Agreement Sample Letter for Employee Employer - DOC by sgt19112

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									                             SAMPLE
                      LETTER OF AGREEMENT

August 1, 2008


Ms. Jane Executive
Executive Director
The Community Clinic
245 Main Street
Our Town, VA 22302

Dear Ms. Executive:

Congratulations. The Virginia Health Care Foundation [hereinafter
referred to as the Foundation or VHCF] has awarded The Community
Clinic a grant for $66,000 to hire a full-time Nurse Practitioner [hereinafter
referred to as the Nurse Practitioner project]. The cycle for this grant is
7/1/2008 – 6/30/2009.

This Letter of Agreement [hereinafter referred to as the Letter] sets forth
the terms of your grant and the manner in which it will be administered. It
includes a description of your project; the specific personnel, items, or
operations for which the Foundation is paying; specific objectives the
project should meet; reporting requirements; the payment process;
evaluation criteria; and several other items.

Please read the terms of this Letter carefully to ensure that you
understand and agree with them. Sign both copies, keep one for your
records and return a copy to the Foundation. You will receive your first
payment upon receipt of your signed Letter.
The Community Clinic, Sample Letter of Agreement
August 1, 2008
Page 2

PROJECT DESCRIPTION:

The Community Clinic is a free medical clinic providing health care to uninsured, eligible
residents of Our Town, Virginia. With this grant, the clinic will increase its capacity
through the addition of one full-time Nurse Practitioner who will staff three additional
day clinics and one evening clinic per week to focus on care for chronically ill patients.
Clinic provider time will be increased from an average of eight hours per week to 40
hours per week. It is estimated that the Nurse Practitioner will provide 2,000 visits to
700 unduplicated patients in FY08.

USE OF FOUNDATION FUNDS:

     Salary and benefit support for a full-time Nurse Practitioner

SPECIFIC PROJECT OBJECTIVES:

1. By August 1, 2008, hire a full-time Nurse Practitioner.

2. By August 1, 2008, update the agency’s Long-Range Financial Plan to include
   specific activities to secure the money needed to sustain the Nurse Practitioner
   Project in FY09, $149,192 (the total cash operating budget for this project). This
   plan should specifically address raising the amount necessary to cover a 25%
   reduction in VHCF funding in FY09 ($16,500). Submit this plan to VHCF with the
   first progress report.

3. By September 1, 2008, begin providing services with additional clinic hours.

4. By September 1, 2008, fully equip the fourth exam room.

5. By June 30, 2009, complete the following media/press events or activities to
   promote the value and impact of the Nurse Practitioner Project, and acknowledge
   VHCF’s funding support at each:

              Hold an open house for the press and public at The Community Clinic, to
               kick-off and publicize the Nurse Practitioner Project. (Early September
               2008)

              Write and disseminate a press release to local and regional media
               regarding the Nurse Practitioner Project and its relation to Cover the
               Uninsured Week. (Early November 2008)

              Create a human interest story with the local paper about the staff,
               volunteers, and/or patients of the clinic (March 2009)

   Submit any articles or press coverage to VHCF within two weeks of their publication.
The Community Clinic, Sample Letter of Agreement
August 1, 2008
Page 3


6. By June 30, 2009, raise $149,192 (the total cash operating budget for this project).
   In each required progress report, detail the efforts of The Community Clinic in
   securing $149,192. Specifically address progress in raising the $16,500 that is
   needed to account for the FY09 reduction in VHCF funding.

7. By June 30, 2009, update the agency’s Long-Range Financial Plan to secure the
   money necessary to sustain the Nurse Practitioner Project for FY10. This Plan
   should specifically address raising the amount necessary to cover a second 25%
   reduction in VHCF funding, $28,875 (1st + 2nd year reductions). Submit this plan to
   VHCF with the third progress report.

8. At least twice during the grant year, conduct a patient satisfaction survey of The
   Community Clinic’s patients. Report on the results of this survey, including the
   number of patients surveyed, with the first and the third required progress reports.

9. Throughout the grant year, conduct quarterly meetings of the Nurse Practitioner
   Project Advisory Board to discuss program development and performance.

10. Throughout the grant year, collect and report on the following data and patient
    information:
         Total number of unduplicated medical patients (including nurse practitioner
          patients) served by the clinic. The goal is to serve 500 unduplicated patients
          by December 31, 2008; and a total of 1,230 by June 30, 2009. In 2007 the
          Clinic served 1,000 unduplicated patients;

          Total number of patient visits provided by the Nurse Practitioner. The goal is
           to provide 800 visits by December 31, 2008; and a total of 2,000 visits by
           June 30, 2009.

          Total number of patient visits (including nurse practitioner visits) provided by
           the clinic. The goal is to provide 1,600 visits by December 31, 2008; and a
           total of 4,000 visits by June 30, 2009. In 2007 the clinic provided 2,000
           patient visits;

          Total number of unduplicated patients served by the Nurse Practitioner. The
           goal is to serve 300 patients by December 31, 2008; and to a total of 700
           patients June 30, 2009.

   Report these data to VHCF with each required progress report.

11. Throughout the grant year, track the number and type of services health
    professionals volunteering at the clinic and the value of services they provided.
    Report these data to VHCF with each required progress report. In 2007, 40 health
    professionals volunteered 120 hours at the clinic.
The Community Clinic, Sample Letter of Agreement
August 1, 2008
Page 4

   Example
    Type of Volunteer(s)        Number        Total Hours   Value
    LPN                         5             190           ($16 per hour) $3,040
    Dentist                     1             75            ($82 per hour) $6,150
    Pharmacist                  2             200           ($39 per hour) $7,800
    Physician (Generalist)      23            780           ($86 per hour) $67,080
    Total                       31            1,245         $ 84,010

12. Throughout the grant year, track the number and value of prescriptions filled by the
    clinic (including medications secured through samples, TPC, RxP, or other sources).
    In 2007, the clinic filled 15,694 prescriptions with a value of $881,082.

   Example
    Source                   Number      Value
    TPC                           10,000       $560,000
    RxPartnership                  2,500       $140,000
    Samples                        1,750        $90,800
    Total                         14,250       $790,800

13. Throughout the grant year, track the number of patients who were unable to obtain
    needed medications.

14. Throughout the grant year, collect data on the following indicators for diabetic
    patients treated by the nurse practitioner at the clinic.
        The number and percent receiving an annual foot exam;

          The number and percent receiving and annual eye exam;

          The number and percent receiving an annual HbA1c test;

          The number and percent receiving exercise and weight loss education.

   Report these data to VHCF with the third progress report, with the goal of
   establishing baseline health outcome data for the second grant year.

15. Throughout the grant year, collect data on the following indicators for hypertensive
    patients treated by the Nurse Practitioner:

          The number and percent receiving a quarterly blood pressure reading;

          The number and percent receiving a 4-6 month cholesterol reading;

          The number and percent receiving exercise and weight loss education.

       Report these data to VHCF with the third progress report, with the goal of
       establishing baseline health outcome data for the second grant year.
The Community Clinic, Sample Letter of Agreement
August 1, 2008
Page 5


16. Throughout the grant year, track the number and sources of referrals to and from
    the clinic. Provide a list of members of the clinic’s referral network with the first
    required progress report. Report changes to this referral network in subsequent
    progress reports.

17. Throughout the grant year, identify uninsured children eligible for FAMIS or FAMIS
   Plus and pregnant women eligible for Medicaid for Pregnant Women or FAMIS
   Moms. Assist these children and pregnant women in the completion of the
   necessary application forms for insurance enrollment, and gathering the required
   documentation, or if they prefer, refer them to the online application at
   www.famis.org and/or the FAMIS toll-free hotline, (866) 873-2647 for assistance.
   Report to VHCF in each required progress report on the number of children and
   pregnant women assisted with the application process.


REPORTING REQUIREMENTS:

As stated at the Grantee Orientation, The Community Clinic must submit a progress
report to the Foundation at the end of each reporting period. There are three reporting
periods in the grant cycle. The First and Third Progress Reports provide detailed
information and data. The Second Progress Report is a brief summary of the project’s
activities to date. The Community Clinic must use the forms and format provided by the
Foundation unless it has received written permission from the Foundation to use an
alternative. The following schedule shows when each report is due to the Foundation:

             Report                    Period               Deadline
        First Report           7/1/2008 – 12/31/2008        1/20/2009
        Second Report           1/1/2009 – 3/31/2009        4/20/2009
        Third Report            4/1/2009 – 6/30/2009        7/20/2009

In addition, The Community Clinic will be expected to report annually for three years
following the conclusion of grant funding through the submission of VHCF’s “Alumni
Survey.”

PAYMENT PROCESS:

Grant payments will be made in three installments and processed as follows:

            Payment                    Schedule
        First Payment  Upon submission of the signed Letter.
        Second Payment Upon the Foundation’s receipt and
                       review of the First Progress Report.
        Third Payment  Upon the Foundation’s receipt and
                       review of the Third Progress Report.
The Community Clinic, Sample Letter of Agreement
August 1, 2008
Page 6




EXPENDITURES OF GRANT FUNDS:

This grant is for the purpose(s) stated in this Letter. The funds provided may be spent
only in accordance with the terms set forth herein. The Community Clinic project is
subject to modification only with the Foundation’s prior written approval.

Expenses charged against this grant may not be incurred prior to the date the grant
period begins or subsequent to its termination date, and may be incurred only as
necessary to carry out the purpose(s) and activities of the approved project.

The grantee organization is responsible for the expenditure of funds and for maintaining
adequate supporting records consistent with generally accepted accounting practices.
The Foundation reserves the right to audit the financial records and insurance coverage
of the grantee organization.

PROJECT EVALUATION:

As stated during the Grantee Orientation, the Foundation will evaluate each project
utilizing several instruments. These include: progress reports, site visits, patient/client
assessment surveys, and partner assessment surveys. These instruments will be used
to determine:
      the extent to which The Community Clinic has met its objectives;
      The Community Clinic’ progress in generating or attracting resources to sustain
        the Nurse Practitioner Project;
      the extent of community commitment and support for the Nurse Practitioner
        Project;
      the cost-effectiveness of the Nurse Practitioner Project’s approach; and
      the overall value of the Nurse Practitioner Project’s approach to delivering
        primary health care.


PUBLIC RELATIONS/COMMUNICATIONS:

The Foundation provides its grantees with a photo-ready logo and brief description of
the Foundation. The Community Clinic agrees to use these materials to cite the
Foundation for its support wherever possible. The Community Clinic shall also provide
the Foundation with the opportunity to participate in any public ceremonies or special
events highlighting the project. Further, The Community Clinic agrees to cooperate fully
with any requests by the Foundation to participate in or to provide pictures, photo
opportunities, or written materials for public relations purposes. Copies of any
published materials mentioning the project shall be provided to the Foundation as soon
as they become available.
The Community Clinic, Sample Letter of Agreement
August 1, 2008
Page 7

A special commemorative plaque acknowledging the Foundation’s support for the
Community Clinic’s Nurse Practitioner Project will be sent to the center in the fall. The
Community Clinic agrees to place the plaque at the project site.
SPECIAL PROVISIONS:

All grants are made and all funds should be used in accordance with current and
applicable laws and pursuant to the Internal Revenue Code, as amended, and the
regulations issued thereunder.

EXTRAORDINARY CIRCUMSTANCES:

In the event of The Community Clinic’s failure to perform or to comply with a substantial
portion of the terms of this Letter, the Foundation reserves the right to terminate this
grant. The Foundation also reserves the right to terminate this grant if the
Commonwealth of Virginia withdraws its appropriation to the Foundation.

NONDISCRIMINATION:

By accepting Foundation funding, The Community Clinic agrees to conform to the
provisions of the Federal Civil Rights Act of 1964, as amended, as well as the Virginia
Fair Employment Contracting Act of 1975, as amended, where applicable, the
Virginians With Disabilities Act, the Americans With Disabilities Act and § 11-51 of the
Virginia Public Procurement Act.

1. During the performance of this contract, The Community Clinic agrees as follows:

   a. The Community Clinic will not discriminate against any employee or applicant for
      employment because of race, religion, color, sex, national origin, age, disability,
      or any other basis prohibited by state law relating to discrimination in
      employment, except where there is a bona fide occupational qualification
      reasonably necessary to the normal operation of the contractor. The Community
      Clinic agrees to post in conspicuous places, available to employees and
      applicants for employment, notices setting forth the provisions of this
      nondiscrimination clause.

   b. The Community Clinic, in all solicitations or advertisements for employees placed
      by or on behalf of The Community Clinic, will state that The Community Clinic is
      an equal opportunity employer.

   c. Notices, advertisements and solicitations placed in accordance with federal law,
      rule or regulation shall be deemed sufficient for the purpose of meeting these
      requirements.

2. The Community Clinic will include the provisions of 1. above in every subcontract or
   purchase order over $10,000, so that the provisions will be binding upon each
   subcontractor or vendor.
The Community Clinic, Sample Letter of Agreement
August 1, 2008
Page 8




LIMIT OF COMMITMENT:

Unless otherwise stipulated in writing, this grant is made with the understanding that the
Foundation has no obligation to provide other or additional support to the grantee
organization.

I trust this letter reflects your understanding of the terms of the Foundation’s grant. If
you have any questions about any portion of this letter, please contact the Foundation’s
Program Officer assigned to your project, or me at (804) 828-5804.

Again, congratulations on the award and much success with your project.

                                                   Sincerely,


                                                   Deborah D. Oswalt


I agree to all terms and conditions set forth in this Letter of Agreement, and understand
  that The Community Clinic will receive its first grant payment upon the Foundation's
                          receipt of a signed copy of this letter.


                ______________________________________________
                               Ms. Jane Executive
                              The Community Clinic

                  ___________________________________________
                                      Date

								
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