metrics for each of the supported strategies included in your project. You may wish to include metrics in a table format.

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* Indicate if you are the Board President or Chairperson 1

Include in the same PDF document as this form, after the Certifications section below, the following required documents. If an item is not applicable to your organization, please indicate this by an “N/A” and explain why it is not applicable.

3. Letters of Commitment and/or Support

4. Latest Audited Financial Statements, including Management letter (Attach letter of explanation if unable to provide)

5. Documentation of Tax Identification Number (can be IRS Determination Letter for non-profit agencies)

6. For non-profit agencies only:

A. IRS Determination Letter: provide a copy of an IRS determination letter which states that your organization has been granted exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. The organization’s name and address on the letter must match your current organization’s name and address. This IRS determination letter can also satisfy the documentation requirement of your organization’s tax identification number (TIN).

B. Verification of 501(c)(3) Status Form: If applicable, an Authorized Representative must annually submit verification that the organization remains a qualified 501(c)(3) tax-exempt organization.

C. Copy of Form 990 Federal Tax return filed for latest fiscal year.

D. Agency organizational chart.

E. Current Board of Directors Roster with names, addresses, office terms (with dates), and professional and/or community affiliations.

F. A completed and signed statement which includes a copy of the Agency’s adopted Code of Ethics.

G. A copy of the Agency’s Articles of Incorporation and Bylaws (if applicable).

Insert/Attach these required documents here.

7. Certifications and Required Forms

A. Application Certification

I have reviewed this application for accuracy.

I understand that Opioid Abatement funds are intended to address specific remediation activities as identified under the NC Memorandum of Agreement (MOA) for the Opioid Settlement Funds.

I understand that these opioid settlement funds are subject to State laws and regulations, and I have read the MOA and agree to the requirements.

I certify that the requested funds will be used in compliance with these requirements and with all requirements outlined in the Rowan County High Impact Opioid Abatement Strategies RFA.

I agree to submit invoices and other relevant documentation to the Rowan County Public Health to pay or be reimbursed, as well as quarterly status reports.

I understand that Rowan County requires audited financial statements for each year that opioid settlement funding is provided to my organization, and that the Rowan County Public Health may monitor the program during the award period.

Agency Authorized Official (print name)

Board Chair/Elected Official (print name)

B. Non-profit agencies only: Verification of 501(c)(3) Status Form

IRS Tax Exemption Verification Form (Annual)

I, _________________________, hereby state that I am ___________________________ of (Printed Name) (Title) _____________________________________ (“Organization”), and by that authority duly (Legal Name of Organization) given and as the act and deed of the Organization, state that the Organization’s status continues to be designated as 501(c)(3) pursuant to U.S. Internal Revenue Code, and the documentation on file with the North Carolina Department of Health and Human Services is current and accurate.

I understand that the penalty for perjury is a Class F Felony in North Carolina pursuant to N.C. Gen. Stat. § 14-209, and that other state laws, including N.C. Gen. Stat. § 143C-10-1, and federal laws may also apply for making perjured and/or false statements or misrepresentations.

I declare under penalty of perjury that the foregoing is true and correct. Executed on this the _____ day of ___________, 20_______.

(Signature)

C. Certification of No Overdue Tax Debts

Date of Certification MM/DD/YYYY

Certification:

We certify that [ORGANIZATION NAME] does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C‑10‑1b.

Sworn Statement:

[Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that we are the Board Chair and [Title of the Second Authorizing Official], respectively, of [insert name of organization] of [City] in the State of [Name of State]; and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action.

Board Chair Signature

[TITLE OF SECOND AUTHORIZING OFFICIAL]

Sworn to and subscribed before me on the day of the date of said certification.

_______________________________ My Commission Expires: __________ (Notary Signature and Seal)

1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment agreement for the tax debt under G.S. 105‑237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.”

D. Code of Conduct Policy

Each recipient of award shall maintain a written Code of Standards of Conduct which shall govern the performance of its officers, employees or agents in contracting with and/or expending Older Americans Act funds and State appropriations.

The recipient Agency’s officers, employees or agents shall neither solicit nor accept gratuities, favors or anything of monetary value from contractors or potential contractors. To the extent permissible under state or local laws, rules or regulations, such standards shall provide for appropriate penalties, sanctions, or other disciplinary actions to be applied for violations of such standards either by the officers, employees or agents of the recipient Agency or by contractors or their agents.

Awards will be made only to responsible Agency(ies) possessing the ability to perform successfully under the terms and conditions of a proposed procurement. Consideration will be given to such matters as Agency’s integrity, compliance with public policy, record of past performance, and financial and technical resources.

I have read and fully understand the context of the information above.

E. Conflict of Interest Policy

The Board of Directors/Trustees or other governing persons, officers, employees or agents are to avoid any conflict of interest, even the appearance of a conflict of interest. The Organization's Board of Directors/Trustees or other governing body, officers, staff and agents are obligated to always act in the best interest of the organization. This obligation requires that any Board member or other governing person, officer, employee or agent, in the performance of Organization duties, seek only the furtherance of the Organization mission. At all times, Board members or other governing persons, officers, employees or agents, are prohibited from using their job title, the Organization's name or property, for private profit or benefit.

a. The Board members or other governing persons, officers, employees, or agents of the Organization should neither solicit nor accept gratuities, favors, or anything of monetary value from current or potential contractors/vendors, persons receiving benefits from the Organization or persons who may benefit from the actions of any Board member or other governing person, officer, employee or agent. This is not intended to preclude bona-fide Organization fund raising-activities.

b. A Board or other governing body member may, with the approval of Board or other governing body, receive honoraria for lectures and other such activities while not acting in any official capacity for the Organization. Officers may, with the approval of the Board or other governing body, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. Employees may, with the prior written approval of their supervisor, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. If a Board or other governing body member, officer, employee or agent is acting in any official capacity, honoraria received in connection with activities relating to the Organization are to be paid to the Organization.

c. No Board member or other governing person, officer, employee, or agent of the Organization shall participate in the selection, award, or administration of a purchase or contract with a vendor where, to his knowledge, any of the following has a financial interest in that purchase or contract:

1. The Board member or other governing person, officer, employee, or agent;

2. Any member of their family by whole or half blood, step or personal relationship or relative-in-law;

3. An organization in which any of the above is an officer, director, or employee;

4. A person or organization with whom any of the above individuals is negotiating or has any arrangement concerning prospective employment or contracts.

d. Duty to Disclosure -- Any conflict of interest, potential conflict of interest, or the appearance of a conflict of interest is to be reported to the Board or other governing body or one's supervisor immediately.

e. Board Action -- When a conflict of interest is relevant to a matter requiring action by the Board of Directors/Trustees or other governing body, the Board member or other governing person, officer, employee, or agent (person(s)) must disclose the existence of the conflict of interest and be given the opportunity to disclose all material facts to the Board and members of committees with governing board delegated powers considering the possible conflict of interest. After disclosure of all material facts, and after any discussion with the person, they shall leave the governing board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists.

In addition, the person(s) shall not participate in the final deliberation or decision regarding the matter under consideration and shall leave the meeting during the discussion of and vote of the Board of Directors/Trustees or other governing body.

I have read and fully understand the context of the information above.

F. Appendix E: E-Verify

STATE OF NORTH CAROLINA AFFIDAVIT

COUNTY OF ROWAN

I, ____________________________ (the individual attesting below), being duly authorized by and on behalf of ________________________________ (the entity contracting with Rowan hereinafter "Employer") after first being duly sworn hereby swears or affirms as follows:

1. Employer understands that E-Verify is the federal E-Verify program operated by the United States Department of Homeland Security and other federal agencies, or any successor or equivalent program used to verify the work authorization of newly hired employees pursuant to federal law in accordance with NCGS §64-25(5).

2. Employer understands that Employers Must Use E-Verify. Each employer, if employing 25 or more employees in this State, after hiring an employee to work in the United States, shall verify the work authorization of the employee through E-Verify in accordance with NCGS§64-26(a).

3. Employer is a person, business entity, or other organization that transacts business in this State and that employs 25 or more employees in this State. (Mark Yes or No)

a. YES ☐ or b. NO ☐

4. Employer's subcontractors comply with E-Verify, and Employer will ensure compliance with E-Verify by any subcontractors subsequently hired by Employer during the term of its contract with Rowan County.

This ________day of _______________, 20____.

Signature of Affiant _______________________

Print or Type Name _______________________

NORTH CAROLINA NOTARY ACKNOWLEDGEMENT

THE STATE OF NORTH CAROLINA, COUNTY OF _________________

Signed and sworn to (or affirmed) before me, this ____ day of ________, 20__.

My Commission Expires: _________________________

Notary Public, _________________________________

Notary Public Signature: _________________________ [Official Seal]

G. Authorization for Individuals to Sign Contracts and Submit Reporting

[Letter from Board President/Chairperson identifying individuals as authorized to sign contracts, expenditure reports, and performance reports]

I, _______________________________________________, Board President/Chairperson of _____________________________________________________ [Agency/Organization’s legal name] hereby identify the following individual(s) who is (are) authorized to sign and/or submit documentation for the organization named above:

Contracts:

Printed Name:

Title:

Email address:

Expenditure Reports:

Printed Name:

Title:

Email address:

Performance Reports:

Printed Name:

Title:

Email address:

H. Business Associate Addendum

THIS ADDENDUM is made this day of Click or tap here to enter text., 20Click or tap here to enter text. to a contractual arrangement between the parties (“Agreement”).

WHEREAS Rowan County is itself a Covered Entity, as that term is defined in HIPAA and will be referred to as “Covered Entity”; and

WHEREAS, Click or tap here to enter text. is, or may be, a Business Associate of Covered Entity and will be referred to as “Business Associate”; and

WHEREAS, Business Associate performs certain services on behalf of or for Covered Entity that require the exchange of information about patients that is protected by the Health Insurance Portability and Accountability Act of 1996, as amended, and the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164 (collectively “HIPAA”).

NOW, THEREFORE, the parties to the Agreement are entering into this Addendum to establish the responsibilities of both parties regarding HIPAA-covered information and to bring the Agreement into compliance with HIPAA.

I. DEFINITIONS

Except as otherwise defined herein, terms used in this Addendum shall have the same meaning as the terms are defined in HIPAA.

II. OBLIGATIONS OF BUSINESS ASSOCIATE

To comply with the Privacy, Security, and Breach Notification obligations imposed by HIPAA, Business Associate agrees to:

A. Privacy and Security Obligations:

1. Not use nor disclose information other than as permitted or required by the Agreement, this Addendum or as required by law.

2. Use appropriate safeguards to prevent use or disclosure of the information other than as provided for by the Agreement and this Addendum.

3. Comply with Subpart C of 45 CFR Part 164 with respect to electronic PHI (protected health information) to prevent use or disclosure of PHI other than as provided for by the Agreement.

4. Report to Covered Entity any use or disclosure of the information not provided for by the Agreement of which Business Associate becomes aware, including breaches of Unsecured PHI as required by 45 CFR 164.410.

5. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any agents or subcontractors that create, receive, maintain, or transmit PHI on behalf of Business Associate agree, in writing, to the same restrictions, conditions, and requirements that apply to Business Associate with respect to such information.

6. Make available PHI in a designated set record set to Covered Entity upon request within three (3) working days as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.524. If Business Associate receives a request for access directly from the individual, then Business Associate will forward the individual’s request to Covered Entity within three (3) working days to be fulfilled by Covered Entity.

7. If Business Associate receives a request pursuant to 45 CFR 164.526 to make any amendment(s) to PHI in a designated record set directly from the individual, then Business Associate will forward the individual’s request to Covered Entity within three (3) working days to be fulfilled by Covered Entity.

8. Maintain and make available upon request within three (3) working days the information required to provide an accounting of disclosures to Covered Entity as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.528. If Business Associate receives a request to provide an accounting of disclosures directly from the individual, then Business Associate will forward the individual’s request to Covered Entity within three (3) working days to be fulfilled by Covered Entity.

9. Make its internal practices, books, and records relating to the use of PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity, available to the Secretary of DHHS and Covered Entity for purposes of determining compliance with HIPAA.

10. To the extent practicable, mitigate any harmful effects that are known to Business Associate of a use or disclosure of PHI or a breach of Unsecured PHI in violation of this Addendum.

11. Use and disclose an individual’s PHI only if such use or disclosure is in compliance with the applicable requirements of 45 CFR 164.504(e) and the terms of this Addendum.

12. Refrain from exchanging any PHI with any entity of which Business Associate knows of a pattern of activity or practice that constitutes a breach as defined by North Carolina State Law, HIPAA, or this Addendum.

13. To the extent Business Associate is to carry out one or more of Covered Entity’s obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to Covered Entity in the performance of such obligation(s).

B. Breach Notification:

In the event that Business Associate discovers any use or disclosure of PHI not provided for by the Agreement, including breaches of Unsecured PHI as required at 45 CFR 164.410, and any security incident of which it becomes aware, Business Associate agrees to take the following measures within three (3) working days after Business Associate first becomes aware of the incident:

1. To notify Covered Entity of any incident involving the acquisition, access, use or disclosure of Unsecured PHI in a manner not permitted under 45 CFR Part E. Such notice by Business Associate shall be provided without unreasonable delay, except where a law enforcement official determines that a notification would impede a criminal investigation or cause damage to national security. For purposes of clarity for this provision, Business Associate must notify Covered Entity of any such incident within the above timeframe even if Business Associate has not conclusively determined within that time that the incident constitutes a breach as defined by HIPAA. For purposes of this Addendum, Business Associate is deemed to have become aware of the breach as of the first day on which such breach is known or reasonably should have been known to such entity or associate of Business Associate, including any person, other than the individual committing the breach, that is an employee, officer or other agent of Business Associate or an associate of Business Associate.

2. To include in the above-described notification the names of the individuals whose Unsecured PHI has been, or is reasonably believed to have been, the subject of a breach.

3. To provide a draft letter to Covered Entity to utilize to notify the individuals that their Unsecured PHI has been, or is reasonably believed to have been, the subject of a breach. The draft letter must include, to the extent possible:

a. A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known;

b. A description of the types of Unsecured PHI that were involved in the breach (such as full name, Social Security Number, date of birth, home address, account number, disability code, or other types of information that were involved);

c. Any steps the individuals should take to protect themselves from potential harm resulting from the breach:

d. A brief description of what Covered Entity and Business Associate are doing to investigate the breach, to mitigate losses, and to protect against any further breaches; and

e. Contact information for individuals to ask questions or learn additional information, which shall include a toll-free telephone number, an email address, web site, or postal address.

III. TERMINATION

A. This Addendum will terminate automatically, without further action by either party, upon termination of the Agreement to which it is attached.

B. Covered Entity may terminate this Addendum if Covered Entity determines that Business Associate has violated a material term of the Agreement or this Addendum.

C. Upon Covered Entity’s gaining knowledge of a breach, as defined by North Carolina State Law or HIPAA, by Business Associate or any of its agents or subcontractors, of the Agreement or this Addendum, Covered Entity shall either:

1. Provide an opportunity for Business Associate to cure the breach or end the violation, and if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity, terminate this Addendum and the attached Agreement; or

2. Immediately terminate this Addendum and the attached Agreement if either has been breached by a Business Associate, and a cure is not possible.

D. In situations where it is not practicable to terminate this Agreement, Covered Entity shall report Business Associate’s breach as defined by North Carolina State Law or HIPAA to the Secretary of DHHS, and continue under the existing arrangement with Business Associate until a reasonable alternative becomes available, or until directed by the Secretary of DHHS to terminate the Agreement.

E. At termination of the attached Agreement and this Addendum, or upon request of Covered Entity, whichever occurs first, Business Associate shall:

1. If feasible, return or destroy all PHI that Business Associate still maintains in any form, received from Covered Entity or created, maintained or received by Business Associate on behalf of Covered Entity. Business Associate shall only destroy PHI with the written approval of Covered Entity. After return or destruction, Business Associate shall retain no copies of such information.

2. If return or destruction is not feasible, Business Associate will provide Covered Entity with documentation explaining the reason it is not feasible. If the PHI is not returned or destroyed, Business Associate will extend the protection of this Addendum to the information and limit further uses and disclosures to those purposes that make the return or destruction of the information not feasible.

F. The obligations of Business Associate under this Addendum shall survive the expiration, termination or cancellation of the attached Agreement and this Addendum, and shall continue to bind Business Associate, its agents, employees, contractors, successors and assigns, as set forth herein.

G. Business Associate shall indemnify Covered Entity for costs associated with any incident involving the acquisition, access, use or disclosure of Unsecured PHI by Business Associate, any agent or subcontractor, in a manner not permitted under 45 CFR Subpart E.

IV. MISCELLANEOUS

A. All PHI that is created or received by Covered Entity and disclosed or made available in any form, including paper record, oral communication, audio recording and electronic display by Covered Entity or its operating units to Business Associate, or is created or received by Business Associate on Covered Entity’s behalf, shall be subject to this Addendum.

B. In the event of an inconsistency between the provisions of this Addendum and the mandatory provisions of HIPAA, as amended, HIPAA shall control. Where provisions of this Addendum are not included as mandated provisions in HIPAA, but are nonetheless permitted by HIPAA, the provisions of this Addendum shall control.

C. Except as expressly stated herein or in HIPAA, the parties to this Addendum do not intend to create any rights in any third parties.

D. This Addendum may be amended or modified only in writing signed by the parties. No party may assign it rights or obligations under this Addendum without the prior written consent of the other party. None of the provisions of this Addendum are intended to create, nor will they be deemed to create, any relationship between the parties other than that of independent parties, contracting with each other solely for the purpose of effecting the provisions of this Addendum and any other agreements between the parties concerning their business relationship.

E. This Addendum will be governed by the laws of the State of North Carolina, venue Rowan County F. No change, waiver, or discharge of any liability or obligation hereunder on any one or more occasion shall be deemed a waiver of performance of any continuing obligation, or prohibit enforcement of any obligation, on any other occasion.

G. In the event that any documentation of the arrangement pursuant to which Business Associate provides services to Covered Entity contains provisions relating to the use or disclosure of PHI that are more restrictive than the provisions of this Addendum, the provisions of the more restrictive documentation will control.

H. In the event that any provision of this Addendum is held by a court of competent jurisdiction to be invalid or unenforceable, the remaining provisions of this Addendum shall remain in full force and effect.

I. Headings in this Addendum are for convenience of reference only and shall not define or limit any of the terms or provisions hereof.

J. A reference in this Addendum to a section in HIPAA means the section as in effect or as amended.

K. Any ambiguity in this Addendum shall be interpreted to permit compliance with HIPAA.

L. Business Associate will not use an agent or subcontractor without written agreement by Covered Entity.

IN WITNESS WHEREOF, the parties have hereunto executed this Business Associate Addendum on the day and year first written above.

Rowan County

ATTESTED:

BUSINESS ASSOCIATE

By:

Title:

ATTESTED:

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