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HomeMy WebLinkAboutNeighborImpactApplicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet NeighborImpact Category/Grant Amount: Title: Other Essential Services / $11,000 HomeSource of NeighborImpact Review Criteria: 1. Organization: • Stable and positive history of providing services in Deschutes County. • Experience delivering similar programs, projects, or activities as those proposed. • Mission and goals are consistent with proposed program, project, or activity. • Stable and experienced Board of Directors or other leadership group. • Adequate staff and/or volunteers to implement proposed program, project, or activity. Points awarded for this section (maximum of 25). 2. Financial Status: • Adequate financial resources available to conduct and sustain operations. • Broad and diverse base of funding sources. • Financial need for a Community Grant to implement proposed program, project, or activity. • Proposed budget is consistent with and appropriate for the fixed grant amount available in the selected Community Grant category. Points awarded for this section (maximum of 25). 3. Program, Project, or Activity: • Program, project, or activity does not address emergency food, clothing, or shelter. (These activities are supported by Deschutes County through a separate grant program in conjunction with United Way's Emergency Food and Shelter program.) • Request is consistent with the fixed dollar amounts indicated in the category/grant amount description at the top of this form. • Number of individuals to be served is appropriate to the budget and scale of proposed program, project or activity. • Serves vulnerable and/or underserved populations and/or communities. • Positively impacts welfare of the community. • Complements, but does not duplicate, existing Deschutes County services. • Implementation strategy is suitable to achieving the stated goals and objectives of proposed program, project, or activity. • Partnerships or collaboration with other agencies are included in implementation strategy. • Other sources of funds or in-kind support are available to supplement Community Grant funds. Points awarded for this section (maximum of 35). 4. Performance Management: • Stated outputs are relevant and reasonable to the scale of the proposed program, project, or activity. • Stated outcomes are relevant and reasonable to the scale of the proposed program, project, or activity. Points awarded for this section (maximum of 15). TOTAL NUMBER OF POINTS AWARDED: COMMENTS: NAME OF RATER: Deschutes County Fiscal Year 2014-15 Community Grant Application Submittal Instructions and Cover Sheet A complete application will consist of the following: 1. This cover sheet, signed and dated. 2, Narrative responses to the attached questions on no more than four single -sided, single-spaced pages. 3, Attachments: a. Proof of the organization's 501(c)(3) tax-exempt status in the form of a letter from the Internal Revenue Service (IRS). b. The first two pages of the organization's most recently submitted IRS 990 or 990 EZ form or, if the organization is not required to file either form with the IRS, a financial statement that provides equivalent information concerning activities and governance, revenue, expenses, and net assets or fund balances. c. An operating budget specific to the proposed operations, program, project, or activity. d. A roster of the organization's Board of Directors. Submit the complete application electronically to judithu@deschutes.org no later than 5:00 p.m. on October 24, 2014. Incomplete and/or late applications will not be reviewed or considered. Please complete the following: Contact Name: Organization Name: Address: City: Bill Kemp Neighborlmpact 2303 SW First Street Redmond Telephone Number: Email Address: State: OR Zip Code: 7756 541-458-2380 x101 billk@neighborimpact.org Application is being submitted to which Community Grant Program funding category*? Health, Mental Health, and Addictions Services Arts and Culture ✓ Other Essential Services: Includes services to youth; underserved, indigent, and/or vulnerable populations; animal welfare; or the environment. * Please refer to the funding guidelines for more information. Certification: On behalf of the organization specified above, I certify the following: 1. All information included in this application is accurate. 2. I am authorized by the governing board to submit this grant application. 3. This organization is located in Deschutes County. 4. If awarded, Community Grant funds will be used in support of Deschutes County residents only. 5. This organization is in good standing with the U.S. Internal Revenue Service and is currently designated as a 501(c)(3) tax-exempt entity. Signature: Print Name: Bill Kemp Title: Chief Development Officer Date: October 24, 2014 Deschutes County Fiscal Year 2014-15 Community Grant Application Organization 1. Describe the history of the organization, including the year the organization was established. Since 1985, NeighborImpact has served Crook, Deschutes and Jefferson counties in Central Oregon. Our organization is considered the largest nonprofit in our region on a client -served basis, serving 55,000 residents annually. NeighborImpact programs support people in our community who need it the most as well people who need a temporary boost. In fact, our programs benefit 1 in 4 residents of Central Oregon and we are the region's leading provider of food, housing services, energy assistance, and early childhood education services. 2. State the organization's mission, goals, and programs or services provided. "Supporting people, strengthening communities" is not only the mission of NeighborImpact, it is at the heart of every decision we make. Our purpose is to empower individuals and families to succeed and help people make better choices for a brighter future. NeighborImpact works to develop solutions and bring resources to Central Oregon to address the issues surrounding poverty. We offer a diverse array of services that meet basic human needs including hunger, education, emergency shelter, and stable housing. Our organization serves families and individuals who are unemployed, low-income, and/or in poverty. Each year our Food Bank distributes 2.6 million pounds of food and we provide energy assistance to over 6,500 households. Our Transitional Housing Program helps families move to permanent housing and we help children in poverty enter school ready to learn through our Head Start Program. Our Matched -Savings Program helps residents save for education, homeownership and to start small businesses while our HomeSource Program helps residents become successful homeowners and conserve financial resources through homebuyer -education, energy -education, financial management, mortgage payment assistance and foreclosure prevention counseling. 3. Describe the leadership and structure of the organization. As a 501(c)(3) nonprofit organization, NeighborImpact employs roughly 200 staff and maintains 15 offices and classrooms in La Pine, Bend, Redmond, Sisters, Prineville and Madras in Central Oregon. We are the lead agency for homeless services, childcare resources, emergency food programs, home ownership, Head Start, and self-help programs for the working poor. For over 25 years, we have focused on building successful families through basic needs, affordable housing, home ownership and trainings to increase life skills, work skills and financial literacy. In addition to the leadership provided by our Executive Director, Scott Cooper, our organization is governed by a 15 -member board of directors representing all three counties and multiple sectors of the community such as government, education, business, and health and human services. As per our bylaws, one-third of our board represents the economically disadvantaged from Crook, Deschutes, and Jefferson Counties. Program, Project, or Activity 1. Provide a title of the proposed initiative for which funds are being requested. HomeSource of NeighborImpact — Homebuyer Education, Counseling, and Home Rehabilitation 2. Describe the goals and objectives of the proposed initiative. The primary goal of our HomeSource program is to offer a variety of classes, programs and services to help underserved Deschutes County residents strengthen their household finances, build financial assets, and acquire, maintain and sustain homeownership. We provide services that are responsive to community needs and enable residents to create tangible assets and build their own financial foundation. Increasing access to quality buyer education, increasing the number of households that participate in homebuyer education classes, and increasing housing affordability and stability for low income households are just a few of the results we will achieve towards our primary goal. Another goal of HomeSource of Neighborlmpact is to provide a continuum of care to help underserved populations move out of homelessness and become financially stable and secure. Clients who are served by Neighborlmpact's Emergency Services Programs (shelter, rent assistance, energy assistance) are directed to HomeSource for financial literacy training and credit and budget counseling. These services help individuals build their knowledge and skills to prevent homelessness and the need for further emergency services. Preventing vulnerable individuals from making uninformed home purchases, falling victim to predatory loans, and depending too heavily on credit are also objectives we will achieve through this project. Lastly, for this project, HomeSource of Neighborlmpact aims to assist Deschutes County residents purchase, maintain, and sustain successful homeownership. We help homeowners resolve mortgage delinquency, avoid foreclosure and address health and safety problems in their home. 3. Identify the target population which will be served. HomeSource of Neighborlmpact is committed to serving low-income individuals and families and those living at or below the poverty line. Our Weatherization Program has an income cap of 60% state median income, and our Housing Rehabilitation and Individual Development Account programs have an income cap of 80% AMI (area median income). Our programs reach those living in rural areas of Deschutes County as well as within underserved urban areas. Of the clients served in Fiscal Year 2013-14, 10% were Hispanic/Latino, 8% were disabled, and 5% were veterans. 4. Identify the geographic area(s) of Deschutes County which will benefit. While services will be available to all County residents, we plan to target Redmond and rural areas of Deschutes County including La Pine. 5. Describe how the proposed initiative will positively impact the community and complement existing services currently provided by Deschutes County. The HomeSource foreclosure mitigation program both preserves affordable housing for homeowners as well as prevents homelessness for those same owners who may not have another housing option if they lose their home. Our comprehensive program helps Deschutes County residents apply for and secure loan modifications that bring down their housing payments to affordable levels. When we are unable to help families secure a loan modification, we work with clients on other options including exiting with dignity or referring them to other programs within our agency or other partner agencies. Our knowledgeable coaches help struggling homeowners access services to try to prevent home foreclosure. Our home rehabilitation program provides funds to help low income homeowners make critical health and safety repairs to their homes. Additionally, our financial fitness programs help position clients to build wealth over the long term to better avoid poverty and weather economic changes. 6. Describe in detail how the proposed initiative will be implemented. In order to promote our classes, workshops, and counseling programs, we advertise in most of the free calendar listings locally (The Bend Bulletin, Nugget, etc.) and purchase print advertising in a variety of sources: Central Oregonian, Roundup(s), Spokesman, Bulletin, Source Weekly, etc. Additionally, we have advertised in the Central Oregon Real Estate Book & Rental Guide and on their website. We also advertise through HomeSmart Oregon, our state wide collaborative formed to promote online home buyer education throughout the state. In order to reach those in Deschutes County who need HomeSource services, NeighborImpact Counselors have specific monthly outreach goals. We also have a department annual target for attending meetings and events, broken down by geographic area. We are pleased to share that we met our 2013-2014 goal of 400 events. We attend chamber events, target the largest area employers, and ask to attend staff meetings. We visit realty and title offices, senior centers, anyone who might have an interest in what we do. Outreach is a crucial component of our HomeSource Program. Homebuyer Education classes are taught by NeighborImpact staff and volunteers in our offices in Bend, LaPine, Redmond, and other rural areas of Deschutes County. We meet regularly with our community partners who help us revise and update curriculum and teach specialized portions of the classes (taxes, insurance, etc.). Typically these partners volunteer their time and include lenders, realtors, and other finance industry professionals. With three regional offices in Deschutes County (Redmond, Bend, and La Pine) we are poised to implement this project as soon as funding is secured. We have tentative workshop dates scheduled throughout Deschutes County in 2015 covering financial fitness and home buyer education. With additional funding we will be able to focus staff on the areas of greatest need immediately. 7. Describe specifically how the requested funds will be used. HomeSource of NeighborImpact requests $11,000 to support our educational and coaching programs and services for Deschutes County residents. Residents will have access to all our coaching and educational services including home buyer pre -purchase counseling and education; foreclosure counseling and education; reverse mortgage counseling; post purchase education for homeowners; financial education; home rehabilitation loans; budget and credit counseling; savings programs (IDAs) and related coaching/mentoring; energy conservation education; weatherization grants; and referrals to emergency services to prevent homelessness. HomeSource of NeighborImpact employs 4.5 FTE to provide services to Deschutes County residents. This funding represents a portion of the overall cost to provide these services to the low and moderate income households in the communities across Deschutes County. 8. Identify any partner agencies which will collaborate to implement the proposed initiative. We work very closely with partner agencies to ensure clients are adequately served without a duplication of effort. Some of our partner agencies include Housing Works, Central Oregon Veterans Outreach, and Central Oregon Association of Realtors. Our largest referral sources include other NeighborImpact programs such as Head Start and Transitional Housing as well as external referral sources Housing Works and realtors and lenders. 9. Describe other sources of funding that will support the proposed initiative. HomeSource will use the funding from the Deschutes County Community Grant to help leverage additional resources from the State of Oregon, NeighborWorks America, and private foundations to cover the full cost of operating these programs. HomeSource of Neighborlmpact is open five days a week for business. Most of our services are free to all community members, with the exception of the home buyer education workshop which requires a reasonable registration fee for the eight hour class. Performance Measurement 1. Identify quantifiable outputs anticipated to be achieved through the proposed initiative (examples: number of persons served, programs or events held, animals rescued, acres restored or protected). In 2015, HomeSource staff will: • Provide a minimum of 100 individuals with foreclosure prevention counseling and foreclosure mitigation services • Provide pre-purchase/budget/credit counseling for 50 clients • Provide Homebuyer Education for 75 clients • Provide 8 Financial Fitness Classes per year • Provide individual financial counseling for 50 clients • Assist 50 homeowners to sustain homeownership through reverse mortgage and default mortgage counseling as an option to prevent foreclosure • Improve quality of life for at least 35 households through weatherization grants which will be targeted to reduce monthly housing costs • Provide 4 Rehabilitation loans to low income homeowners who have a health or safety issue with their primary residence 2. Describe the anticipated outcomes of the proposed initiative (examples: fewer persons institutionalized, greater knowledge and understanding of local history, fewer animals in shelter care, more natural areas available for wildlife and recreation). In 2015, the HomeSource program will: • Increase housing affordability and stability for low income households through home rehabilitation and weatherization • Increase the number of households that access Homebuyer Education prior to shopping for a home • Increase knowledge in order to sustain affordable homeownership through Foreclosure Prevention Coaching, Mediation Support and Post -Purchase Education • Increase understanding of the importance of homeownership through innovative programs • Increase the number of households correcting or building credit to achieve financial goals • Reduce household energy burden and carbon emissions through rehabilitation, weatherization and education HomeSource of Neighborlmpact 2014-2015 Program Budget Salaries, Benefits, Insurance Total 2014-2015 Budget FTE dedicated to Deschutes County Deschutes County Community Grant $434,323.00 $260,593.80 $7,900 Program Expenses Training $28,056.00 $16,833.60 Travel $12,500.00 _ $7,500.00 $400 Telephone $6,750.00 $4,050.00 Postage $2,000.00 $1,200.00 _ Printing $8,000.00 $4,800.00 _ Rent $73,913.00 $44,347.80 $800 Office Supplies $6,000.00 $3,600.00 Technology and Equipment $2,500.00 $1,500.00 Marketing/ Other Fees and Services $30,000.00 $18,000.00 _ $1,200 Legal, liability, and permits $2,075.00 $1,245.00 Utilities, Janitorial, etc. _ $6,906.00 $4,143.60 Fiscal Admin Pool $63,255.00 $37,953.00 $700 IT- Program $16,839.00 $10,103.40 HR Admin Pool _ $8,000.00 $4,800.00 ED Pool - Admin $15,914.00 $9,548.40 Other $5,000.00 $3,000.00 TOTAL OTHER OPERATING $ 287,708.00 $ 172,624.80 $ 3,100.00 TOTAL $ 722,031.00 $ 433,218.60 $ 11,000.00 Neighborlmpact Board of Directors Roster Community Representatives Susan Bailey — Deschutes County President Executive Committee Accounting Technician Deschutes County Road Department Term: 1/13 - 12/14 Susan Bray — Deschutes County Term: 1/13 — 12/15 Chad Carpenter — Crook County Executive Committee Executive Director The Landing Youth and Tutoring Center, Inc. Term: 1/13 — 12/14 Walt Ponsford — Jefferson County Term: 1/13 - 12/14 Sharon R. Smith — Deschutes County Attorney at Law Bryant Lovlien & Jarvis Term: 1/14 - 12/16 Joe Hight — Crook County Annual Term: 11/13 - 10/14 Representatives of Economically Disadvantaged Laura Beebe — Deschutes County Term: 1/13 - 12/15 Brian Carmack — Crook County Associate Pastor, Eastside Church Term: 1/14 - 12/16 Linda Walker — Jefferson County Secretary/Treasurer Executive Committee Coalition on Housing & Homelessness Term: 1/13 - 12/14 Andrus Soper — Deschutes County Executive Committee Term: 1/13 - 12/15 Head Start Policy Council Liaison Elected Public Officials Mike Ahern — Jefferson County Jefferson County Commission Coldwell Banker Term: 1/13 - 12/15 Seth Crawford — Crook County Crook County Commission Term: 3/14 - 12/16 Tony DeBone — Deschutes County Deschutes County Commission Term: 1/14 - 12/16 Edward B. Onimus — Deschutes County Executive Committee Redmond City Council Term: 1/14 - 12/16 Sharlene Weed — Deschutes County Representative of Sisters City Council Executive Director, Sisters Habitat for Humanity Term: 1/13 - 12/14 1 as of 3-10-14 60036 Form 990 Department of the Treasury Internal Revenue Service A B Check if applicable: Address change Name change Initial return Terminated ElAmended return Application pending Return of Organization Exempt From Income Tax omsNo. tg45-tl047 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung 20 2 benefit trust or private foundation) Open to Public ► The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection For the 2012 calendar year, or tax year beginnin] 7 /01/12 , and ending 06/30/13 C Name of organization Doing Business As Neighborlmpact D Employer identification number 93-0884929 Number and street (or P,O, box if mail is not delivered to street address) 2303 SW First Street Room/suite E 541-548-2380 City, town or post office, state, and ZIP code. Redmond OR 97756-9608 G Gross receiptsS 14,006,294 F Name and address of principal officer: Scott Cooper 2303 SW 1st St Redmond OR 97756 1 Tax-exempt status: g so1(c)(3) `L 5O1f0 ( ) 1 (insert no.) r1 4447'0)(1) or .1 Website: www.neighborimpact.org K Farm of organization: Corp /al en 1 1 Trust Part! Summa H(a) Is this a group return for affiliates? Yes H(b) Are all affiliates included? Yes If "No," attach a list (see instructions) H(c) Group exemption number Po' X No I No Association 1 I Other ► L Year of formation: 1985 nn State of legal domicile: OR Activities & Governance 1 Briefly describe the organization's mission or most significant activities: See Schedule 0 • 2 Check this box if the organization discontinued its operations or disposed of more than 3 Number of voting members of the governing body (Part VI, line 1a) 4 Number of independent voting members of the governing body (Part VI, line 1 b) 5 Total number of individuals employed in calendar year 2012 (Part V, line 2a) 6 Total number of volunteers (estimate if necessary) 7a Total unrelated business revenue from Part VIII, column (C), line 12 b Net business from 25% of its net assets. i 3 13 4 13 5 236 6 350 7a 0 7b 0 unrelated taxable income Farm 990-T, ling,34 , ip. i. Revenue JA 8 Contributions and grants (Part VIII, line 1 h) 9 Program service revenue (Part VIII, line 2g) 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 12 Total revenue — add lines 8 through 11 (must equal Part VIII. column (A). line 12) Prior Year Current Year 15,119,252 13,593 , 392 579,157 363,437 -411,859 39,437 — 81, 812 -14,619 15,204,738 13,981,647 Expenses 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 14 Benefits paid to or for members (Part IX, column (A), line 4) 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 16aProfessional fundraising fees (Part IX, column (A), line 11e) b Total fundraising expenses (Part IX, column (D), line 25) ► 141,635 17 Other expenses (Part IX, column (A),lines lla-11d,11f-24e) 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 19 Revenue less expenses. Subtract line 18 from line 12 , , 7,782,267 5,881,426 0 5,744,881 5,844 , 847 0 1, 685, 456 2,335,529 15,212,604 14,061,602 -7,866 -80,155 Net Assets n Fund Balanc 20 Total assets (Part X, line 16) 21 Total liabilities (Part X, line 26) 22 Net assets or fund balances. Subtract line 21 from line 20 .. . . . .... . ... , Beginning of Current Year End of Year 8,130,073' 7,987,651 428,669 366,402 7,701,404 7,621,249 PartII Signature Block _ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Sign Here Signature of officer Scott Cooper Type or print name and title Dale Executive Director Paid Preparer Use Only Print/Type preparer's name Sara Hummel Preparer's signature Dale if PTIN P00991199 93-0819646 Check self-employed Firm's name Jones & Roth, P.C._ Firm's EIN P.O. Box 10086 mrm'e address ► Eugene, OR 97440 Phone. 0, 541-687-2320 May the IRS discuss this return with the preparer shown above? (see instructions) n Yes No For Paperwork Reduction Act Notice, see the separate instructions. Form 9 0 (2012) DAA 60036 Form 990 (2012) Neighborlmpact 93-0884929 Part III Statement of Program Service Accomplishments Check if Schedule 0 contains a response to any question in this Part III .... 1 Briefly describe the organization's mission: See Schedule 0 Page 2 xi 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990 -EZ? If "Yes," describe these new services on Schedule O. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services? If "Yes," describe these changes on Schedule O. 4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. Yes X No Yes X No 4a (Code: ) (Expenses $ 6, 752,313 including grants of$ 5 , 6 41, 703 ) (Revenue $ ... 112 , 8 3 5 ) Neighborlmpact and its 44 partner agencies collected and distributed 3.7 million lbs. of food throughout Central Oregon. A total of 41,463 individuals were served. As the region's food bank, Neighborlmpact provides vital supplemental assistance to income -qualified households, preventing, hunger for children, the elderly and struggling working-class families and individuals. Neighborlmpact's energy assistance program served 16,491 individuals last year. Direct funding from state and local government as well as public purpose charges collected by utilities helped minimize high winter heating bills for low-income households, with priority being given to the low—income elderly and disabled and households with small children. Neighborlmpact is able to a ..;n h `. 1 rx .y, natural gas, fuel oil, 4b (Code: ) (Expenses $ 4, 894 , ; ,'f' I cludr ran . ) (Revenue $ 13,984) Neighborlmpact's HeadStart and Oregon Pre-Kindergarten,program helped 516 children become school ready in 2013. Three and four-year olds learn letters, numbers, colors and social -emotional skills essentrial to being able to fully participate in a kindergarten environment. Participants in the program are selected based on eligibility criteria from low-income and disadvantaged families, with special consideration given to children who have suffered early childhood trauma, extreme poverty, family disruption or disability. Approximately 30 percent of Neighborlmpact HeadStart program is federal funded, while the remaining 70 percent is state -funded. The agency operated 24 classrooms in Crook and Deschutes Counties in 2013. 4c (Code: ) (Expenses $ 1, 6 4 0 , 0 8 2 including grants of$ 2 3 9 , 7 2 3 ) (Revenue $ 236,618) Neighborlmpact's Housing Center Programs provide first-time home ownership classes, foreclosure prevention counseling, mortgage assistance payments, reverse mortgage counseling, financial literacy education and a matched savings program. The program also offers housing rehabilitation and weatherization programs, which address critical life -safety issues and help low-income households reduce energy costs while improving personal health and well-being. 4d Other program services. (Describe in Schedule 0.) (Expenses $ including grants of$ ) (Revenue $ 4e Total program service expenses ► 13,286,569 DM Form 990 (2012) Internal Revenue Service P.O. Box 2508 Cincinnati, OH 45201 Date: OCT 3 1 2006 NEIGHBORIMPACT 2303 SW 1ST ST REDMOND, OR 97756 Dear Sir or Madam: NOV C 2006 Department of the Treasury Person to Contact: Roger Meyer ID# 31-07707 Toll Free Telephone Number: 877-829-5500 Employer Identification Number: 93-0884929 This is in response to the amendment to your organization's Articles of Incorporation filed with the state on August 31, 2006. We have updated our records to reflect the name change as indicated above. Our records indicate that a determination letter was issued in February 1986 that recognized you as exempt from Federal income tax. Our records further indicate that you are currently exempt under section 501(c)(3) of the Internal Revenue Code. Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. If you have any questions, please call us at the telephone nurnber shown in the heading of this letter. Sincerely, ile&CAW Cind ]IVestcott Manager, Exempt Organizations Determinations Applicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet Grandma's House of Central Oregon Category/Grant Amount: Title: Other Essential Services / $11,000 Program Support Review Criteria: 1. Organization: • Stable and positive history of providing services in Deschutes County. • Experience delivering similar programs, projects, or activities as those proposed. • Mission and goals are consistent with proposed program, project, or activity. • Stable and experienced Board of Directors or other leadership group. • Adequate staff and/or volunteers to implement proposed program, project, or activity. Points awarded for this section (maximum of 25). 2. Financial Status: • Adequate financial resources available to conduct and sustain operations. • Broad and diverse base of funding sources. • Financial need for a Community Grant to implement proposed program, project, or activity. • Proposed budget is consistent with and appropriate for the fixed grant amount available in the selected Community Grant category. Points awarded for this section (maximum of 25). 3. Program, Project, or Activity: • Program, project, or activity does not address emergency food, clothing, or shelter. (These activities are supported by Deschutes County through a separate grant program in conjunction with United Way's Emergency Food and Shelter program.) • Request is consistent with the fixed dollar amounts indicated in the category/grant amount description at the top of this form. • Number of individuals to be served is appropriate to the budget and scale of proposed program, project or activity. • Serves vulnerable and/or underserved populations and/or communities. • Positively impacts welfare of the community. • Complements, but does not duplicate, existing Deschutes County services. • Implementation strategy is suitable to achieving the stated goals and objectives of proposed program, project, or activity. • Partnerships or collaboration with other agencies are included in implementation strategy. • Other sources of funds or in-kind support are available to supplement Community Grant funds. Points awarded for this section (maximum of 35). 4. Performance Management: • Stated outputs are relevant and reasonable to the scale of the proposed program, project, or activity. • Stated outcomes are relevant and reasonable to the scale of the proposed program, project, or activity. Points awarded for this section (maximum of 15). TOTAL NUMBER OF POINTS AWARDED: COMMENTS: NAME OF RATER: Deschutes County Fiscal Year 2014-15 Community Grant Application Submittal Instructions and Cover Sheet A complete application will consist of the following: 1. This cover sheet, signed and dated. 2. Narrative responses to the attached questions on no more than four single -sided, single- spaced pages. 3. Attachments: a. Proof of the organization's 501(c)(3) tax-exempt status in the form of a letter from the Internal Revenue Service (IRS). b. The first two pages of the organization's most recently submitted IRS 990 or 990 EZ form or, if the organization is not required to file either form with the IRS, a financial statement that provides equivalent information concerning activities and governance, revenue, expenses, and net assets or fund balances. c. An operating budget specific to the proposed operations, program, project, or activity. d. A roster of the organization's Board of Directors. Submit the complete application electronically to judithu@deschutes.org no later than 5:00 p.m. on October 24, 2014. Incomplete and/or late applications will not be reviewed or considered. Please complete the following: Contact Name: Woody Medeiros Organization Name: Address: City: Grandma's House of Central Oregon P. O. Box 6372 Bend Telephone Number: Email Address: State: OR Zip Code: 97708 541-383-3515 grandm anabendcable. com Application is being submitted to which Community Grant Program funding category*? ❑ Health, Mental Health, and Addictions Services El Arts and Culture ® Other Essential Services: Includes services to youth; underserved, indigent, and/or vulnerable populations; animal welfare; or the environment. * Please refer to the funding guidelines for more information. Certification: On behalf of the organization specified above, I certify the following: 1. All information included in this application is accurate. 2. I am authorized by the governing board to submit this grant application. 3. This organization is located in Deschutes County. 4. If awarded, Community Grant funds will be used in support of Deschutes County residents only. 5. This organization is in good standing with the U.S. Internal Revenue Service and is currently designated as a 501(c)(3) tax-exempt entity. Signature: • ( —Lott? TV /IP Of ..erucx s`*, Woody Medeiros • Print Name: S (AD C.)0 1T 4 _ rn E Cl gy! CC) C Executive Director Title: October 19, 2014 Date: Deschutes County Fiscal Year 2014-15 Community Grant Application Questions Please respond to the questions below in the order shown. Reponses must be thorough, but provided on no more than four single -sided, single-spaced pages. Required attachments such as proof of non-profit status and copies of tax forms are excluded from the four page limit. Any additional documents submitted beyond those stated in the instructions, such as brochures, leaflets, newsletters, or reports, will not be considered a part of the application and will be discarded without review. Organization 1. Describe the history of the organization, including the year the organization was established. Grandma's House of Central Oregon is a 501 (c) (3) organization which was founded in 1992 with contributions from businesses, community members, churches, service clubs and foundations. Grandma's House is an educational, welfare, non-profit, residential home and outreach center for homeless and/or abused pregnant teens between the ages of 12 and 19 years old and their babies. Some of the teens who come to Grandma's house choose to parent their babies and some choose adoption. We operate non-stop 24 hours a day, 7 days a week, and 365 days a year. The components of the programs we offer are described below. Whether choosing adoption or parenting, Grandma's House offers hope, support and tools to young parents to make good life decisions for themselves and their babies. The support of this grant funding will assist Grandma's House in continuing to provide a safe, nurturing shelter in a stable, supportive environment with access to comprehensive maternal and infant healthcare programs, counseling, education, emotional and psychological support and early intervention. We provide workshops and support in life -skills, substance abuse counseling, crisis intervention, pre & post -natal care, breastfeeding, nutrition, parenting skills and child abuse prevention. 2. State the organization's mission, goals, and programs or services provided. The mission/goal of Grandma's House is to help each young woman become self- sufficient and able to make responsible decisions for herself and her child. This, in turn, enables her to move on into independent living as a productive and confident community member. The specific services provided are described within this document. 3. Describe the leadership and structure of the organization. Grandma's House Executive Director, Woody Medeiros, has been in major leadership roles with Grandma's House for over 21 years (first 3 years as the Resident Coordinator then last 18 years as the Executive Director). With oversight by a volunteer Board of Directors Woody leads a dedicated staff including a Resident Case Manager, Elsa Milne (1.0 FTE —1 year), Program Assistant / Volunteer Coordinator, Linda Collins (1.0 FTE — 7 years, started volunteering over 20 years ago), Night Supervisor, Sharon Petrie (.20 FTE — 3 months). Grandma's House also relies heavily upon its volunteer base including over 800 hours annually from 30 House Moms who help ensure 24 hour supervision of the residents and facility. 1 Grandma's House has a stong Board of Directors who are committed to the organization and provide leadership in planning, fundraising and other aspects of our operations. Program, Project, or Activity 1. Provide a title of the proposed initiative for which funds are being requested. Grandma's House respectfully submits this application for funding to the Deschutes County Community Grants Program in the amount of $11,000. We seek funding to provide for program support giving shelter and outreach to homeless and/or abused pregnant and parenting teen girls in crisis. The total budget for this fiscal year is $172,843. 2. Describe the goals and objectives of the proposed initiative. The primary activities of Grandma's House center on achieving success in four major initiative areas: • Healthy Pregnancies, Healthy Mothers & Healthy Babies: To provide a safe nurturing shelter and supportive environment for teens in crisis pregnancy resulting in healthy full term pregnancies and healthy newborns. Giving solid parenting tools for teen parents, teen mothers with newborn infants and support of teens choosing adoption. To teach, support and encourage pregnant and parenting teens to become healthy, self-sufficient, nurturing adults so that they can in turn foster healthy nurturing attitudes and skills in their children. • Grandma's Closet: To re -donate maternity and baby items, clothing, furniture, bedding and personal care items to low income/no income families with infants and babies through our network of 21 Community referral partners. Grandma's Closet has been in existence at Grandma's House since 1993 and is run by a staff Volunteer Coordinator, volunteers and through the participation of residents. • Angel's Wing After -Care Program: To support our parenting teen mothers transitioning from Grandma's House into independent living within the community. Under the "Angel's Wing" participants receive case management, one-on-one counseling, and activities for moms and babies to interact in a supportive and social environment with a focus on goal setting and continuing education. • Teen Pregnancy Awareness, Prevention & the Realities of Teen Pregnancy: To promote and engage the community in teen pregnancy awareness, prevention, effects of alcohol and drugs on newborns and teen parenting realities by doing interactive presentations to not only pregnant teens and classrooms but also out in the community by addressing at risk youth and young adults. 3. Identify the target population which will be served. Over the course of a year, we serve in a residential setting, numerous generational members of families. At any given time, we serve at least eight young women and their babies. In the larger context, we also serve teen girls' parents and families as we provide counsel in acceptance, support of new life challenges for teens who are experiencing new responsibilities in their lives. Our teens are planning for education, a career, and managing life with a baby. We help our teen clients in decision making and learning life skills. In many cases, we serve teen fathers of babies, supporting them in decision making processes. In general, we help provide assistance for our young mothers in achieving success and making life decisions related to school, employment and a new life's responsibility with a child to care for. 2 4. Identify the geographic area(s) of Deschutes County which will benefit. The majority of our teens and babies served are from the greater population area of Bend. 5. Describe how the proposed initiative will positively impact the community and complement existing services currently provided by Deschutes County. In serving the Central Oregon community for the last 22+ years, Grandma's House has built a strong reputation and connection to the community. Our community partnerships include a maternal child health nurse assigned through Deschutes County Health Department Nurse Family Partnership, education through the Bend High Teen Parent Program, health and developmental screenings through Healthy Beginnings, food via the Neighborlmpact Feed the Need Program, and volunteer screening and transportation assistance through the Department of Human Service. 6. Describe in detail how the proposed initiative will be implemented. We have staffing in place. We have an established residential home for teen mothers and their babies. Our educational and outreach programs are implemented on an on-going basis, year-round. 7. Describe specifically how the requested funds will be used. The requested funds will be used to support the operational expenses of Grandma's House, its staffing/operations, and educational programming throughout Deschutes County. We conduct workshops for teens, and other support programs. 8. Identify any partner agencies which will collaborate to implement the proposed initiative. Again, Grandma's House is the only shelter of its kind east of the Cascades in Oregon. We serve as an outreach resource to pregnant and parenting teens in Deschutes County. As mentioned previously, our community partnerships include a maternal child health nurse assigned through Deschutes County Health Department/Nurse Family Partnership, education through the Bend High Teen Parent Program, health and developmental screenings through Healthy Beginnings, food via the Neighborlmpact Feed the Need Program, volunteer screening and transportation assistance through the Department of Human Services. 9. Describe other sources of funding that will support the proposed initiative. To date, we have received the following funding commitments: United Way of Deschutes County Allocations & Designated Donations $34,000; Emergency Food & Shelter Program $5,000; Emergency Shelter Grant Program $10,000. We submitted a funding request (by invitation) to the Maybelle Clark Macdonald Fund for $15,000 this month. We have also submitted an application to the Brooks Resources Corporation in Bend for $5,000 and the Chambers Family Foundation for $7,500. And, we will be submitting the following requests in the coming months: PGE Foundation, $5,000; The Autzen Foundation, $5,000; Meyer Memorial Trust, $20,000; Oregon Community Foundation, $15,000; and First Story, $2,000. In addition, Grandma's house receives donations from individuals, businesses, and service organizations. We send an annual giving letter at the end of the year that generates funding for our organization. 3 Performance Measurement 1. Identify quantifiable outputs anticipated to be achieved through the proposed initiative (examples: number of persons served, programs or events held, animals rescued, acres restored or protected). The children of teen mothers are more likely to be born prematurely and at low birth weight and are two times more likely to suffer abuse and neglect compared to children of older mothers. It is widely recognized that prenatal health care, as well as a healthy and secure lifestyle, significantly reduces the number of low birth weights and other medical complications which are typical to the pregnant teen and an expensive burden to the medical system. Further, without supportive counseling and education, teen mothers and their children are often destined to live lives of poverty, neglect, and potential abuse. When a pregnant teen comes to Grandma's House she feels she is at the end of the road; homeless, hungry, tired and most often sick, she may only be looking for a hot meal and a safe place to sleep. At Grandma's House she will find hope and a path to a future that she didn't know existed. Some will stay a night, some will stay a year; all say that their lives were improved by their experience. They enter our program to carry out healthy full term pregnancies, learn to parent an infant already born, or to complete a successful adoption. While here they will gain the necessary life -skills for a smooth transition into independent living or a safe return to family. 2. Describe the anticipated outcomes of the proposed initiative (examples: fewer persons institutionalized, greater knowledge and understanding of local history, fewer animals in shelter care, more natural areas available for wildlife and recreation). Our anticipated program outcomes include: • Healthy Pregnancy with decreased pre -term complications • Teens follow proper nutritional guidelines for healthy fetal development and nutritional needs of self and child with increased awareness of healthcare needs • Increased knowledge of parenting skills, reduced neglect/ Child Protective Services intervention • Teen mothers provide appropriate care and social interaction to their babies • Meeting the needs of 100% of referrals for infants in need of warm, clean clothing • Reduced duplication of services by effective communication with community partners We will measure success by the following: • Full term pregnancy with healthy infant birth weight • Assessments done by visiting health nurse and Healthy Families of the High Desert • 75% of teen mothers still breast-feeding after 3 months • 100% of babies seen in routine appointments and have up to date vaccinations at 8 weeks • Teen mom participation in workshops in nutrition, parenting and self-esteem classes • Records kept of 250+ referrals filled from Grandma's Closet • Feedback from recipients and community partners Grandma's House extends its great appreciation for the opportunity to apply for funding assistance through the Deschutes County Community Grant Program. 4 Grandma's House of Central Oregon 2014-15 Budget J INCOME ACC'T # ACCOUNT NAME Contributed Support 4000 Individuals $25,000.00 4200 Businesses $15,000.00 4210 Churches $3,000.00 TOTAL CONTRIBUTED SUPPORT: $43,000.00 Grants $5,000.00 $70,000.00 4300A EFSP 4300B 4300C Private Found. Service Organ. _ _ TOTAL GRANTS: $75,000.00 United Wav 4310A UW Allocated $24,000.00 4310B UW Designated $13,000.00 TOTAL UNITED WAY: $37,000.00 4500 Inkind Goods 4600 Inkind Services Resident Contribution 4700A Contribution $4,000.00 4700B Independ. Fund $800.00 4700C Independ. Savings $800.00 TOTAL RESIDENT CONTRIBUTION: $5,600.00 Fundraising 5400A Other Agency $10,000.00 5400B Garage Sale $600.00 5400C Mother's Day $3,500.00 TOTAL FUNDRAISING: $14,100.00 Interest Income 5600 Interest $300.00 Y _ TOTAL INTEREST INCOME $300.00 Refunds/Rebates 5900 Refunds/Rebates TOTAL INCOME $175,000.00 Grandma's House of Central Oregon 2014-15 Budget ACCT # ACCOUNT NAME EXPENSES 6010 $50,400.00 $25,200.00 Salaries & Wages Executive Director 6020 Program Manager 6070 Volunteer Coord/Prog Asst. $27,120.00 6050 Night Supervisor $9,600.00 6075 Reserve for raises TOTAL SALARIES & WAGES: $112,320.00 6080 Other Personnel Expenses Overnight ($40) TOTAL OTHER PERSONAL EXPENSES: $4,500.00 $4,500.00 Company Taxes f 6100 Payroll Taxes $14,604.00 TOTAL COMPANY PAYROLL TAXES: $14,604.00 7020 7050 Administrative Bank Charges $400.00 _ Membership Dues $675.00 TOTAL ADMINISTRATIVE: $1,075.00 7070,Inkind Expense -Goods 7080 Inkind Expense -Services Insurance 7090a Board $1,000.00 7090b 7090c General Liability $561.60 $1,872.00 Prof. Liability _ 7090d Auto $1,185.60 7090e Property 51,560.00 7090f A & M $1,060.80 7090g Renewal Fee $250.00 TOTAL INSURANCE: $7,490.00 7130 Taxes, licenses, fees $650.00 $650.00 TOTAL TAXES, LICENSES, FEES: 7150 Office Supplies $900.00 TOTAL OFFICE SUPPLIES: $900.00 — 7190 Maintenance $4,000.00 TOTAL MAINTENANCE: $4,000.00 Education 7200a Education ($500 vol) $250.00 Grandma's House of Central Oregon 2014-15 Budget 7200b Staff Dev/TACS $300.00 $4,909.00 $550.00 TOTAL EDUCATION: 7210 Telephone/Internet TOTAL TELEPHONE/INTERNET: $4,909.00 Auto Expense 7220a Maintenance $250.00 7220b Gas $600.00 TOTAL AUTO EXPENSE: $850.00 7230a Utilities $3,465.00 Electricity 7230b Gas $1,050.00 7230c Water $2,500.00 TOTAL UTILITIES: $7,015.00 7510 Fundraising Exp. $800.00 TOTAL FUNDRAISING EXPENSE: $80.00 7540 Professional Fees $7,250.00 TOTAL PROFESSIONAL FEES: $7,250.00 Resident Assistance 9930A Activity Fund $800.00 9930B Groceries $2,100.00 9930C Independence Fund $800.00 9930D 9930E Household Supplies Resident Savings $650.00 $800.00 9930F Resident Support $1,000.00 9930G Resident Workshops $500.00 TOTAL RESIDENT ASSISTANCE: $6,650.00 TOTAL EXPENSE $172,843.00 NET INCOME $2,157.00 Grandma's House of Central Oregon 2014-15 Budget ACC'T # ACCOUNT NAME INCOME Contributed Support 4000 Individuals $25,000.00 4200 Businesses $15,000.00 4210 Churches $3,000.00 TOTAL CONTRIBUTED SUPPORT: $43,000.00 Grants 4300A 4300B 4300C EFSP $5,000.00 Private Found. Service Organ. $70,000.00 TOTAL GRANTS: $75,000.00 United Wav 4310A UW Allocated $24,000.00 4310B UW Designated $13,000.00 TOTAL UNITED WAY: $37,000.00 4500 Inkind Goods 4600 Inkind Services Resident Contribution 4700A 4700B 4700C 5400A 5400B 5400C Contribution $4,000.00 Independ. Fund $800.00 Independ. Savings $800.00 TOTAL RESIDENT CONTRIBUTION: $5,600.00 Fundraising Other Agency $10,000.00 Garage Sale $600.00 Mother's Day $3,500.00 TOTAL FUNDRAISING: $14,100.00 5600 Interest Income Interest TOTAL INTEREST INCOME Refunds/Rebates $300.00 $300.00 5900 Refunds/Rebates TOTAL INCOME $175,000.00 Grandma's House of Central Oregon 2014-15 Budget ACC'T # ACCOUNT NAME EXPENSES Salaries & Wages 6010 $50,400.00 Executive Director 6020 Program Manager $25,200.00 6070 Volunteer Coord/Prog Asst. $27,120.00 6050 Night Supervisor $9,600.00 6075 Reserve for raises TOTAL SALARIES & WAGES: $112,320.00 6080 Other Personnel Expenses $4,500.00 Overnight ($40) TOTAL OTHER PERSONAL EXPENSES: $4,500.00 Company Taxes 6100 Payroll Taxes $14,604.00 TOTAL COMPANY PAYROLL TAXES: $14,604.00 Administrative 7020 Bank Charges $400.00 7050 Membership Dues $675.00 TOTAL ADMINISTRATIVE: $1,075.00 7070 Inkind Expense -Goods 7080 Inkind Expense -Services Insurance 7090a Board $1,000.00 7090b 7090c General Liability $561.60 $1,872.00 _ Prof. Liability 7090d Auto $1,185.60 7090e Property $1,560.00 7090f A & M $1,060.80 7090g Renewal Fee $250.00 TOTAL INSURANCE: $7,490.00 7130 Taxes, licenses, fees $650.00 $650.00 TOTAL TAXES, LICENSES, FEES: 7150 Office Supplies $900.00 TOTAL OFFICE SUPPLIES: $900.00 7190 Maintenance $4,000.00 TOTAL MAINTENANCE: $4,000.00 Education 7200a Education ($500 vol) $250.00 Grandma's House of Central Oregon 2014-15 Budget 7200b Staff Dev/TACS $300.00 $4,909.00 TOTAL EDUCATION: $550.00 7210 Telephone/Internet TOTAL TELEPHONE/INTERNET: $4,909.00 Auto Expense 7220a 7220b Maintenance $250.00 Gas $600.00 TOTAL AUTO EXPENSE: $850.00 7230a 7230b 7230c Utilities $3,465.00 Electricity Gas $1,050.00 Water $2,500.00 TOTAL UTILITIES: $7,015.00 7510 Fundraising Exp. $800.00 TOTAL FUNDRAISING EXPENSE: $80.00 7540 Professional Fees $7,250.00 TOTAL PROFESSIONAL FEES: $7,250.00 Resident Assistance 9930A Activity Fund $800.00 9930B Groceries $2,100.00 _ 9930C Independence Fund $800.00 9930D 9930E 9930F 9930G Household Supplies $650.00 $800.00 Resident Savings Resident Support $1,000.00 Resident Workshops $500.00 TOTAL RESIDENT ASSISTANCE: $6,650.00 TOTAL EXPENSE $172,843.00 NET INCOME $2,157.00 Grandma's House of Central Oregon Board of Directors List September, 2014 Janet Stevens , Board President Bend Bulletin, Deputy Editor 2130 NE Eighth Bend, OR 97701 541-382-3076 (Home) 541-420-4721 (Cell) jsteven703(c@gmail.com Janet Stevens has lived in Bend since 1953. She writes editorials and a column for The Bulletin, where she has worked since graduating from the University of Oregon. Janet brings a wealth of knowledge and friends to Grandma's House. She has written many articles and Woody has often said that if it wasn't for those articles Grandma's House would not be here today. Janet has served on the boards of Sunriver Preparatory School, the Boys & Girls Clubs of Central Oregon, the High Desert Museum and the Oregon State Bar Board of Governors. She has been a member of the board of Grandma's House for about 10 years and is an active volunteer at the house, as well. She is the mother of two adult children, two dogs and three cats. Gordon Pennock, Board Vice President, Facilities Engineer Retired 20375 Marsh Road Bend, OR 97701 541-410-9734 (Cell) gordo1947@gmail.com Gordon Pennock has over 30 years in the woodworking and construction business. He has used that experience as the facility chairman for a YMCA in San Diego for over 15 years and now as the Facility Manager for Grandma's House. Gordon has always believed in some kind of community involvement and Grandma's House is a great fit. Caroline Ponzini, Treasurer Stahancyk, Kent & Hook Attorneys 158 NE Greenwood Avenue, Suite 1 Bend, OR 97701 541-410-5771 (Cell) 541-318-9115 (Work) caroline@stanhancyk.com Caroline has an ongoing interest in supporting women and families, recently joining the Grandma's House Board after moving to Bend in 2012. Caroline is a family law attorney with Stahancyk Kent & 1 Hook, P.C., and a graduate of the University of Puget Sound and Lewis & Clark Law School. Caroline skill she brings is having worked with under -served youth, and served as a peer support volunteer for families dealing with postpartum depression and anxiety through Baby Blues Connection in Portland. In her free time, Caroline enjoys skiing and biking with her son, knitting, and playing music. Emily Hunt, Secretary #1 Bank of the Cascades 276 SE Tee Ct. Bend, OR 97702 503-880-1291 (Cell) ehunt@botc.org Emily Hunt was born and raised in Oregon, growing up in Portland. She has been in Banking for over three years, starting with Umpqua Bank in Portland continuing with Bank of the Cascades in Redmond. Emily brings another area of fiscal responsibility. Previously, she has worked in Real Estate, obtaining her Oregon Realtor's License in 2007. Emily has always enjoyed being an active member of the community; she began volunteering with homeless shelters in Portland at a young age and has continued to volunteer through various organizations over the past 13 years. Erin Lawless, Secretary #2 Certified Medical Assistant, Bend Memorial Clinic 62877 Bilyeu Way Bend, OR 97701 541-390-6341 (Cell) et lawless@yahoo.com Erin Lawless was raised in Central Oregon. She is a Medical Assistant at Bend Memorial Clinic. 17 years ago Erin was a resident at Grandma's House, she has held a love for the program and decided that she would like to be on the board so she could contribute more. The skill Erin brings is resident advocacy - her input is invaluable. Dawn Cofer, Board Member Bank of the Cascades 848 NE Loskley Bend, OR 97701 541-408-4584 (Cell) 541-617-3619 (Work) Dawn Cofer is a Manager with Bank of the Cascades. She has been in banking and financial services since 1989. Dawn's skill is supporting the fiscal responsibilities of Grandma's House and helping residents set up banking accounts. Dawn also works with the girls doing mock job interviews then giving feedback, tips and support afterwards. She serves as president of Bend Senior High Booster Club and is Treasurer of High Desert Professionals. She is a native Oregonian and has lived in Central Oregon with her husband Jason, daughters Shelby & Jaycee for the past 10 years. She enjoys reading, spending time with family and cooking. 2 Megan West, Board Member MS, LPC, NCC, CADC I - Deschutes County Behavioral Health 2577 NE Courtney Drive Bend, OR 97701 541-678-1981 (Cell) 541-322-7603 (Work) Megan West works at Deschutes County Health Department in Behavioral Health. She attended Oregon State University where she received a Bachelor of Arts degree in Psychology and a Master of Science degree in Community Counseling, Megan is a National Certified Counselor (NCC) and a Licensed Professional Counselor (LPC). Megan is a volunteer with the Deschutes County Public Health Reserve Corps, the Oregon State Emergency Response Network (Serve -OR), and the Central Oregon EMDR Trauma Recovery Network. She is also a Certified Field Traumatologist and has extensive knowledge regarding sex trafficking and the efforts involved in rehabilitating the survivors of this horrific trade. Megan brings many skills to Grandma's House residents, as listed above. In addition she generously offers counseling to our staff as needed and serves on both the Grandma's House board and Deschutes County Domestic Violence Council. Most recently Megan returned from a trip to Cambodia where she was able to gain a greater understanding of the incredible work being done around the world aimed at abolishing sex trafficking and the efforts involved in rehabilitating the survivors of this horrific trade. As she continues her work in the trauma field she hopes and intends to devote a significant portion of her time and efforts toward this cause. 3 arm 990 Department et rhe Treasury Internal Revenue Service A For the 2012 calendar yea 3 Check if applicable: C Return of Organization Exempt From income Tax Under section 501(c), 527, or4947(ax1) of the Internal Revenue Code (except black lung benefit trust or private foundation) The organization may Piave to use a copy of this retJm to satisfy state reporting requirements_ ortax year beginning 7/01 , 2012, and ending 6/30 OMB No. 1545-0047 2012 Open to Public Inspection r 2013 lAddr lonee Name charge indral :alum Terminated A•rr„•afadd return Applra1on :Iding F r't2 11 and address of p rncipaI officer SAME AS C ABOVE GRANDMA'S HOUSE OF CENTRAL OREGON PO BOX 6372 BEND, OR 97708 Tax-exempl states 4501(c)(3) J 531(c) ( )- (insert no) 14942(2)(1) c- i 527 Website: a HTTP : //WWW _ GRAND!4ASHOUSEOFCENTRAL0RCGGON . ORG/ K Fom o10.'narirt:on_ ix i PartSumrrfaty Cor)"xaton t '',rust I Assocratim D Employer Identification Number 94-3162069 E Telephone nnrr er (541) 383-3515 G Grossreroipts $ 295,257_ H(a) Is this a group return for ariirates? !_J yes X No H(b) Are all affil';a,es indaded? Y'ts No If -No' attach a lis;. (see instructions) H(c) Group exemption number Other°- L Year o- .S,rrra ion: 1992 M Site o` legal domicile: OR 3 0 0, d N 111 K 1 Briefly describe the organization's mission or most srenif-fcant Activities: GRANDMA' S ROUSE IS A NON—PROFIT HOME AND OUTREACH THAT PROVIDES SAFE SHELTER TO HOMELESS AND/OR ABUSED PREGNANT, PARENTING AND ADOPTING GIRLS BETWEEN THE AGES OF 12 AND 19. 2 Check this box - Q if the organization discontinued its operations or disposed of more than 25% of its net assets. 3 Number of valuta members of the governing body (Part VI. line la) 4 Number of independent voting members of the Governing body (Pari VI, line 1b) 5 Total number of individuals employed in calendar year 2012 (Part V. Irne 22) 6 Total number of volunteers (estimate if necessary) 6 7a Total unrelated business revenue from Part VIII. column (0), line 12 7aJ b Net unrelated business taxable income from Form 990-1, line 34 [ 7a: 3 I 4 5 8 Contributions and grants (Part VIII, line ]h)... _. . 9 Program service revenue (Part VIII, line 2g). 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, Sc. 10c, and 11e) 12 Total revenue — add lines 8 through 11 (must equal Part VIII, column (A), line 12) ... . 13 Grants and similar amounts paid (Part IX, column (A); lines 1-3) 14 Benefits paid to or for members (Part IX, column (A); line 4). 15 Salaries, other compensation, employee benefits (Pari IX. column (A), lines 5-10) 16a Professional fundraising fees (Part IX, column (4), line 1 le) . .. ... ........... b Total fundraising expenses (Part IX, column (D), line 25) 5, 664 . 17 Other expenses (Part IX. column (A). lines l ie -1 id, 1]f -24e) 18 Total expenses. Add lines 13.17 (must equal Part IX, column (A), line 25) 19 Revenue less expenses- Subtract line 18 from line 12 :19, 20 Total assets (Part X, Zine 15)- - ▪ 21 • 22 Net assets or fund balances. Subtract line 21 from line 2Q Part.E d signature Block Total liabilities (Part X, line 26) Prior Year ' 7 7 6 33 0. 0. Current Year 274, 085. 2,400. 121,062. 1,377. 704. 173, 034. 296,177- 1, 778. 14, 438. 292, 701. 110, 498 . 124, 011. 43, 061. 153,559. 142, 618 Beginning of Current Year 378,190. 8,151.! 71, 407. 195,418. 97, 283 _ End of Year 475,473. 8,151_ 370,039. 467,322 . Under cenahiuo al peglry, I dnc!a!e r:a1 I have examinee this ret1r.. icdudi-i4 accompanying s`hedeles and stetemens. and to the best of my knomled_- and belief. it is :rue, correct, and c•- Dec:aratcn of pre.arer (00er than office:) i5 based or• all r: lorrnator of -Ie ;ch preparer has any :rmowtedge. Sign Here Styr-iabopa XRISTIN LARSON T.^e or crnt n .rr: and title. bale TREASURER Paid Preparer Use Only Pur xTp5 etec-arc's name , Freparsr's sipr.ah--re LANCE BRANT !LANCE BRANT Firm's name CAPSTONE CPA' S, LLC Date Fan's address '908 NE 4TH ST STE 201 BEND, OR 97701-4646 May the IRS discuss this return with the prepare'. shown above? (see instructio-ts) BAA For Paperwork Reduction Act Notice, see the separate instructions. Check Li if f 1l'N see-cn:,:oyed 1P00294439 Firm's ElN rP 30-0096573 Phone nc, (541) 382-5099 IX Yes No EEao1131. 12114r 2 Form 990 (2012) Form 990 (2012) GRANDMA'S HOUSE OF CENTRAL OREGON Path tate ?lent of Program Service Accomplis invents Check if Schedule 0 contains a response to any question in this Part 111 1 Briefly describe the organization's mission: 94-3162069 Page 2 GRANDMA'S HOUSE IS A NON-PROFIT HOME AND OUTREACH THAT PROVIDES SAFE SHELTER TO HOMELESS AND/OR ABUSED PREGNANT, PARENTING AND ADOPTING GIRLS BETWEEN THE AGES OF 12 AND 19. 2 Did the organization undertake any significait urogram services during the year which were not listed on the prior Form 990 or 990 -EZ? Yes y, No If 'Yes,' describe these new services on Schedule 0 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services? r Yes No If 'Yes,' describe these changes on Schedule 0. 4 Describe the organization's program service 3CCamphshments for eec- of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) orcanizctiorw and section 4-947(a)(;) Irick are required to report tie amount of grants and allocations to others, the total expenses, arid revenue, if any, for each program service reported. 4a (Code: ) (Expenses $ J.72, 765 _ including grants of $ ) (Revenue $ ) TO PROVIDE FOOD, SHELTER, PRENATAL CARE AND EDUCATION TO HOMELESS & PREGNANT TEENS 4 b (Code: ) (Expenses $ including grants of $ )(Revenue $ ) 4 c (Code: ) (Expenses $ including grants of $ ) (Revenue $ 4d Other program services. (Describe in Schedule 0.) (Expenses $ including Grants of S 4e Total program service expenses * 172, 765 )(Revenue $ ) BAA TEE.eoloa D&O&12 Form 9911 (2012) Applicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet Families Forward Category/Grant Amount: Title: Other Essential Services / $11,000 Opportunities for Kids Program Review Criteria: 1. Organization: • Stable and positive history of providing services in Deschutes County. • Experience delivering similar programs, projects, or activities as those proposed. • Mission and goals are consistent with proposed program, project, or activity. • Stable and experienced Board of Directors or other leadership group. • Adequate staff and/or volunteers to implement proposed program, project, or activity. Points awarded for this section (maximum of 25). 2. Financial Status: • Adequate financial resources available to conduct and sustain operations. • Broad and diverse base of funding sources. • Financial need for a Community Grant to implement proposed program, project, or activity. • Proposed budget is consistent with and appropriate for the fixed grant amount available in the selected Community Grant category. Points awarded for this section (maximum of 25). 3. Program, Project, or Activity: • Program, project, or activity does not address emergency food, clothing, or shelter. (These activities are supported by Deschutes County through a separate grant program in conjunction with United Way's Emergency Food and Shelter program.) • Request is consistent with the fixed dollar amounts indicated in the category/grant amount description at the top of this form. • Number of individuals to be served is appropriate to the budget and scale of proposed program, project or activity. • Serves vulnerable and/or underserved populations and/or communities. • Positively impacts welfare of the community. • Complements, but does not duplicate, existing Deschutes County services. • Implementation strategy is suitable to achieving the stated goals and objectives of proposed program, project, or activity. • Partnerships or collaboration with other agencies are included in implementation strategy. • Other sources of funds or in-kind support are available to supplement Community Grant funds. Points awarded for this section (maximum of 35). 4. Performance Management: • Stated outputs are relevant and reasonable to the scale of the proposed program, project, or activity. • Stated outcomes are relevant and reasonable to the scale of the proposed program, project, or activity. Points awarded for this section (maximum of 15). TOTAL NUMBER OF POINTS AWARDED: COMMENTS: NAME OF RATER: State:' Deschutes County Fiscal Year 2014-15 Community Grant Application Submittal Instructions and Cover Sheet A complete application will consist of the following: 1. This cover sheet, signed and dated. 2. Narrative responses to the attached questions on no more than four single -sided, single-spaced pages. 3. Attachments: a. Proof of the organization's 501(c)(3) tax-exempt status in the form of a letter from the Internal Revenue Service (IRS). b. The first two pages of the organization's most recently submitted IRS 990 or 990 EZ form or, if the organization is not required to file either form with the IRS, a financial statement that provides equivalent information concerning activities and governance, revenue, expenses, and net assets or fund balances. c. An operating budget specific to the proposed operations, program, project, or activity. d. A roster of the organization's Board of Directors. Submit the complete application electronically to judithuAdeschutes.org no later than 5:00 p.m. on October 24, 2014. Incomplete and/or late applications will not be reviewed or considered. Please complete the following: Contact Name: Kenny LaPoint Organization Name: Address: City: Families Forward 405 SW 6th St. Redmond Telephone Number: Email Address: OR Zip Code: 541-323-7419 97756 klapoint@housing-works.org Application is being submitted to which Community Grant Program funding category*? ❑ Health, Mental Health, and Addictions Services ❑ Arts and Culture CI Other Essential Services: Includes services to youth; underserved, indigent, and/or vulnerable populations; animal welfare; or the environment. * Please refer to the funding guidelines for more information. Certification: On behalf of the organization specified above, I certify the following: 1. All information included in this application is accurate. 2. I am authorized by the governing board to submit this grant application. 3. This organization is located in Deschutes County. 4. If awarded, Community Grant funds will be used in support of Deschutes County residents only. 5. This organization i ' in : ood standing with the U.S. Internal Revenue Service and is currently designated as a 501(c}(3) tax-exempt entity. Signature: Print Name: (40A .� . Title: Date: �p jZ2 4 Deschutes County Fiscal Year 2014-15 Community Grant Application Questions Please respond to the questions below in the order shown. Reponses must be thorough, but provided on no more than four single -sided, single-spaced pages. Required attachments such as proof of non- profit status and copies of tax forms are excluded from the four page limit. Any additional documents submitted beyond those stated in the instructions, such as brochures, leaflets, newsletters, or reports, will not be considered a part of the application and will be discarded without review. Organization 1. Describe the history of the organization, including the year the organization was established. In 2003, Housing Works (abn of Central Oregon's regional housing authority) created Families Forward, a 501(c) (3) nonprofit community development corporation. The nonprofit was formed in response to the increased need for programs and services for the residents of Housing Works - controlled affordable apartment communities and the housing authority's program participants. 2. State the organization's mission, goals, and programs or services provided. Families Forward's mission is "Fostering personal achievement for Central Oregonians. " It is our belief, that provided with educational opportunities and economic resources, low-income families can thrive and become self-sustaining. This is reflected in our core service areas: Family Sustainability, Personal Asset Building, and Opportunities for Kids. Our programs are aimed at offering low-income families the tools and knowledge they need to become personally and economically self-sufficient and self-sustaining. Families Forward has grown steadily since its creation. It now offers nine programs ranging from an adult education series to overcome negative rental histories to youth programs for educational, recreational, and social opportunities to one-on-one homeownership counseling. 3. Describe the leadership and structure of the organization. Thomas J. Kemper, Executive Director, is responsible for the overall operations of Families Forward and its programs. Kemper has twenty-five years of extensive experience in real estate investment, finance and development. With a legal, tax and accounting background, Kemper has developed a strong track record in the financing and development of over $2 billion in real estate transactions. Patty Schouviller, Housing and Resident Services Director, is responsible for day-to-day program implementation, working closely with community partners. She is responsible for integration of resident services at all Housing Works -controlled properties. Kenny LaPoint, Public Affairs Director for Families Forward is responsible for fund development within Families Forward. Program, Project, or Activity 1. Provide a title of the proposed initiative for which funds are being requested. Opportunities for Kids after school and summer program 2. Describe the goals and objectives of the proposed initiative. Opportunities for Kids will provide positive child and youth programs for the low-income children residing at Housing Works' properties. The program will offer children access to best practices programs that: improve study habits; provide homework assistance; help youth avoid peer pressure by teaching refusal skills for alcohol, drugs, tobacco and premature sexual activity; improve health; encourage creativity through art and literature classes; and promote sportsmanship and team work through recreational sports and community projects in a safe and supervised environment after school and during the summer The objective of the Opportunities for Kids program is in the title, "Opportunity". By providing positive and accessible environments staffed by knowledgeable staff, we are creating opportunities for the most vulnerable children in our community: opportunities to graduate from high school, attend post -secondary schooling and become high producing members of society. The end goal of these programs is to break the cycle of poverty in our community. 3. Identify the target population which will be served. Low incomes limit the ability of households to access the services or programs that could provide their children with the educational, recreational, and social opportunities they currently lack. Through the Opportunities for Kids program, Families Forward has the potential of impacting the lives of up to 1,600 low income youth between 4-18 years old currently residing in Housing Works affordable housing properties. The children are from very -low to low-income, mainly single -parent households that just scrape by on one or more retail or service jobs and some form of public assistance. A family of 4 may earn up to 80% of Area Median Income (AMI) or $49,400. A majority of the households only earn up to 50% AMI ($31,200 for a family of 4). 4. Identify the geographic area(s) of Deschutes County which will benefit. The Opportunities for Kids after school and summer youth program will serve children residing in Housing Works controlled properties in Deschutes County. The following properties would be served by the program: Summit Park (88 units) Eastlake Village (56 units) 2017 NE Full Moon Drive Bend, OR 97701 675 NE Bellevue Loop Bend, OR 97701 Ariel Glen (70 units) Ariel South (97 units) 1700 SE Tempest Drive Bend, OR 97701 1707 SE Tempest Drive Bend, OR 97701 Tamarack Village (33 units) 555 N Larch Sisters, OR 97759 Aspen Villas (40 units) Putnam Pointe (43 units) Centennial Point (4 units) 933 NW Canal Blvd. Redmond, OR 97756 Independence Place (2 units) 750 NW Lava Rd. Bend, OR 97701 410 SE 6th Street Bend, OR 97701 1251 & 1253 SW 27th St. Redmond, OR 97756 Fairhaven Townhomes (19 units) Healy Heights (70 units) 25th and Elm St. Redmond, OR 97756 1900 NE Bear Creek Rd. Bend, OR 97701 522 Total Deschutes County Units Served by Offered Youth Programs 5. Describe how the proposed initiative will positively impact the community and complement existing services currently provided by Deschutes County. Youth programs help ease the burden on families, especially those headed by single parents. They allow parents the time to work more hours or increase their education, thereby creating more opportunities for self-sufficiency and ultimately breaking the cycle of poverty. With positive supervised activities for youth, the surrounding community at large will benefit through decreased crime (drug use, vandalism, etc.), resulting in cost savings to public systems. 6. Describe in detail how the proposed initiative will be implemented. The Opportunities for Kids program will be implemented through the provision of: • On-site youth programs, both after school and during the summer, at Housing Works apartment communities and provided in collaboration with Boys & Girls Clubs. • Off-site youth program scholarships provided in partnership with Boys and Girls Clubs and Kids Inc. (Bend Parks and Recreation) All programs will be marketed, by site managers and the resident service coordinator to the low- income families residing in Housing Works' properties. 7. Describe specifically how the requested funds will be used The funds will be used for the continued operation of on-site youth programs at Housing Works owned properties as well as to provide scholarships for youth seeking to attend off-site after school and summer youth programs. 8. Identify any partner agencies which will collaborate to implement the proposed initiative. • Boys and Girls Clubs • Bend Parks and Recreation (Kids Inc.) 9. Describe other sources of funding that will support the proposed initiative. • Housing Works resident service fees ($35,000 annually) 6 Rental Income from Families Forward owned property, Gateway Commons ($8,000 Annually) • Private and foundation grants (Estimated at $10,000 annually) Performance Measurement 1. Identify quantifiable outputs anticipated to be achieved through the proposed initiative (examples: number of persons served, programs or events held, animals rescued, acres restored or protected). • 50 participating youth • 25% higher graduation rate for participants compared to non -participants • 25% higher post -secondary education completion rates for participants compared to non- participants 2. Describe the anticipated outcomes of the proposed initiative (examples: fewer persons institutionalized, greater knowledge and understanding of local history, fewer animals in shelter care, more natural areas available for wildlife and recreation). • Increased youth participation due to availability of resources • Decreases in the overall poverty rate (breaking the cycle of poverty) • Well maintained affordable housing • More kids doing better academically • Fewer kids getting into trouble and as a result less property damage in the community Proposed Program Budget Unit Price Quantity 40 @ 2 months Total Price $7000 On Site Youth Program Operations- Ariel Glen/Ariel South $87.50/per child- per month Off -Site Youth Program Scholarships -Kids Inc. $88.00/per child- per month 3 @ 6 months $1584 1 Off -Site Youth Program Scholarships- Redmond/Terrebonne Boys and Girls Club $80/per child -per month 6 @ 6 months $2,880 TOTAL $11.464 FamiliesForward GOsreeg pormershps, creating opportunitles. Board of Directors October 2014 Nick Snead Board President Jefferson County Representative Community Development Director, City of Madras, OR 6/30/2018 Laura Cooper Crook County Representative Attorney, Ball Janik, Bend, OR 6/30/2017 Bobbi Brooks Crook County Representative Retired Banker, Prineville OR 6/30/2015 Henry Hartley Crook County Representative Retired City Manager, Prineville, OR 6/30/2016 Michael Hinton Deschutes County Representative Lending Director, Neighborlmpact, Redmond OR 6/30/2016 Dennis Pahlisch Deschutes County Representative President/CEO, Pahlisch Homes, Bend OR 6/30/2018 David Tarbet Deschutes County Representative Chief of Police, Redmond OR 6/30/2017 George Nielson Jefferson County Representative Retired Circuit Court Judge, Madras OR 6/30/2016 Janet Brown Jefferson County Representative Economic Development Manager, Jefferson County, Madras OR 2/7/2016 Michelle Brown Resident Commissioner Bend OR 1/3/2018 A Nonprofit Corporation of the Central Oregon Regional Housing Authority 405 SW 6th Street, Redmond OR 97756 Fom, 990 -EZ Short Form Return of Organization Exempt From Income Tax Under section 601(c), 627, or 4947(6X1) of the Internal Revenue Code (except black lung benefit trust or private foundation) ▪ slwnsoting organizations of deneradrlee0funde, orgsniutions Um operate ant or more hospital facilities, end certain controlling orgsntratione as defined in secllon 512(b)j13) muff fife Form 09D(see Instructions). Allegro argantratfons with groes recolpis kin than *200.000 and rote) assets leu than 1500,900 at the end of the year rosy use Ode tom. Depanment of the Treasury inlem& Revenue service ► The orgeatrat/on maey have to use e copy of this rorum to satisfy stale reporting requirements. A For the 2012 calendar year, or tax year beginning 7/1/2012 , and ending Check if applicable: C Name of organization Address change Name change Initial return Families Forward. Inc OMB No. 1545.1150 2012 Opera to Public Inspection 6130/2013 D employer Identification number Number and street (or P.O. box, ti mail is not delivered to street ad roes) Terminated 405 SW 6th Street CAmended return City or town Room/suite 76-0738741 E Telephone number state or country F Group Exemption LI Application pending Redmond Oft 97755 Number Po G Accounting Method: 0 Cash a Accrual Other (specify) ► H Check 0 11 the organization is 1 Website: ► h1fp:l/www.oregonhousingworks.or9/oUrnonprofit.php not required to attach Schedule B 3 Ta:.esempt status (check only one) — ID50s(c)(3) n501(c) ( )4 (insert no.)171 4947(ax1) or 0527 (Form 990, 990 -EZ, or 990 -PF). K Check 10 El if the organization is not a section 509(a)(3) supporting organization or a section 527 organization and its gross receipts are normally not more than $50,000. A Form 990 -EZ or Form 990 return is not required though Form 990-N (e -postcard) may be required (see Instructions). But if the organization chooses to file a return, be sure to file a complete retum. L Add lines sb, 6c, and 7b, to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or If total assets Part Il, line 25. column (8) below) are $500,000 or more, file Form 990 instead of Forrn 990 -EZ 1► $ 179,838 Revenue, Expenses, and Changes In Net Assets or Fund Balances (see the instructions for Part I) Check if the organization used Schedule 0 to respond to any question in this Part 1 ZIPa4 (541) 923-1018 Part 1 Contributions, gifts, grants. and similar amounts received . . . , . . . . . . . . . . . 2 Program service revenue including government fees and contracts . . 3 Membership dues and assessments 4 Investment income 5a Gross amount from sale of assets other than inventory 15a b Less: cost or other basis and sales expenses 5b c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) 6 Gaming and fundraising events a Gross income from gaming (attach Schedule G if greater than $15,000) 16a b Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) . . 16b I c Less: direct expenses from gaming and fundraising events_ . . . . Bc d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) 7a Gross sales of inventory, Tess returns and allowances 7a b Less: cost of goods sold 76 c Gross profit or (loss) from sales of inventory (Subtract Zine 7b from line 7a) 8 Other revenue (describe in Schedule 0) 9 Total revenue. Add lines 1, 2. 3, 4, 5c, 6d, 70, and 8 10 Grants and similar amounts paid (list in Schedule 0) 11 Benefits paid to or for members 12 Salaries, other compensation, and employee benefits 13 Professional fees and other payments to independent contractors 14 Occupancy, rent, utilities, and maintenance 15 Printing, publications, postage, and shipping 16 Other expenses (describe in Schedule 0) 17 Total expenses. Add lines 10 through 16 53.763 124.969 1,106 9 10 79,838 11 12 13 05,932 14 15 42,719 257 16 18 Excess or (deficit) for the year (Subtract line 17 from line 9) ▪ 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end -of -year figure reported on prior year's return) Z20 Other changes in net assets or fund balances (explain in Schedule 0) 21 Nei assets or fund balances at end of year. Combine lines 18 through 20 For paperwork Reduction Act Notice, see the separate instructions. HTA 17 18 52,450 201,356 -21,520 19 451.615 20 21 430,095 Form 990 -EZ (2012) Form 990 -EZ (2012) Families Forward Inc. Mal Balance Sheets. (see the instructions for Part 11) Check if the organization used Schedule Oto respond to any question in this Part II 76-073$741 pane 2 22 Cash, savings, and Investments 23 Land and buildings 24 Other assets (describe in Schedule 0) 25 Total assets 26 Total liabilities (describe in Schedule 0) 27 Net assets or fund balances (line 27 of column (B) must agree with line 21). Statement of Program Service Accomplishments (see the instructions for Part HI.) Check lithe organization used Schedule Oto respond to any question In this Pari 111 Part III (A) Beginning of Year (e) End of year 113,875 22 346,505 23 70,347 329,567 24,556 24 484,936 25 51,249 451,153 33,321 26 21,050 What is the organization's primary exempt purpose? See Statement 1 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited. and other relevant information for each program title. 28 See Statement 2 451,615 a (Grants $ ) If this amount includes foreign grants, check here . . . 29 See Statement 3 (Grants $ ) If This amount includes foreign grants, check here 30 See Statement 4 ► (Grants $ ) If this amount includes foreign grants, check here . -•_,_ 31 Other program services (describe in Schedule 0) _ (Grants $ ) If this amount includes foreign grants, check here ► 0 32 Total , rogram service expenses. (add lines 28a through 31a) . i 32 , 131,041 Part IV List of Officers, Directors, Trustees, and Key Employees List each one even if not compensated (see the instructions for Part IV) Check if the organization used Schedule 0 to respond to any question in this Part IV . . . . . . 27 430,095 Expenses (Required forsection 501(c)(3) and 501(c)(4) organizations and section 4547(e)(1) truete; optional for others.) 26a 29a 97,846 3,541 30a 29,652 31a (a) Name and title Laura Cooper Chair Michael Hinton Vice Chair Bobbie Brooks Board Member Henry Hartley Board Member HONK (b) Average hours per week devoted to position HrNVK .25 HONK .25 Hawk .25 .25 HrNVK .25 Craig Unger Board Member Janet Brown Board Member HAWK .25 Nick Snead Hr/WK .25 Board Member Hr)WK .25 Board Member Hr/WK .25 Tom Kemper Executive Director HrIWK 2.00 Board Member George Neilson Jan Thackery Hr/WK HrMIK (c) Reportable compensation (Forms W-2/1099.MISC) (If not paid, anter -0-) 0 0 0 0 0 0 0 0 0 0 (d) Health be efts contributions to employee benefit plans, and defend compensation 1 0 (e) Estimated amount of Other compensation Form 990 -EZ (2012) Applicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet St. Vincent de Paul Redmond Category/Grant Amount: Title: Other Essential Services / $11,000 Recycling Project Review Criteria: 1. Organization: • Stable and positive history of providing services in Deschutes County. • Experience delivering similar programs, projects, or activities as those proposed. • Mission and goals are consistent with proposed program, project, or activity. • Stable and experienced Board of Directors or other leadership group. • Adequate staff and/or volunteers to implement proposed program, project, or activity. Points awarded for this section (maximum of 25). 2. Financial Status: • Adequate financial resources available to conduct and sustain operations. • Broad and diverse base of funding sources. • Financial need for a Community Grant to implement proposed program, project, or activity. • Proposed budget is consistent with and appropriate for the fixed grant amount available in the selected Community Grant category. Points awarded for this section (maximum of 25). 3. Program, Project, or Activity: • Program, project, or activity does not address emergency food, clothing, or shelter. (These activities are supported by Deschutes County through a separate grant program in conjunction with United Way's Emergency Food and Shelter program.) • Request is consistent with the fixed dollar amounts indicated in the category/grant amount description at the top of this form. • Number of individuals to be served is appropriate to the budget and scale of proposed program, project or activity. • Serves vulnerable and/or underserved populations and/or communities. • Positively impacts welfare of the community. • Complements, but does not duplicate, existing Deschutes County services. • Implementation strategy is suitable to achieving the stated goals and objectives of proposed program, project, or activity. • Partnerships or collaboration with other agencies are included in implementation strategy. • Other sources of funds or in-kind support are available to supplement Community Grant funds. Points awarded for this section (maximum of 35). 4. Performance Management: • Stated outputs are relevant and reasonable to the scale of the proposed program, project, or activity. • Stated outcomes are relevant and reasonable to the scale of the proposed program, project, or activity. Points awarded for this section (maximum of 15). TOTAL NUMBER OF POINTS AWARDED: COMMENTS: NAME OF RATER: Deschutes County Fiscal Year 2014-15 Community Grant Application Submittal Instructions and Cover Sheet A complete application will consist of the following: 1. This cover sheet, signed and dated. 2. Narrative responses to the attached questions on no more than four single -sided, single-spaced pages. 3. Attachments: a. Proof of the organization's 501(c)(3) tax-exempt status in the form of a letter from the Internal Revenue Service (IRS). b. The first two pages of the organization's most recently submitted IRS 990 or 990 EZ form or, if the organization is not required to file either form with the IRS, a financial statement that provides equivalent information concerning activities and governance, revenue, expenses, and net assets or fund balances. c. An operating budget specific to the proposed operations, program, project, or activity. d. A roster of the organization's Board of Directors. Submit the complete application electronically to judithu(c�deschutes.org no later than 5:00 p.m. on October 24, 2014. Incomplete and/or late applications will not be reviewed or considered. Please complete the following: Contact Name: Organization Name: Address: City: X IA 5 r)6114- c_ Pauj2 Ad" ]101 Le. St s 1;.,�'traL t Telephone Number: Email Address: L State: Zip Code: 41- 576 V-9 -L/ ,cVt ( d kv1Grc fifty g/, L2i1 to Application is being submitted to which Community Grant Program funding category*? ❑ Health, Mental Health, and Addictions Services ❑ Arts and Culture l$' Other Essential Services: Includes services to youth; underserved, indigent, and/or vulnerable populations; animal welfare; or th environm n * Please refer to the funding guidelines for more information. Certification: On behalf of the organization specified above, I certify the following: 1. All information included in this application is accurate. 2. 1 am authorized by the governing board to submit this grant application, 3. This organization is located in Deschutes County. 4. If awarded, Community Grant funds will be used in support of Desdhutes County residents only. 5. This organization. is in good standing with the U.S_ Internal Revenue Service and is currently designated as a 501(0(3) tax-eiernpt entity. Signature: / Print. Name: )(j rt ,5-1/A Titter_ Date: 9ciec V( 'Lola_ !7-010)11 SVDP(St.Vincent de Paul) Redmond Store Operations- Recycling Project 1) St. Vincent de Paul Redmond was organized as a 501 c 3 effective November 2, 2006 in Redmond, Oregon. 2) The mission of the organization was and is to provide assistance and services to individuals and families in the Redmond, Oregon area, who are in need. Services include: food boxes, rent/mortgage assistance, utility/propane assistance, clothing, household, furniture, education and referrals to partner agencies. 3) SVDP Redmond is led by a volunteer Board of Directors who oversee all the financial matters and important decisions for the organization. The Social Services. Food Bank, and Thrift Store Operations have Managers/Directors who report to a liaison from the Board. All staff and volunteers at each department answer to the Managers/Directors. 1) SVDP Recycling Project and purchase of a forklift/supplies and storage for the forklift, is the project for which funds are being requested. 2) The goal of the project is to expand the recycling efforts of SVDP Redmond; to reduce the cost of waste disposal, to increase funding for SVDP, and to assist with the quality of the environment. Currently, recycling operations include the recycling of cardboard, metal, clothing, shoes, books. The purchase of a forklift/storage is needed to expand recycling efforts to include palletized electronics in partnership with C.Kiwila & Assoc. on behalf of RLGA (recycles non -operational or old electronics for manufacturers or private businesses). 3) Residents of Deschutes County, who are located in the Redmond community area, who are in need, will be served through the benefits of this project. 4) The Redmond community area would be the primary area benefitted from this project. 5) By expanding recycle efforts to include electronics, SVDP will save $ on waste disposals, will increase revenues, and will utilize those $ to further assist residents in Deschutes County/Redmond community area who are in need. Expanded assistance services to those in need coupled with reducing landfill costs/dumping will assist Deschutes County in cost saving measures. 6) The plan by SVDP Redmond will, acquire funding to purchase a forklift/storage/supplies/misc. as needed to implement the expanded recycle program and will work with C.Kiwila & Assoc./RLGA to carry out the program. 7) All funds granted or acquired will be used for the expanded electronic recycle program. 8) Partners would be SVDP Redmond, Kiwila & Assoc./RGLA and Deschutes County through cost savings and environmental savings measures. 9) If needed, SVDP Redmond will contribute funding to assist in the purchases and implementation of this project. -2- Recycling Project continued 1) By palletizing and recycling used and defective electronics, SVDP will use Tess funding for landfill disposals, will dispose of less mass at the local landfill, and will see an increase of approximately $200-$300 per month in revenues. 2) Anticipated outcomes for the project include savings and increased revenues for SVDP, increased services to those in need, and less disposals at the landfill. SVDP Redmond Store Operations- Recycling Project Project Budget Income: Grants Total Income: $11,000 $11,000 Expense: Forklift Purchase $5000 Forklift Storage $5000 Supplies & insurance $1000 Total Expense: $11,000 Board Directory St.Vincent de Paul — Redmond Conference President 2008-2014 Vice -President 2006-2014 Jamie Kanski Norm Czerwonka P.O.Box 922 64523 McGrath Rd. Redmond, Oregon 97756 Bend, Oregon 97701 541 -548 -6565(H)541 -610-6628(c) 541-389-8237(H) scanlonjt@aol.com npczfish@bendbroadband.com Co -Vice President 2007-2014 Secretary 2009-2014 Tom Lakin John Valenti 1514 SW 21" Place 3650 SW Canal Blvd. Redmond, Oregon 97756 Redmond, Oregon 97756 541-548-8084(H) 541-316-8988 maandtlakin@aol.com John.valenti@gmail.com Treasurer 2009-2014 Director 2010-2014 Barry Greig Lois Northrup 11367 Highcrest Ct. P.O. Box 44 Redmond, Oregon 97756 Redmond, Oregon 97756 541-604-4318 541-548-4589(H) 541-350-5365(c) bpgreig@gmail.com luceee@bendbroadband.com Director 2007-2014 Director 2010-2016 Tom Gorman Ed Allumbaugh 1056 Niagara Falls Dr. P.O.Box 1785 Redmond, Oregon 97756 Redmond, Oregon 97756 541-504-8645(H) 541-504-7595(H) Tom Gorman@msn.com allumbaugh39@bendbroadband.com -2- Board Directory continued - Director 2009-2014 Elton Gregory 1757 Turnstone Rd. Redmond, Oregon 97756 541-548-4841(H) eggdeg@yahoo.com Director 2013-2016 Richard Anderson 960 NW Quince Redmond, Oregon 97756 541 -526 -1131(H)541 -829-9096(C) mr2andersons@msn.com Director 2014-2017 Raymond Houghton 6931 NW 25th Lane Redmond, Oregon 97756 503-863-1700 hotie@comcast.net SVDP Mailing Address: 1616 SW Veteran's Way, Redmond, Oregon 97756 Social Services: 541-923-5264 syssredmond@gmail.com Thrift Store: 541-504-9840 svredmond@gmail.com Social Services Director Cameo Chambers 2645 NW 13th St. Redmond, Oregon 97756 541-350-5698(c) Cambri 4@yahoo.com (underscore between 1 and 4) Thrift Store Manager Don Smith 20728 Liberty Lane Bend, Oregon 97701 541-788-3905 dpsmith@bendbroadband.com Food Services Manager Susan Sisco 1522 NW Lower Bridge Way Terrebonne, Oregon 97760 541-923-0439 (H) S M sisco@yahoo.com (underscore between S and M) revised March 2014 2:17 PM 10/15/14 Cash Basis St. Vincent de Paul Redmond Profit & Loss Budget vs. Actual October 2013 through September 2014 Income 5900 Other Income 5901 • Interest Income 5902 • Misc. Income Total 5900 • Other income 5300 • Sales 5304 • Recyclables 5303 • Vehicle Sales 5301 • Store Sales Total 5300 • Sales 5200 • Grant Income 5218 • Grant - Volunteer Connect Grant - City of Redmond Utility Grant Income - EFSP United Way 5207 • Grant - HPC Total 5200 • Grant Income 5000 • Operation Income 5008 • Cash Donations - Store 5005 • Contributions 5007 • St. Thomas Contribution Total 5000 • Operation Income 5100 • Assistance Income 5105 • Donation - Fire Wood 5104 • City of Redmond Utilities 5102 • Donations - Food 5103 • Donations to Social Services Total 5100 • Assistance Income Total Income Gross Profit Expense 8150 • Postage 7550 • Fees 7150 • Automobile 7155 • Automobile Insureance 7151 • Fuel 7152 • License, Fees & Taxes 7153 • Maintenance & Repair 7150 • Automobile - Other Total 7150 • Automobile 7950 • Misc Expenses 8720 • Storage - Rental Unit 8700 • Supplies 8600 • Property Expenses 8601 • Rent - C -More Bldg. ri , b:)I,) !e erb: Jul (ti c -FSS Sept YTD Budget Variance 6,119.34 1,835.00 7,954.34 12,332.48 12,550.00 478,327.22 403,100.00 75,227 22 503,209.70 403,100.00 100,109.70 40.00 1,870.00 7,500.00 2,584.00 11, 994.00 649.88 8,035.00 8,400 00 -365.00 0.00 0.00 0.00 8,684.88 8,400.00 284.88 200.00 -100.00 2,400.00 -2,500.00 21,393.38 15,000.00 6,393.38 220.00 21,713.38 17,400.00 4,313.38 553,556.30 428,900.00 124,656.30 553,556.30 428,900.00 124,656.30 385.63 120.00 265.63 5,371.00 380.00 4,99100 146.00 3,443.14 2,820.00 623.14 824.00 150.00 674.00 1,391.87 180.00 1,211.87 336.54 2,235.00 -1,898.46 6,141.55 5,385.00 756.55 1,107.51 870.00 237.51 940.00 5,524.27 4,800.00 724.27 68,687.50 68,693.00 -5.50 Page 1 of 2 1:7!IM 10/15/14 Cash Basis St. Vincent de Paul Redmond Profit & Loss Budget vs. Actual October 2013 through September 2014 8602 • Insurance - Liability 8303 • Insurance - Property 8604 • Repairs & Maintenance 8605 • Building Improvements Total 8600 • Property Expenses 8550 • Payroll Expenses 8551 • Bonus 8553 • Wages 8554 • Workman's Comp 8555 • - SUTA 8556 • INTUIT DIRECT DEPOSIT FEE 8550 • Payroll Expenses - Other Total 8550 • Payroll Expenses 8000 • Office Expense 66493 • Printing 8000 • Office Expense - Other Total 8000 • Office Expense 7900 • Marketing & Fund Raising 7500 • Dues & Subscriptions 8850 • Utilities 8750 • Telephone 8852 • Natural Gas 8851 • Electric 8854 • Trash Disposal Total 8850 • Utilities 7201 • Bank Merchant Fees 7200 • Bank Charges 7100 • Accounting 6000 • Assistance Expense 6023 • Fire Wood 6022 • Volunteer Connect 6021 • Christmas Families 6020 • Motel Assist 6019 • Redmond ID Clinic 6014 • United Way 6010 • City of Redmond Utilities 6001 • Food 6002 • Rent 6003 • Utilities 6004 • Other Assistance Expense 6005 • Propane Total 6000 • Assistance Expense Total Expense Sept YTD Budget Variance 2,346.00 1,765.00 581.00 3,506.00 4,051.30 5,200.00 -1,148.70 2,261.00 0.00 2,261.00 80,851.80 75,658.00 5,193.80 4,089.88 219,046.98 222,851.00 -3,804.02 2,937.56 3,600.00 -662.44 6,421.58 7,576.00 -1,154.42 633.45 494.00 139.45 17,428.02 17,339.00 89.02 250,557.47 251,860.00 -1,302.53 65.00 3,338.40 2,400.00 938.40 3,403.40 2,400.00 1,003.40 3,215.75 8,000.00 -4,784.25 0.00 90.00 -90.00 3,588.90 5,160.00 -1,571.10 5,294.62 4,315.00 979.62 9,175.86 8,528.00 647.86 1,279.52 320.00 959.52 19, 338.90 18,323.00 1,015.90 7,539.74 7,255.00 284.74 7.20 3,960.00 3,735.00 225.00 210.00 65.75 468.53 753.50 1,269.50 5,617.00 3,917.63 15,106.27 15, 000.00 106.27 4,427.00 7,200.00 -2,773.00 7,444.32 2,400.00 5,044.32 1,160.47 3,741.01 1,200.00 2,541.01 44,180.98 25,800.00 18,380.98 432,525.20 404,676.00 27,849.20 121,031.10 24,224.00 96,807.10 Page 2 of 2 Applicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet American Red Cross — Oregon Mountain River Chapter Category/Grant Amount: Title: Other Essential Services Prepare! Deschutes County (note: project was funded with a Community Grant in 2012-13) Review Criteria: 1. Organization: • Stable and positive history of providing services in Deschutes County. • Experience delivering similar programs, projects, or activities as those proposed. • Mission and goals are consistent with proposed program, project, or activity. • Stable and experienced Board of Directors or other leadership group. • Adequate staff and/or volunteers to implement proposed program, project, or activity. Points awarded for this section (maximum of 25). 2. Financial Status: • Adequate financial resources available to conduct and sustain operations. • Broad and diverse base of funding sources. • Financial need for a Community Grant to implement proposed program, project, or activity. • Proposed budget is consistent with and appropriate for the fixed grant amount available in the selected Community Grant category. Points awarded for this section (maximum of 25). 3, Program, Project, or Activity: • Program, project, or activity does not address emergency food, clothing, or shelter. (These activities are supported by Deschutes County through a separate grant program in conjunction with United Way's Emergency Food and Shelter program.) • Request is consistent with the fixed dollar amounts indicated in the category/grant amount description at the top of this form. • Number of individuals to be served is appropriate to the budget and scale of proposed program, project or activity. • Serves vulnerable and/or underserved populations and/or communities. • Positively impacts welfare of the community. • Complements, but does not duplicate, existing Deschutes County services. • Implementation strategy is suitable to achieving the stated goals and objectives of proposed program, project, or activity. • Partnerships or collaboration with other agencies are included in implementation strategy. • Other sources of funds or in-kind support are available to supplement Community Grant funds. Points awarded for this section (maximum of 35). 4. Performance Management: • Stated outputs are relevant and reasonable to the scale of the proposed program, project, or activity. • Stated outcomes are relevant and reasonable to the scale of the proposed program, project, or activity. Points awarded for this section (maximum of 15). TOTAL NUMBER OF POINTS AWARDED: COMMENTS: NAME OF RATER: Deschutes County Fiscal Year 2014-15 Community Grant Application Submittal Instructions and Cover Sheet A complete application will consist of the following: 1. This cover sheet, signed and dated. 2. Narrative responses to the attached questions on no more than four single -sided, single-spaced pages. 3. Attachments: va. Proof of the organization's 501(c)(3) tax-exempt status in the form of a letter from the Internal Revenue Service (IRS). 0/. The first two pages of the organization's most recently submitted IRS 990 or 990 EZ form or, if the organization is not required to file either form with the IRS, a financial statement that provides equivalent information concerning activities and governance, revenue, expenses, and net assets or fund balances. k.)e! An operating budget specific to the proposed operations, program, project, or activity. t- A roster of the organization's Board of Directors. Submit the complete application electronically to judithu@deschutes.org no later than 5:00 p.m. on October 24, 2014. Incomplete and/or late applications will not be reviewed or considered. Please complete the following: Contact Name: Organization Name: Lis ccs ,S -41 -00, -\') City: A 0, 6 (', Qei V ate9em i \L w D BP0,49 ,$) Telephone Number: Email Address: State: c Zip Code: Lis oc, 5 ,, pAC Application is being submitted to which Community Grant Program funding category*? ❑ Health, Mental Health, and Addictions Services ❑ Arts and Culture Other Essential Services: Includes services to youth; underserved, indigent, and/or vulnerable populations; animal welfare; or the environment. * Please refer to the funding guidelines for more information. Certification: On behalf of the organization specified above, I certify the following: 1. All information included in this application is accurate. 2. I am authorized by the governing board to submit this grant application. 3. This organization is located in Deschutes County. 4. If awarded, Community Grant funds will be used in support of Deschutes County residents only. 5. This organization is in good standing with the U.S. Internal Revenue Service and is currently designated as a 501(c) 3) tax-exempt entity/) Signature: 1 • Print Name: C) Title: FcLL. D Date: PCC n) L? �' e Deschutes County FY2013-14 Community Grant Application Organization 1. Describe the history of the organization, including the year the organization was established. The history of the American Red Cross is inseparable from the history of America itself. Since 1881, American Red Cross members and volunteers have been an essential part of our nation's response to war, natural disaster and other human suffering. We've been witness to great tragedy, but more importantly we've seen the triumph of the human spirit as people work together to help each other rebuild their lives and communities. The American Red Cross was first chartered in Oregon on February 4, 1917. Throughout World War I, Red Cross volunteers made garments, bandages and surgical dressings. A Red Cross canteen provided comfort to service personnel traveling through Oregon. During the influenza epidemic of 1918, Red Cross assisted overtaxed health agencies. The chapter recruited nurses and provided necessary items such as pneumonia jackets and masks. During the depression, Red Cross volunteers made and distributed food and clothing to needy families. 2. State the organization's mission and goals. The American Red Cross prevents and alleviates human suffering in the face of emergencies by mobilizing the power of volunteers and the generosity of donors. The American Red Cross, through its strong network of volunteers, donors and partners, is always there in times of need. We aspire to turn compassion into action so that... ...all people affected by disaster across the country and around the world receive care, shelter and hope; ...our communities are ready and prepared for disasters; ...everyone in our country has access to safe, lifesaving blood and blood products; ...all members of our armed services and their families find support and comfort whenever needed; and ...in an emergency, there are always trained individuals nearby, ready to use their Red Cross skills to save lives. 3. Describe the leadership and structure of the organization. If governed by a Board of Directors, list the members' names and positions held. The Oregon Mountain River Chapter is led by an Executive Director, Lisa Stroup, who is supported and overseen by the Chapter's Board of Directors. Oregon Mountain River Chapter Board of Directors Paul Dickinson, Chair Linda Zivney, Co -Chair Dick Grimes Dave Jones Mike Kirsch Terry Lynch Jeff McVay Larry Medina 1 Kayley Mendenhall Kyle O'Hollaren Kevin Putnam Susanna Ross Ross Silver Peter Skrbek Deschutes County FY2013-14 Community Grant Application 4. Attach proof of the organization's nonprofit status in the form of a letter from the U.S. Internal Revenue Service. Attached. Financial Status 1. Attach a copy of the first two pages of the organization's most recently submitted IRS 990. Attached are the first two pages of the IRS 990 from 7/1/11 through 6/30/12. This 990 covers the entire organization, including all chapters. Since the American Red Cross is a single entity existing through federal charter, individual chapters are not required to file separate Form 990s. Program, Project, or Activity 1. Provide a title of the proposed initiative for which funds are being requested. Prepare! Deschutes County — Year Two 2. Year one was very successful! Please see attached update completion report. 2. Describe the goals and objectives of the proposed initiative. Prepare! Deschutes County is part of a regional initiative to improve disaster preparedness and increase community resiliency. The project will ensure that citizens, schools, businesses and the entire community can bounce back from disasters of all sizes, saving lives and helping to preserve our economy. Specific project goals and objectives Goal #1: Increase ability of communities to bounce back from disasters Objectives: • Increase community preparedness • Increase community connectivity include: Goal #2: Reduce the impact of disasters by motivating people to take action and prepare Objectives: • Increase awareness of disaster threats • Increase knowledge of how to prepare for and respond effectively to disasters • Ensure preparedness education and planning reaches/includes vulnerable populations Goal #3: Raise preparedness as a topline issue in the business community Objectives: • Increase business resiliency • Inspire businesses to share the message of preparedness with their employees, vendors, industries, and customers 2 Deschutes County FY2013-14 Community Grant Application 3. Identify the target population which will be served. Our preparedness education and community resiliency planning work will involve and benefit a wide variety of Deschutes County residents, including youth, adults, schools, non -profits, businesses, faith -based organizations, government entities, neighborhood associations, etc. Because groups such as the elderly, children, people living in poverty, and those with disabilities are disproportionately impacted and face the hardest road to recovery after disasters large and small, an important component of this project is reaching vulnerable populations. We will make special efforts to ensure our preparedness education is reaching underserved groups such as economically disadvantaged children and families, those with physical challenges, youth, seniors, and English- language learners. We will also make sure that the needs of these vulnerable populations are considered as communities are developing their resiliency action plans. 4. Describe how the proposed initiative will positively impact the community and complement existing services currently provided by Deschutes County. Every resilient community has designated responders- government agencies and groups such as the Red Cross — that stand ready to help after a disaster. To ensure that we act as a tightly coordinated response network, the Red Cross convenes partner agencies. Together, the partners define roles and responsibilities, confirm that we have the right tools and resources, and develop clear collaboration plans. Developing these partnerships improves our ability to reach and assist the vulnerable members of our community. When our community works together as a team we are able to avoid redundancy, identify gaps in our system, and better utilize our resources. Through Prepare!, the Red Cross will convene and strengthen partnerships so that together we can develop a stronger, more resilient county — positively impacting our residents, businesses, schools, and organizations and saving lives and livelihoods in the event of a disaster. 5. Identify the geographic area(s) of Deschutes County which will benefit. Residents throughout the entire county will benefit from preparedness education and the capacity - building work we will do to improve the resiliency of communities around the county 6. Describe in detail how the proposed initiative will be implemented. Project implementation involves three major components: 1. Community Engagement As the nation's most trusted partner in disaster response and preparedness, the Red Cross is uniquely qualified to facilitate a planning and implementation process that results in community- wide disaster response and recovery plans. • Bring together neighborhoods, organizations, faith -based groups, schools, businesses, local government and community leaders to review their specific risks and current level of preparedness. This is the process we used for the Prepare! Redmond Initiative. 3 Deschutes County FY2013-14 Community Grant Application Increase Deschutes County volunteer response/preparedness teams by recruiting, training, and engaging these volunteers in disaster specific exercises, activities, and educational opportunities. 2. Preparedness Education Throughout Deschutes County, we will provide training that covers topics such as local disaster risks, first aid, CPR, sheltering, and other preparedness skills. We will educate citizens of all ages about disasters that can occur in our geographic area and how to prevent, prepare for and respond to these situations by establishing family meeting places and addressing emergency communication strategies, making personal and family disaster plans, and building emergency supply kits. We can tailor this education to various audiences, including young children (using our Preparedness Pals and Pillow Case Programs) older youth (with our Together We Prepare Program), seniors, and non- English speakers (with our adult version of Prepare!). We also have a specific training program for businesses and organizations (including government agencies).This program will give them the tools and resources to develop a resiliency/recovery plan for their facility and staff. All four of these preparedness programs were put in place during the first year of this program and have proved extremely effective. Please see the attached Completion Report for actual statistics. We will make special efforts to reach the county's most vulnerable populations, especially by partnering with non -profits that serve these groups such as NeighborImpact, The Bethlehem Inn, Grandma's House, The Loft, other Deschutes County United Way Partner Agencies and Head Start. Activities will include: • Educating the employees, volunteers, and clients at partner non -profits about preparedness • Helping partner non -profits develop and/or update their organization's disaster plans • Identifying ways to integrate preparedness into the ongoing structures and activities of these partner non -profits 3. Disaster Response Capacity -Building We will build the capacity of Deschutes County to respond quickly and effectively in the event of a disaster, so that lives are saved, damage is minimized, and residents — families, businesses, organizations, and public services — are able to bounce back in a timely manner. This capacity -building work includes: • Recruiting and training local volunteers; • Identifying new sites for shelters; • Restocking and updating pre -positioned disaster supplies; and • Building a strong community network by increasing the number of community partnerships, strengthening the relationships among partners, and clarifying roles, responsibilities and communication strategies in a disaster. 7. Describe specifically how the requested funds will be used. Funds will be used to support expenses in Deschutes County related to volunteer recruitment, training, and support; as well as personnel and supplies to deliver preparedness education and facilitate community engagement and planning. 4 Deschutes County FY2013-14 Community Grant Application 8. Identify any partner agencies which will collaborate to implement the proposed initiative. Partners include Project Wild Fire, Deschutes County Emergency Management, Pet Evacuation Team„ St. Charles Health System, City of Bend, City of Redmond, City of LaPine, City of Sisters, Deschutes Public Health, Girl Scouts, Head Start, Neighborlmpact, Deschutes County Sheriff's Office, Redmond Municipal Airport, Redmond Fire and Rescue, Redmond Police Department, City of Bend Fire and Police Departments, schools, and business and faith community networks. 9. Describe other sources of funding that will support the proposed initiative. Support for the regional Prepare! project has been secured from the Clark Foundation, the Maybelle Clark Macdonald Fund, and businesses such as Wells Fargo, Pacific Power, Deschutes Brewery, Bigfoot Beverages, Service Master and more. In addition, a grant from the federal Corporation for National and Community Service will fund AmeriCorps members throughout the state, including one that will serve a second year here with the Oregon Mountain River Chapter, her primary focus is preparedness training and she will spend a significant part of her time on Prepare! Deschutes County. 10. Attach an operating budget specific to the proposed initiative. Attached. Performance Measurement 1. Identify quantifiable outputs anticipated to be achieved through the proposed initiative (examples: number of persons served, programs or events held, animals rescued, acres restored or protected). • Continuation of work in Prepare! Redmond with community strategic partners committee composed of representatives from a variety of sectors of the community, including businesses, schools, government, non -profits, etc. • Development of a community -specific action plan to improve preparedness and resiliency • 1,200 people in Deschutes County trained in safety and preparedness 2. Describe the anticipated outcomes of the proposed initiative (examples: fewer persons institutionalized, greater knowledge and understanding of local history, fewer animals in shelter care, more natural areas available for wildlife and recreation). Short-term 90% of preparedness presentation attendees demonstrate increased knowledge of disaster preparedness on a pre- and post -survey Intermediate 50% of preparedness presentation attendees have taken at least one significant preparedness action in the three months following the presentation Long-term • Increased ability of communities to bounce back from disasters • Reduced negative impact of disasters 5 Deschutes County FY2013-14 Community Grant Application Prepare! Deschutes County Budget FY15 COMMUNITY ENGAGEMENT $23353 Community training supplies, media/marketing, travel, outreach events to bring Deschutes County communities together to collaborate, plan, resource and execute activities, trainings, and events that build community resiliency PREPAREDNESS EDUCATION $3168 Materials/supplies and travel costs for training in preparedness throughout Deschutes County DISASTER RESPONSE CAPACITY -BUILDING $6960 Recruitment, training, and support costs to expand volunteer corps; travel, supplies, and equipment to increase community partnerships, identify new shelters, and restock/rotate prepositioned supplies throughout Deschutes County STAFFING COSTS $43298 Part of time of Executive Director, Disaster Program Manager, one AmeriCorps member, and support from our Red Cross regional team TOTAL $76779.00 6 THE AMERICAN NATIONAL RED CROSS Consolidated Statement of Financial Position June 30, 2013 (with comparative information as of June 30, 2012) (In thousands) Assets 2013 2012 Current assets: Cash and cash equivalents $ 82,721 $ 52,905 Investments (Note 8) 618,139 626,872 Trade receivables, including grants, net of allowance for doubtful accounts of $6,963 in 2013 and $5,657 in 2012 (Note 11) 233,089 216,517 Contributions receivable (Note 2) 80,303 70,011 Inventories, net of allowance for obsolescence of $4,714 in 2013 and $4,105 in 2012 112,950 113,876 Other current assets 23,230 24,922 Total current assets 1,150,432 1,105,103 Investments (Note 8) 1,466,762 1,356,851 Contributions receivable (Note 2) 12,205 16,030 Land, buildings, and other property, net (Note 3) 1,018,454 1,050,793 Other assets (Note 9) 250,982 249.184 Total assets 3,898,835 3,777,961 Liabilities and Net Assets Current liabilities: Accounts payable and accrued expenses 325,810 281,012 Current portion of debt (Note 4) 18,236 14,400 Postretirement benefits (Note 10) 3,734 3,991 Other current liabilities (Note 9 and 11) 154,398 164,121 Total current liabilities 502,178 463,524 Debt (Note 4) 695,755 538,958 Pension and postretirement benefits (Note 10) 554,645 1,001,636 Other liabilities (Notes 4 and 9) 156,200 178,620 Total liabilities 1,908,778 2,182,738 Net assets (Notes 6 and 7): Unrestricted net assets 398,444 133,687 Temporarily restricted net assets 861,605 757,513 Permanently restricted net assets 730,008 704,023 Total net assets 1,990,057 1,595,223 Commitments and contingencies (Notes 4, 5, 8, 10, and 11) Total liabilities and net assets $ 3,898,835 $ 3,777,961 See accompanying notes to the consolidated financial statements. 3 'TIDE AMERICAN NATIONAL RED CROSS Consolidated Statement of Activities Year ended June 30, 2013 (with summarized information for the year ended June 30, 2012) (in thousands) Un estricled Temporarily Restricted Permanently Restricted Totals 2013 2012 Operating revenues and gains: Contributions: Corporate, foundation and individual giving United Way and other federated Legacies and bequests Services and materials Products and services: Biomedical Program materials Contracts, including federal government Investment income (Note 8) Other revenues Nei assess released from restrictions $ 278,866 5 552,132 5 $ 830,998 S 437,768 32,905 62,625 - 95,530 100,227 64,022 10,191 22,011 96,224 94,629 16,212 38,290 54,502 37,424 2,037,732 2,037,732 2,153,870 125,153 125,153 136,876 73,132 73,132 82,552 16,781 31,916 48,697 58,100 73,575 398 73,973 69,071 630,997 (636,9971 - Total operating revenues and gains 3.355,375 58,555 22,011 3,435,941 3,170,517 Operating expenses: Program services: Services to the Anned Forces 56,645 - 56,645 53,045 Biomedical services (Note 12) 2,164,815 2,164,815 2,239,784 Community services 57,200 57,200 77,538 Domestic disaster services 467,245 467,245 279,190 Health and safety services 216,222 216,222 195,596 International relief and development services 92,742 - 92,742 186,726 Total program services 3,054,869 3,054,869 3,031,879 Supporting services: Fund raising 189,431 - 189,431 172,407 Management and general 136,283 - 136.283 140,847 Total supporting services 325,714 - 325,714 313,254 Total operating expenses 3,380,583 3,380,583 3,345,133 Change in net assets front operalions (25,208) 58,555 22,011 55,358 (174,616) Nouoperating gains (losses) (Notes 4 and 8) 42.670 45,537 3,974 92,181 (36,514) Pension -related changes other than nes periodic beaefii cosi (Note 10) 247,295 - 247295 (385,570) Change in net assets 264,757 104,092 25,985 394,834 (596,700) Net assets, beginning of year 133.687 757,513 704,023 1,595.223 2.191.923 Net assets. end of year $ 398,444 $ 861,605 $ 730,008 $ 1,990,057 $ 1,595,223 See accompanying notes to the consolidated financial statements. 4 THE AMERICAN NATIONAL RED CROSS Statement of Functional Expenses (In thousands) E E w.2 2 GAcn �: en I01 N '0en v Nv -- '1 , a 0 — N el, N r• N. 00 00 01 I� 00+0`.0 c 00 G 01 01 Cli N CO or or+P o-• M — .-- or N C M 09 00 M 00 M CO 00 00 0 00 O N 00 0 V 00 01R WO M m 7 M 10- 070' 0- O+10 hM I'1 N .r1 00 0, 00 0000 10 00 0.N 00 N O, 00 0.0, T 10 .•+N 01 10 .0 00 N .. 00 IA N to, 0- 0 - .0 bO�00T S ,61 • Or. M N 10 N b 0O .0 G;rn 0% 000 0of ▪ N 000, 4 01 00 0`� O 10 N 00 O O N 01 60 O o�W0') • n '0 0.1 00 0 C 00 O N b or., 0 Q0 00 V" 01 rr 00 rn '0 M 1 O M N M 10 CO N 69 01 O P 00 00 000 N CO eery 6. 000 v0i 00 n ON en N Q 10 2 a P N O N 00 C c .0 N M M d 0• 01 V, • K. RQ O 1 O 01 01 N or O r b Q Q 00 .- N 0- 0 7 00 M IN I R 10 0 N M 00 en ,o 00 00 col CO e b vt 00 7 0 00 • 00 M M 10 00 N M N 1.6 0-•eV 0C+ 00 t- .nN M V 00 10 0 N 01 1• a 7 00 O h 0.0 00 Of V T^ 7 N N M rn N 00 .o CO 01 00 00 rn 7 00 r1 r1. r`.. 00 a0 0- M O ri M a N M00 N 00 N N. 01 N rn co 01 41 on oo O sp. • O ,yr.d G 0000 001 0 or" W M cel .0 To v E See accompanying notes to the consolidated fin