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Home My WebLink AboutThe Center FoundationApplicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet The Center Foundation Category/Grant Amount: Title: Other Essential Services / $11,000 South Deschutes County Brain and Spinal Cord Injury Prevention Initiative 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 201445 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 jilditla 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: Carol Stiles Organization Name: TCF (the Center Foundation Address: 2200 NE Neff Road City: Bend Telephone Number: State: Oregon I Zip Code: 97701 541 322-2199 Email Address: c est .iles( eenterfoundat.inmore Application is being submitted to which Community Grant Program funding category*? O Health, Mental Health, and .Addictions Services ❑ Arts and Culture X ❑ 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, 1 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: e Title: 1/Y E (.-t `ir V D r -6- V., Date: 1 l9 — 0 3 / The Organization: TCF (The Center Foundation) 1. Led by physicians, physical therapists and business leaders, The Center Foundation (TCF) became a non-profit in 2002 and is recognized as a leader in youth sports medicine for injury prevention and concussion management. Before 2002, The Center provided the medically trained, certified athletic trainers (ATCs) as a community service, but it became clear the work required community support to sustain and expand the program. 2. TCF's mission is to benefit the health, wellness and education of Central Oregon youth. TCF believes that playing sports and being active is good for kids and research demonstrates that involvement in team activities benefits youth in multiple ways. However, when kids are active, they can get hurt so TCF provides services to keep kids safe enabling them to enjoy the advantages that physical activity and athletics delivers. Services provided by TCF include: (1) placing certified athletic trainers in Sisters, Bend and La Pine High Schools and support to five other small schools, (2) teaching first through third grade students brain and spinal cord injury prevention awareness, (3) providing free bike helmets to children in need, (4) conducting concussion testing, identification, management and awareness in Central Oregon high schools, (5) professional development through medically based conferences and (6) an annual scholarship program for outstanding Central Oregon students. In January, 2015, TCF will begin working with Bend LaPine middle schools to develop concussion testing, identification and education for coaches, nurses, parents and students. The goals of TCF are to keep kids safe, active and protected regardless of the families' financial resources. 3. TCF bylaws establish a 15 -member board comprised of community and business members and medical professionals. The President and President-elect are community members, the Treasurer (non-voting) is The Center's CFO. There is a professional Executive Director responsible for the foundation's operations. The board advances the TCF mission by setting policy, guaranteeing fiscal integrity, community networking, assuring strategic goals are met and through financial contributions. The board meets 10 times a year including an annual summer retreat to review its strategic plan progress, financial status and community outreach and to set the course for the coming year. This proposal fulfills a board goal of continuing to provide excellent programs and to make those programs accessible to under -served populations. This project proposes placing brain and spinal cord injury prevention and free bike helmets in the two, south county grade schools for students first through third grade. Program: 1. This project will be the South Deschutes County Brain and Spinal Cord Injury Prevention Initiative funded for 2014-15 by Deschutes County. Already established in many Bend elementary schools, the brain and spinal cord injury prevention project and free bike helmet program has been a success. During the 2013-14 school year nearly 1,400 1 -3rd grade students receiving educational information about the importance of the brain and spinal cord and ways to protect those important body components. Additionally over 850 free bike helmets were fit and distributed during the same time period. TCF believes it is important for children in the south county area to have access to the same materials and free bike helmets. 2, 3, & 4. The goal is to decrease the risk of fatal and/or life -changing injuries to children ages 6-8 years in LaPine and Three Rivers elementary schools by expanding the Bend -based 1 -3rd grade brain and spinal cord injury prevention and free bike helmets to the high risk areas in southern Deschutes County. The purpose is to (a) raise awareness among the 1 -3rd grade students in LaPine and Three Rivers Elementary Schools about the importance of the brain and spinal cord to life and quality of life (b) expose those students to information and strategies to protect their lives by protecting their brain and spinal cord and (c) to assure that all students have access to properly fitted and safety approve helmets. The objectives are to (a) provide brain and spinal cord injury prevention education to 1-3 grade student in the two schools named (b) increase student and teacher awareness of the safety strategies which help prevent injuries and (c) examine helmets belonging to a 1-3 grade student for proper fit and condition (d) provide new helmets to any 1-3 grade student without a helmet or with an improperly fitting helmet. Specifically, the target population is 1 -3rd grade children attending LaPine and Three Rivers Elementary Schools. There are 116 1 -3rd grad students at Three Rivers and 202 students at LaPine Elementary School for a total of 318 children. We propose purchasing 350 helmets for south county children with the remaining 32 helmets available for public safety and the medical clinics to access should they find children needing helmets. 5. The south county area continues to struggle with economic issues, housing and at risk families. Deschutes County and its partner's have made this area a high priority for education, services and interventions. LaPine and Three Rivers Elementary Schools are known to house a higher than average number of at -risk children and have above average rates of free and reduced lunches. The targeted schools do an amazing job of problem solving and innovative planning with regard to programs and services striving to strengthen their populations. Because of the distance of this area from Bend and the population size, access to services has been a challenge. Additionally and with respect to bicycles and other wheeled toys, south county has a number of unpaved and unimproved roads increasing the risk for youth choosing to use their bicycles. This initiative will increase safety awareness for 6-8 year old students and decrease the risk of head injury that could lead to loss of life or long-term brain damage. Handouts at the brain and spinal cord injury prevention classes will offer parents important safety information they might not otherwise receive. The schools and teachers benefit because the brain and spinal cord injury prevention education includes crossing the street, use of car seats, play ground safety, exiting school buses as well as wheeled toy safety. It should be noted that Bend LaPine District personnel have asked TCF to make the brain and spinal cord injury prevention program and free bike helmets available in south Deschutes County. 6. Implementation of the project has three phases. Phase 1 is building relationships with the two schools, scheduling appointments to review the program, scheduling the sessions, ordering helmets, securing assistance from local law enforcement to handout reward and free helmet coupons, training volunteers to fit helmets and assuring materials are available. Phase 2 is the certified athletic training and volunteers going into the schools to conduct the presentations and distribute the helmets. Students and parents will be alerted prior to the actual education day and students will be asked to bring their bike helmets( if available). Brain and spinal cord injury programs occur in the spring in preparation for nicer weather and summer activities. Phase 3 is evaluation and follow-up. The athletic trainer will 'wrap around' with the teachers and school administrators for feedback on student responses, observable changes in student behavior and parent feedback. This material will be used for feedback to the Deschutes County Commission and to work with the community to sustain the program in coming years. The program (phase 2) has an organized instructional outline lasting 45-60 minutes. Depending on the preferences of the grade school teachers, classes may be combined. The instruction is very interactive and the outline is A) Introduction of the athletic trainer and topic B) Introduction of the brain and spinal cord 1. shape, location, and size of each organ 2. actual spinal column skeleton display 3. life size squishy brain 4. students may handle each 5. fragile nature of each i.e. brain is the consistency of soft butter C) Purpose of each organ 1. purpose of the brain 2. purpose of the spine and spinal cord 3. examples of what happens if injured D) How do we protect ourselves 1. street safety 2. car safety 3. play ground safety 4. school bus safety 5. wheeled toy safety E) Bike Helmets 1. why bike helmets matter 2. proper way to wear a bike helmet 3. melon demonstration. A melon is dropped without a helmet and with a helmet to demonstrate, very graphically, that helmets matter. F) Helmet check and fit. 1. students bring their helmets to the instructor and trained volunteers to check for damage and fit. If helmet is no longer good, student receives new one. 2. if students have no helmet at all, volunteers will fit them for a new, safety approved helmet. 7. The grant funds being requested are $4,712 and the cost of the entire south county program is $5,387. $3,500 350 new bike helmetsat $10 @ Deschutes Cty $ 940 40 hours staff time x $25/hr Deschutes Cty $ 272 495 miles x .55/mi Deschutes Cty $ 200 Melons, drop clothes TCF $ 75 printing TCF $ 400 grant management TCF 8. Partners to implement this project will be Bend LaPine School District, LaPine and Three Rivers Elementary Schools, local public safety and the LaPine medical clinic. When implemented, TCF provides free helmet coupons to public safety and local physicians. If they see a child without a helmet, the parent is given a coupon for a free helmet. The parents simply contacts TCF and we arrange for the student to be fitted with a free helmet. 9. In addition to Deschutes County, TCF will support the program with cash and in-kind support. During the course of the grant, TCF will approach local resources to assist in providing helmets and ongoing education at the end of the grant period. The funding strategies employed by this foundation to sustain programs include grant writing, community fundraising and direct ask campaigns. Project Outcomes and Evaluation Project Goal: Provide brain and spinal cord injury prevention to 1 -3rd grade students in two, south county elementary schools. Objectives Output Provide brain & spinal cord injury prevention information to 1-3 grade students 1. Parent information packets produced 2. 1-3 grade students scheduled to attend instructional 3. 90% of students attend 4. Students and teachers are presented research based brain and spinal cord injury prevention information L 1. 2. 3. Outcome Evaluation Students become more safety conscious and can answer questions at the end of the session about safety 50% of parents receive safety information after the session 75% of student participants will improve their safety habits 1. Brain and spinal cord injury prevention coordination will a)obtain feed back from teachers after the program b) obtain behavior change information from School staff. Provide safety approved and well fitted bike helmets to 1 -3rd grade students in need. 1. 2. 3. 5 volunteers receive bike helmet fit training 100% of 1-3`d children attending the training have properly fitted bike helmets 100% of 1 -3rd children know how to properly wear a bike helmet 1. There will be 0% preventable head injuries (on wheeled toys) in children who have attended the 1 -3rd training session during the summer 2015. 1. Collect data from Deschutes County Public Health Thank you for the opportunity to submit this request and potentially to partner with the Deschutes County Board of Commissions. This request will impact several hundred children in a high need area of the county, raise safety awareness in the schools and within families. yak miff pod apf/aroft aci/BdgAaalli...go wado,f" TCF The Center Foundation Stay Strong 1 Play Smart Board of Directors July 2014 Tim Bollom Chuck Brockman Tom Carlsen, President Mike Caravelli Cammy Gilstrap Mike Gonsalves Michael Hurley Glen Lasken, President-elect Patsy Melville Blake Nonweiler Dave Stewart Viviane Ugalde Carol Stiles, Secretary — not voting member Derek Garrett, Treasurer — not voting member Form 990 Department of the Treasury Internal Revenue Service OleThe organization may have to use a copy of this return to satisfy state reporting requirements. ,TUN 30, 2013 EXTENSION GRANTED TO 5/15/14 Return of Organization Exempt From Income Tax Linder section 501(c), 627, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) A For the 2012 calendar year, or tax year beginning JUL 1, 2012 and ending B Check it applicable; []Address change Name change []Initial return Termin- ated C Name of organization THE CENTER FOUNDATION OMS No. 1345,0047 2012 Open to Public Inspection Doing Business As D Employer identification number 93-1296341 Number and street (or P.O. box if mail is not delivered to street address) 2200 NE NEFF ROAD #200 return Amended City, town, or post office, state, and ZIP code BEND, OR 97701 F Name and address of principal officer: DEREK GARRETT SAME AS C ABOVE � Appllca- tion pending Room/suite E Telephone number 541-322-2379 G Gress receipte 326,324. Tax-exempt status: MI 501(c)(3) [J 501(c) ( _)411 (insert no.) 4947(a)(1) or 1 527 ,! Website:► CENT ERF OUNDATION .ORG K Farm Of ortanizatiorr I Cor oration Trust Asscclation Other ► L Year H(a) Is this a group return for affiliates? H(b) Are all affiliates included? I 1 Yes 11X1No Yes 1 No If No, attach a list. (see instructions) H(c) Group exemption number /O- M M State of le . al domicile:OR Part Summary ormalion• 2000 Activities & Governanc 1 Briefly describe the organization's mission or most significant activities: SEE SCHEDULE 0 2 Check this box ► I 1 if the organization discontinued its operations or disposed of 3 Number of voting members of the governing body (Part VI, line 1a) 4 Number of independent voting members of the goveming 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) 2 c w 7 a Total unrelated business revenue from Part VIII, column (C), line 12 b Net unrelated business taxable income from Form 990-T, line 34 8 Contributions and grants (Part VIII, line 1h) 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) ...... 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) _ 16a Professional fundraising fees (Part IX, column (A), line 11 e) b Total fundraising expenses (Part IX, column (D), line 25) ► 24,622 . 17 Other expenses (Part IX, column (A), lines 11a -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 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 l'Part Il . I 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. Prior Year 3 15 4 7 5 1 6 32 7a 0 . 7b_ 0 . Current Year 281,469. 259,708. 29,475. 38,035, 1,581. 2,380. -7,981. -3,055. 304,544. 297,068. 23,100. 30,000. 0. 0. 47,721. 47,429. 2,700. 0. 253,270. 281,023. 326,791. 358,452. -22,247. -61,384. Beginning of Current Year End of Year 201,898. 212,704. 0. 53,554. 201,898.E 159,150. Sign Here Paid Preparer Use Only Signature of officer `DEREK GARRETT, TREASURER Type or print name and title Print/Type preparer's name WENDY CAMPOS Date Preparers signature Firm's name b., MOSS ADAMS LLP Firm's address ► 805 SW BROADWAY #1200 PORTLAND, OR 97205 Date Check stll•empbycd Firm's EIN ■ Phone no. May the IRS discuss this return with the proparer shown above? (see instructions] 232001 12-10-12 LHA For Paperwork Reduction Act Notice, see the separate instructions. PTIN P00448102 91-0189318 (503)242-1447 DO Yes _ r1 Ne Form 990 (2012) Applicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet ICON City Category/Grant Amount: Title: Other Essential Services / $11,000 Mobile Shower Truck 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: Megan Sergi Organization Name: Address: Icon City PO Box 7322 City: f Bend ,I Telephone Number: 541-848-1667 State: OR Zip Code: 97701 Email Address: megan@iconcity.us Application is being submitted to which Community Grant Program funding category*? ❑ Health, Mental Health, and Addictions Services ❑ Arts and Culture X 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: -into r� Print Name: MF ia/1 J J Title } �1 )1/ /I c , t r 4(0 11 k .' �t ] c .e e Date: IO A 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. Icon City begin its work in June of 2009 and received formal 501(C) (3) status in March of 2010 as a community outreach organization. Icon City began as a group of Bend residents who were seeing the needs in their community grow while resources were diminishing. Icon City saw this as an opportunity to create a paradigm shift. The question was asked, "What if the resources that are needed are already here? What if they are in us? What if they are in our communities and its residents?" 2. State the organization's mission, goals, and programs or services provided. Mission. The purpose of Icon City as fully stated in its mission is to "create awareness and solutions for urgent social needs." Project Goals. Icon City exists to meet the basic needs of the homeless community. We do this through weekly outreach: Mobile Showers, food, hygiene supplies, survival gear and basic need support utilizing the innovative "Be -Remedy Text Line." The Icon City Shower Truck delivers dignity and unlocks opportunity for those experiencing homelessness — one mobile shower at a time. Fundamental to this project are three beliefs: 1. Everyone has the right to be clean. 2. Those experiencing homelessness can't access jobs and housing or maintain health and well-being if they are not clean. 3. With hygiene comes dignity; with dignity, opportunity. Weekly Icon City's Mobile Shower truck will be available to the homeless community at five different outreach locations, all located within Deschutes County: o Family Kitchen in Bend (2 times per week) o The Redmond Senior Center o Downtown Bend/Journey Church Parking Lot o Various homeless camps in partnership with Central Oregon Veterans Outreach (COVO) • Annually 2,600 showers will be accessed through our mobile shower truck Services provided. Weekly showers & hygiene supplies to Deschutes County's homeless population. 4. Describe the leadership and structure of the organization. Leadership and direction are provided to Icon City by a volunteer Board of Directors. There are no paid staff. The Directors are integral in the creation of Icon City programs as well as resource development. The Board has a wide range of non-profit, business, housing and strategic planning experience. The current Icon City Board of Directors are: Kenny LaPoint, Public Affairs Director, Housing Works and Families Forward and Icon City Board Chair Megan Sergi, Program Director, Cascade Youth & Family Center Lonnie Chapin, The Wild 107.7 Morning Show Host Jeremy Boethin, Owner Lifestyle Chiropractic Dan Forsell, Deputy Sheriff, Deschutes County Our board is educated, passionate and experienced on issues people experiencing homelessness face. The board has large community connections/support from media, criminal justice, health care and the non-profit sector. Two of our five board members are voting members for the Central Oregon Homeless Leadership Coalition. We have lead sub- committees on the 10 -year plan to end homelessness, which includes housing and youth issues. Annually we participate in planning and act in leadership roles at the region's largest outreach events: Project Connect and The Point in Time Count (formerly The One Night Homeless Count). Program, Project, or Activity 1. Provide a title of the proposed initiative for which funds are being requested. Icon City would like to request a grant in the amount of $11,000 to go towards the annual operation of the Mobile Shower Truck for Deschutes County. This outreach effort has proven to be extremely valuable to our most vulnerable community members and our social service partner agencies providing resources to their clients in Deschutes County. 2. Describe the goals and objectives of the proposed initiative. The Icon City Shower Truck goals and objectives are to provide sanitation, assist in deterring potential public health problems, and perhaps most critically, providing a much needed service to help a population struggling to retain a sense of dignity and self worth. Weekly Icon City's Shower Truck will provide outreach at the following locations: • Family Kitchen in Bend (2 times per week) • The Redmond Senior Center • Downtown Bend/Journey Church Parking Lot • Various homeless camps in partnership with Central Oregon Veterans Outreach (COVO) Annually Icon City's Shower Truck will provide outreach to: • Project Connect 3. Identify the target population which will be served. Icon City will provide benefit to homeless & low-income individuals, displaced youth and families in Deschutes County as well as local social service agencies. 4. Identify the geographic area(s) of Deschutes County which will benefit. • Bend, Redmond, LaPine, Sisters 5. Describe how the proposed initiative will positively impact the community and complement existing services currently provided by Deschutes County. The largest way the Shower Truck will positively impact the community is through increased personal hygiene that will allow for increased success as individuals seek employment and housing opportunities. We all know that first impressions are the most important and not having sufficient access to bathing services will only perpetuate the cycle of poverty. By providing a vulnerable individual with access to a shower the outcome of enhanced self- efficacy is immediate. Other tangible rewards are to gain employment, increase income, obtain housing and, in some cases, the end result may be economic self-sufficiency. Not only does economic self-sufficiency result in less reliance on public services and benefits but it creates a productive, dignified member of our community. Granted a shower is not going to eliminate poverty, but the dignity it does offer opens the door to positive possibilities. 6. Describe in detail how the proposed initiative will be implemented. The Shower Truck initiative is already a proven success. Icon is requesting the $11,000 to help continue the operation of the only mobile shower services available in Central Oregon. All outreach will continue in the five locations Deschutes County locations. All Shower Truck outreach will continue to be organized and staffed by dedicated volunteers. Icon City has not missed a weekly outreach in 5 years, since becoming a non-profit in 2009. In a county like Deschutes, where real estate prices are exploding, mobile programs ensure that services are not subject to rising rents and potential evictions. And perhaps more importantly, going mobile gives us the flexibility to reach the homeless who are scattered throughout our community. 7. Describe specifically how the requested funds will be used. Shower Truck Storage (indoor & heated, to .revent frozen •i.es $275 per month @ 12 months $3,300 Insurance -Volunteer & Vehicle Annual Premium $5,047 Gasoline & Maintenance Mileage (12k annually @ rate of $6,720 $0.56 per mile, covering fuel and maintenance) 8. Identify any partner agencies which will collaborate to implement the proposed initiative. • The Family Kitchen in Bend • Central Oregon Veterans Outreach • Cascade Youth and Family Center • Redmond Senior Center • Family Access Network (FAN) • Bethlehem Inn • Full Circle Outreach • Shepherd's House • Foundry Church • Journey Church 9. Describe other sources of funding that will support the proposed initiative. Source of Funding Private Donors Funding Amount $7,000. Fundraising Grants $3,000. Confirmed, Requested or Projected Confirmed Projected $11,000 TOTAL $21,000 Performance Measurement Reauested 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). • Icon City will provide over 2,600 showers annually to those in need. 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). • Greater opportunities to employment and education • Fewer people affected by poor hygiene • Increased access to public spaces • Raised self-esteem, self-efficacy and self-worth Applicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet La Pine Community Kitchen Category/Grant Amount: Title: Other Essential Services / $11,000 Operating Expenses 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: Kim Hafermalz Organization Name: Address: City: La Pine Community Kitchen 16480 Finley Butte Rd (PO Box 813) La Pine Telephone Number: Email Address: State: Oregon Zip Code: 97739 541-536-1312 director@lapineconununitykitchen.org Application is being submitted to which Community Grant Program funding category*? ❑ Health, Mental Health, and Addictions Services ❑ Arts and Culture X 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: I. 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: ) k vr, 14rrry Title: (__. iCt_44e 0;tr� Date: t'r)e.-- 4,4- y AoiSI Organization History: The La Pine Community Kitchen started in 2002 providing lunches to seniors, the working poor, the disabled, the unemployed, children out of school, and the homeless. Since then the "Kitchen" has grown to providing five hot meals a week, emergency food boxes; fresh produce and dairy, and free clothing. We "employ" approximately 60 volunteers a month. Many of whom are also in need of our services. Mission, goals, services The La Pine Community Kitchen provides free nutritious food and donated clothing to the residents of Southern Deschutes County without discrimination or judgment. Our goal is to provide a safe and inviting place for the needy and vulnerable of Southern Deschutes County to meet their most basic needs. In addition, we are entering into a new partnership with the Deschutes County Behavioral Health Client Club House project. Darin Darlington is starting a satellite program here in La Pine, and we offering our dining room for his clients to meet and socialize. He says this project is integral to his client's treatment, and going all the way to Bend is not an option for most of them. Leadership Structure The La pine Community Kitchen has one paid employee, the Executive Director. The Administrative Assistant and the three department manager's, and they are all volunteers. There is no kitchen manager at this time. The Board of Directors is made up of long time volunteers, and those who don't volunteer on a regular are on call when the need arises. Project Project Title Operating expenses Goals and objectives Our goal is to continue operating the La Pine Community Kitchen as we for the last twelve years, and also make our facility available to help other organizations, such as the Deschutes County Behavioral Health Client Club House project. To do this we need operating funds to pay our basic monthly bills. Target population We serve seniors, disabled, veterans, children, the unemployed, the homeless, and soon the behaviorally challenged. Geographic Area We serve southern Deschutes County. How project will be positively impact the target population We will be providing a safe and pleasant place for people come and get their basic physical and social needs met. How the project will be implemented We will continue to serve meals and provide food and clothing as we have always done with funds from United Way, The Hunger Prevention Coalition, and other sources. The new partnership with Deschutes County Behavioral Health Client Club House project will start meeting for a meal once a week in a small closed off dining room, and they will stay for an additional hour to socialize and play games. It is expected that the program will grow from there to multiple days a weeks. How the funds will be used The funds will be used to meet the operating expenses, so we can continue to our vital work Partner agencies Deschutes County Behavioral Health St Vincent de Paul, La Pine (Share in food drives) La Pine Chamber of Commerce (Civic events and fundraising) Lions Club (fundraising for both organizations) Other sources of funding The La Pine Community Kitchen receives donations from: • Individuals • Local social organizations • Churches • Small business • Foundations So far this year, we have received non-food specific grants from: • Midstate Electric • Cascade Natural Gas • Deschutes County Discretionary Funds • Meyer Memorial Trust We have applied and are waiting for awards from: • The Barbara Emily Knudson Charitable Foundation • The Cow Creek Foundation • The Chambers Family Foundation. Performance Measurement We count all customers in all departments each time they visit. The Deschutes County Behavioral Health Client Club House project will do their program evaluation for the satellite program. Quantifiable outputs anticipated We anticipate our service levels to be the same in 2014-2015 as the previous year. Please see the attached documentation. The number of participants in the Deschutes County Behavioral Health Client Club House is unknown at this time because the program hasn't started yet. Anticipated outcomes The programs at the La Pine Community Kitchen have been helping the people in need of Southern Deschutes County for over twelve years. By providing a hot meal five days a week, an emergency food box for those who qualify once a month, fresh produce and dairy items twice a week, and free clothing opportunities once a month we help extend a person or family's budget, so they can pay rent, buy gas, pay other bills, etc. Proposed Budget Operating Expenses for 3 months Tess Salary,Taxes, and Food Costs Supplies Misc. Services (day labor when needed and volunteers aren't available All Utilities Maintenance and constru Vehicle including Insuranc Misc. expenses 1,500.00 1,400.00 2,100.00 3,200.00 1,500.00 1,300.00 11,000.00 La Pine Community Kitchen 16480 Finley Butte Road - P.O. Box 813 - La Pine, OR. 97739 OFFICERS NAME EMAIL PHONE CELL President : Jim Flemming 9fngrs@gmail.cor 541-419- 9403 541-350-1459 Vice President Jennifer Wells lapinelaw@yahoo.com 541-536-3566 541-948-1279 Secretary Penny Vicari pennyvicari@hotmail.cam 541-771-9376 Treasurer Clyde Evans clydeevansl@grn©il.com 541-536-3278 909-496-7264 Member Fred Crouch caroljoyce5@juno.com 541-536-3836 541-420-6317 Member Patti Delk jdelk@crestview.com 541-536-7489 Member Susan McDonough bettyboop4sure@gmail.com 503-410-9832 Member Marjorie Proffitt proffittma@msn.com 541-536-3064 541-815-0113 Member Patti Spires spirespatricia@yahoa.com 541-433-2333 541-536-4631 Member Mary Thorson Iandmthor@aol.com 541-536-2912 Ex Director Kim Hafermalz kim.5rmalz@gmail.com 510-896-9257 Forth 990 -EZ Department of the Treasury Internal Revenue Service Short Form Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) P. Do not enter Social Security numbers on this form as it may be made public. ► Information about Form 990 -EZ and its instructions is at www.irs.gov/form990. A For the 2013 calendar year, or tax year beginning B Check if applicable: ❑ Address change ❑ Name change ❑ Initial retum ❑ Terminated ❑ Amended return Application pending G Accounting Method: fl Cash ❑ Accrual Other (specify) 0- 1 1 Website: ► blip:www.lapinecommunitykitchen.argl C Name of organization 1 A Pine Community Kitchen January 1 , 2013, and ending OMB No. 1545-1150 00013 Open to Public Inspection December 31 ,20 13 D Employer identification number 20-2087631 Number and street (or P.O. box, if mail is not delivered to sireel address) PO Box 813 noom/suite E Telephone number (541) 536-1312 City or town, state or province, country, and ZIP or foreign postal code 1a_P__inn Orman li77 9 F Group Exemption Number ► J Tax-exempt status (check only one) — ❑ 501(c)(3) ❑ 501(c)1 ) -4 (Insert no.) 0 4947(a)(1) or K Form of organization: ❑ Corporation ❑ Trust ❑ Association 0 Other 0527 H Check ► ❑ if the organization is not required to attach Schedule B (Form 990, 990 -EZ, or 990 -PF). L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) below) are $500,000 or more, file Form 990 instead of Form 990 -EZ ► Part I Net Assets 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 I 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 5a b Less: cost or other basis and sales expenses L 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 Bator than $15,000) b Gross income from fundraising event (not nc) d'r : $ 4218 of contributions from fundraising events .reported on li e 1) - h Schedule G if the sum of such gross income and conte tjon ° ' ceeds $15,000) . . 6b Less: direct expenses from gaming d draining events [ 6c 16a1 910 1 2 3 4 5c 121567 c I d Net income or (loss) from gami ' undraising events (add lines 6a and 6b and subtract line 6c) Gross sales of inventory, less returs and allowances 7a Less: cost of goods sold Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) Other revenue (describe in Schedule 0) Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 ► 7a b c 8 9 10 11 12 13 14 15 16 17 18 19 7b 6d 3308 7c 8 9 124875 Grants and similar amounts paid (list in Schedule 0) Benefits paid to or for members Salaries, other compensation, and employee benefits Professional fees and other payments to independent contractors Occupancy, rent, utilities, and maintenance Printing, publications, postage, and shipping Other expenses (describe in Schedule 0) Total expenses. Add lines 10 through 16 10 11 12 13 14 23472 345 19123 15 16 17 Excess or (deficit) for the year (Subtract line 17 from line 9) 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) 20 Other changes in net assets or fund balances (explain in Schedule 0) 21 Net assets or fund balances at end of year. Combine lines 18 through 20 ► 18 83090 126030 (1155) 19 121548 20 21 _ 120393 For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 106421 Form 990 -EZ (2013) Form 990-IZ12013) Part II 20-2087631 Page 2 Balance Sheets (see the instructions for Part II) Check if the organization used Schedule 0 to respond to any question in this Part II 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)/ (A) Beginning of year (B) End of year 17954 22 16789 103594 23 103594 P. 24 _2.837 -0- 121548 25 120383 Al -0- _ -0- 26 _ - - '0`. -0- 121548 27 120393 Part III Statement of Program Service Accomplishments (see the instructionsfor Part III) Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.) Check if the organization used Schedule 0 to respond to any question in this Part III • ❑ What is the organization's primary exempt purpose? 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 f9r-e?ch program title. 28a 33367 28 LaP_tne Calmmunitv_Kitachoriorravides mnr f1hatf 9a.0 �� I aU gu tlx_to_famWes. ti= _ + ., etderhi_anil.____---- ueterans_ouaMondav,fridambasis:_euermweek...Q .vnLunlea1s,aLottiflemora_th 7..117+ •curs_of ___.__ ___ __ _ _ __ _ 531(_ SenlicaEacta.kearw._....v..___.______. ._ _ � _G� _ _..------_---- �'.W__�_. (Grants $ �) If this amount includes foreign grants, check here . . . . ► ■ 29 La.Pit Catarnunity iitcheanrtavides.sanalondhax_{cst rdabaserton.lami)xsiaelomantonthba is____ tcalaceitiles_wittt.rne-, ihe.USDA titetta. D mr. ]diamera cilmthis_tetxort._thePatant,nr vi . 3 __._._ factrilmes-Alae danailies.reveilced uaa]w].(b.sttnrndiic �r_ 0.1 '✓"'iI6 - -- (Grants $ , ) 50 j ) If this - ount includes foreign grants, check here . . . . ► • 29a 69'74 ; - vs each_week._La.Pine CammuniitvlCitnhen nroxides-clethino- rsionallwaienaitents,_lrecidina_Aiso.._ 30a 21979 leants:[othinnwere.distributed_ 2..252 tniIiesiiurinathis.teno f1._____________ _ - -- 14' (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 ° _ ► ❑ 31a 32 Total program service expenses (add lines 28a through 31 a) ■ 32 Part IV List of Officers. Directors. Trustees. and Key Employees (list each one even if not compensated—see the instructions for Part M Check if the organization used Schedule 0 to respond to an v question in this Part IV (a) Name and title (b) Average hours per week devoted to position (c) Reportable compensation (Forms W-2/1099-MISC) (if not paid, enter -0-) (d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation £hristioaRiaas..Execut ue.GWeclpts._.___,._._.T pa Box 813. La Pine. Orenan 97739 .35_hrs 4 hrs _2083.5 -0- P. lartes.Etetninu._Eresideoi. p0 Box 813. La Pine. Grecian 97139 _2.837 -0- 0_ .Lennif)er_Wells..1lice-Pr sicient_______.______ .... po Bax 813. La Pine. Grecian 97739 lhr 2 brs 2 hrs Al -0- _ -0- -0- - -0- -0- _ - - '0`. -0- P_ nnv 1icari._Secr_etant PO Box 613. La Pine. ()rennin 97739 Civi ! E any. fr uter_.y p0 Box 813. La Pine. Oreann 97739 Cite Barharrf._Member_____�_ PO Box 813. La Pine. Oreaon 91738 7 hrs •0- -0- -0- Eted.O.romh..1111embez- 25 hrs 35 hrs 1 hrs - 2 brs -0:. .1- 0 -0- - -0- -Q;- -0- -0- -0- -0- -0- -0- PO 60x_813, La Pine. 0rnapn 07739 PaRti-Relk..111.1rmwtaer Pa Box 813. La Pine. Oreapn 97739 Patti_SDites.Member PO Rox 813. La Pirie._drenon 97339 MarKibiarsen.11itember__W_____________ �W •-■ e... • ,s- •, :of ., . Form 990 -EZ (2013) Applicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet Bend's Community Center Category/Grant Amount: Title: Other Essential Services / $11,000 Sustainable Support for BCC Meal Programs 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: Please complete the following: Contact Name: Linda Heatley, Executive Director Organization Name: Bend's Community Center (BCC) Address: 1036 NE 5`h Street Bend, OR 97701 Telephone Number: 541-312-2069 Email Address: linda@bendscommunitycenter.org Application is being submitted to which Community Grant Program funding category: Other Essential Services: Includes services to youth; underserved, indigent, and/or vulnerable populations; animal welfare; or the environment. 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. Print Name: £;k 1o, 5. f)eci+ Title: F o e_A—0 Date: 10— di/ _ /&/ 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. Bend's Community Center (BCC) is an innovative and responsive 501(c)3 non-profit organization which was founded in 2002 when it first opened its doors at the site of the former Bend Senior Center. BCC has evolved over the years, responding to community needs, creating win-win- situations whenever possible, and adding new programs as volunteers and funding allowed (see #2 below for complete list of Programs and Services). BCC social service programs have been established to meet the basic needs of those in the community, and BCC occupies a unique niche in the community as both an event center and a social service provider. BCC became a United Way agency in 2009. Unfortunately, in 2012, several factors contributed to a crisis in operations — BCC saw declining revenues from fundraisers and donations (due to the depressed economy), and increased costs due to higher demand for services. Furthermore, the BCC Thriftstore, a significant program, was running a loss when it needed to be running a surplus. When the BCC Board voted in early September 2012 to dissolve the organization, we did not really see an alternative at that time — we faced a serious cash flow crunch, leases/mortgages on three buildings, and we were more than $110,000 in the red on our P&L (due primarily to our cyclical revenue stream that is always much stronger around the holiday season). We started the difficult process of talking with various organizations (e.g. United Way, churches, nonprofits, etc.) to who could pick up some of the services/programs we were going to be stopping. Two things happened. First, we heard from many private individuals and organizations that BCC served a critical role in the community, and if we could cut back to our "core services" of food and seniors programs, they would be willing to help out financially and as volunteers. Second, we saw a possibility of consolidating operations down to a single building by Oct. 31. So, we kept the doors open and continued to provide meals and services for the homeless and seniors. And people stepped up with donations and volunteer time like they said they would. Ironically, the food and senior programs were the programs that were doing ok and had always been able to cover their cost because of community and donor support - it was other BCC programs like the Thriftstore that caused the financial hole in the first place. After months of hard work and many significant steps to become more stable and financially sustainable, BCC is now close to being right -sized. Actions taken include: • Let our former Executive Director/Founder go (Taffy Gleason) and hired Linda Heatley as new/current Executive Director • Downsized operations from three buildings to a single facility (and went from an annual budget of roughly $700,000/yr in 2011 to approximately $250,000/yr in 2013) • Underwent an independent financial review (by SGA) which has been reviewed and accepted by United Way (this document is available upon request) • Brought in a nonprofit Board expert (Jessica Sotelo, Executive Director of Partners for Prosperity) to a BCC Board Retreat where we discussed our mistakes and lessons learned of the previous 12-18 months and were briefed on Board governance, roles and responsibilities • Recruited and approved several new Board members (now up to 11) • Continued with fundraising events and community appeals, and signed a contract with Central Oregon Council on Aging to continue operating the successful Senior Meal Program 2. State the organization's mission, goals, and programs or services provided. The BCC Mission Statement reads: "Building a strong community by providing resources for basic needs, job training, volunteer opportunities and a space that brings people together". What this means in plain language is that we try to identify and implement simple, relatively low-cost non -duplicative activities that address basic needs and make a real difference in the lives of those less fortunate in the community. BCC social service programs provide food, clothing, shelter (tents and outdoor survival equipment), transportation (bus -passes), hygiene (showers), firewood, and job training to the hungry, homeless and low-income in the region. Our target population is primarily from Deschutes County, but some BCC programs serve the tri -county region and beyond (e.g. we provide food boxes to families in crisis and food to other homeless shelters and food kitchens). Since our restructuring in the fall of 2012, we have closed the BCC Thriftstore, Warehouse, Bike Shed, and Diaper Bank and cut back to our core programs listed below: 1) Feed the Hungry (provides roughly 1,750 meals per week through Sunday breakfast and lunch, meals -to -go, food boxes, and meals for Shepherd's House) 2) Senior Congregate Meal Program (provides roughly 260 meals per week to low-income seniors in Bend) 3) Keep Them Warm (provides >4,500 items of outdoor survival equipment or clothing annually including tents, sleeping bags, stoves, heavy coats, etc.) 4) Firewood Distribution (provides 60 cords of wood annually to veterans and the homeless) 5) Becca's Closet (provides >400 dresses/suits to low-income students in the tri -county region for them to participate in dances and other social functions) 6) Community benefit events (BCC serves as a host site for medical and dental vans, flu clinics, and blood drives as well as fundraisers for at -risk persons and families) 7) Hall Rentals (BCC provides a valuable space resource for local nonprofits and clubs) 3. Describe the leadership and structure of the organization. BCC has an active 11 member Board of Directors (see attached), 4 full-time staff (Executive Director, Office Manager, Kitchen Manager and Maintenance Person), and one part-time staff (Kitchen Assistant). Day-to-day operations are led by Linda Heatley, Executive Director, who was hired as part of the restructuring in the Fall of 2012. Board members bring a wide variety of skills and experience including: sales and marketing, grantwriting, event planning, IT, business start-up, and property management. In addition, they bring valuable connections with veterans, health care, private sector and various faith groups. Program, Project, or Activity 1. Provide a title of the proposed initiative for which funds are being requested. Sustainable support for BCC Meal Programs: 2. Describe the goals and objectives of the proposed initiative. Our Feed the Hungry Program and Senior Congregate Meal Program have become the "face" of Bend's Community Center. Feed the Hungry (FTH) is the largest food kitchen in Central Oregon, providing an estimated 1,750 meals per week to low-income hungry and homeless men, women and children throughout the region. With the help of community donations and volunteers, every Sunday, BCC provides free breakfast and lunch, and hundreds of sack lunches and meals to go. In addition, BCC provides meals/food boxes for many other food kitchens, shelters and the surrounding homeless camps, and we partner with other agencies to provide the same for families in crisis. Through a contract with Central Oregon Council on Aging (COCOA), BCC hosts the Senior Congregate Meal Program in Bend, providing a healthy lunch to low-income seniors (and their guests) every Monday through Friday. In addition, BCC offers a comfortable and welcoming setting for a library and many social activities such as dances, BINGO, billiards, and puzzles. We have also recently started providing a number of health-related services (e.g. tai chi and foot care) that was requested by the seniors. This is an especially appropriate relationship since for many years the BCC building was the original Bend Senior Center. There are three primary goals to our project: • To stabilize the critical "paid positions" of our meal programs (i.e. Kitchen Manager, Kitchen Assistant, and Janitor) • To ensure that we continue to provide healthy nutritional meals to the ever growing population of homeless and low-income in our community • To grow the Senior Meal Program by continuing to provide healthy nutritional meals and through targeted outreach efforts 3. Identify the target population which will be served. BCC's targeted population includes the poor, hungry, homeless, low-income and disadvantaged throughout the region — young, old, teens and families with young children. Many are veterans and people with serious mental health disorders and/or physical disabilities. Our plan is to continue our outreach to retirement communities and assisted living places to let their residents know about what we do at BCC and to encourage them to take advantage of our services. 4. Identify the geographic area(s) of Deschutes County which will benefit. BCC programs/services are available to all residents of Deschutes County, but the primary beneficiaries of this project will be those living in Bend. 5. Describe how the proposed initiative will positively impact the community and complement existing services currently provided by Deschutes County. By providing essential, nutritious meals to the hungry, homeless and low-income residents of our region, this initiative will positively impact the community and complement existing services provided by Deschutes County. Having a regular site/reason for at -risk populations to gather (i.e. food programs) means that it is possible to overlay a number of critical health-related services in a highly cost effective and efficient manner — this includes BCC hoisting the Mosaic Medical Van (2x/month) and the Dental Van (1x/month). By providing warm clothing, tents, sleeping bags, and firewood, we are also helping to cut down on the number of people who get sick and need to go to the ER. 6. Describe in detail how the proposed initiative will be implemented. BCC's Feed the Hungry Program and Senior Congregate Meal Program are already established services. If approved, this proposal will help us to expand these programs and enable us to better serve the residents of Deschutes County. In 2012, BCC secured a major, two-year pledge from an anonymous donor to help us through our financial difficulties (including paying off over $100,000 of debt. That pledge runs out December 31, 2014, and while we have made significant progress in diversifying our revenue stream (e.g. increased hall rentals, added fundraisers such as Foodie Crawl, new partnership with Bend Film, etc.), the Deschutes County grant would give us a little more time and help us with this transition. 7. Describe specifically how the requested funds will be used. Deschutes County funds will be used to support the paid positions of key personnel for the two food programs. This includes: Kitchen Manager, Kitchen Assistant, and Janitor. 8. Identify any partner agencies which will collaborate to implement the proposed initiative. BCC partners with United Way of Deschutes County, Central Oregon Council on Aging, Hunger Prevention Coalition, and Neighborlmpact (through its Food Bank). In terms of outreach and service delivery, BCC partners with Central Oregon Veterans Outreach and Shepherd's House. 9. Describe other sources of funding that will support the proposed initiative. A significant portion of our United Way allotment goes to the food programs. Our contract with COCOA helps to support the Senior Meal program. BCC holds two significant fundraisers during the year: 1. The Foodie Crawl which brought in $14,000 in April of 2014, and 2. The Hoedown for Hunger which brought in $10,000 in November of 2013. Finally, we send out two donation appeal letters each year in the Spring and Winter and net approximately $20,000 for the year. Performance Measurement 1. Identify quantifiable outputs anticipated to be achieved through the proposed initiative: • BCC will be able to sustain adequate staffing for the meal programs (all 3 positions continue in the following year budget) • The numbers for the Feed the Hungry Program will grow from 1,750 meals per week to over 2,000 meals per week • The number of low-income Bend seniors served will grow from 52 to 65 meals per day 2. Describe the anticipated outcomes of the proposed initiative: Through this project, BCC will be able to grow and expand our highly successful food programs, better serving the ever increasing numbers of people in need. BCC will also have time to develop additional revenue streams to help cover the cost of the grant funds when it runs out. BCC has a remodeled hall (courtesy of another anonymous donor) which features a new A/V system with a projector in the ceiling, new lighting and new flooring. As a result, we will be able to hold/develop more fundraising events and increase our hall rentals. We are in the beginning stages of a new partnership with Bend Film and anticipate forming profitable new partnerships with other organizations over the next year. Budget Form - Deschutes County Community Grant Program Bend's Community Center Feed the Hungry/Senior Meal Program October 2014 to September 2015 Revenue Org Budget Project Budget Funds Requested from Deschutes County Other Foundations Government grants and contracts Donations from businesses Donations from individuals Special events Program fees Investment income Senior Meal Reimbursement (COCOA) Hall Rentals In-kind Volunteer hours @ $15.00 per hour In-kind Food donations $ 11,000 $ 11,000 $ 85,000 $ 48,560 $ 15,000 $ 5,000 $ 15,000 $ 7,500 $ 40,000 $ 20,000 $ 27,500 $ 15,000 $ - $ - $ - $ - $ 48,000 $ 48,000 $ 15,000 $ 7,500 $ 150,000 $ 132,000 $ 10,000 $ 10,000 Total Revenuer $ 416,500 $ 304,560 Expenses Org Budget Project Budget Personnel Contract Services Depreciation Insurance Mortgage & Utilities Travel Supplies Repairs & Maintenance Taxes Special Events License and memberships In-kind Volunteer hours @ $15.00 per hour In-kind Food donations $ 118,500 $ 77,641 $ 30,000 $ 25,000 $ - $ - $ 10,000 $ 8,321 $ 55,000 $ 26,695 $ 1,000 $ 153 $ 20,000 $ 14,000 $ 12,000 $ 6,615 $ 150 $ - $ 8,000 $ 500 $ 1,000 $ 20 $ 150,000 $ 132,000 $ 10,000 $ 10,000 Total Expenses a $ 415,650 $ 300,945 "Building a strong community by providing resources for basic needs, job training, volunteer opportunities, and a place that brings people together" BCC is a 501(c)3 non-profit organization Linda Heatley, Director ph: 541-312-2069 fax: 541-312-2084 1036 NE 5th Street Bend, OR 97701 em: info@bendscommunitycenter.org web: www.bendscommunitycenter.org BCC Board of Directors Bruce Abernethy, Grant Writer (President) Bend - La Pine School District 1411 NW Trenton Avenue Bend, OR 97701 541-330-0240 (h) 541-355-1024 (w) abernethy9@aol.com Chris Atkin, Retired (Treasurer) 2501 NW High Lakes Loop Bend, OR 97701 541-678-5016 (h) 541-505-1399 (c) atkin43@gmail.com Mike Cheney, Sales Manager Horizon Broadcasting 2977 NW Wild Meadow Drive Bend, OR 97701 541-419-0886 (c) mcheney@horizonbroadcastinggroup.com Tom Gates, Manager Deschutes Trade Exchange P.O. Box 1314 Sisters, OR 97759 541-548-0651 (h) 541-639-7569 (c) thom@deschutestrade.com Jamie Giannioses, Sales Monterey Company 2186 NW High Lakes Loop Bend, OR 97701 541-639-8487 (w) 541-408-8487 (c) threegmen@gmail.com Lindsay Greco, President SmartBrain Technology 21690 Dale Road Bend, OR 97701 541-699-8200 Igreco@smartbraintech.com Amanda Lenke, Creative Director Lenke Design 61145 SW Halley Street Bend, OR 97702 541-788-4333 (c) thelenkes@gmail.com Dustin McCord Reliable Services Property Management 508 SE 6th Street Bend, OR 97702 541-948-7492 (cell) dustinmccord@gmail.com Greg Rompel, Business Information Analyst Central Electric Cooperative 20985 Spinnaker Street Bend, OR 97701 541-312-7723 (w) 541-815-2675 (c) grompel@cec.coop Wendy Rudy, Community Outreach Heart n' Home Hospice Care 920 SW Emkay, Ste 104 Bend, OR 97702 541-508-4037 (w) 541-250-2965 (c) wendyr@gohospice.com Sarah Williamson, Public Relations Sarah Williamson PR 379 NW 16th Street Bend, 97701 503-349-3548 (c) sarah@swpr-group.com Key Staff Linda Heatley, Executive Director 1036 NE 5th Street Bend, OR 97701 541-312-2069 (w) 541-390-6837 (c) lnda@bendscommunitycenter.org Fdrm 990 Department of the Treasury Internal Revenue Service Return of Organization Exempt From income Tax Under suction 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ► Do not enter Social Security numbers on this form as it may be made public, ► Information about Form 990 and its instructions is at www.lrs.gov/form990, OMB No, 1545.0047 2013 Open to Public Inspection A For the 2013 calendar year, or tax year beginning 2013, and ending B Check it applicable: Address change Name cnonge Initial return Terminated Amended return Application pending c BEND'S COMMUNITY CENTER 1036 NE FIFTH STREET BEND, OR 97701 L9E F Name and address of principal officer: SAME AS C ABOVE l Tax•eoerapt status IXF501(c)(3) 1 1501(c) ( ) (in or! n0.) 4947(a)(I) or 527 J Website: ► BENDSCOMMUNITYCENTER.OR _ 1< Form o1 organization; )( Corporallon Trust [ Assoclalion Other [Part I Sllrnmary - 1 Briefly describe the organization's mission or most significant activities; Activities & Governance D Employer Idonlificellon Numbe G Gross receipts $ 435, 080. H(a) Is Ono group return for subordinates? Yes X No H(b) Are all subordinates included? 6 Yes No If 'No,' attach a list, (sue instructions) H(c) Group exemption number L Year of formal on: 1999 I M Slate of legal domicile: OR PROUDED A KIN.VARIETY OF PUgIIC_ PRESENTATIONS,_ EDUCATIONAL CLASSES, AND WOR OPS FOR THE COMMUNITY AND PROVIDED A LOCATION FOR NONPROFIT ORGANIZATIONS TO HOST SaIMILAR EVENTS, 2 Check this box ► [ If the organization discontinued its operations or disposed of more than 25% of its net assets. 3 Number of voting members of the governing body (Part VI, line 1a) 3 4 Number of independent voting members of the governing body (Part VI, line 1b) �_ T 5 Total number of Individuals employed in calendar year 2013 (Part V, line 2a) 5 6 Total number of volunteers (estimate if necessary) 7a Total unrelated business revenue from Part VIII, column (C), lino 12 b Net unrelated business taxable income from Form 990-T, line 34 7a 7b 11 11 5 3Q5 0. 0. cc 8 Contributions and grants (Part VIII, line 1h) 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 Ile). ...... ...... . 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), fines 1.3) 14 Benefits pald to or for members (Part IX, column (A), line 4) 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 16a Professional fundraising fees (Part IX, column (A), line 11 e) . . . . . . ... . ............... b Total fundraising expenses (Part IX, column (D), line 25) 1,- 17 17 Other expenses (Part IX, column (A), lines 1la•11d, 11f -24e) 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 19 Revenue less expenses. Subtract lino 18 from line 12 Prior Year 456, 871. 16,499, 1. 19,731 . 493, 052. Current Year 414, 033. 20, 754 • 4, 289, 435,080 . 257,276. 114,950 . 302,382. 559, 658 204,186. 319, 136. -66,606, cin" 4 Z7 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 684,567. 518, 071. 166, 496. 115, 944. End of Year 762,794. 480, 354. 282,440 Part II 1 Signature Block Under penaItios of perjury, I declare thal I have examined this return, including occompanying schedules and statements, and lo the best of my knowledge and beliel, it Is bus, correct, and complete, Daclaration of preparer (other Then officer) Is based on all information of which prepare( has any knowledge. Sign Here Signature of officer 7810 Type or print name and lllle, Paid Preparer Use Only r'rnlVFype p,n star's name. I''reparor's si(Inalul LARRY E , NELSON , LARRY 1' . jtrf t-inn'ename ► KERKOCH KATTER & NELSO 1'''', Finn's address 45 NW HAWTHORNE AVE Firm's LIN ► TRIP P00236555 93-1154108 BEND, OR 97701-2900 Phone no, May the IRS discuss this return with the preparer shown above? (sen instructions) (541), 382-3468 !X Yes L No BAA For Paperwork Reduction Act Notice, see the separate Instructions. TLEA0113L 11/00/13 Form 990 (2013) Form 990 (2013) BEND'S COMMUNITY CENTER 93-1269614 Page 2 1,15TTTIFTSTRIFEilifTil Program Service omplishments Check if Schedule 0 contains a response or note to any line in this Part Illi 1 Briefly describe the organization's mission: PROVIDED A WIDE VARIETY OF PUBLIC PRESENTATIONS, EDUCATIONAL CLASSES2. AND WORKSHOPS FOR THE COMMUNITY AND PROVIDED A LOCATION FOR NONPROFIT ORGANIZATIONS TO HOST SIMILAR EVENTS. 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990•EZ? 0 Yes g 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? . Q Yes 0 No If 'Yes,' describe these changes on Schedule 0, 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)(1) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported, 4a (Code: ) (Expenses $ 287, 224 . including grants of $ ) (Revenue $ 435, 080 , ) PROVIDED A WIDE VARIETY OF PUBLIC PRESENTATIONS) EDUCATIONAL CLASSES., AND WORKSHOPS FOR THE COMMUNITY AND PROVIDED A LOCATION FOR NONPROFIT ORGANIZATIONS TO HOST SIMILAR EVENTS, 4 b (Code: ) (Expenses $ including grants of $ ) (Revenue $ 4c (Code: ) (Expenses $ including grants of $ ) (Revenue $ ) 4 d Other program services. (Describe in Schedule 0.) (Expenses $ Including grants of $ ) (Revenue $ 4 e Total program service expanses ■ BAA 287, 224. 1L•EA0102L 07r02.r13 Form 990 (2013) Applicant: Deschutes County Community Grant Program 2014-15 Application Review Rating Worksheet Big Brothers Big Sisters of Central Oregon Category/Grant Amount: Title: Other Essential Services Community Based Mentoring 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: 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 a 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: Amanda Clow Organization Name: Address: City: J Bar J Youth Services/Big Brothers Big Sisters of Central Oregon 62895 Hamby Road Rend Telephone Number: Email Address: State: Oregon Zip Code: 97701 (541)389-1409 agow@bbbsco.org Application is being submitted to which Community Grant Program funding category*? ❑ Health, Mental Health, and Addictions Services ❑ Arts and Culture N 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: ,jt()a—ajN, Print Name: Stephanie Alvstad Title: Executive Director Date: October 22, 2014 Deschutes County Community Grant Application, 2014-2015 J Bar J Youth Services/Big Brothers Big Sisters of Central Oregon Organization: 1. Describe the history of the organization, including the year the organization was established. J Bar J Youth Services (J Bar J), our parent company, is a 501 © (3) nonprofit corporation founded in 1967 as a working ranch for troubled boys (juvenile offenders). J Bar J has 47 years of experience as the largest regional provider of services for at -risk youth. The agency has 5 programs and a budget of $5.6 million. J Bar J has a high level of management expertise and will provide five important functions to the program: oversight; technical assistance; fiscal procedures; policy direction and fundraising. J Bar J keeps separate accounts for each programmatic division and each grant stream and is audited annually. The agency has 100 employees, serving over 1,000 youth each year through residential and community based programs located throughout Deschutes County. Biq Brothers Biq Sisters of Central Oregon (BBBSCO) is affiliated with Big Brothers Big Sisters of America (BBBSA), established in 1904. This nationally recognized mentoring program is the oldest and largest in the United States. J Bar J initiated affiliation with BBBSA in 1994, becoming the sponsoring organization. BBBSCO has provided mentoring programs for Deschutes County children for 20 years. In that time, thousands of children have been touched by our programs. 2. State the organization's mission, goals, and programs or services provided. J Bar J's mission is "to promote innovate options for children, youth and families toward self-sufficiency and personal responsibility". BBBSCO's mission is "to provide children facing adversity with strong and enduring, professionally supported 1 - to -1 relationships that change their lives for the better, forever". National research shows that the positive relationships between these children ("Littles") and their Big Brother or Big Sisters ("Bigs") has a direct, measurable and lasting impact on the children's lives. BBBSCO offers two mentoring programs. In both cases, the matches are carefully monitored and supported by our professionally trained staff to ensure positive growth, child safety and excellence in youth outcomes. Programs/services include: Community Based Mentoring — adults and children are paired in one-to-one mentoring relationships and participate in a variety of activities in the community and on their own schedule. School Based Mentoring - children are matched with adults who meet with the child at a set time every week in their school to work on homework, visit the library, play outside or enjoy lunch together. 3. Describe the leadership and structure of the organization. The governing body for J Bar J Youth Services is a seven -member board of directors, with a diverse business and community background. In addition, BBBSCO receives support and guidance from the BBBSCO Advisory Board. A member of the BBBSCO Advisory Board sits on the J Bar J Board of Directors as a liaison to the program. BBBSCO requires affiliates in communities of less than 100,000 to have a sponsoring agency to assist in sustaining small programs. J Bar J provides oversight and maintains a Management Agreement with the BBBSCO. J Bar J Youth Services has a high level of management expertise and will provide five important functions to the program: oversight; technical assistance; fiscal procedures; policy direction and fundraising. J Bar J keeps separate accounts for each programmatic division and each grant stream and is audited annually. The Executive Director for J Bar J Youth Services in Stephanie Alvstad. BBBSCO programs are directly supervised by Amanda Gow, Program Director. Program, Project, or Activity: 1. Provide a title of the proposed initiative for which funds are being requested. The title for this initiative is the Community Based Mentoring Program. 2. Describe the goals and objectives of the proposed initiative. The Community Based Mentoring Program, the project for which we are seeking assistance, will increase the number of children served in Deschutes County with positive prevention based mentoring opportunities. Deschutes County Community Grant Application, 2014-2015 J Bar J Youth Services/Big Brothers Big Sisters of Central Oregon The strategy is to introduce a trained and positive role model into the child's life, building the child's capacity for competence and confidence, so they are able to make better choices. The anticipated outcomes in the relationships between the "Bigs" and "tittles" will better prepare the child for success. The Community Based Mentoring Program focuses on after school and non - school time activities for youth. Many children are identified as facing adversity because they may come from single parent and/or low income households, have inadequate support systems or lack of positive activities and role models. Our mentors spend an average of 6-12 hours per month with their mentees and often these relationships become long-term. We strive to better prepare children for lifelong successes. BBBSCO seeks to foster self-sufficiency and provide youth with character -building and judgment enhancement skills in order to facilitate improved school performance, school attendance and positive youth development. Last year BBBSCO matched over 247 youth with 247 mentors. In addition, staff provided 3,500 hours of case management support for "Littles" and 1,200 hours of support to "Bigs". BBBSCO volunteers contributed 15,000 hours of service last year alone. 3. Identify the target population which will be served. BBBSCO serves children, ages 6-16, primarily from single parent/guardian, low income households where parents/guardians are often incarcerated or deployed. 4. Identify the geographic area(s) of Deschutes County which will benefit. Programs and services are located throughout Deschutes County, including Bend, Redmond, LaPine and Sisters as well as smaller communities of Tumalo and Terrebonne. 5. Describe how the proposed initiative will positively impact the community and complement existing services currently provided by Deschutes County. The programs of BBBSCO deeply engage communities through collaboration with families, mentors, community funders, schools and other partners. Our programs have a positive outcome for youth in a broad range of outcome areas as demonstrated by rigorous studies conducted by Public/Private Ventures. These studies conclude that unlike other more narrowly focused interventions for youth, Big Brother Big Sister programs can positively impact the whole child, across multiple domains of youth development. Our goal is to impact the community by offering opportunities to children who would otherwise not have them. We will introduce every child in our program to new activities and educational experiences as we connect them with their community. In addition, benefits are provided to the families of the children served and the volunteers who's lives will be enhanced as they contribute to making a difference in the lives of children. 6. Describe in detail how the proposed initiative will be implemented. The primary activities of the program include identifying children facing adversity, recruiting and screening adult candidates for "Bigs", training those adult volunteers, providing intensive case management and monitoring the success of the program on an on-going basis. Staff will work with community partners and schools to identify high risk children who could benefit from having a trusted adult in their life. The program currently has 2.5 FTE in Deschutes County. Describe specifically how the requested funds will be used. BBBSCO anticipate serving 172 children over the next 12 months in Deschutes County. Funds requested will provide professionally trained staff to facilitate the following activities: Youth Selection and Orientation. BBBSCO recruits youth through schools, law enforcement and other community partners. Most referrals come through schools, as teachers and school professionals identify youth in need of services, either because of behavioral issues or because these youth are not succeeding academically. Each youth, and their parents/guardians, will receive an individual orientation to the program by staff. Youth are interviewed, assessed and trained prior to the match. Mentor recruitment, screening, orientation and training. All mentors are at least 18 years of age. We require mentors to make a 12 month commitment. BBBSCO conducts background investigations on all mentors, thoroughly screening each individual. Deschutes County Community Grant Application, 2014-2015 J Bar J Youth Services/Big Brothers Big Sisters of Central Oregon Mentors receive orientation, training and support by BBBSCO staff. All volunteers are required to attend training prior to the match. Topics include: child development; signs of abuse; mandatory reporting; cultural competency/sensitivity and other specialized areas. BBBSCO provides ongoing training and support for mentors. The Match. Once the "Big"and the "Little" have completed the above process, they are carefully matched in a long term, safe mentoring relationships — one relationship at a time. BBBSCO focuses on quality rather than quantity. Matches spend an average of 6-12 hours per month together, engaged in community activities, in a safe and mutually convenient place. Ongoing Support. BBBSCO staff provides necessary ongoing case management and support for the "Bigs" and "Littles" (and their families). BBBSCO also provides community, educational and recreational activities free of charge, to every child and volunteer in the program. The goal is to keep "Bigs" and "Littles" together for 24 months, as research shows the most positive results come from children in long term matches. 7. Identify any partner agencies which will collaborate to implement the proposed initiative. BBBSCO has established and maintained comprehensive service linkages and partnerships with over 30 local agencies and many leadership groups that provide planning input and referral. The partnerships between BBBSCO and the schools involved with this project are established and have proven to be successfully. State and regional collaborations add further strength. J Bar J actively participates in many youth -serving organizations. Some of BBBSCO's strongest partner organizations include: Deschutes County school districts, Better Together (regional collective impact organization); Boys & Girls Clubs of Central Oregon, Bend and Redmond City Police, Deschutes County, Family Access Network, The Kids Center, Oregon State Judicial System and many others. 8. Describe other sources of funding that will support the proposed initiative. Funding for BBBSCO comes from a diverse combination of sources, including general donations, grants and event income. To date, BBBSCO has secured the following funding commitments. Funding Source Umpqua Bank Trust Management BNSF Community 101 Amount $3,000 $10,000 $1,500 $1,000 Other pending proposals for funding and events include (either pending submission, awaiting notification or planned): Funding Source Amount Planned Pending Submission Awaiting Notification Islands Fund $20,000 X Ford Family Foundation $50,000 X Cow Creek Umpqua Indian Foundation $15,000 X Jubitz Foundation 1,000 X Safeco 10,000 X Collins Foundation 15,000 X Hayden Homes 3,000 X Nevis 1,000 X Moda 1,000 X Deschutes Brewery 1,000 X Mt. Bachelor 6,000 X Les Schwab 3,000 X Bigfoot Beverages 900 X Other donations 9,300 X Total Contributions $15,250 X Events (Bowl for Kid's Sake; Comedy Benefit; Oregon High Desert Classic) $118,201 X Deschutes County Community Grant Application, 2014-2015 J Bar J Youth Services/Big Brothers Big Sisters of Central Oregon 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). Program Outputs will include the following • A total of 172 children will be served. • A total of 172 volunteers will be supported with ongoing case management services designed to meet their individual needs. New volunteers will be trained in child safety and educated on how to be a mentor to a child facing adversity. • A total of 172 families will receive ongoing support and services from BBBSCO. • A total of 172 children will be tracked in the AIM management system for outcomes (BBBSA database). • A total of 24 match activities that influence education, recreation and civic awareness will be provided free of charge to all volunteer and children in the program. These include: science nights, hikes, rafting trips and community service projects. 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). Youth Specific Outcomes, BBBSCO's goal is to empower youth to achieve their highest potential. BBBSCO's Community Based Mentoring Program focuses on youth who have limited opportunities to develop self-esteem, talents, character, experience and community service outside of school settings. Our organization addresses the absence of positive adult role models and mentors in the lives of youth. Children linked to a mentor are more likely to attend school regularly, have better peer relationships and perform better in the classroom. BBBSA and BBBSCO utilize an evidence based Youth Outcome Survey (YOS) to measure results. This pre/post survey is administered to youth prior to being matched and annually thereafter. In 2014-2015, we anticipate BBBSCO youth will report improving or maintaining in the following areas, as reported by the YOS and tracked in AIM database and monitored monthly for quality assurance. Outcome Areas Objectives 2014-2015 Higher aspirations, greater confidence, and better relationships (socio -emotional competence) Social Acceptance 89% Parental Trust 96% Scholastic Competency 86% Presence of Special Adult 100% Educational Expectations 96% Avoidance of risky behaviors Attitudes Toward Risk — smoking, drinking, drugs, skipping school, hitting, breaking the rules in school, being late for school 96% Educational success. Scholastic Competence 86% Grades (academic achievement) 96% Educational Expectations 96% Program Specific Outcomes, BBBSCO's program specific goals for 2014-2015 include the following: • BBBSCO programs to serve 6% more children/volunteers • 12 month retention rate of 64% for Community Based Matches • 12 month retention rate of 41% for Site Based Matches (School Based) • 90% of matches will receive support services on a monthly basis. • Program revenue will increase by 5% J Bar J Youth Services, Inc. Big Brothers Big Sisters of Central Oregon Community Based Mentoring Project 2014-2015 INCOME BUDGET Direct Public Grants $79,400 Direct Public Support $40,450 Government Contracts $0 Government Grants $63,600 Special Event Income $118,201 TOTAL INCOME $301,651 EXPENSE BUDGET Payroll $208,694 Occupancy $10,140 Property Plant and Equipment $4,060 Operations $12,973 Youth Assistance $1,480 Business $49,379 Special Events Expenses $14,925 TOTAL EXPENSE $301,651 NET INCOME S0 J Bar J Youth Services - Board of Directors Big Brothers Big Sisters of Central Oregon - Advisory Board Name Address and Phone Number Occupation or Connection to organization # of years on the board J Bar J Youth Services - Board of Directors Jon Scanlan 133 N.W. Wall St., Bend, OR 97701 (541)416-5615 (wk) (541)350-4901 jon.r.scanlon@lesschwab.com Board Chair. Real Estate Manager, Les Schwab Tire Center 5 Ed Bartz 22160 N.E. Butler Market Rd., Bend, OR 97701 (541)389-5296 edbartz@eco-scapes.com Board Member. Owner - Eco-Scapes 4 Jeannette P. McKenzie 705 S.W. Bonnett Way Suite 1200, Bend, OR 97702 (541)617-6004 jeannette.mckenzie@mssb.com Board Secretary. Morgan Stanley Smith Barney - Vice President 4 Myles Conway 360 S.W. Bond Suite 400, Bend, OR 97702 (541)749- 4019 mconway@martenlaw.com Board Member. Attorney - Schwabe Williamson & Wyatt 5 Paul Hannabach 61348 Triple Knot Rd., Bend, OR 97702 (541)647- 2183 paulhannaback@msn.com Board Member. Attorney - Law Office of Paul F. Hannaback 4 Rob Rowley 3436 N.W. McCready, Bend, OR 97701 (541)383- 8112 (H) (541)410-1194 (M) candr@bendbroadband.com Board Member. Businessman 1 Kim Jalbert 20428 N.E. Cady Way, Bend, OR 97701 (541)420- 2171 kjalbert@total-property.com Board Member. Owner - Property Management _ 1 Big Brothers Big Sisters of Central Oregon - Advisory Board Katy Sparks 59680 Calgary Loop, Bend, OR 97702 (541)318-3011 (W) (541)639-6848 (M) ksparks@bmctotalcare.com Board Chair. Marketing & PR Manager - Bend Memorial Clinic 4 Lee Anderson 20040 Badger Rd., Bend, OR 97701 (541)617-6233 (W) (541)480-7111 (M) leea@ktvz.com Board Member. News Director - KTVX/KFXO TV 6 Kim Evered 2473 N.W. Awbrey Rd., Bend, OR 97701 (206)499- 6771 (M) kburly@hotmail.com Board Member. Sales & Marketing - SBOATI Tenant Insurance 5 Marc Landry 2617 N. Three Sisters Dr., Bend, OR 97701 (541)420 - 1501(M) m1952@yahoo.com Board Member. Business Owner 2 Richard Andrews 20900 Cooley Rd. Bend, OR 97701 (541)416-5584 (W) (541)350-0863 (M) Richard.N.Andrews@lesschwab.com Director, Internal Audit & Controls - Les Schwab Tire Center 1 Chris Ochs 61056 Honkers Lane, Bend, OR 97702 (541)316-4957 (W) (775)232-7129 (M) cochs@hayden-homes.com Board Member. Director of Marketing - Hayden Homes 2 Tina Whittington 2769 N.E. Sedalia Loop, Bend, OR 97701 (541)312- 6064 (W) (541)728-8569 (M) tinawhittington@umpaquabank.com Board Member. Vice President - Store Manager - Umpqua Bank 1 Dawn Cofer 848 N.E. Locksley Dr., Bend, OR 97701 (541)330- 7576 (W) (541)408-4541 (M) dcofer@botc.com Board Member. Branch Manager - Bank of the Cascades 1 Shantelle Flick 63881 Hunters Circle, Bend, OR 97701 (541)941- 9178 (M) (541)633-1982 (W) Shantelle.Flick@usbank.com Board Member. Credit Analyst - U.S. Bank 1 Deana Jones 906 N.W. Harriman St., Bend, OR 97701 (541)266- 3590 deana@juniper-insurance.com Board Member. Owner/Agent - Juniper Insurance 1 Kyle Piro 56390 Twin Rivers Dr., Bend, OR 97707 (541)213- 9410 (H) (541)318-9115 (0) Kyle@stahancyk.com Board Member. Attorney - Stahancyk, Kent & Hook 1 Taylor Fowler 1922 N.W. Newport Hills Dr., Bend, OR 97701 (541)325-1243 (H) (541)388-1434 (W) taylorfowles@gmail.com Board Member. Dentist/Owner - Cosmetic & Family Dental Care 1 Form 990 Department of the Treasury Infernal Revenue Service Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(ax1) of the Internal Revenue Code (except black lung benefit trust or private foundation) ► The organization may have to use a copy of this return to satisfy state reporting requirements. OMB No. 1545-0047 2012 Open to Public Inspection'. A B For the 2012 calendar year, or tax year beginning 7/01 , 2012, and ending 6/30 2013 Check 4 applicable: Address change Name change Initial return Terminated Amended return Application pending yr G J BAR J YOUTH SERVICES, INC. 62895 HAMBY ROAD BEND, OR 97701 D Employer Identification Number 93-0677650 _ r Telephone number G Gross receipts $ 4, 973, 534. Yes X No Yes No F Name and address of principal officer: SAME AS C ABOVE Tax.exempl status X 501(c)(3) 1501(c) ( )' (insert no.) 4947(a)(1) or 527 J Website: ► JBARJ.ORG H(a) Is This a group return for affiliates? H(b) Are all affiliates included? If 'No,' attach a list, (see Instructions) H(c) Group exemption number K Form of organization_ IX Corporation Trust Association Other* L Year of Formation: 1971 M Stale of legal domicile: OR Part- i Summa Activities & Governance 1 Briefly describe the organization's mission or most significant activities: INNOVATIVE OPTIONS FOR AT -RISK YOUTH AND FAMILIES TOWARD SELF—SUFFICIENCY AND PERSONAL RESPONSIBILITY 2 Check this box ► ❑ if the organization discontinued its operations or disposed of more than 25% of its 3 Number of voting members of the governing body (Part VI, line la) 4 Number of independent voting members of the governing body (Part VI, line lb) 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 unrelated business taxable income from Form 990-T, line 34 net assets. 3 4 5 6 7 7 132 0 7a 0. 7b a� d iv8 Contributions and grants (Part VIII, line 1h) 9 Program service revenue (Part VIII, line 2g) 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) CC 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 2,436,997. 1,200,461. -10, 468. 465,950 . 4,092,940. 0. Current Year 2,591,207. 1,111, 358. 29,466. 380,273. 4,112,304. v c v fL as la zLL 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) 16a Professional fundraising fees (Part IX, column (A), line 11e) b Total fundraising expenses (Part IX, column (D), line 25) 0- 17 17 Other expenses (Part IX, column (A), lines 11a -11d, llf-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 2,998,889. 2,857,351. 1,202,356. 4,201,245. -108,305. 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 1,326,632. 452,066. 874,566. 1,099,478. 3,956,829. 155, 475. End of Year 1,828,338. 798,297.. 1,030,041. Part I!' Signature Block Under penalties of perjury, I declare Thal 1 have examined this raturn, Including eco m Jug schedules and statements, and to the best of my knowledge and belief, it is true, correct, and comptcre. Declaration or prepnrer{o11 than officer) is based on all Inlormallen of w1t1Ch sparer has any knowledge. Sign Here10. Slgnat Type or print name . nd title. k&n i A \ vstrAik Dale Paid Preparer Use Only Print/Type preparer's name STUART D. KATTER Preparer's signature STUART D.T" Date ✓O -z8*—/,3 �r .f eself.enrployed P002 +67'i 05 Firm's name Firm's address KERKOCH KATTER & NELSON, LLP 45 NW HAWTHORNE AVE BEND, OR 97701-2900 May the IRS discuss this return with the preparer shown above? (see instructions) BAA For Paperwork Reduction Act Notice, see the separate instructions. Firm's EIN ► 93-1154108 Phone no. (541) 382-3.468 No X Yes TEEA0113L 12/18112 Form 990 (2012) Form 990 (2012) J BAR J YOUTH SERVICES, INC. 93-0677650 Page 2 IPart 111 Statement of Program Service Accoinplishments Check if Schedule 0 contains a response to any question in this Part Ill . N. 1 Briefly describe the organization's mission: INNOVATIVE OPTIONS FOR AT—RISK YOUTH AND FAMILIES TOWARD SELF—SUFFICIENCY AND PERSONAL RESPONSIBILITY. 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990 -EZ? ❑ Yes 0 No 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?❑ Yes a No 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 and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. 4a (Code: ) (Expenses $ 1,200,245 including grants of $ 1,425,547 . ) (Revenue $ 5, 453. ) CORRECTIONAL SERVICES ARE PROVIDED IN A RESIDENTIAL SETTING FOR UP TO 24 ADJUDICATED BOYS, AGES 12-17. 4b (Code; ) (Expenses $ 1, 139, 636. including grants of $ 19,512 . ) (Revenue $ 1,118,083 . ) EDUCATIONAL TRAINING PROGRAMS ARE PROVIDED FOR YOUNG GIRLS IN A RESIDENTIAL SETTING. 4c (Code: ) (Expenses $ 621, 305. including grants of $ 601, 914. ) (Revenue $ 77,354 . ) PREVENTION SERVICES ARE PROVIDED THROUGH CASCADE YOUTH & FAMILY SERVICES TO MANY AT—RISK YOUTH THROUGH CRISIS INTER— VENTIONTJ PARENT—CHILD INTERVENTION, AND PARENT TRAINING. 4d Other program services. (Describe in Schedule 0.) SEE SCHEDULE 0 (Expenses $ 530,392 , including grants of $ 326,529 . ) (Revenue $ 203,561 . ) 4e Total program service expenses ► 3, 491, 578. BAA TEEA0102L 08/08/12 Form 990 (2012)