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DocuSign Envelope ID:FF14B287-E90C-42B9-8A0F-A14FA00E82AF <br />Exhibit A-3 ABCD Quarterly community and Provider Outreach and Case ManagementReport <br />Year One July 1,2022 -June 30,2023•4th Quarter Report <br />Please complete and submit report electronically to: <br />Janice Tadeo,ABCD Program Manager at lanice.tadeo@hca.wa.qov <br />Cc:Pixie Needham,Dental Program Administrator at pixie.needham hca.wa.gov and <br />Heather Gallagher,ABCD State Managing Director,hqallagher@arcorafoundation.orq <br />Organization: <br />ABCD Contact Person: <br />Phone and Email: <br />4th Quarter <br />Report Due:07/09/2023 (report due on this 4/1/2023 - <br />date to allow HCA to close out fiscal year)6/30/2023 <br />Maximum Brief description (for events,provide date heldlattendedl for <br />$$available staff assignments,provide name and title)-no more than <br />for this 100 words (complete Exhibit A-3 and attach supporting <br />Performance Category _Yes/No deliverable document if providing additional detail) <br />Attend and participate in ABCD <br />Coordinator/Program Meeting $1,000.00 <br />Update ABCD provider roster to DentistLink $100.00 Complete Exhibit B-3 <br />Community and Provider Outreach |$1,298.00 I Complete Exhibit B-3 <br />Coordinate Care |$324.00 Complete Exhibit B-3 <br />Page 11 of 20 <br />HCA Contract No.:K2747-04