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FFATAFORM <br />Subreclplent Agency; Kittitas County <br />Grant and Year: 2019 Agreement Number: E20-168 <br />Completed Darren Higashiyama Commander (509) 933-8206 by: <br />Name Tills Telephone <br />Date Completed: 11/08/19 <br />tSTEP 1 <br />,_ <br />~"' ,. ---YES STOP, no further NO <br />Is your grant agreement less than $25,000? D analysis needed, [{] GOtoStep2 <br />GO to Step 6 <br />STEP2 -- <br />In your preceding fiscal year, did your YES NO STOP, no further <br />organization receive 80% or more of Its annual D GO toSTEP3 [{] analysis needed, GO to <br />gross revenues from federal funding? Step 6 <br />----STSP '~ ,, ---..... ~ --~ <br />In your preceding fiscal year, did your YES NO STOP, no further <br />organization receive $25,000.000 or more In D GOtoSTEP4 D ar:ialysls needed, GO to <br />federal f unalng? Step6 -STEP4 - <br />Does the public have access to Information about YES STOP, no further NO <br />the total compensation• of senior executiVes In D ana lysis needed, D GOtoSTEP5 <br />your organization? GO to step 6 <br />-,->STEP'S -L_ -~ <br />Executive #1 Name: <br />Total Compensation amount: $ <br />Executive #2 Name: <br />Total Compensation amount: $ <br />Executive #3 Name: <br />Total Compensation amount: $ <br />Executive #4 Name: <br />Total Compensation amount: $ <br />Executive #5 Name: <br />Total Comperisation amount $ <br />STER 6~ <br />If your organization does not meet these criteria, speclflcally Identify below !!!:h criteria that is not met for your <br />organization: For !;isamgle ; "Our organization received leri~ !han 125,000!" <br />Kittitas County did not receive 80% or more annual gross revenues from federal funding <br />Signature: _____________________ _ Date: 11/08/19 <br />* Total compensation refers to: <br />• Salary and bonuses <br />• Awards of stock, stock options, and stock appreciation rights <br />• Other compensation Including, but not limited to, severance and termination payments <br />• Life Insurance value paid on behalf of the employee <br />Addltlonal Resources: <br />http://www .whltehouse .gov/omb/open <br />http://www .hrsa .gov/grants/ffata . hfml <br />http :Jtwww.gpo.9ov/fdsys/pkg/FR·2010-09-14/pdf/2010-22705 .pd f <br />hllp ://www .grants.gov/ <br />Page 1 of 3 <br />--- <br />-- <br />~ <br />'