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HomeMy WebLinkAboutGrant Request - CRR Seniors#47 Economic Development Fund Discretionary Grant Program Organization: Crooked River Ranch Senior Group Organization Description: Established in 1997, this organization provides social interaction, education, community involvement and support for seniors. Project Name: Fuel for Dial -A -Ride Service Project Description: These grant funds will be used to keep the organization's dial -a - ride service operating until a permanent source of funding can be identified. This is the only organization with wheelchair -accessible service for Crooked River Ranch. Project Period: Beginning April 26, 2012 Amount of Request: $4,000 Previous Grants: None Deschutes County Discretionary Grant Application Deschutes County Board of Commissioners 1300 NW Wall St., Bend, OR 97701 (541) 322-7697 Fax (541) 385-3202 www.deschutes.orq APPLICANTCgINFORMATION �A G ff `4NArD' iv r12, Organization Name SxNiop., 612ocre Street Address Ro. g City 7-6/2¢604/4.Are D /Q - Contact Name r5 R.Yfrl&N17 gligakdig Beginning Date ./ 1 241 /2— End Date Requested Amount $ if 00O ad TYPE OF REQUEST (SELECT ONE): Project Name A -A44 6 rkey FUert Zip 9 7744 Phones/n..6-4..706, E-mail Address Kupx/vie '1c 1454,a,jn Date Funds Needed A,0 1Al Total Project Budget q CO A D Funds for a capital purchase or the purchase or equipment Funds for a fundraising event Funds for an event (not a fundraiser) Funds for staffing Other (Please specify): OW IYA.00 gr GIs Anvifar` AJZ out. 1214 G -R -1Z CP6 V4#1 Aterp .gyp To Fuptp a op_ Fvok /Thrift- o r'l A. f'Urnt'D(E I; c)1-rP . ORGANIZATIONAL INFORMATION 1. For an application to be considered by the Board of Commissioners, proof of the organization's non- profit status must be submitted with this application. 2. Describe the organization including the history, mission, leadership structure and primary functions and activities (maximum 250 words). E GAR- Ss /4-/k5 G',uo yr Wi4 eSIAR5L. � � es /rS Afro RRot/SPg ,baa e1* Alr ,e Re a/4ft16AW4 .5 (J1'010.127' 6d& vim's a tet live Age U"teeizHEb si ' 04^4P ops p! EG-roas A`/N a /gY- AR Krf. it" L �d figdmrliL° 5(Cid14140.11-Wgr Fr, p_ 6 44 Fr 1,P Quiz 1°�����'� c f71(17705 A-PUGAr{;U1V , G.:P frit2vNrr `yr f Anre L lrrA7 JJT 3. Describe the program (project, activity or event) seeking grant funding. Include the specific individuals, communities or groups benefiting from this program (maximum 250 words). WE" ofE•A Ant EitIng IsENo'JLC Tits g 71:3 ked 12., -rheit C 7 i& ATP oi-- ffN, ' PM/L'rcf7' SzNi. o r oiv' ' fie' - art Iz. Pu. pGJJG . w ` » 6$Nx.7r n 41 J SP Aviento 4. Itemize the anticipated expenditures for the program. Also, provide a list of anticipated sources of funding and amounts projected. ure sae SpeN,r` INN, Sr3a6 .-ifiac /4 , v 4- Faf - /VW( ( h dui- f f X -P ewe J2, , 15 L 1,77 1r`"e W ; F Ate' ua 5 111-1-.41X-1: WE id> gt NG d S NFA 6 P J P i o �*6a �'c. f'" fp1+r5, .6.- � %, 1f" AV /090-G f &Tof + /' Or/+C4/ '61-6 5-»u 5. Explain how this program will positively impact the community's economic health (maximum 250 words). C> bE, V(L P IP7 S c2PP'R-11) TY e e LOQW •C Iz-VI 7:1c=. 13.e jap )1:1,/ 1-1 P)' ,rpt ppb; f JT e!v 1 S . 6. Identify the outcomes the organization seeks to achieve through this program (maximum 250 words). TWE Ggi30-L'1 t / f{E9/ c r - � i�VG Gia l/ClG INE /beg invp rG 7� Av-a-i S/f lt" G/U`o 1:701641, DISCLAIMER AND GRANT AGREEMENT I certify that my answers are true and complete to the best of my knowledge. If this application results in the receipt of a Deschutes County Discretionary Grant, I agree to the following: • The grant funds will be used only for the intended purpose, identified in #3 above. • The grantee will complete a project completion form within 30 days of expending grant funds. A failure to return the project completion form will disqualify organizations from consideration for future discretionary grant funding. • The grantee will make available its financial records to Deschutes County upon request. Signature �P Date Gi�. �4 7,z, r2, BOARD OF COMMISSIONERS' GRANT ALLOCATION Tammy Baney Anthony DeBone Alan Unger Date Date Date Amount Amount Amount CRR DIAL -A -RIDE (Sponsored by the Crooked River Ranch Seniors) PO Box 1514, CRR, OR 97760 Serving seniors/disabled persons and residents in Crooked River Ranch with extended service to Terrebonne, _ ll .d.Redmond, OEM Need to go shopping, have a doctors appointment or a ride to the airport? SAVE THE FUSS AND LEAVE THE DRIVING TO US DOOR TO DOOR PIC_'K 11P ANI) RETURN HOURS OF SERVICE TO AND FROM TERREBONNE AND REDMOND Monday, Wednesday, and Friday 8:00 a.m. to 4:00 p.m. (One day advance scheduling required) Round trip fee to Terrebonne or Redmond is $5.00 per person Round trip fee to locations on CRR is $3.00 per person Round trip fee to Bend is $10.00 per person TO SLillitUULm A II i H. (541) 598-5559 CAN YOU HELP US HELP YOUR CUSTOMERS/CLIENTS? ESalim MLA -RIDE 348-039 CROOKED RIVER RANCH SENIOR'S DIAL -A -RIDE VAN PROVIDES THE ONLYREGULARLY SCHEDULED PUBLIC TRANSPORTATION WITH WHEEL CHAIR LIFT FROM CRR TO YOUR LOCATION CRR DIAL -A -RIDE IS AN ALL VOLUNTEER EFFORT, SUPPORTED BY THE CRR SENIORS, MODEST FARES, AND A SMALL, FIXED STATE FUEL SUBSIDY NOT TIED TO FUEL PRICES. OUR DRIVERS RECEIVE NO COMPENSATION. WE NEED TO ENCOURAGE OUR VOLUNTEERS AND RECUIT NEW DRIVERS. ANYCONTRIBUTION THAT WE CAN USE TO REWARD OUR VOLUNTEERS WOULD BE APPRECIATED. IT CAN BE IN FUNDS, GIFT CARDS OR DISCOUNTS, ETC. THESE SELFLESS DRIVERS DONATE THEIR TIME, AND THEIR OWN FUEL COSTS TO PICKUP THE VAN. YOUR CONTRIBUTION WILL BE ACKNOWELEDGED ON A PLAQUE IN THE VAN, IN OUR BROCHERES, AND WEBSITE. A CERTIFICATE OF APPRECIATION WILL BE PRESENTED TO YOU CONTACT: RAY KURKA 548-2630 VAN FUND INCOME/EXPENSE 1ST QUARTER 2012 ASSUMING THE MINIMUM OF 3X WEEK USE OF VAN (MANY TIMES VAN RUN 4X WEEK) JANUARY FEBRUARY MARCH TOTAL INCOME JEFFERSON COUNTY 624.88 0.00 0.00 624.88 RIDERS 65.00 125.00 155.00 345.00 TOTAL 689.88 125.00 155.00 969.88 EXPENSES BEND OIL 417.66 352.0 479.50 1249.23 STORAGE/MAINTENANCE. 75.00 75.00 225.00 VAN REPAIR QS 150.68 0.00 150.68 GAS REIMBURSEMENT .__ 04...._ 0.00 35.00 35.00 _ TOTAL 492.66 577.75 589.50 1659.91 BANK BALANCE 03.31 2635.93 APRIL EXPENSES STORAGE/MAINTENANCE -75.00 LIABILITY INSURANCE -1356.00 BEND OIL -420.14 BALANCE AS OF 04.19 784.791 # OF RIDERS 13 25 31 69 AVERAGE RIDERS/TRIP 1 2 2.5 1.70 AVG MONTHLY COST 553.00 AVG MONTHLY INCOME 324.00 LOSS PER MONTH -229.00 AVG COST TRIP/PERSON 24.05 AVG. COST PER TRIP 46.08 ASSUMING THE MINIMUM OF 3X WEEK USE OF VAN (MANY TIMES VAN RUN 4X WEEK) INTERNAL REVENUE SERVICE DISTRICT DIRECTOR P. O. BOX 2508 CINCINNATI, OH 45201 Date: AUG 211997 CROOKED RIVER RANCH SENIOR GROUP PO BOX 1514 CROOKED RIVER RANCH, OR 97760 J) DEPARTMENT OF THE TREASURY Employer Identification Number: 93-1154912 DLN: 17053135008007 Contact Person: EO CUSTOMER SERVICE Contact Telephone Number: (213) 894-2289 Accounting Period Ending: May 31 Form 990 Required: Yes Addendum Applies: No Dear Applicant: Based on information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from federal income tax under section 501(a) of the Internal Revenue Code as an organization described in section 501(c)(3). We have further determined that you are not a private foundation within the meaning of section 509(a) of the Code, because you are an organization described in section 509(a)(2). If your sources of support, or your purposes, character, or method of operation change, please let us know so we can consider the effect of the change on your exempt status and foundation status. In the case of an amend- ment to your organizational document or bylaws, please send us a copy of the amended document or bylaws. Also, you should inform us of all changes in your name or address. As of January 1, 1984, you are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Since you are not a private foundation, you are not subject to the excise taxes under Chapter 42 of the Code. However, you are not automatically exempt from other federal excise taxes. If you have any questions about excise, employment, or other federal taxes, please let us know. Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a)(1) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the part of the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a)(1) organization. Donors may deduct contributions to you as provided in section 170 of the Letter 947 (DO/CG) -2 - CROOKED RIVER RANCH SENIOR GROUP Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055, 2106, and 2522. Contribution deductions are allowable to donors only to the extent that their contributions are gifts, with no consideration received. Ticket pur- chases and similar payments in conjunction with fundraising events may not necessarily qualify as deductible contributions, depending on the circum- stances. See Revenue Ruling 67-246, published in Cumulative Bulletin 1967-2, on page 104, which sets forth guidelines regarding the deductibility, as chari- table contributions, of payments made by taxpayers for admission to or other participation in fundraising activities for charity. In the heading of this letter we have indicated whether you must file Form 990, Return of Organization Exempt From Income Tax. If Yes is indicated, you are required to file Form 990 only if your gross receipts each year are normally more than $25,000. However, if you receive a Form 990 package in the mail, please file the return even if you do not exceed the gross receipts test. If you are not required to file, simply attach the label provided, check the box in the heading to indicate that your annual gross receipts are normally $25,000 or less, and sign the return. If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. A penalty of $10 a day is charged when a return is filed late, unless there is reasonable cause for the delay. However, the maximum penalty charged cannot exceed $5,000 or 5 per- cent of your gross receipts for the year, whichever is less. This penalty may also be charged if a return is not complete, so please be sure your return is complete before you file it. You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T, Exempt Organization Business Income Tax Return. In this letter we are not determining whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code. You need an employer identification number even if you have no employees. If an employer identification number was not entered on your application, a number will be assigned to you and you will be advised of it. Please use that number on all returns you file and in all correspondence with the Internal Revenue Service. In accordance with section 508(a) of the Code, the effective date of this determination letter is May 19, 1995. This determination is based on evidence that your funds are dedicated to the purposes listed in section 501(c)(3) of the Code. To assure your continued exemption, you should keep records to show that funds are expended only for those purposes. If you distribute funds to other organizations, your Letter 947 (DO/CG) -3 - CROOKED RIVER RANCH SENIOR GROUP records should show whether they are exempt under section 501(c)(3). In cases where the recipient organization is not exempt under section 501(c)(3), there should be evidence that the funds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient. If distributions are made to individuals, case histories regarding the recipients should be kept showing names, addresses, purposes of awards, manner of selection, relationship (if any) to members, officers, trustees or donors of funds to you, so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service. (Revenue Ruling 56-304, C.B. 1956-2, page 306.) If we have indicated in the heading of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, District Director Letter 947 (DO/CG)