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Home My WebLink About20111015.tiff RESOLUTION RE: APPROVE APPLICATION FOR EMERGENCY SHELTER GRANT ASSISTANCE 2011 AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with an Application for Emergency Shelter Grant Assistance 2011 from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Greeley/Weld County Housing Authority, to the Colorado Department of Local Affairs, Division of Housing, with further terms and conditions being as stated in said application, and WHEREAS, after review,the Board deems it advisable to approve said application,a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, ex-officio Housing Authority Board, that the Application for Emergency Shelter Grant Assistance 2011 from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Greeley/Weld County Housing Authority,to the Colorado Department of Local Affairs, Division of Housing, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said application. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 25th day of April, A.D., 2011. BOARD OF COUNTY COMMISSIONERS N WELD COUNTY, COL RADO ATTEST: ,Gk•% • -, arbara Kirkmeyer Chair Weld County Clerk to the Board • c ?`� Sean P.C Pro-Tem BY: . , Deputy Clerk to the Boar i iam F. G cia PP VEDA • EXCUSED David E. Long un At rney ,pc hec, 9 P JCLIA DouglAs Rademacher Date of signature: al i UQ., p-Yk 2011-1015 J.a ll HA0029 MEMORANDUM d DATE: April 15, 2011 TO: Commissioner Kirkmeyer lID FROM:Tom Teixeira,Weld County Housing Authority CRE:2011-2012 ESG Application COLORADO Request approval of the 2011-2012 Emergency Shelter Grant application to the State Department of Local Affairs,Division of Housing. The request totals$105,000.00. The Request are as follows: Catholic Charities: $40,000.00 A Woman's Place $25,000.00 Greeley Transitional House $15,000.00 Room at the Inn $10,000.00 Stepping Stones of Windsor $6,500.00 Weld Housing Authority $4,000.00(admin) Total $105,000.00 Request this be placed on the Agenda of the April 25"'Housing Authority Board meeting. Monthly reports are attached: Request Work Session Approve BOCC Agenda Sean Conway Bill Garcia Barbara Kirkmeyer Dave Long Doug Rademacher + 2011-1015 LOCAL GOVERNMENT SUMMARY PAGE (TO BE COMPLETED ONLY BY LOCAL JURISDICTIONS WITH SUBGRANTEES) EMERGENCY SHELTER GRANT ASSISTANCE 2011 APPLICANT INFORMATION I. LOCAL JURISDICTION . CDH Project Number --- Local Government Name: Weld County Housing Authority U F Local Government Address: P.O. Box 130 For CDH Use only City: Greely State: CO Zip:80632 3. Date Received For CDH Use Only 4 ?ame of Contact Persolifor'Application and 5. Phone: 6.FAX: 7 EMA fic Rep its",tagteSdov Eox 970 353-7x437 970 353-7463 tom@greelev-weldha.ore SELECT ONE: Thomas Teixeira �r TYPE OF ORGANIZATION S.—SS.V "sy •❑ 9-klous WITS M: fa 1& e elt «t eSv 'A,ri:; (List counties served) 12. ,r t e s ''. -pL�°c?':1"l. IFS 6ii5 e`Ja`; Weld County (use drop down boxes 8 4 115 61814I4 l4 I4 16 I BUDGET SUMMARY,—ALL.Projects' I•' ' Use Additional Sheets if Necessary 13. I .r- ; ,,eq 'G:I. C_ q, 14. C<T r. [ feJi1 „� 15. ,.�y�, z� e � ,,E, 16 g5,c c 17.Local •T:i'' x,t:"..,'lye..: Government Agency 1 Name $20,000 Admin Catholic Charities $11,000 $9,000 Agency 2 Name $15,000 $10,000 A Womans's Place Agency 3 Name $11,000 $3,000 $1,000 Greeley Transitional House Agency 4 Name $8,500 $1,500 Room at the Inn $0.00 Agency 5 Name Stepping $6,500 Stones of Windsor $0,O0 $0.00 Agency 6 Name $O0 $O'ob NM $25,500 $54,500 $16,500 p.:O;156 $0",0.0 $0 00 20. ti.ttH ' ''- 6 a.: `�,' arj $100,500 $4,000 SIGNATURE OF AUTHORIZED OFFICIAL OR AGENCY REPRESENTATIVE n • .'' B �F rcY�ui 22 #‘:,,,k.. , J . 1:.,, L C1 :', , 6"e0X j V/,4a ;4.P -: (use drop down box) `,<.I< • Chair. Board of Commissioners Weld SELECT it Barbara Kirkmever County Housing Authority EMAIL: bkirkmever@co.weld.co.us 23. 1f- , , .;•e k 4:r .,t:• r , rt.., @'Et vg, .ltaritet.t,f :;C .0, i'q"z I'' 24. G/1�1��eck_ M 4/1/2011 MATCH CERTIFICATION SOURCES OF LOCAL MATCH (Attach ,upporting documentation for available mdtch. Documentation should reflect funds avaiL•.bility during the ESG contract year.) Other Federal (including.pass-through funds, e.g. City CDBG, County-FEMA, etc.) NAME AMOUNT $0.00 $0.00 $0.00 NAME AMOUNT Weld County Housing Authority $4,000 $D$0$ WOO Z '. ) (liter l«nil l-01;i0)(9-4 T°lalinl t! Fund Raising/Cash $b000 Loans $000 Building Value or Lease $0_00 Donated Goods $0.0 Donated Computers $00 New Staff Salaries $000 Volunteers ($5.00 per hour) $0,00 Volunteer Medical/Legal Other (specify) :.,.. $0.00 I certify that match funds have been identified and committed to support the proposed ESG project and have not been used to match previous ESG awards (i.e. the value of a donated building used as match in a 2009 award cannot be used as match in 2010). This form is a description of the sources and amounts of such match funds, which are not being used as match for any other federal program. • 4/1/2011 11 EMERGENCY SHELTER GRANT PROGRAM ASSURANCES AND CERTIFICATIONS Barbara Kirkmever ( orne of Thief elected oiliMai or apprcp i cy: r )c-p_,"it siguatoi-y; Weld County of oxe city, count_or nonprofit organization) which is applying to the State of Colorado for funding through the Emergency Shelter Grant Program from the U.S. Department of Housing and Urban Development(HUD), hereby assures and certifies that: Amounts awarded under this program will be used only for these purposes: 1. Assist in the prevention of homelessness. 2. Assist in supporting the essential operating costs of s. 3. Assist in improving the quality of supportive services to the homeless. Projects will not require participation in religious services,as a condition for receiving assistance. All projects funded will develop and administer, in good faith, a policy designed to ensure the is free from the illegal use, possession or distribution of DRUGS and ALCOHOL by its beneficiaries. Political activities will be prohibited in accordance with subsection 675 (e) of the Community Services Block Grant Act of 1981. The town, city, county or nonprofit organization certifies that matching supplemental funds required by the regulations at 24 CFR 576.71 and 576.85(a)(3), as mentioned by the amendments to Items 415(a) and 415(c) of the Stewart B. McKinney Homeless Assistance Act made by Section 832(e) of the Cranston-Gonzalez National Affordable Housing Act of 1990 (Public Law 101-625, November 28, 1990) will be provided. The amendment exempts the first $100,000 from the matching requirement and requires that the benefit of the $100,000 exemption be provided to those recipients from the State that are least capable of providing the matching funds. The requirements of 24 CFR 576.21(a)(4)(ii) which provide that the funding of homeless prevention activities for families that have received eviction notices or notices of termination of utility services meet the following standards: (A) that the inability of the family to make the required payments must be the result of a sudden reduction in income; (B) that the assistance must be necessary to avoid eviction of the family or termination of the services to the family; (C) that there must be a reasonable prospect that the family will be able to resume payments within a reasonable period of time; (D) that the assistance must not supplant funding for preexisting homeless prevention activities from any other source; (E) occur a week before eviction, foreclosure or termination. The requirements of 24 CFR 576.51(b)(2)(iii) concerning that submission by nonprofit organizations applying for funding of a certification of approval of the proposed project(s) from the unit of local government in which the proposed project is located. The requirements of 24 CFR 576.51(b)(2)(v) concerning the funding of emergency in hotels or motels or commercial facilities providing transient housing. The requirements of 24 CFR576.56(a)(3) concerning the provision of termination and/or grievance procedures for an individual or family who violates program requirements. The requirement of 24 CFR576.56(b) concerning the involvement of homeless individuals and families in providing work or services pertaining to policy-making and in operations of facilities or activities assisted under this part. The requirement of 24 CFR576.57 concerning the prohibition of conflict of interest or financial interest in decision-making by elected officials, appointed officials, staff or board of directors except as may be granted by HUD as provided in 570.611(d). The requirements of 24 CFR 576.73 concerning the continued use of buildings for which Emergency Grant funds are used for rehabilitation or conversion of buildings for use of emergency s for the homeless; 15 or when funds are used solely for operating costs or essential services, concerning the population to he served. The building standards requirement.of 24 CFR 576.75. The requirements of 24 CFR 576.77, concerning assistance to the homeless. The requirements of 24 CFR. 576.79, other appropriate provisions of 24 CFR Part 576, and other applicable Federal law concerning nondiscrimination and equal opportunity. The requirements of 24 CFR 576.80 concerning minimizing the displacement of persons, as a result of a project assisted with these funds. The requirements of 24 CFR 576.80 concerning the Uniform Relocation Assistance and Real Acquisition Policies Act of 1970. The requirement of the Cranston-Gonzalez National Affordable Housing Act (Public Law 101-625, November 28, 1990 contained in Section 832(e)(2)(C) that grantees develop and implement procedures the ensure the confidentiality of records pertaining to any individual provided family violence prevention or treatment services under any project assisted"under the Emergency Shelter Grant Program"will,except with written authorization of the person or persons responsible for the operation of such , not be made public." The requirement that local government will comply with the provisions of and regulations and procedures applicable under section 104(g) of the Housing and Community Development Act of 1974 with respect to the environmental review responsibilities under the National Environmental Policy Act of 1969 and related authorities, as specified in 24 CFR Part 58, and as applicable to activities of nonprofit organizations. The requirement that no Federal appropriated funds have been paid, by or on behalf of the local government or nonprofit organization, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal loan, the entering into of any cooperative agreement, and modification of any Federal contract, grant, loan or cooperative agreement. The requirement that if any funds, other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the local government or nonprofit organization shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The requirement of disclosure specified in Subpart C of 24 CFR Part 12 regarding assistance from other HUD-funded programs. The requirement that the local government or nonprofit organization shall require that the language of the PROHIBITION OF THE USE OF FEDERAL FUNDS FOR LOBBYING CERTIFICATION be included in the award documents for all standards at all tiers including subcontracts, subgrant, and contracts under Grant, loans, and cooperative agreements and that all subrecipients shall certify and disclose accordingly. The requirement that(68 Fed. Reg. 43430) agencies receiving funding from the Emergency Shelter Grant Program become compliant with Homeless Management Information System (HMIS) as required by the Department of Housing and Urban Development. The required certification that the submission of an application for any emergency Shelter grant is authorized under applicable law and that the local government or nonprofit organization possesses legal authority to carry out emergency Shelter grant activities in accordance with applicable law and regulations of the Department of Housing and Urban Development Barbara Kirkmever Chair, Board'of Coneiaissioners'Weld County"Housing Autiioritir Na e Title 7Pgnature Date 16 CDOH PERFORMANCE MEASUREMENTS AND OUTCOMES All ESC proposals must comply with the CDOH Performance Measurements and Outcomes. I have read the performance and outcome measurements shown below and understand that these may differ from measurements required by HUD. (Please Use Drop Down Box) YES Name:Barbara Kirkmever Title: Cha" . Boardof Commissioners Weld County Housing Authority Date: 4/1/2011 /5 Signature d f Performance Measurements and Outcome Requirements Objective: Serve the lowest income and hardest to serve individuals and families meeting critical housing needs through state and federal initiatives by creating a suitable living environment or decent affordable housing. ESG `s=,F�,•aa': ESG Funding rS R�cl=i'r' .w rtnr,r(i is--�p, 1. End chronic homelessness and move homeless families and individuals into permanent housing. 2.Availability/accessibility for the purpose of creating suitable living environments. 3. Promote self-sufficiency, efficient use of funds and effective program administration. i1' 'L.I " r'Yxlc m¢V:sr o lic2:tvr -s ;I . rl .birl:. si; ,}a4 re *z 5a: l!$f; ie •B{'r1rI, • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • Recipient expended all ESG funds within the established grant timeframe. • Recipient met the deadline for submitting their signed grant agreement. • Recipient met the deadline for submitting evidentiary documents. • Recipient met the deadline for submitting performance reports. • Recipient meets required standards for documentation of homelessness. • Recipient complies with required record keeping methods. • Recipient complies with the due process of terminating ESG funded assistance of participant. • Amount of money leveraged. • Does recipient have findings from previous compliance reviews? Y�r�ikrk,str - =dlsb ec 't4i(tl .b c .,. :-.01o6. .r re tes 7if. •,:;t f r `r Lrtip g'or • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • The total number of adults and children served on an annual basis (reported under Homeless Assistance Services). • The number of persons served by race and ethnicity. `er{:i_i yr L.-:,'E mfe .rF ar E'la eC E,Y'E • Number of persons assisted with ESG funds for eviction notices. • Number of persons assisted with ESG funds for utility termination notices. • Number of persons assisted with ESG funds for security deposits and/or first month's rent. • The total number of adults and children served on an annual basis (reported under Homeless Prevention Services). • The number of persons served by race and ethnicity. it,. eor teF2:O.•r= in, ;El ltO.r Ltit. x o[ tits= t ,.ur `ll °•tr'lct • Number of homeless persons that received ESG funded services concerned with employment. • Number of homeless persons that received ESG funded services concerned with health. • Number of homeless persons that received ESG funded services concerned with substance abuse. • Number of homeless persons that received ESG funded services concerned with education. • Number of homeless persons that become successfully independent of ESG funded services. • Number of homeless persons that return to their prior living situation • The total number of adults and children served on an annual basis (reported under Homeless Assistance Services). 17 • The number of persons served by race and ethnicity_ 18 Form W.9 Request for Taxpayer Give Form to the may.January 2011) Identification Number and Certification requester. Do not Department of the Treasury Interval Revenue Service send to the IRS. Name(as shown on your Income tax return) Housing Authority of the County of Weld r\i Business name/disregarded entity name,if different from above Weld County Housing Authority O- Check appropriate box for federal tax c m c classification(required): 0 individual/sole proprietor 0 c Corporation 0 S Corporation 0 Partnership 0 Trust/estate TO o ❑ Limited liabilty company.Enter the tax classification(CC corporation,S=S corporation,P=partnership)► 0 Exempt payee c • a u omar(see i'csa"ca°"s)► Govermental Address(number,street.and apt or suite no.) Requester's name and address(optional) v $, P.O.Box 130 oCity,state,and ZIP code m m Greeley CO 80632 List account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line I Social security number to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer Identification number number to enter. 8 4 - 1 5 6 8 4 4 6 Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. I am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 4. Sign Signature of _ Here u.s.person► u /x= Date it- /777 2ti ( General Instructions Note.If a requester gives you a form other than Form W-9 to request your TIN,you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is a foreign person, 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U.S.person that is a partner in a partnership conducting a trade or business in the United 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.10231X Form W-9(Rev.1-2011) Weld County Housing Authority ATTN:Tom Teixeira 903 6th St P.O. Box 130 Greeley, CO. 80631 March 28, 2011 Dear Tom, Enclosed is the Emergency Shelter Grant Application for Room at the Inn. It is complete with all attachments except for an audit copy. What I attached is a Financial statement recommended from Kitty Peterson &Associates, PC, we proceed with a financial review this year. We are planning the review for 2010 in July of 2011. On another issue, please note that I had some trouble accessing the drop down boxes in the application. They would not open for me, so I answered next to the boxes instead. I hope that this will not cause a problem for our application submittal. Thank you, Tom, and if I have overlooked anything or if you should need more from me, please let me know. Sincerely, 7, / w c. elly Lobato Executive Director Room at the Inn 1213 5th Ave Greeley, CO. 80631 (970) 378-0100 Application for Colorado Division of Housing (CDOH) EMERGENCY SHELTER GRANT ASSISTANCE 2011 APPLICANT INFORMATION 1. APPLICANT 2. CDH Project Number For CDH Use only NAME: Room at the Inn 3. Date Received ADDRESS: 1213 5th Ave For CDH Use Only CITY: Greelev STATE: CO ZIP: 80631 4. Current ESG Program Recipient? _ CURRENT El % PRIO� NEVEn , ._ 5 ti. a � »c4� °:e, sod' I Mai. �6. n 7. Ft�X: 8. • :heir-Fr-Mr;t.=W(drop down box) Ms. Shelly Lobato (970)378-0100 (970)373-4516 shellvrati(d)vahoo.com TYPE OF ORGANIZATION 10- arriallilit ❑ 11. Weld Please attach 501 (c)(3) ruling. 12. : • • (Use drop down box) 8 4 — e 1' 5 5; 4 1 7 1 6 1 7 1 13. .: :(List counties served)Weld County 14. (A) ' _ , 9 B •�• - >: t �,: ,Crp�st7 15. (Check all that apply): 0 Men 0 Women 0 Families ®Youth O Domestic Violence ® Emergency - Maximum Capacity per Night:88 Maximum Stay: 60 Days ® or Months O ® Day - Maximum Capacity: 0 Average Number of Clients Served per Day:0 ❑ Transitional - Total Units:0 Maximum Length of Stay:0 Days❑ or Months ❑Average Stay: 0 Days ❑ or Months 0 ❑ Homeless Prevention: - Number of Families and/or Individuals expected to Serve with ESG and Match Funds Each Year: 0 Are you requesting dollars for a new program in this request? SELECT ONE: If yes, program name: SIGNATURE OF AUTHORIZED OFFICIAL OR AGENCY REPRESENTATIVE (drop down box) Ms. Shel obato Executive Director 19. 20. . 3/27/2011 C , ;;r: shel ti@vahoo.com BUDGET Line Item Expense: 21.Operations: 22.Essential 23. Homeless 24.Administration Services: PreN/ention: Local godt w sub Grant: Insurance $3,000.00 $0.00 $0.00 $0.00 Agency Utilities $3,500.00 $0.00 $0.00 $0.00 Transportation $2,000.00 $0.00 $0.00 $0.00 Case Management $0.00 $1,500.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 -16/IMMO $ 8,500 $ 1,500 $0.00 $ 0.00 26. ^ r ' t . f; $10,000.00 27. , , '- Name: Value of In-Kind or Volunterr staff related to Services ((41$5/hr) Amount: $42,720.00, Name Amount (Additional Space on page 13) PROPOSED PROJECT BUDGET EXPLANATION AND DOCUMENTATION 28. „ ,. ,,, Please also provide the following: • If you are requesting Operations,please identify any operating staff for which you are requesting funding. • (b)If you are requesting an increased level of funding or a new service under Essential Services, you must demonstrate that a new/increased level of need exists and ESG funding will not replace governmental funding. • (c)If you are requesting Homeless Prevention funding, please explain how you will ensure that your clients meet HUD requirements for homeless prevention assistance. All requests should be eligible, necessary and reasonable. You may also use the following page for the budget if necessary. (When typing below, please do not use the return (enter) key. Line will automatically wrap around) BUDGET PAGE EXPLANATION AND DOCUMENTATION) (28.CONTINUED)YOU MAY BEGIN YOUR BUDGET EXPLANTION ON THIS PAGE: (When typing below, please do not us,, to-n iea ors nF. wil autos ^sly wr t OPERATIONS: Room of the Inn is requesting support with necessary costs incurred in the daily operation of our shelter. Specifically, funding assistance for case management, agency insurance, utility expenses, and necessary transportation costs of our agency van. The agency van is used daily to transport our clients from our centalized Day Center to their overnight accommodations. Room at the Inn operates 7 days per week for 365 days per year. Our yearly insurance costs are approximately$5000.00 per year. With the occurrence of increased energy costs, we anticipate that our agency utilities will cost approximately$10,000.00 this year.Yearly transportation costs for transportation will be near $4320.00, while maintenance and repair usually cost our agency approximately $2500.00 annually. ESSENTIAL SERVICES: Room at the Inn is seeking funds from the Emergency Shelter Grant for case-management and counseling activities. Assuring the long-term success of families requires access to one to one support and assistance programs. Enrollment into specific courses and/or support programs will become an integral and vital part of our long term self-sufficiency goals,whether that program is offered at the Room at the Inn agency or with a collaborating partner. It is our hope that such life skills/educational programs and counseling support will promote the development of new competencies in the family,thus empowering the family to advocate on their own behalf in the future. Room at the Inn also offers Strengths Based Case Management to each program family. Case management for our clients costs our agency roughly$20,000.00 per year. ESG programming is implemented by the following staff: Shelly Lobato, Exicutive director of Room at the Inn: Shelly oversees the 24 hour, 365 day per year program. She supervises employees, and 14 church volunteer coordinators. Shelly has 7 years of non-profit experience and her key responsibilities include:Volunteer training, schedule coordination, case management and referral to homeless clients and others in an outreach capacity,leads internal sessions in the areas of people skills and guest/volunteer dynamics. She coordinates professionals from outside agencies for education,life skills courses and counseling for clients. Shelly completes the screening process for all potential clients and determines eligibility for participation into the program. Shelly manages the financial records for individual donors and completes all grant writing duties for the agency. She also manages the day to day expenses and operations of the agency. As well, she is the community liaison,joining other agencies to work in continuum on such boards as Housing and Emergency Services Network, Greeley Interfaith Association. Shelly will also speak publicly about the services of Room at the Inn at various community forums. Shelly has been the Director since December 2010 and was trained by National Interfaith Hospitality Network. She will be attending a national gathering of all the IHN directors in September to expand her educational knowledge on every aspect of Executive Directorship. Shelly has 7 years of Corporate Management Also served on the board of directors as chair for fundraising for A Woman's Place for 5 years and Room at the Inn for 2 years. Case Management: Shelly performs case-management services for current Room at the Inn clients, helping families to join her as co- conspirators in creating an effective plan that engages the family onto a path of independance and self-reliance. Shelly also provides some direct case management and referral to others in an outreach capacity. Room at the Inn is looking to hire a Case Manger within the next month. EXTENT AND URGENCY OF THE NEED }A i 29. (A)What is the need to be addressed? How urgent 3s the need? Pleae p srovide local data or,statisric l hi/on-nation(waiting list,number of clients turned away,'etc.)that supports the needs your agency will address: (S'e'1 r . o__�P n1.a _^ tie i _ : se the r' ,,rr ,€:r=;Yi Key. Line wiL. around Room at the Inn was initially developed because there was an incredible need for shelter space for families with children. In the late 90's-early 2000's, Weld County shelters were hearing the brunt of the large population in need, turning away families in need of bed space because there were none available. Since the day we opened our doors, we have never had an empty shelter. In fact, we have been at capacity over 75% of the time over the course of 9 years. The collapse of the housing market has played a significant role in our community need. Many families were affected and lost their homes. What started with a windfall of homeowners enduring foreclosure has developed into a massive amount of renters, who have unexpectedly lost their housing because their landlords had foreclosed on the property. The mess reared its ugly head when it was discovered that as banks and lenders foreclosed on homes at an astounding rate and that*Weld County led the national list of foreclosure per capita in 2006. Realtytrac, an Irvine, California based company that tracks national foreclosure rates,posted in late 2006, that Weld County held the title for the highest foreclosure rate in the nation for 8 months consecutively as of that report. In Jan. 2007, the same company reported that Greeley had the highest foreclosure rate in the nation for the fifth consecutive month. The foreclosure rate in Greeley was six times the national average at 50.6 filings per 1,000 households. **In 2008, new foreclosure filings rose to an average of 230 per month, and***2009 reported a record breaking numbers, exceeding any of the previous years. Exacerbating this problem is the steady growth of unemployment. ***In Jan, 2011, the Colorado Department of Labor and Statistics reported that the Weld unemployment rate was 8.8% in January, 2010,Increased from the reported number of 8.6%in November, 2009, and 7.9%for November, 2009. Room at the Inn has tangibly experienced these findings, as last year, 85%of our client population had lost their housing due to unemployment. These issues have made a tremendous difference in family stability and as with most communities, these are the reasons why families now make up 40 percent of the homeless population, and, why one out of every four homeless people is a child. Knowing that even one child is struggling to receive his/her basic human needs is unconscionable. Sadly, homelessness exists at an unacceptable level in Greeley. To respond to this urgent issue, Greeley currently has three operating homeless shelters. Guadalupe Center, Greeley Transitional House, and Room at the Inn operate 365 days a year to try to meet the needs of Greeley's Homeless population. Recently Catholic Charities is expanded their facility to accommodate additional beds to ease overflow. Though their expansion is important to the cause, Greeley Transitional House, Catholic Charities and Room at the Inn have remained at capacity to serve the homeless, many times nursing a waiting list of people who could not be immediately accommodated because of overflow. (B) Did you turn clients away in the last grant period of January 1, 2010 thru December 31, 2010?YES If so how many, 20 where did they golt is unknown where most families went though some did secure space in other agencies.,did you refer them to another agency?YES PROJECT PLAN 30. Describe your project plino assist the target population as it directly relates to the nee a addressed in Line29. MTh -.?-g e u :r- :he r * (fir ter.) T ' -111 auto uv*, around'.. . (Be sure to include the geographical areas and specific activities that you plan to provide). If this proposal is requesting funding for more than one activity(Essential Services, Operations/Staff Operations, Prevention), describe each separately. Operations: Room at the Inn, Greeley Interfaith Hospitality Network helps homeless familes to meet the challenges of homelessness and has helped families to regain their independence and renew their lives. The direct mission of Room at the Inn is to support families who struggle with poverty and crisis, and journey with them to their independence. Obtaining our Federal 501 (c) (3) status in 2001, we opened our doors for service to homeless families on September 30 of that year. Room at the Inn operates 24 hours per day, 365 days per year, working in partnership with 8 churches, to provide for their immediate needs of shelter,food, safety, and friendship.Local communities of faith provide overnight accommodations and warm meals for families,while agency staff works with families in a comprehensive case management program during the day at our local day center. The day center also serves as an office for parents to find employment,housing and other resources as well as a retreat for their families from the elements. The Room at the Inn Homeless Shelter provides services to an average of 125 people, or 36 homeless families per year. In 2010, we were successful with helping 85%of our client families to achieve long term permanent housing of their own. Essential Services:Room at the Inn uses the Strengths-Based Model when case managing our clients. This model encourages the family to identify for themselves, goals and aspirations that they have each have individually and as a family unit. Strong support and guidance is given to reach personal objectives and family goals while achieving self- sustenance. Clients are also given opportunities to learn parenting and stress management skills, fmancialldebt management and review,take budgeting courses, and receive guidance and support to further educational goals for each member of the family. All families who are interested in education will sit with a college counselor to learn about education opportunities and enrollment procedures. Clients receive one on one support in obtaining employment or better employment, and staff is active in helping each family fmd suitable, safe housing for families. Counseling for families who need it will also be offered in many aspects via a partnership with one of local professional agencies. PLAN FOR FINANCIAL STABILITY 31. Provide a plan for the future financial stability of the proposed project. (How will the program continue in the future if ESG funding is no longer provided?) ti= n= w, p} Dt , t ,e __.••r bceY 1 9-i'_ -, S D 131Ci^all S ._our L_ If this proposal is requesting funding for more than one activity (Essential Services, Operations, Prevention), describe each. Room at the Inn is committed to raising funds for the long term continuation of providing service to homeless families. Our funding is heavily created by individual and church support, grants, and fundraising. We have fundraisers activities, our Hearts for Homeless Gala, Mario the PEDDLER and Annual Golf Marathon. These fundraising events account for an average of 40% of our annual budget of$93,000.00. Grants for this year, including ESG, will account for roughly$45,000. Our individual giving program which we endearingly rail our"Innkeepers" has reduced a little this year, we suppose because of the national economy concerns.We anticipate that at the current giving rate,we will receive around$20,000.00 from our Innkeeper program this year. However, our Board of Directors are implementing an very aggressive and innovative marketing program to increase the revenues in this area. This plan has objectives and focused goals to attract both individual households as well as local businesses. OPERATIONS: Funding as previously mentioned, are used to support the direct services and programs of Room at the Inn Another great source of support for Room at the Inn operating dollars is the unique partnerships that we have created with the local faith community. This partnership has the potential to reach 30,000 people through our membership of 8 local churches. We have had 1400+volunteers provide hands-on, face to face volunteer duties in 2010. The benefits of our design to utilize precious community in-kind donations such as bedroom and dining space in our participating churches and volunteers for meals, hospitality hosting, and overnight stays, saves our agency an estimated $240,000.00 in annual operation costs. We find that engaging the community to directly participate creates a win-win situation for all. Volunteers not only find awareness about the homeless issue,they become veritable catapults for change in our clients lives. Many clients have found landlords and employers through their contact with volunteers. Clients change the lives of volunteers as well, as many volunteers are profoundly touched by unknowing ability to make a difference as individuals.. If the Emergency Shelter Grant cannot meet our full funding request, Room at the Inn is committed to continually seek sources and innovative opportunities to fund our agency in its entirety, as we believe in the vital nature of our assistance within our community. ESSENTAIL SERVICES: ESG funding aids us greatly in bringing professional case management support for our clients. Through our case management program, follow -up for families who leave our agency for long-term,permanent housing,translates to clients staying in there homes premanently and not falling back into homelessness. We feel that case-management is truly"essential" and commit to finding funding opportunities to continue to provide it. EXPERIENCE 32. Explain below any F aaerience your organization or unit of local government has in implementing the activities that you have proposed in this application. l=s h l" :, ;-, TM it r Specifically,include the years of experience of staff and/or organization that will be administering the ESG funds. Where your organization and staff lack experience, explain how you will obtain the technical assistance needed to administer and complete the project. Shelly Labatt), Executive director of Room at the Inn: Shelly oversees the 24 hour, 365 day per year program. She supervises employees, and 14 church volunteer coordinators. Shelly has 7 years of non-profit experience and her key responsibilities include:Volunteer training,schedule coordination, case management and referral to homeless clients and others in an outreach capacity, leads internal sessions in the areas of people skills and guest/volunteer dynamics. She coordinates professionals from outside agencies for education, life skills courses and counseling for clients. Shelly completes the screening process for all potential clients and determines eligibility for participation into the program. Shelly manages the financial records for individual donors and completes all grant writing duties for the agency. She also manages the day to day expenses and operations of the agency. As well, she is the community liaison,joining other agencies to work in continuum on such boards as Housing and Emergency Services Network, Greeley Interfaith Association. Shelly will also speak publicly about the services of Room at the Inn at various community forums. Shelly has been the Director since December 2010 and was trained by National Interfaith Hospitality Network. She will be attending a national gathering of all the IHN directors in September to expand her educational knowledge on every aspect of Executive Directorship. Shelly has 7 years of Corporate Management,Also served on the board of directors as chair for fundraising for A Woman's Place for 5 years and Room at the Inn for 2 years Church Coordinators (16 volunteer Positions): Church coordinators recruit and organize volunteer from their participation communities of faith. They supervise assistant coordinators and volunteers as they manage volunteer hosing duties in all phases of the Room at the Inn program within their host church. 1000+Community Volunteers:There dinner preparation and serving, are a variety of volunteer responsibilities that are provided everyday of the year. The volunteers who give so graciously of their time, talent, and treasure are an important aspect of Room at the Inn that keeps the agency operating. Needed on a daily basis, all volunteers function as agency staff. Volunteers provide most of the agency hosting responsibilities which include:being a presence in the evening and overnight stays with guests and providing special activities for guests. Some volunteers also provide one- year of mentoring to families and individuals within the community,bringing support to those in crisis through a unique bond. Room at the Inn receives technical support through our National Organization Family Promise. Family Promise also offers continued training at all levels, from Executive Director to volunteer, and the opportunity to implement innovative programming developed at the National Level. Currently there are over 160"networks" such as ours across the United States and Canada. . REPORT 33.Beds (including cribs) 18 18 34.Sleeping Rooms 6 6 35.Total Families Served 30 40 36. Total Persons in Families 88 _ 120 37. Total Individuals Served 0 0 38. Total Nights 2824 3800 AVERAGE COST PER PERSON OR HOUSEHOLD SERVED WITH ESG FUNDING 39. What is the average cost per person served for each of your ESG-funded activities? $0.00 (Total Activity Budget/#Unduplicated Clients) CLIENT PARTICIPATION REPORT. 40. Client Paid Hours se— e- Cy 41. Client Unpag_oidirs ;2B CONTINUUM OF CARE COORDINATION 42. %-'7'T",ity,`s r sa 2 4 ? t= x:r` E, P A%.`PPO YES I Who provides the following services in your Do you have a written SUPPORTIVE SERVICES community? agreement to coordinate (1) If it's your organization put an"X" in this services? Use the drop TYPE OF SERVICE column beside the corresponding service; down box to (2) If it's another organization, please list their Answer"Yes"or"No"or"NA" name (Not Applicable) 43. Information and Referral ®Organization Name UNITED WAY/OTHERS Not Applicable 44.Emergency 0 Organization Name GREELEY Not Applicable TRANSITIONAL HOUSE, CATHOLIC CHARITIES,A WOMEN'S PLACE 45.Transitional Housing ❑ Organization Name NONE SELECT ONE: 46. Permanent Housing(w/services) ❑ Organization Name WELD HOUSING Yes AUTHORITY,ISLAND GROVE VILLAGE APT. 47.Soup Kitchen ❑ Organization Name ABUNDANT LIFE AND Yes SALVATION ARMY 48. Case Management ® Organization Name WELD COUNTY SOCIAL Yes SERVICES AND JOB SERVICES 49.Transportation O Organization Name CITY OF GREELEY BUS Yes 50.Daycare ❑ Organization Name VARIOUS LOCAL No PROGRAMS 51.Medical treatment ❑ Organization Name NORTHERN No COLORADO MEDICAL CENTER, SUNRISE HEALTH CENTER 52.Substance Abuse Counseling ❑ Organization Name NORTH RANGE No BEHAVIORAL HEALTH/AA CHAPTERS 53.Psychological O Organization Name NORTH RANGE No BEHAVIORAL HEALTH 54.Employment 0 Organization Name WELD COUNTY JOB Yes SERVICES 55.Life Skills/Budgeting ® Organization Name CONSUMER CREDIT Yes COUNSELING 56.Educational 0 Organization Name WC School Dist 6, AIMS Yes Community College 57.Security Deposit O Organization Name Faith Community Yes Service Fund 58. Eviction Prevention ❑ Organization Name FAITH COMMUNITY Yes SERVICE 59. Back Mortgage Payments ❑ Or anization Name NONE Not A licable 60. Utility Assistance Payments ❑ Organization Name CAHOLIC CHARITIES, No CONVICTION FOR INDEPENDENT LIVING CONTINUUM OF CARE NARRATIVE sv-• i z ,maw , '1'P at ye r " s mfi m ss • £,t af^ 61. E 3io x u rd a a ome e s �g e ntisl s�� home ess E i s r[ttctiuites x e ed a e• e , e s �+a o r e t s.�. F e �� } " S ,,, e W x t-jec 42��AS.� .F � x�'r�.a m�.-- .. J`.ti •;"Y3 '�-Y.^..Y+,`.`—` � J...,°d". j"x,. Rt; . .�� ..c_1 ."i.5..,TJ. rrt .' v. "1 o-,..Fiyo el o �'' �-'7, zr' (When typing below, please do not use the return (enter) key. Line will automatically wrap around) Room at the Inn enjoys very close working relationships with nearly every service agency in Weld and many in Larimer Counties. Room at the Inn case managers work daily in conjuction with case managers and employees of other service agencies to find resources and programs that will help clients to succeed. As well. We meet once a month with our local United Way counsel for non-profits group or HESN(Housing and Emergency Services Network)brings together directors and/or staff from local service agency to discuss local poverty issues and implement projects that meet the needs of our low income community members. This group is in the process of developing a city wide forum for case- managers to meet for increased communication and development of collaborative efforts. Room at the Inn also works in conjuction with Social Service case managers,including the departments of TANF, Food Stamps,Medicaid/Medicare, on behalf of shared clients. FINANCIAL CAPACITY- •. „ (When typing below, please do not use the return (enter) key. Line will automatically wrap around) Room at the Inn has a financial system that keeps a tight account of financial spending. Deposit of checks and other money sources are done daily if needed by Executive Director, Shelly Lobato. Before making deposits, it is our process to photocopy every check and deposit ticket for our private file records. Checks are deposited in account at New West Bank by 4:00pm every day. Payments for utilities and other reocurring debt is handled by our agency Treasurer. Decisions to make payments for activities (other than agency utilities and other necessary expenses) are made by the Executive Director, Shelly Lobato. When payment approval is made, a formal request is given to our Treasure,who then creates and signs a check for payment and delivers it personally to the Executive Director. The Executive Director makes arrangements for payment to be made to the correct party. At this point in time, Room at the Inn is using the signature of our Board President for all written checks. This method is was implemented to keep very strict control measures over agency fund disbursements. We feel that having an accountability system in place that does not allow for personnel who make deposits to be able to withdraw funds,or vice-versa, discourages fraud and deception. Our Finance Committee is working to further increase efficiency and transparency in all of our financial processes. Current processes will be scrutinized and changes will be made if it is apparent that those changes will improve our system. Room at the Inn uses the accounting system of QuickBooks for non-profit for more accurate reporting and easier streamlining of agency spending and accounts receivables. The Agency Treasurer does a internal review once per month on the financail information that is entered into the program.She will report to the Board of Directors once per quarter on progress of transparency and efficiency. Once every six months, our agency accounts are reviewed by an outside party, Karen Turner who is Assistant Proferssor of accounting Studies at University of Northern Colorado and a Certified Internal Auditor. In July of 2010 Kitty Peterson&Associates, PC of Loveland Colorado did an 2009 Audit (Financial Statement). Room at the Inn will be doing one for 2010 in the next few months. ABILITY TO COMPLY WITH HOMELESS MANAGEMENT INFORMATION SYSTEMS (HMIS) 3x a Et-ping 1 c_a CIO of L eturr, ( r- ' I . Line will a isal w rar, 63. When-and where did your agency staff receive training on Homeless Management Information Systems (HMIS)? Room at the Inn has worked intensly with Beverley Cisse, HMIS specialist with Colorado Coalition for the Homeless. Beverley has made several on- site visits in 2008, to guide us throuh the system, and as well To personalize our input screens for increased actors Taacrt accuracy in reporting_.Shelly is looking into getting trained.e 64._,144—computer(s)and p printers that are/can he dedicated to HMIS Models,Operating Systems,Storage Dell Inspiron 8600—Laptop 76487—OEM -0011903 Intel Pention —Processor 1.6 GHz 599 MHz and 512 MB Of Ram Microsoft Windows XP Professional version 2002 Dell Dimension DIME521 76477-OEM-0011903-00102 AMD Athlon 64 x 2 Dual Core Processor 3800+ 2.00 GHz and 960 MB of Ram Microsoft Windows XP Professional Edition Dell Dimension DIME521 89572-OEM-7332166-00096 AMD Athlon 64 x 2 Dual Core Processor 3800+ 2.00 GHz and 958 MB of Ram 32 Bit Operating System All computers are regularly maintained onsite for function and virus, firewall and spy ware protection by a professional Technician. Every person who has a professional responsibility to have access to client files will sign a firm confidentiality agreement with the Room at the Inn agency. This agreement is a legal binding contract that states that Room at the Inn will take legal action if confidentiality is violated. As well, all clients will sign a Release of Information form at intake. This document allows communication between their case manager and other professionals in the community who are working with this the family to secure housing and other needed resources. For Added security, all client files are kept in a locked, fire and water proof cabinet. 66. at, _. •••. i ; ,€U. Please place an"X"in the box that best describes your current HMIS status. 9 I am a new applicant. ❑My agency is entering all HUD-required HMIS data elements on a consistent basis. 0 My agency is in discussions with my systems operator regarding my participation. We have not yet been trained on the HMIS system. ❑ My agency is a new State ESG Applicant, but we enter HMIS information for another Federal grant. ❑ My staff has been trained on HMIS, but I am waiting to upgrade equipment and or training before we fully participate. ❑My agency is exempt from HMIS. OTHER DOCUMENTS TO SUBMIT WITH ESG APPLICATION (See attached pages) ABILITY TO COMPLY WITH STATE'S INSURANCE REQUIREMENTS The State requires various insurance. Please use drop down box in each section indicating E= if you have the required insurance or NO if you do not. You may provide an explanation after each section of challenges that you face. 1. "The Contractor shall obtain, and maintain at all times during the term of the agreement,insurance in the following kinds and amounts: a. Workers Compensation Insurance as required by state statute and Employer's Liability Insurance covering all of the contractor's employees acting within the course and scope of their employment. Yes l.a.Issues or Explanation: b. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalency,covering premises, operations, fire damage,independent contractors,products and completed operations,blanket contractual liability,personal injury, and advertising liability within minimum limits as follows: i. $1,000,000 each occurrence ii. $1,000,000 general aggregate; iii. $1,000,000 products and completed operations aggregate;and iv. $50,000 any one fire. Yes 1.b.Issues or Explanation: c.Automobile Liability Insurance covering any auto(including owned,hired and non-owned autos)with a minimum limit as follows: $1,000,000 each accident combined single limit. Yes 1.c.Issues or Explanation: 2. The State of Colorado is named(or will be named within 7 business days of the effective date of the contract)as additional insured on Commercial General Liability and Automobile Liability Insurance policies(leases and construction contracts will require the additional insured coverage for completed operations on endorsements CD 2010 11/85,CG 2037 or equivalent). Coverage required of the contract will be primary over any insurance or self-insurance program carried by the State of Colorado. Yes 2. Issues or Explanation: 3. The Insurance includes(or will include within 7 business days of the effective date of the contract)provisions preventing cancellation or non-renewal without at least 45 days prior notice to the State by certified mail; Yes 3. Issues or Explanation: 4. The contractor will require all insurance policies in any way related to the contract,and secured and maintained by the contractor,to include clauses stating that each carrier will waive all rights of recovery under subrogation or otherwise,against the State of Colorado, its agencies,institutions,organizations,officers,agents,employees and volunteers. Yes 4. Issues or Explanation: 5. All policies evidencing the insurance coverage required hereunder shall be insured by insurance companies satisfactory to the State. Yes 5. Issues or Explanation: 6. The contractor shall provide certificates showing insurance coverage required by the contract to the State within 7 business days of the effective date of the contract. Yes 6. Issues or Explanation: 7. Notwithstanding subsection"a'of this section,if the Contractor is a"public entity"agrees,within the meaning of the Colorado Government Immunity Act, CRS 24.10-101,et seq, as amended("Act"),the contractor shall at all times during the term of the contract maintain only such liability insurance by commercial policy or self-insurance, as is necessary to meet its liabilities under the act and show proof of insurance upon request. Yes 7. Issues or Explanation: Instructions for Completion of Match.Certification All applicants are _- :- to complete the Match Certification form. Eligible forms of match are as follows: • The value of salary paid to staff to carry out the ESG Program. • The value of the time and services contributed by volunteers to carry out the program at a rate of $5.00 per hour. • Volunteers providing professional services such as medical or legal services valued at the reasonable and customary rate in the community. • The value of any donated material or building. • The value of any building lease using a method to reasonably calculate fair market value. • Award letters from foundations, organizations, private individuals, and other government sources. **Note: These awards must overlap the ESG funding period to be eligible. ** MATCH CERTIFICATION SOURCES OF LOCAL MATCH .e.1Cf 't 1Cientaticr ff, i ..o1? _ a✓:.Ti. Jilt tk 1hO:11 1: cam- .w, di _g £lvd to Other Federal (including pass-through funds,e.g.City CDBG,County FEMA,etc) NAME AMOUNT $0.00 $0.00 $0.00 .. NAME AMOUNT $0.00 $0.00 $0.00 Fund Raising/Cash $0.00 Loans $0.00 Building Value or Lease $0.00 Donated Goods $0.00 Donated Computers $0.00 New Staff Salaries $0.00 Volunteers ($5.00 per hour) $42,720.00 Volunteer Medical/Legal $0.00 Other (specify) $0.00 I certify that match funds have been identified and committed to support the proposed ESG project and have not been used to match previous ESG awards (i.e. the value of a donated building used as match in a 2009 award cannot be used as match in 2010). This form is a description of the sources and amounts of such match fu ds,which are not being used as match for any other r federal f program. • e U< A,Ree 3/28/2011 Additional Funds Documentation The list of all sources of additional funds not included as match to be used to carry out your proposed project. Be specific. Sources of Additional Funds Amount of Additional Funds DONATIONS $25,000.00 FUNDRAISING $28,000.00 GRANTS $3,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Additional Funds Committed to the ESG Process $53,000.00 Kit4DA Weld County Housing Authority ox P.O. Box 130 Greeley, CO 80632 970 353-7437 C. COLORADO CERTIFICATION OF LOCAL APPROVAL BY LOCAL BOARD OF COMMISSIONERS FOR NON-PROFIT ORGANIZATIONS I Barbara Kirkmever, Chair, duly authorized to act on behalf of Weld County hereby approve the following project(s) proposed by Room at the Inn,which is located in Weld County. ATTEST: • l <� /IJ � By: a(_UaA - L fiL Clerk to the = .and , �, Barbara Kirkmeyer, air /a .: tom ri Board of County Commissioners By ',�//L/_' �� ia�8t: �'�ir�,,� � Weld County,Colorado Deputy Clerk the Board � Date: ,V /7O// Certification of Consistency with Consolidated Plan I Rebecca L. Safarik, Community Development Director certify that Room at the Inn located in the City of Greeley is consistent with the Consolidated Plan for the City of Greeley 67( Rebecca L. Safarik Community Developme Director Date of Certification t4AR 3 1 2011 EMERGENCY SHELTER GRANT PROGRAM ASSURANCES AND CERTIFICATIONS Shelly Lobato (name of chief elected official or appropriate non-profit signatory) Room At The Inn of (town. city, county or nonprofit organization)which is applying to the State of Colorado for funding through the Emergency Shelter Grant Program from the U.S. Department of Housing and Urban Development(HUD), hereby assures and certifies that: Amounts awarded under this program will be used only for these purposes: 1. Assist in the prevention of homelessness. 2. Assist in supporting the essential operating costs of s. 3. Assist in improving the quality of supportive services to the homeless. Projects will not require participation in religious services,as a condition for receiving assistance. All projects funded will develop and administer, in good faith, a policy designed to ensure the is free from the illegal use,possession or distribution of DRUGS and ALCOHOL by its beneficiaries. Political activities will be prohibited in accordance with subsection 675 (e) of the Community Services Block Grant Act of 1981. The town, city, county or nonprofit organization certifies that matching supplemental funds required by the regulations at 24 CFR 576.71 and 576.85(a)(3), as mentioned by the amendments to Items 415(a) and 415(c) of the Stewart B. McKinney Homeless Assistance Act made by Section 832(e) of the Cranston-Gonzalez National Affordable Housing Act of 1990 (Public Law 101-625, November 28, 1990) will be provided. The amendment exempts the first $100,000 from the matching requirement and requires that the benefit of the $100,000 exemption be provided to those recipients from the State that are least capable of providing the matching funds. The requirements of 24 CFR 576.21(a)(4)(ii) which provide that the funding of homeless prevention activities for families that have received eviction notices or notices of termination of utility services meet the following standards: (A) that the inability of the family to make the required payments must be the result of a sudden reduction in income; (B) that the assistance must be necessary to avoid eviction of the family or termination of the services to the family; (C) that there must be a reasonable prospect that the family will be able to resume payments within a reasonable period of time; (D) that the assistance must not supplant funding for preexisting homeless prevention activities from any other source; (E) occur a week before eviction, foreclosure or termination. The requirements of 24 CFR 576.51(b)(2)(iii) concerning that submission by nonprofit organizations applying for funding of a certification of approval of the proposed project(s) from the unit of local government in which the proposed project is located. The requirements of 24 CFR 576.51(b)(2)(v) concerning the funding of emergency in hotels or motels or commercial facilities providing transient housing. The requirements of 24 CFR576.56(a)(3) concerning the provision of termination and/or grievance procedures for an individual or family who violates program requirements. The requirement of 24 CFR576.56(b) concerning the involvement of homeless individuals and families in providing work or services pertaining to policy-making and in operations of facilities or activities assisted under this part. The requirement of 24 CFR576.57 concerning the prohibition of conflict of interest or financial interest in decision-making by elected officials, appointed officials, staff or board of directors except as may be granted by HUD as provided in 570.611(d). The requirements of 24 CFR 576.73 concerning the continued use of buildings for which Emergency Grant funds are used for rehabilitation or conversion of buildings for use of emergency s for the homeless; or when funds are used solely for operating costs or essential services, concerning the population to be served. The building standards requirement of 24 CFR 576.75. The requirements of 24 CFR 576.77, concerning assistance to the homeless. The requirements of 24 CFR 576.79, other appropriate provisions of 24 CFR Part 576, and other applicable Federal law concerning nondiscrimination and equal opportunity. The requirements of 24 CFR 576.80 concerning minimizing the displacement of persons, as a result of a project assisted with these funds. The requirements of 24 CFR 576.80 concerning the Uniform Relocation Assistance and Real Acquisition Policies Act of 1970. The requirement of the Cranston-Gonzalez National Affordable Housing Act (Public Law 101-625, November 28, 1990 contained in Section 832(e)(2)(C) that grantees develop and implement procedures the ensure the confidentiality of records pertaining to any individual provided family violence prevention or treatment services under any project assisted"under the Emergency Shelter Grant Program" will, except with written authorization of the person or persons responsible for the operation of such, not be made public." The requirement that local government will comply with the provisions of and regulations and procedures applicable under section 104(g) of the Housing and Community Development Act of 1974 with respect to the environmental review responsibilities under the National Environmental Policy Act of 1969 and related authorities, as specified in 24 CFR Part 58, and as applicable to activities of nonprofit organizations. The requirement that no Federal appropriated funds have been paid, by or on behalf of the local government or nonprofit organization, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal loan, the entering into of any cooperative agreement, and modification of any Federal contract, grant, loan or cooperative agreement. The requirement that if any funds, other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the local government or nonprofit organization shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The requirement of disclosure specified in Subpart C of 24 CFR Part 12 regarding assistance from other HUD-funded programs. The requirement that the local government or nonprofit organization shall require that the language of the PROHIBITION OF THE USE OF FEDERAL FUNDS FOR LOBBYING CERTIFICATION be included in the award documents for all standards at all tiers including subcontracts, subgrant, and contracts under Grant, loans, and cooperative agreements and that all subrecipients shall certify and disclose accordingly. The requirement that(68 Fed.Reg. 43430) agencies receiving funding from the Emergency Shelter Grant Program become compliant with Homeless Management Information System (HMIS) as required by the Department of Housing and Urban Development. The required certification that the submission of an application for any emergency Shelter grant is authorized under applicable law and that the local government or nonprofit organization possesses legal authority to carry out emergency Shelter grant activities in accordance with applicable law and regulations of the Department of Housing and Urban Development. Shelly Lobato Executive Director Name Title L CDOH PERFORMANCE MEASUREMENTS AND OUTCOMES All ESG proposals must comply with the CDOH Performance Measurements and Outcomes. I have read the performance and outcome measurements shown below and understand that these may differ from measurements required by HUD. (Please Use Drop Down Box) YES Name:Shell Lobato Title:Exec a irector Date: 3/28/2011 Signature r n 1 frformance Measurements and Outcome Requirements Objective: Serve the lowest income and hardest to serve individuals and families meeting critical housing needs through state and federal initiatives by creating a suitable living environment or decent affordable housing. ESG ESG Funding 1.End chronic homelessness and move homeless families and individuals into permanent housing. 2.Availability/accessibility for the purpose of creating suitable living environments. 3. Promote self-sufficiency, efficient use of funds and effective program administration. • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • Recipient expended all ESG funds within the established grant timeframe. • Recipient met the deadline for submitting their signed grant agreement. • Recipient met the deadline for submitting evidentiary documents. • Recipient met the deadline for submitting performance reports. • Recipient meets required standards for documentation of homelessness. • Recipient complies with required record keeping methods. • Recipient complies with the due process of terminating ESG funded assistance of participant. • Amount of money leveraged. • Does recipient have findings from previous compliance reviews? al, • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • The total number of adults and children served on an annual basis (reported under Homeless Assistance Services). • The number of persons served by race and ethnicity. • Number of persons assisted with ESG funds for eviction notices. • Number of persons assisted with ESG funds for utility termination notices. • Number of persons assisted with ESG funds for security deposits and/or first month's rent. • The total number of adults and children served on an annual basis(reported under Homeless Prevention Services). • The number of persons served by race and ethnicity. • Number of homeless persons that received ESG funded services concerned with employment. • Number of homeless persons that received ESG funded services concerned with health. • Number of homeless persons that received ESG funded services concerned with substance abuse. • Number of homeless persons that received ESG funded services concerned with education. • Number of homeless persons that become successfully independent of ESG funded services. • Number of homeless persons that return to their prior living situation • The total number of adults and children served on an annual basis (reported under Homeless Assistance Services). Room at the Inn : Greater Greeley IHN, Inc. 1213 5th Ave • Greeley, CO. 80631 • (970) 378-0100 • www.roomattheinn.us RE: HUD/ESG Grant Project Match Documentation Volunteer Agency: Our Saviors Lutheran Church,First Congregational, First Christian Church, St.Peter's Catholic, 1st United Methodist Church, Greeley Mennonite, Family of Christ, Summitview Community Church This document is to verify that our churches will commit at least 8,544 volunteer hours per hosting rotation for Room at the Inn. Our church is scheduled for 5 hosting rotations for the Emergency Shelter Grant period of 2011-2012. Our total Volunteer hour commitment for the ESG Grant 2011- 2012 is: 8,544 hours Shelly Lobato Executive Director Room At The Inn J- COPY OF YOUR 501 (c)(3) Ruling COPY INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. O. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number: Date: arj 2 4 ?1 5 84-1554767 • DLN: 17053092964045 ROOM AT THE INN INTERFAITH Contact Person: HOSPITALITY NETWORK INC FAITH E CUMMINS ID# 31534 1213 5TH AVE Contact Telephone Number: GREELEY, CO 80631-4229 (877) 629-5500 Public Charity Status: 170W) (1) (A) (vi) Dear Applicant: Our letter dated November 2000, stated you would be exempt from Federal income tax under section 501(c) (3) of the Internal Revenue Code, and you would _ be treated as a public charity, rather than as a private foundation, during an advance ruling period. Based on the information you submitted, you are classified as a public charity under the Code section listed in the heading of this letter. Since your exempt status was not under consideration, you continue to be classified as an organization exempt from Federal income tax under section 501(c) (3) of the Code. Publication 557, Tax-Exempt Status for Your Organization, provides detailed information about your rights and responsibilities as an exempt organization. You may request a copy by calling the toll-free number for forms, (800) 829-3676. Information is also available on our Internet Web Site at www.irs.gov. If you have general,questions about exempt organizations, please call our toll-free number shown in the heading between 8:30 a.m. - 5:30 p.m. Eastern time. Please keep this letter in your permanent records. Sincerely yours, Ci4t. • ins +o,....e. Lois G. erner Director, Exempt Organizations Rulings and Agreements Letter 1050 (DO/CG) rr[�1 Dejn ft innient of 'Iten,ur_ 1(� 1. Internal Revenue Seri P .O. Box 2508 In reply refer to : 0248222025 Cincinnati OH 45201 Mar . 23 , 2010 LTR 4168C EO 84- 1554767 000000 00 00011482 BODC: TE ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK INC STACY ROMERO ;tit--A 1213 5TH AVE GREELEY CO 80631-4229 013738 Employer Identification Number : **-***4767 Person to Contact : R Clemons Toll Free Telephone Number : 1-877-829-5500 Dear Taxpayer : This is in response to your request of Mar . 12, 2010 , regarding your tax-exempt status . Our records indicate that a determination letter was issued in 3, that recognized you as exempt from Federal income tax, and discloses that you are currently exempt under section 501 (c) (Octob of the Internal Revenue Code . Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a) ( 1) and 170 (b) ( 1) (A) (vi) . Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106 , and 2522 of the Code . If you have any questions , please call us at the telephone number shown in the heading of this letter . Sincerely yours , Michele M . Sullivan , Oper . Mgr . Accounts Management Operations I COPY OF YOUR MOST RECENT AUDIT ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK, INC. Financial Statements December 31, 2009 Kitty Peterson & Associates, PC 231 W. 4th St. Phone: 970-663-3564 Loveland, Colorado 80537 Fax: 970-663-0955 To the Board of Directors of Room at the Inn Interfaith Hospitality Network, Inc. Greeley, Colorado We have reviewed the accompanying statement of financial position—income tax basis of Room at the Inn Interfaith Hospitality Network, Inc (a non-profit organization) as of December 31, 2009, the related statement of activities—income tax basis for the year then ended, the statement of functional expenses — income tax basis and the statement of cash flows — income tax basis in accordance with Statements on Standards for Accounting and Review Services issued by the American Institute of Certified Public Accountants. All information included in these financial statements is the representation of the management of Room at the Inn Interfaith Hospitality Network, Inc. A review consists principally of inquiries of Company personnel and analytical procedures applied to financial data. It is substantially less in scope than an audit in accordance with generally accepted auditing standards, the objective of which is the expression of an opinion regarding the financial statements taken as a whole. Accordingly, I do not express such an opinion. Based on our review, we did not become aware of any material modifications that should be made to the accompanying financial statements in order for them to be in conformity with the income tax basis of accounting. /�-- ) ( C ' X--%7C 4-C w C( i• 1 (7- 41 Kitty Peterson & Associates, PC ,/ Loveland, Colorado July 27, 2010 ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK, INC Statement of Financial Position - Income Tax Basis December 31, 2009 ASSETS CURRENT ASSETS Cash and cash equivalents $ 20,259 Total Current Assets 20,259 PROPERTY AND EQUIPMENT Vehicles 6,570 Office Equipment 4,409 Homeless Shelter Furniture 8,953 19,932 Less accumulated depreciation (9,547) Net Property and Equipment 10,385 TOTAL ASSETS $ 30,644 LIABILITIES AND NET ASSETS NET ASSETS Unrestricted $ 30,644 TOTAL NET ASSETS 30,644 TOTAL LIABILITIES AND NET ASSETS $ 30,644 See accompanying notes and accountant's report 2 ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK, INC Statement of Activities - Income Tax Basis For the Year Ended December 31, 2009 UNRESTRICTED NET ASSETS Support and revenue Public support $ 25,900 Government 5,800 United Way, designation for current period 49,266 Fundraising events, net 10,177 Grants 10,096 Rental Income 2,120 Total Support and Revenue 103,359 Expenses Program services Direct assistance programs 81,634 Supporting services Management and general 12,643 Fundraising 4,180 Total Expenses 98,457 Increase in unrestricted net assets 4,902 Net assets at beginning of period 25,742 Net assets at end of period $ 30,644 See accompanying notes and accountant's report 3 ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK, INC Statement of Functional Expenses - Income Tax Basis For the Year Ended December 31, 2009 Program Support Total Service Service Fundraising Expenses Salaries and benefits $ 53,345 $ 7,703 $ 3,849 $ 64,897 Direct program expense 4,216 - - 4,216 Payroll taxes 4,711 557 331 5,599 Payroll expenses - 1,060 - 1,060 Insurance 3,079 - - 3,079 Dues & subscriptions 132 28 - 160 Office supplies & expenses 1,283 390 - 1,673 Postage 331 - - 331 Professional fees - 525 - 525 Supplies 969 - - 969 Utilities 6,338 - - 6,338 Miscellaneous - 501 - 501 Education & training - 1,077 - 1,077 Repairs & maintenance 887 - - 887 Rent 1,200 - - 1,200 Telephone 1,528 464 - 1,992 Auto & travel 843 257 - 1,100 78,862 12,562 4,180 95,604 Depreciation 2,772 81 2,853 Total expenses $ 81,634 $ 12,643 $ 4,180 $ 98,457 See accompanying notes and accountant's report 4 ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK, INC Statement of Cash Flows - Income Tax Basis For the Year ended December 31, 2009 CASH FLOWS FROM OPERATING ACTIVITIES Change in net assets $ 4,902 Adjustments to reconcile change in net assets to net cash provided by operating activities: Depreciation expense 2,853 Net cash provided by operating activities 7,755 CASH FLOWS FROM INVESTING ACTIVITIES Purchase of Equipment (6,334) Net cash used by investing activities (6,334) NET INCREASE IN CASH 1,421 CASH & CASH EQUIVALENTS-BEGINNING OF PERIOD 18,837 CASH & CASH EQUIVALENTS-END OF PERIOD $ 20,259 See accompanying notes and accountant's report 5 ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK, INC Notes to Financial Statements December 31 , 2009 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Nature of Activities Room at the Inn Interfaith Hospitality Network Inc., (the Organization) is nonprofit program located in Greeley, CO, designed to help homeless families achieve self-sufficiency and regain a home for themselves and their children. Shelter for the families is provided through a unique, innovative method by utilizing an interfaith hospitality network of congregations and hundreds of volunteers throughout Weld County. Revenues are derived primarily from contributions from the general public, grants from private foundations and United Way. Basis of Accounting The accompanying financial statements have been prepared on the income tax basis of accounting, which is a comprehensive basis of accounting other than generally accepted accounting principles. Accordingly, revenue is recorded when received rather than when earned and expenses are recorded when paid rather than when the obligation is incurred. Property and equipment recorded at January 1, 2006, have been recorded as an asset. Contributed Services During the year ended December 31, 2009, the value of contributed services meeting the requirements for recognition in the financial statements was not material and has not been recorded. The Organization received approximately 10,700 volunteer hours during the year. Estimates The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. Property and Equipment Property and equipment is stated at cost or at the estimated fair market value at the date of donation. Prior to 2009, depredation is provided using MACRS over the estimated useful lives. 2009 depreciation is provided using the straight-line method over the estimated useful lives. Depreciation expense for the year ending December 31, 2009 is $2,853. Accumulated depreciation as of December 31, 2009 is $9,547. The cost of maintenance and repairs is charged to expense when incurred; significant renewals and betterments are capitalized. 6 ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK, INC Notes to Financial Statements December 31 , 2009 Financial Statement Presentation Under Statement of Financial Accounting Standards (SFAS) No. 117, financial Statements of Not-for-Profit Organizations, the Organization is required to report information regarding its financial position and activities according to three classes of net assets: unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets. Contributions Under SFAS No. 116, Accounting for Contributions Received and Contributions Made, contributions received are recorded as unrestricted, temporarily restricted, or permanently restricted net assets depending on the absence or existence or nature of any donor restrictions. Cash and Cash Equivalents For purposes of the statements of cash flows, the Organization considers all highly liquid investments available for current use with an initial maturity of three months or less to be cash equivalents. Income Taxes The Organization is a not-for-profit organization that is exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code. However, income from certain activities not directly related to the Organization's tax-exempt purpose is subject to taxation as unrelated business income. In addition, the Organization qualifies for the charitable contribution deduction under Section 170(b)(1)(A) and has been classified as an organization other than a private foundation under Section 509(a)(2). Functional Expenses The costs of providing various programs and other activities have been summarized on a functional basis in the Statement of Activities — Income Tax Basis and the Statement of Functional Expenses— Income Tax Basis. Accordingly, certain costs have been allocated among the programs and supporting services benefited. Compensated Absences It is impracticable to estimate the amount of compensation for future absences, and, accordingly, no liability has been recorded in the accompanying financial statements. The Organization's policy is to recognize the costs of compensated absences when actually paid to employees. 7 ROOM AT THE INN INTERFAITH HOSPITALITY NETWORK, INC Notes to Financial Statements December 31, 2009 NOTE 2 — FUND RAISING Fund raising includes the following: Golf Marathon $ 9,268 Hearts for Homeless 12,074 Other 2,459 23,801 Less direct expense 13,624 Net fund raising $10,177 NOTE 3 — CONCENTRATION OF CREDIT RISK The revenue from United Way comprised of approximately 51% of the total support the Organization received in 2009. During 2010, the Organization has lost its funding from United Way and are writing additional grants in order to obtain alternative sources of revenue. 8 W-9 (Attached as a separate document in this packet) Form W'-ei Request for Taxpayer Give Form to the (Rev.January 2011) requester.Do riot Department of the Treasury Identification Number and Certification send to the IRS. Internal Revenue Service Nafne(as shown on your m me tax return) [ / 6r rail-er /r'/r' .;"i,<t:-/sir74 A/ �9 -4i 1 {y i�'PILt.:cck, - is ci Business name/disregarded entity name,if different T from above fen0 M Cc .1 �ILa Ln v1 as a Check appropriate box for federal tax co o e classification(required): ElIndividuaVsole proprietor 0 C Corporation 0 s Corporation 0 Partnership 0 Trust/estate ao e` 0 Umtted •liability company.Enter the tax classification(CC corporation,S=S corporation,Pr-partnership)► 0 Exempt payee c m u I other(seeinsauctions)► IUoll - Prot t.t y f Address(number,street,and apt.or suite no.) Requester's name and address(optional) o 11 to! ( C7Th s C "Th f-tl R-7 m City,state,and ZIP code N C-tre el:e et gOlD1 List account number(s) optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line I Social security number to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other - - entities,it is your employer identification number(EIN).If you do not have a number,see How to get a 77N on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number number to enter. ILL — / 55* 767 Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. I am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other th interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 4. Sign signature of / Here us ► �i eh (tern"(IR niter-ire Date► ,-.77142C [201 General Inst ctions Note.If a requester gives you a form other than Form W-9 to request your TIN,you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving is cored(or you are waiting for a number to be issued), Further,in certain cases where a Form W-9 has not been received,a partnership is required to presume that a partner is a foreign person, 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U.S.person that is a 3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. 2011 - 2012 COLORADO ESG APPLICATION INSTRUCTIONS APPLICATIONS ARE DUE TO THE COLORADO DIVISION OF HOUSING ON Friday, APRIL 1, 2011. • If you use a carrier or the post office, it must be postmarked no later than April 1, 2010. • If you plan to hand delivery the application to the Colorado Division of Housing, we must receive it by 5:00 pm on April 1, 2011. • You must submit one(1) Original application and one(1)Copy of the application. Following are line-by-line instructions for completion of the 2011 -2012 Colorado ESG application. Question#s 1. Please complete the name and mailing address of the applicant in this box. 2. For DOH use only. 3. For DOH use only. 4. For DOH use only. 5. Name of contact person for application and reporting. This should be the person most knowledgeable and available to answer questions about the proposal. Use drop down box for salutation. 6. Phone number of contact person. 7. Fax number of contact person. 8. Email address of contact person 9. Check if the applicant agency is a municipality or county 10. Check if the applicant agency is a housing authority. 11. Check if the applicant agency is a 501(c)(3) nonprofit. 12. Use the drop down boxes for your Federal Employer Identification Number(FEIN). 13. Identify your service area(geographic area served: Name of City,County or Region). 14. Enter#of years your organization has been in operation. 15. Indicate population(s)served. 16. Check each program type for which you are requesting ESG funding and provide other information as requested. 17-18. Local Government applicants should type the name and title of the chief local elected official signing the application (e.g. Mayor or Chairperson of the Board of County commissioners who has signature authority for contracts). Nonprofit agencies should type the name and title of the person authorized by the agency to submit the application (generally the Executive Director or President of the Board of Directors who has signature authority for contracts). Use drop down box for salutation. 19. Signature of person authorized by the agency to submit the application and email address. 20. Date application is signed by authorized person. BUDGET 21-24 Please show individual line items in the first column. In corresponding columns, place the amount requested under the expenditure categories for operations, essential services, homeless prevention, or administration. (For example in the "Operations" category, you may wish to apply for funds to pay shelter rent, insurance and staff.) ***List each of these separately and the amount 25. Each column will subtotal each expenditure category automatically. 26. Please show the total funding request in this box. 27. Identify match source(s) and amounts. BUDGET EXPLANATION AND DOCUMENTATION 28. Please provide an explanation of your proposed project budget and provide documentation of your need for requested categories of Operations, (including Staff Operations) Essential Services and Homeless Prevention. If you are requesting an increased level of funding or a new service under Essential Services, you must demonstrate that a new or increased level of need exists and that ESG funding will not replace governmental funding. All requests should be eligible, necessary and reasonable. (When typing, please do not use the return (enter) key. Line will automatically wrap around) EXTENT AND URGENCY OF THE NEED 29. (A) Describe the need and the urgency of the need be addressed. Provide local data that supports your assessment of the need. (B) Did you turn away any clients during the period January 1, 2009 through December 31, 2009? If so, list details on how many, where did they go, did you refer them to another agency? (When typing, please do not use the return (enter) key. Line will automatically wrap around) PROJECT PLAN 30. Describe your project plan to assist the target population as it directly relates to the need(s)identified in Line 29. Address geographical areas and specific activities you will undertake. Please address all categories of your request i.e., (Essential Services, Operations, Prevention) (When typing, please do not use the return (enter) key. Line will automatically wrap around) PLAN FOR FINANCIAL STABILITY 31. Provide a plan for the future financial stability of the proposed project(s) How will the program continue in the future If ESG funding is no longer provided? (When typing, please do not use the return (enter) key. Line will automatically wrap around) EXPERIENCE 32. Describe the experience of your organization in implementing the activities that you have proposed in the application. Specifically, include the years of experience of staff and your organization. If you lack experience with the activities, explain how you will obtain the technical assistance needed to complete the project. (When typing, please do not use the return (enter) key. Line will automatically wrap around) SHELTER REPORT For categories 33-38, please list the actual number for 2010-2011 and the projected number for 2011-2012. 33. Beds (including cribs). 34. Sleeping Rooms. 35. Total Families Served 36. Total Persons in Families. Please report all adults and children within families served by your program. Include couples without children in the count of total persons in families. 37. Total Individuals. Please report all single individuals served by your program. This includes homeless youth, single females, and single males served by your shelter and/or homeless prevention program. 38. Shelter Nights. Calculate the shelter nights by multiplying the total persons in a family by the nights of shelter provided for the family.Total shelter nights per individual are the total number of nights an individual stayed at the shelter. By adding the total shelter nights per family for each family to the total shelter nights for each individual,the total shelter nights provided is derived. AVERAGE COST PER PERSON OR HOUSEHOLD SERVED 39. Provide the average cost per person or family served for each of your ESG activities. Use Total Activity Budget/ # of Clients or Households. For example, your homeless prevention program provides 30 households per year with eviction and utility shut-off prevention at an average cost of $300.00 per household; your agency provides housing counseling services to 50 clients at an average cost of$65.00 per client; your shelter serves 100 clients per year at an average cost of XX dollars per person per day. CLIENT PARTICIPATION REPORT 40. Paid hours: Please report the total hours worked by clients on shelter or prevention-related activities for which pay was received. Example - the hours a client was paid for assisting in the demolition of a storage shed at the shelter site. 41. Unpaid Hours. Show total volunteer hours provided by clients to assist the shelter program. CONTINUUM OF CARE/COORDINATION 42. Are you a participating member of your local Continuum of Care? Use drop down box for "Yes", "No"or"We don't have one" if there is not a regional Continuum of Care for your area. Note: Most areas of the State have a regional Continuum of Care. The question is really asking, "Are you connected?" SHELTER SERVICES: 43-60. In the first column is a list of the different types of services inwhich we want to know who provides the service in your community. If it is your agency that provides these types of services, in the middle column mark the box"D"wlth an "X". If a different agency provides these types of services, list that agency name in the middle column. In the right hand column, use the drop down box to indicate "Yes" if you have a written service coordination agreement with the agency. Indicate"No" if you do not or"Not Applicable"if it is your agency. CONTINUUM OF CARE NARRATIVE 61. Explain how you coordinate homeless housing, essential services and homeless prevention activities with other local nonprofit agencies, and mainstream service providers (such as TANF, Food Stamps, Housing Assistance,etc.)within your community or Continuum of Care FINANCIAL CONTROL SYSTEMS 62. Explain your organization's financial control system and procedures, and explain how your agency monitor its activities to ensure that ESG funds are spent in a timely manner. ABILITY TO COMPLY WITH HOMELESS MANAGEMENT INFORMATION SYSTEMS (HMIS). 63. If you are not currently receiving ESG funding, please answer, "Not Applicable" For existing ESG projects, explain when and where you received training on Homeless Management Information Systems. 64. List the computer resources available for HMIS data entry, including the type of computer equipment and computer storage capacity. 65. Explain how you ensure that client files are kept confidential? 66. Indicate with an "X"the box that best describes your HMIS status PLEASE MAKE SURE YOU EXAMINE, FILL OUT AND ATTACH ALL PERTINENT PAGES! LOCAL GOVERNMENT SUMMARY PAGE .To be completed ONLY by LOCAL GOVERNMENTS with sub grantees. LOCAL GOVERNMENTS: PLEASE MAKE SURE YOU AND YOUR SUBGRANTEES HAVE COMPLETED ALL QUESTIONS, INCLUDED ALL ATTACHMENTS(BELOW) AND SUBMITTED ALL REQUIRED SIGNATURES! THIS IS A COMPETITIVE PROCESS. ALSO, REMEMBER YOU WILL NEED TO SUBMIT ONE (1) ORIGINAL AND TWO (2) COPIES OF THE APPLICATION FOR YOU AND YOUR SUBGRANTEES. PLEASE MAKE SURE YOU EXAMINE, FILL OUT AND ATTACH ALL PERTINENT PAGES! Additional pages include the following: ABILITY TO COMPLY WITH STATE'S INSURANCE REQUIREMENTS MATCH CERTIFICATION ADDITIONAL FUNDS DOCUMENTATION CERTIFICATION OF LOCAL APPROVAL BY LOCAL BOARD OF COMMISSIONER FOR NONPROFITS CERTIFICATION OF CONSISTENCY WITH CONSOLIDATED PLAN EMERGENCY SHELTER GRANT PROGRAM ASSURANCES AND CERTIFICATIONS W-9 TAYPAYER IDENTIFICATION REQUEST (Our accounting staff advises this that the information for your type of agency is located on your 501(c)(3) ruling. Please make sure you check the correct box. We cannot advise you, correct your form or guess.). REQUEST FOR COPY OF YOUR MOST RECENT AUDIT TO ACCOMPANY THIS APPLICATION REQUEST FOR COPY OF YOUR 501(c)(3) RULING CDOH PERFORMANCEMEASUREMENTS AND OUTCOMES APPLICATIONS ARE DUE BACK TO THE COLORADO DIVISION OF HOUSING BY 5:00 p.m. Thursday, April 1, 2010. • If you use a carrier or the post office,your applications must be postmarked no later than April 1, 2010. • If you plan to hand delivery the application to the Colorado Division of Housing, we must receive it by 5:00 pm on April 1, 2010. MAIL ENTIRE PACKET TO: Shannon Picaso COLORADO DIVISION OF HOUSING 1313 SHERMAN STREET ROOM 518 DENVER,CO 80203 2011 ESG Scoring Sheet The Grant Review Committee will evaluate and score applications based upon the following criteria and/or assumptions. The review will be primarily internal, based on agency performance in meeting quality, effectiveness and timeliness standards: AGENCY NAME APPLICATION# SCORING CRITERIA FOR 2011 ESG GRANT PROGRAM APPLICATION Applicant is a qualified if"No"Agency is 501(c)(3)? Yes No DISQUALIFIED if"No"Agency is Application received on time? Yes No DISQUALIFIED 1.Location of Agency 20 points Located in(non-ESG Entitlement Area) Located in ESG entitlement Area (Adams,Aurora, Denver or Colorado Springs) SCORE 20 points 5 points 2.Length of Time Agency has received ESG from the State of Colorado? 15 points More than Less than Less than Less than Less than 2 SCORE 10 Years 10 years, 5 years 3 years years but more but more but more than 5 years than 3 than 2 15 points 10 points 6 points 3 points 0 points 3.Applicant compliance or agency status with regard to Homeless Management Information Systems as reported by the Continuum of Care/CDH (or is exempt)? 15 points Complete& Accurately Enters New Agency accurate enters HMIS HMIS,but Existing Start-up,or participatio info,but not has issues nonprofit Refuses n in HMIS yet fully related to agency w/ Participatio for HUD implemented completenes equipment n, or needs programs s and and staff equipment (or not accuracy but needs and training required) training SCORE 15 points 10 points 5 points 1 points 0 points 4. Applicant correctly filled out application,including all required attachments,certificates, signatures,co-3ies. No blank questions. 5 points Answered All required All forms Correct Neatness SCORE (1 Point each) all signatures / Number questions certificate of Copies s submitted Check if applies 5.Applicant identifies and documents NEED for shelter and/or services 10 points Applicant Applicant Some No other Low level of Applicant identifies an presents a unmet provider NEED does not urgent strong NEED exists in exists for prove the NEED for NEED for exists for region shelter or NEED shelter or shelter or shelter or services, services services services SCORE 10 points 8 points 6 points 4 points 2 points 0 points 6.Proposed Project Budget 10 Points Well- Budget At least No documented documented one eligible . All items ;Most items eligible requests are eligible, are eligible, and necessary, necessary& document & reasonable ed reasonable. category SCORE 10 points 8 points 6 points 0 points 7.Match Requirement(Dollar for Dollar) 10 points Agency Agency meets 1 to 1 doesn't match meet match SCORE 10 points 0 points S.Ability to Meet Insurance Requirements 5 points Agency Agency Agency Agency Agency Agency currently currently currently meets few of does not lacks meets or meets or meets or the have insurance will meet all will meet has ability insurance financial and/or is insurance Parts 1, to meet requirement resources not requirement 2,3,5, &6 some to obtain insurable requirement insurance SCORE 5 points 4 points 3 points 2 points 1 point 0 points 9.How are Agency Reports Submitted?(New agencies see substitute 9& 10 below.) 5 points Always Overall Mostly Often late Neither No timely/ T&A T&A with T&A reports accurate errors submitted (T&A) SCORE 5 points 4 points 3 points 2 points 1 point 0 points 10.Agency spent all dollars from previous year? 5 points Yes No,but No,didn't Asset Mgr spend all approved $ SCORE 5 points 3 points SUBTOTAL EXISTING AGENCIES : NEW AGENCIES: SUBSTITUTE THIS QUESTION FOR Q 9 AND 10 The following question will be substituted for Questions 9 and 10,for new applicants or those who did not receive 09-10 grant funding.APPLICATIONS WILL BE SCORED ON MANAGEMENT CAPACITY AS RATED BY THEIR ASSIGNED HOUSING DEVELOPMENT SPECIALIST AGENCY MANAGEMENT CAPACITY AS RATE BY HOUSING DEVELOPMENT SPECIALIST 10 Points Existing Existing Existing Existing New New program program program program, program nonprofit with with good some staff but lacks start-up excellent staff capacity capacity staff capacity capacity and track record 10 points 7 points 5 points 3 points 1 point 0 points SCORE SUBTOTAL POINTS NEW AGENCIES: Application for Colorado Division of Housing (CDOH) EMERGENCY SHELTER GRANT ASSISTANCE 2011 APPLICANT INFORMATION 1• AI PLICAN9 2. CDH Project Number For CDH Use only NAME: Stepping Stones of Windsor 3. Date Received ADDRESS: 503 Walnut St. For CDH Use Only CITY: Windsor STATE: CO ZIP: 80550 4.Current:ESGFiver=Recipient? '. CURRENT PRIOR NEVER 5 bgap ? � 6. 7 _ • 8. itAS _ a(drop down box) Ms Krista Goddard 970-686-2368 970-686-0769 windsorsteppingstones04(cayahoo.c om - TYPE OF ORGANIZATION 9 �tf'i(�p E ker rei'; kf :�1F�� T: �4 g2 f : t' X � 10 a 11 YCl:rf�P51P{� R{ , }w =• Please attach 501 (c)(3) ruling. 12 ^• �� °p _�' 3% ,. ;;ice i. .. Use dro• down box 4 7 --- 0 9 1 9 7 6 9 13. Ltst counties served Weld RE-4 School District Windsor/Severance 14. (A) :t n, .`� f �b` '� �� e �y,� 7 (B) d:��}' ."'LL�, t..� 1k,�t s� �k e= •y;"Y a }..a• e ¢• rfi�C`i�c l�i a 15. (Check all that apply): X Men X Women X Families X Youth X Domestic Violence 16. •1 ,-; . r ` ' . O Emergency - Maximum Capacity per Night:0 Maximum Stay: 0 Days O or Months O O Day - Maximum Capacity: 0 -Average Number of Clients Served per Day:0 O Transitional - Total Units:0 Maximum Length of Stay:0 Days 0 or Months 0 Average Stay:0 Days ▪ or Months X Homeless Prevention: - Number of Families and/or Individuals expected to Serve with ESG and Match Funds Each Year: 75 Are you requesting dollars for a new program in this request? No If yes,program name: SIGNATURE OF A. THORIZED.OFFICIAL;OR AGENCY REPRESENTATIVE { y{ 7 �• .tea- �e r' 1! ! • r '. �� eir �.to 18 =r i7� e� .�.sf ,i��i �*f 1 f4TJ:: na,c_A k);;�m } (drop down box) :0•1$4.•.•..,. t .. Ms. Krista Goddard President 19. ��r : , ,�.iee�nc " f =i: f Fr oqr ►, 20. Ea 3/28/2011 windsorsteppin.gstones04@yahoo.com 1 BUDGET Line'Itetn;Eapense: 2t.Operations: 22.Essential 23.Homeless 24 Administration Services: Prevention:. Local gov't w sub Gra it Eviction $0.00 $0.00 $3,000.00 $0.00 Prevention/rental assistance Utility,Shut-off $0:00 $0:00 $2,500.00 $0:00 prevention 1st-Month Rent $0.00 $0:00 $1,000.00 $0.00 $0:00 $0.00 $0.00 $0.00 $000 $0:00 $0.00 $0.00 $0,00 $0.00 $0.00 $0.00 $0:00 $0:00 $0.00 $0.00 ,g`'.: Soar $0:00 $Q;0;0 $0.00 r.:;v : . $0,00 so o $0:00 $0,00 rl'; '_ $0:00 $0,00 $0,'00 $0.00 o..e .e $0100 $0:00 $0:0`4 $0;00 .$ ) $0400 $4 0 OM $0.00 25. ° i '( . $ 0.00 $ 0.00 $6,500.00 $ 0.00 26. $6,500.00 27. ;C.k rF. ,' t . '',: A 0;,, 1'•%.' Name: Local Churches Amount: $5,500.00, Name Windsor Food Pantry Amount $2,500.00, Fundraising $3,000.00 (Additional Space on page 13) kSil r "" +ey adc cI`,' `�Si ltipri.f'c c'3 _ :f c "f "" r g 4'"f„-.�u �s ' :yes . > ;«$,'F'�Ec s w a x shy a Y. r i5 �,� �'si , ti ` ,i, t�,'iZ"S R 5d ' ti „' g l proi �" r,� P s rip 28. h4E SatFi. ii Please also provide the following: • If you are requesting Operati"ons, please identify any operating staff for which you are reduestin$funding. • (b)If you are requesting an increased level of funding or a new service under F s*Etlal, en4Oes, you must demonstrate that a new/increased level of need exists and ESG funding will not replace governmental funding. • (c) If you are requesting It __ W"' Pro, 00611 funding, please explain how you will ensure that your clients meet HUD requirements for homeless prevention assistance. All requests should be eligible, necessary and reasonable. You may also use the following page for the budget if necessary. (When typing below, please do not use the return (enter) key. Line will automatically wrap around) s.. . 4 EXPLANATION t OCUMENTAfii©N) a 2 (28.CONTINUED)YOU MAY BEGIN YOUR BUDGET'EXPLANTION ON THIS PAGE: (When typing below, please do not use the return (enter) key. Line will automatica;ly wrap around) We continue to see an increase in need from clients within the Weld RE-4 School district which is our area of service. Funding for the homeless prevention we assist with is not meeting the need, and we have had to turn clients away. Our requirements for assistance must match the following: Must be a resident of the Windsor RE-4 School District Must have an eviction or utility shut-off notice dated within 7 days of the request for assistance We speak with the landlord to make sure an eviction will not take place within 30days of the date we assist the client The need for assistance must be due to a sudden, short term issue, not a chronic problem We speak with the client to ensure that there is a plan of action to prevent the need of future assistance within a short amount of time We recommend other resources for the client to look in to that may be of assistance We use the ESG intake forms Poe a Y OF TH 3N a .st i xs 3, $ 29 A vi 'Fa g $ Iy ♦ � � 'S t I ¢ f � e (When typing below,please do not use the return (enter) key. Line will automatically wrap around) Windsor and Severance have seen an increase in the need for assistance with eviction and utility shut-off prevention du to the closing of some local businesses and the increase of gas costs for travel to work. There has also been a continuing rise in the amount ofpeople still searching for work due to the economic health of the area and we find that there are clients whose unemployment is running out before a new position can be found, leading to the need for assistance. In th first 6 months of the 2010-2011 grant year Stepping Stones assisted a total 36 households with homeless prevention du, to either eviction or utility shut-off payments. Included in the 36 households were 46 children under the age of 18. (B)Did you turn clients away in the last grant period of January 1, 2010 thru December 31,2010? Yes If so how many, 6 Where did they go they were referred to other local agencies, Did you refer them to another agency? Churches, United Way, Catholic Charities, Lutheran Family Services qx.?Y t. N ey 6V. Ott T. %a ,`... ,. 4.'.- stx. _ .fad �. '3'-s ...``� '�'4,40 .,;,� J,v zrs 5 Sad.$, $ S Xa (When typing below, please do not use the return (enter) key. Line will automatically wrap around). (Be sure to include the geographical areas and specific activities that you plan to providh See Attached If this proposal is requesting funding for more than one activity (Essential Services, Operations/Staff Operations, Prevention), describe each separately. �:Li > ?`r .z aSS St.. . -x ", a 9 99.t r v,, ,NTM '^ ;z m .tx r £ 3 Stepping Stones of Windsor Project Plan 2011-2010 Who Qualifies? Persons applying for assistance from this grant must have written evidence of: * Living on the street or otherwise homeless * Coming from short-term emergency shelter * Coming from transitional housing * Being evicted from private dwelling * Being evicted from an apartment or other shared housing * Release from an institution * Fleeing from Domestic Violence * Have notification of a utility shut-off * Residence within the Windsor/Severance Weld RE-4 School District What Services Are Available? * Eviction prevention * Utility shut-off prevention * First Month's Rent How Often Can You Apply? * Due to the high demand for limited resources households can apply one time a year per service provided, not exceeding maximum assistance amount. * Returning clients may apply for additional services one year from the date of last assistance. How Much Can a Client Receive? * Stepping Stones of Windsor's goal is to provide 80% of the need up to a maximum of $480.00 total per household per year. The exact amount to be provided will be based on the client's ability to contribute as determined in the case work. Eligibility Requirements: * Must reside in the Windsor/Severance RE-4 School District * Must have an eviction or utility shut-off notice dated within seven (7) days of the request for assistance. * Need for assistance must be due to a sudden event (ie. car repair, medical emergency) and not a chronic problem. This is determined in the intake with the client. * Client must have a plan to prevent the problem from reoccurring. This is also determined during the intake with the client. * Client must fill out the ESG intake form, present notice of need and photo ID prior to intake appointment. * If client is seeking assistance to stop an eviction a Stepping Stones representative will contact the Landlord to ensure no eviction will take place during a month that assistance is given. Referrals/Resources: Each client is presented with a list of additional resources that may be of assistance during the time of crisis. Referrals/resources include, but are not limited to- * Windsor Food Pantry * LEAP * Weld County Department of Social Services * Windsor Clothes Closet * CARE Housing * Weld County Food Bank * Weld County Housing Authority 31 Provide a plandor the future financial stability of the proposed project. (How will-the program continue in the future'if ESG funding is no longer provided?)(When typing below. please do ': use the return (enter) key. Line will automatically wrap around) If this proposal is requesting funding for more than one activity (Essential Services, Operations,Prevention, describe each. Stepping Stones of Windsor is an all volunteer board and has very little overhead. With that. all monies donated to Stepping Stones go back into the community. We have been working to raise awareness in the community of the needs as well as of our mission. Stepping Stones has begun working with other non-profit organization to hold fundraisers such as soup suppers, bingo and silent auctions.The Ministerial Affiance has been a great asset to assisting Stepping Stones, and we have recently received donations from Good Samaritan and other local churches as well. Each year we send out a letter to the Chamber members offering a chance to donate and making them aware of the services weprovide. W Y t .,;;;;Li t x , sY� .k t4 � i nl`PP.+4 1 frs`F- d' XP -� s '� "t • ' D 4aq, aix 3t V ,- 32. 9t„� ti�� nF H�4h�L�Y � 6 :: � } ry • , 1,-t r l i t44 .,r y t s );i _P, • L4 a.a F?1 .;.. j. (When typing below, please do not use the return (enter) key. Line will automatically wrap around) See Attached Specifically,include the years of experience of staff and/or organization that will be administering the ESG funds. Where your organization and staff lack experience, explain how you will obtain the technical assistance needed to administer and complete the project. We work with a CPA that assists us with our yearly taxes and have a local attorney that files our yearly non-profit status report. With the varied experiences of the board, there are not many areas where we need help with in£ormatim If we find a need, we go through our resources to find where we can get help. 4' a(..;� dal €� � k. a a „ rig'" ;. , .�k€°Ac t.. 33.Beds (including cribs) 0 34.Sleeping Rooms 0 0 t4,4'48:4" 35.Total Families Served S'8 75 36.Total Persons in Families 147 165 37.Total Individuals Served 11 38.Total Nights 0 0 AVERAGEAVEMOWtOST PER teRsog-ORilOUSEHOLD SERVED WITH ESG FUNDING 39. "`d .lwf d i' � . a x X k � g:azttr� ..d ..,. - ' jiW'$362.45/family or $133.05/person (Total Activity Budget/# Unduplicated Clients) 4 Stepping Stones of Windsor Board Member Information (2011-2012) Board Members are as follows: President; Krista Goddard, board member since August 2006, trained on HMIS,former client, office manager at Methodist Church,initial contact for clients,client interviews, assists With quarterly reports for ESG Vice-President/Secretary; Susan Carey, board member since October 2006, sends thank-you letters for donations,writes meeting agenda and minutes, interviews clients, retired school teacher Treasurer; Debbie Jochems, member of board since February 2010, financial advisor, local landlord, assists with balancing financials,intake interviews Board Member; Barbara Goff, board member since December 2007, experience in writing grants, non-profit development focusing on skill development to facilitate self-sufficiency, division head of Medicaid Home Community Based Services Case Management Board_Member; Joyce Durol-Folbrecht, board member since March 2009,works in food service and catering at Colorado State University, active in and knowledgeable about local issues, community outreach representative for Stepping Stones, present landlord Board Member; Felipe Sorzano, board member since July 2007, responsible for publicity-articles in past, local realtor Roars Member, Bob Folbrecht, Member since March 2009, retired chiropractor,active in and knowledgeable in local issues, present landlord Board Member; Peter Jochems,member since February 2010,financial advisor, local landlord, assists with balancing financials Board Member; Elizabeth Kueny, board member since June 2010, Masters degree in Social Work, interviews clients Mae"; Mary Koehler, board member since July 2010, coordinates volunteers at Bethel Lutheran church in Windsor, community member for many years, active in town meetings CLIENT PARTICIPATION REPORT 40 Client Paid,.Hours 1 0 41 Client Unpaid I-lours 18 CONTINUUM OF CARE COORDINATION 42 Are you a participating ember ofyour local Continuum ofeare)?. N/A / Who provides the following services in your r Do you have a written SUPPORTIVE SERVICES community? agreement to coordinate (1)If it's your organization put an "X" in this, services? Use the drop TYPE OF SERVICE column beside the corresponding service; down box to (2)If its another organization, please list their Answer"Yes" or"No"or"NA" name (Not Applicable) 43. Information and Referral X Organization Name SELECT ONE: 44. Emergency O Organization Name SELECT ONE: 45. Transitional Housing [] �,Organization Name SELEO1 ONE: 46. Permanent Housing(w/services) O Organization Name SELECT ONE: 47.Soup Kitchen O Organization Name SELF ONE: 48. Case Management O Organization Name SE`L EGT,ONE 49. Transportation _ 0 Organization Name '' SELECT ONE: 50. Daycare 0 Organization Name SELECT:ONE: 51. Medical treatment O Organization Name SELECT:ONE 52. Substance Abuse Counseling O Organization Name SE CTONE:53. Psychological O Organization Name . . smutI;fONEi 54.Employment 0 Organization Name SELECT ONE: 55. Life Skills/Budgeting 0 Organization Name SliLE I€lE: 56.Educational O Organization Name . , S E-f,T.ONE 57. Security Deposit X Organization Name aattlel St 58. Eviction Prevention X Organization Name SELECTONE: 59.Back Mortgage Payments O Organization Name SELECT ONE 60. Utility Assistance Payments X Organization Name ; SEL"ECT'+ONE: -e . . C0NTINUUMi1:CARE'NARR'ATIVE 61 'i? pxli s..a r. �tsrx a4 s �s PF�,t i4, 4 t7 5r rc �i ' e- at ts„=.l. .:F Eka., .,: k.&._- Ns< ao . ". ; �tf,4,�EEt e E . ,_,.;.i=,., c, .;f=y a.n„ a' •1?t,.i�t ,3 ` t4t=.�.§F, ti r �, x1,. (When typing below, please do not use the return (enter) key. Line will automatically wrap around) Stepping Stones of Windsor is not associated with a continuum of care as there are no other organizations within our area of care. We have worked with the local churches and have received referrals from United Way 211 of Weld County. The Town of Windsor has also referred clients to Stepping Stones for assistance with eviction prevention. 5 FINANCIAL CAPACITY - _— 62. Explain youy:.oigaz ization's iinanciAi'cnntroi:sv Gezn and Frocetlur �.and eacplain ow vou,r agency will m nitor. its acttv�t ies ooensur hat �+Grdollars are spentin a tiine-h;manner; (When typing below, please do not use the return (enter) key. Line will .iutornatically wrap around) Stepping Stones of Windsor uses Quicken to manage the finances of the agency. Monthly finance reports are prepared and distributed to the full board at the monthly meeting. The board of directors oversees development of the budget; ensures accurate tracking/monitoring/accountability for funds; ensures adequate financial controls; reviews major grants and associated terms. The signers on the checking account do not reconcile the account or prepare the monthly report. Requests for funds are fulfilled on a first come, first served basis. Checks are not written in the client's name, but to the person/agency/company to whom the client owes money. 6 ABILITY TO COMPLY WITH HOMELESS MANAGEMENT INFORMATION SYSTEMS (HMIS) :When typing below, plea:e do not use the return (enter) key. Line will automatically wrap around) 63 1Ylxea and, v e dtd your agar. sY.a egoive E %ng,ori lath ia. 4x140. Es a oa tzrait40 M Kr ista Goddard received HMIS training on Oct. 23, 2007 by Beverly a Cisse. ,p'_ 64. -1 1( 5 ,o R_° �'" a tyt 7, �gq.' 93 :'$47— _ IBM computer and monitor, canon printer,Windows XP , ,!.it,tclYr,:.¢'t'.�' ' ,..s°G e" E ' _'�.), b.t .,-S`�h'FS Ertl rii .' The client files are kept in a locked file cabinet.The computer used for HMIS is password controlled as is the HMIS database. 66. S � s L Please place an"X" in the box that best describes your current HMIS status. 0 I am a new applicant. X My agency is entering all HUD-required HMIS data elements on a consistent basis. 0 My agency is in discussions with my systems operator regarding my participation. We have not yet been trained on the HMIS system. Q My agency is a new State ESG Applicant, but we enter HMIS information for another Federal grant. 0 My staff has been trained on HMIS, but I am waiting to upgrade equipment and or training before we fully participate. 0 My agency is exempt from HMIS. 7 OTHER DOCUMENTS TO SUBMIT WITH ESG APPLICATION (See attached pages) 8 ABILITY TO COMPLY WITH STATE'S INSURANCE REQUIREMENTS The State requires various insurance. Please use drop down box in each section indicating YES if you have the required insurance or ND if you do not. You may provide an explanation after each section of challenges that you face. 1. 'The Contractor shall obtain, and maintain at all times during the term of the agreement, insurance in the following kinds and amounts: a. Workers Compensation Insurance as required by state statute and Employer's Liability Insurance covering all of the contractor's employees acting within the course and scope of their employment. N/A 1.a.Issues or Explanation: Stepping Stones of Windsor is all volunteer;no staff or employees b. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalency, covering premises, operations, fire damage,independent contractors,products and completed operations, blanket contractual liability, personal injury, and advertising liability within minimum limits as follows: i. $1,000,000 each occurrence ii. $1,000,000 general aggregate; iii. $1,000,000 products and completed operations aggregate;and iv. $50,000 any one fire.. Yes Lb. Issues or Explanation: Stepping Stones is covered for liability by the First United Methodist Church's policy with Church Mutual. c.Automobile Liability Insurance covering any auto(including owned, hired and non-owned autos)with a minimum limit as follows: $1,000,000 each accident combined single limit. N/A 1.c.Issues or Explanation: Stepping Stones of Windsor does not have any vehicles and does not transport clients 2. The State of Colorado is named(or will be named within 7 business days of the effective date of the contract)as additional insured on Commercial General Liability and Automobile Liability Insurance policies(leases and construction contracts will require the additional insured coverage for completed operations on endorsements CD 2010 11/85,CG 2037 or equivalent). Coverage required of the contract will be primary over any insurance or self-insurance program carried by the State of Colorado. N/A 2. Issues or Explanation:Stepping Stones has no insurance in it's own name 3. The Insurance includes(or will include within 7 business days of the effective date of the contract)provisions preventing cancellation or non-renewal without at least 45 days prior notice to the State by certified mail; N/A 3. Issues or Explanation:Stepping Stones has no insurance in it's own name 4. The contractor will require all insurance policies in any way related to the contract, and secured and maintained by the contractor, to include clauses stating that each carrier will waive all rights of recovery under subrogation or otherwise, against the State of Colorado, its agencies, institutions, organizations,officers, agents, employees and volunteers. N/A 4. Issues or Explanation:Stepping Stones has no insurance in it's own name 5. All policies evidencing the insurance coverage required hereunder shall be insured by insurance companies satisfactory to the State. Yes 5. Issues or Explanation:Church Mutual is Satisfactory to the State of Colorado 6. The contractor shall provide certificates showing insurance coverage required by the contract to the State within 7 business days of the effective date of the contract. N/A 6. Issues or Explanation:Stepping Stones has no insurance in it's own name 7. Notwithstanding subsection"a'of this section, if the Contractor is a"public entity" agrees,within the meaning of the Colorado Government Immunity Act, CRS 24-10-101, et seq, as amended("Act"), the contractor shall at all times during the term of the contract maintain only such liability insurance by commercial policy or self-insurance, as is necessary to meet its liabilities under the act and show proof of insurance upon request. N/A 7. Issues or Explanation:Stepping Stones has no insurance in it's own name 9 Instructiaojdor Completion of Match Certificntioji All applicants are required to complete the Match Certification form. Eligible forms of match are as follows: • The value of salary paid to staff to carry out the ESG Program. • The value of the time and services contributed by volunteers to carry out the program at a rate of $5.00 per hour. • Volunteers providing professional services such as medical or legal services valued at the reasonable and customary rate in the community. • The value of any donated material or building. • The value of any building lease using a method to reasonably calculate fair market value. • Award letters from foundations, organizations, private individuals, and other government sources. **Note: These awards must overlap the ESG funding period to be eligible. ** MATCH CERTIFICATION SOURCES OF LOCAL MATCH (Attach supporting documentation for available match. Documentation should reflect funding availability during the ESG contract year.) y 4nt`,t..,, a Y :4,Atlltell sti l..e 1'a �ef7pep Ztl ° a�.,Y �f�4� 6 E7jC�i t)?7 .a) 'l' Yl A NAME AMOUNT $0.00 0,13.. $0:00 NAME AMOUNT Town of Windsor $10,000.00 $0.00 $0.00 �'t4�1/:i)�Yi;ret°.fCal< .�,`�ale)3Sk�41 ll@ti�lltf° Fund Raising/Cash $3,000.00 Loans $0.00 Building Value or Lease $650.00 Donated Goods $1,500.00 Donated Computers $0.00 New Staff Salaries $0.00 Volunteers ($5.00 per hour) $2,000.00 10 Volunteer Medical/Legal S0.00 Other (specify) $0.00 1 certify that match funds have been identified and committed to support the proposed ESG project and have not been used to match previous ESG awards (i.e. the value of a donated building used as match in a 2009 award cannot be used as match in 2010). This form is a description of the sources and amounts of such match funds, which are not being used as match for any other federal program. Drt 7OO1 'tG( "IA.atcle�Li 3/28/2011 Additional Funds Documentation The list of all sources of additional funds not included as match to be used to carry out your proposed project. Be specific. Sources of Additional Funds Amount of Additional Funds Individual Donation $1,500.00 Good Samaritan $2,400.00 Chamber Letter $1,500.00 Bingo $500.00 Silent Auction $600.00 $0:00 $OtgO $OS0 Total Additional Funds Committed to the ESG Process $6,500.00 11 a Weld County Housing Authority P.O. Box 130 Greeley, CO 80632 IIIDC 970 353-7437 COLORADO CERTIFICATION OF LOCAL APPROVAL BY LOCAL BOARD OF COMMISSIONERS FOR NON-PROFIT ORGANIZATIONS I Barbara Kirkmeyer, Chair, duly authorized to act on behalf of Weld County hereby approve the following project(s) proposed by Stepping Stones of Windsor,which is located in Weld County. ATTEST: r /T"'� By ✓I Clerk to the Board � � �' /I arbara Kirkmeyer, hair /V . ' Board of County Commissioners By: //.i/ii,/ ��►r� � L. J�;ur��Vi i/ .' Weld County, Colorado Deputy Cler o the Board 116 �•,O Date:3/3c/v2-G./ an SAMPLE Certification of Consistency with Consolidated Plan Must be completed by Consolidated Plan Coordinator or Appropriate Official for any and each of the following Colorado jurisdictions in which a project/program operates. The Department of Local Affairs, Division of Housing will provide the Certification of Consistency with projects outside of these areas. • ° ¢ t . k r. f t is v f t a �'...... .#.kit..° I, . (name) (title) certify that : •?r [(agency or program name) located in (name of Jurisdiction) is consistent with the Consolidated Plan for (name of jurisdiction). /7V/A p / itA r Name Title of Certifying Official for Jurisdiction Date of Certification: 14 EMERGENCY SHELTER GRANT PROGRAM ASSURANCES AND CERTIFICATIONS Krista Goddard(name of chief elected official or appropriate non-profit signatory) of (town, city, county or nonprofit organization) Stepping Stones of Windsor which is applying to the State of Colorado for funding through the Emergency Shelter Grant Program from the U.S. Department of Housing and Urban Development(HUD), hereby assures and certifies that: Amounts awarded under this program will be used only for these purposes: 1. Assist in the prevention of homelessness. 2. Assist in supporting the essential operating costs of s. 3. Assist in improving the quality of supportive services to the homeless. • Projects will not require participation in religious services, as a condition for receiving assistance. All projects funded will develop and administer, in good faith, a policy designed to ensure the is free from the illegal use, possession or distribution of DRUGS and ALCOHOL by its beneficiaries. Political activities will be prohibited in accordance with subsection 675 (e) of the Community Services Block Grant Act of 1981. The town, city, county or nonprofit organization certifies that matching supplemental funds required by the regulations at 24 CFR 576.71 and 576.85(a)(3), as mentioned by the amendments to Items 415(a) and 415(c) of the Stewart B. McKinney Homeless Assistance Act made by Section 832(e) of the Cranston-Gonzalez National Affordable Housing Act of 1990 (Public Law 101-625, November 28, 1990) will be provided. The amendment exempts the first $100,000 from the matching requirement and requires that the benefit of the $100,000 exemption be provided to those recipients from the State that are least capable of providing the matching funds. The requirements of 24 CFR 576.21(a)(4)(ii) which provide that the funding of homeless prevention activities for families that have received eviction notices or notices of termination of utility services meet the following standards: (A) that the inability of the family to make the required payments must be the result of a sudden reduction in income; (B) that the assistance must be necessary to avoid eviction of the family or termination of the services to the family; (C) that there must be a reasonable prospect that the family will be able to resume payments within a reasonable period of time; (D) that the assistance must not supplant funding for preexisting homeless prevention activities from any other source; (E) occur a week before eviction, foreclosure or termination. The requirements of 24 CFR 576.51(b)(2)(iii) concerning that submission by nonprofit organizations applying for funding of a certification of approval of the proposed project(s) from the unit of local government in which the proposed project is located. The requirements of 24 CFR 576.51(b)(2)(v) concerning the funding of emergency in hotels or motels or commercial facilities providing transient housing. The requirements of 24 CFR576.56(a)(3) concerning the provision of termination and/or grievance procedures for an individual or family who violates program requirements. The requirement of 24 CFR576.56(b) concerning the involvement of homeless individuals and families in providing work or services pertaining to policy-making and in operations of facilities or activities assisted under this part. The requirement of 24 CFR576.57 concerning the prohibition of conflict of interest or financial interest in decision-making by elected officials, appointed officials, staff or board of directors except as may be granted by HUD as provided in 570.611(d). 15 The requirements of 24 CFR 576.73 concerning the continued use of buildings for which Emergency Grant funds are used for rehabilitation or conversion of buildings for use of emergency s for the homeless; or when funds are used solely for operating costs or essential services. concerning the population to be served. The building standards requirement of 24 CFR 576.75. The requirements of 2-4 CFR 576.77. concerning assistance to the homeless. The requirements of 24 CFR 576.79, other appropriate provisions of 24 CFR Part 576, and other applicable Federal law concerning nondiscrimination and equal opportunity. The requirements of 24 CFR 576.80 concerning minimizing the displacement of persons, as a result of a project assisted with these funds. The requirements of 24 CFR 576.80 concerning the Uniform Relocation Assistance and Real Acquisition Policies Act of 1970. The requirement of the Cranston-Gonzalez National Affordable Housing Act (Public Law 101-625, November 28, 1990 contained in Section 832(e)(2)(C) that grantees develop and implement procedures the ensure the confidentiality of records pertaining to any individual provided family violence prevention or treatment services under any project assisted "under the Emergency Shelter Grant Program" will, except with written authorization of the person or persons responsible for the operation of such , not be made public." The requirement that local government will comply with the provisions of and regulations and procedures applicable under section 104(g) of the Housing and Community Development Act of 1974 with respect to the environmental review responsibilities under the National Environmental Policy Act of 1969 and related authorities, as specified in 24 CFR Part 58, and as applicable to activities of nonprofit organizations. The requirement that no Federal appropriated funds have been paid, by or on behalf of the local government or nonprofit organization, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal loan, the entering into of any cooperative agreement, and modification of any Federal contract, grant, loan or cooperative agreement. The requirement that if any funds, other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the local government or nonprofit organization shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The requirement of disclosure specified in Subpart C of 24 CFR Part 12 regarding assistance from other HUD-funded programs. The requirement that the local government or nonprofit organization shall require that the language of the PROHIBITION OF THE USE OF FEDERAL FUNDS FOR LOBBYING CERTIFICATION be included in the award documents for all standards at all tiers including subcontracts, subgrant, and contracts under Grant, loans, and cooperative agreements and that all subrecipients shall certify and disclose accordingly. The requirement that(68 Fed. Reg. 43430) agencies receiving funding from the Emergency Shelter Grant Program become compliant with Homeless Management Information System (HMIS) as required by the Department of Housing and Urban Development. The required certification that the submission of an application for any emergency Shelter grant is authorized under applicable law and that the local government or nonprofit organization possesses legal authority to carry out emergency Shelter grant activities in accordance with applicable law and regulations of the Department of Housing and Urban Development. }t^t tyt Q G it1ct4 President Name I Title + fit otf1 jfY 3.D A A 3/28/2011 Signature Date 16 CDOH PERFORMANCE MEASUREMENTS AND OUTCOMES All ESG proposals must comply with the CDOH Performance Measurements and Outcomes. I have read the performance and outcome measurements shown below and understand that these may differ from measurements required by HUD. (Please Use Drop Down Box) Yes Name: Krista Goddard Title: President Date:3/28/2011 Signature ht T- -r ' '.oVa Performance Measurements and Outcome Requirements Objective: Serve the lowest income and hardest to serve individuals and families meeting critical housing needs through state and federal initiatives by creating a suitable living environment or decent affordable housing. ESG ESG Funding • 1. End chronic homelessness and move homeless families and individuals into permanent housing. 2.Availability/accessibility for the purpose of creating suitable living environments. 3. Promote self-sufficiency, efficient use of funds and effective program administration. EErt.) • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • Recipient expended all ESG funds within the established grant timeframe. • Recipient met the deadline for submitting their signed grant agreement. • Recipient met the deadline for submitting evidentiary documents. • Recipient met the deadline for submitting performance reports. • Recipient meets required standards for documentation of homelessness. • Recipient complies with required record keeping methods. • Recipient complies with the due process of terminating ESG funded assistance of participant. • Amount of money leveraged. • Does recipient have findings from previous compliance reviews? I i 6€ • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • The total number of adults and children served on an annual basis (reported under Homeless Assistance Services). • The number of persons served by race and ethnicity. • Number of persons assisted with ESG funds for eviction notices. • Number of persons assisted with ESG funds for utility termination notices. • Number of persons assisted with ESG funds for security deposits and/or first month's rent. • The total number of adults and children served on an annual basis (reported under Homeless Prevention Services). • The number of persons served by race and ethnicity. • Number of homeless persons that received ESG funded services concerned with employment. • Number of homeless persons that received ESG funded services concerned with health. • Number of homeless persons that received ESG funded services concerned with substance abuse. • Number of homeless persons that received ESG funded services concerned with education. • Number of homeless persons that become successfully independent of ESG funded services. • Number of homeless persons that return to their prior living situation • The total number of adults and children served on an annual basis(reported under Homeless Assistance Services). • The number of persons served by race and ethnicity. 17 �yLA4URY DEPARTMENT OF THE TREASURY `%'c% a INTERNAL REVENUE SERVICE \ WASHINGTON, D.C. 20224 EVLH TAX EXEMPT AND GOVERNMENT ENTITIES DIVISION Date: Employer Identification Number APR - d 2D95 47-0919769 Person to Contact and ID Number: Ellen S. Berick (50-23902) Toll Free Contact Number: (877) 829-5500 Accounting Period Ending: Stepping Stones of Windsor December 31 503 Walnut Public Charity Status: Windsor, CO 80550 509(a)(1) & 170(b)(1)(A)(vi) Form 990 Required: Yes Effective Date of Exemption: May 13, 2003 Contribution Deductibility: Yes Advance Ruling Ending Date: December 31, 2007 Dear Applicant: We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. During your advance ruling period, you will be treated as a public charity. Your advance ruling period begins with the effective date of exemption and ends with the advance ruling ending date shown in the heading of this letter. Shortly before the end of your advance ruling period, we will send you Form 8734, Support Schedule for Advance Ruling Period. You will have 90 days after the end of your advance ruling period to return the completed form. We will review the information you provide and determine whether you have met the public support test. We will then notify you, in writing, about your public charity status. COPY OF YOUR MOST RECENT AUDIT *Stepping Stones has not had an audit. We are currently looking into obtaining one. 19 2011 ESG Scoring Sheet The Grant Review Committee will evaluate and score applications based upon the following criteria and/or assumptions. The review will be primarily internal, based on agency performance in meeting quality, effectiveness and timeliness standards: AGENCY N i rinne5 $ li inriSo _ APPLICATION# SCORIN CRITERIA FOR 2011 ESG GRANT PROGRAM APPLICATION Applicant is a qualified if"No"Agency is 501(e)(3)? es No DISQUALIFIED if"No"Agency is Application received on time? CieD No DISQUALIFIED 1.Location of Agency 20 points Located in(non-ESG Entitlement Area) Located in ESG entitlement Area (Adams,Aurora,Denver'or Colorado Springs) SCORE 20 points 5 points 2.Length of Time Agency has received ESG from the State of Colorado? 15 points More than Less than Less than Less than Less than 2 SCORE 10 Years 10 years, 6 years 3 years years but more but more but more than 5 years than 3 than 2 15 points 10 points 6 points 3 points 0 points 3.Applicant compliance or agency status with regard to Homeless Management Information Systems as reported by the Continuum of Care/CDH(or is exempt)? 15 points Complete& Accurately . Enters New Agency. accurate enters 11MIS HMIS,but Existing Start-up,or participatio info,but not has issues nonprofit Refuses • n in HMIS yet fully related to agency W/ Participatio . for IIUO implemented completenes equipment n,or needs programs a and and staff, equipment (or not accuracy but needs and training required.) trsining SCORE 15 points 10 points " 5 points - '1 points 0 wants 4.Applicant correctly filled out application,including all required attachments,certificates, `signatures, Ass.:No blank questions. Answered All required .: All forms Correct ' Neatness , SCORE (1 Pointeach) all ",;. signatures f Number,,'. ques ons r ,certificates of Copies;`. a submitted _ Check if 'f applies b.Applicant identifies and documents NEED for shelter and/or services 10 points - Applicant Applicant Some No other Low level of Applicant identifies an presents a unmet provider NEED does not urgent strong NEED exists in exists for prove the NEED for NEED for exists for region shelter or NEED shelter or shelter or shelter or services, services services services _ SCORE 10 points 8 points 6 points 4 points 2 points 0 points 6.Proposed Project Budget 10 Points Well- Budget At least No documented documented one eligible All items ;Most items eligible : requests are eligible, are eligible, and necessary, necessary& document & reasonable ed reasonable. category - SCORE 10 points 8 points 6 points Opoints 7.Match Requirement (Dollar for Dollar) 10 points Agency Agency meets 1 to 1 doesn't match meet match SCORE 10 points 0 points 8.Ability to Meet Insurance Requirements 5 points Agency Agency Agency Agency. Agency Agency currently currently currently meets few of does not lacks meets or meets or meets or the have insurance will meet all will meet has ability insurance financial and/or is insurance Parts 1, to meet requirement resources not requirement 2,3,5,&6 some to obtain insurable requirement insurance SCORE 5 points 4 points 3 points 2 points 1 point 0 points 9.How are.Agency Reports Submitted?(New agencies see substitute 9&10 below)5 points Always Overall Mostly Often late Neither No timely/ T&A T&A with T&A reports accurate errors submitted (T&A) SCORE 5 points *points 3 points 2 points 1 point O'points 10.Agency spent all dollars fromprevious year? 5 points Yes No,but No,didn't Asset Mgr spend all approved $ SCORE 5:points 3'pointe. . SUBTOTAL EXISTING AGENCIES: NEWAGENCIES: SUBSTITUTE THIS QUESTION FOR Q 9 AND 10 The following question will be substituted for Questions 9 and 10,for new applicants or those who did not receive 09-10 grant funding.APPLICATIONS WILL BE SCORED ON MANAGEMENT CAPACITY AS RATED BY THEIR ASSIGNED HOUSING DEVELOPMENT SPECIALIST AGENCY MANAGEMENT CAPACITY AS RATE BY HOUSING DEVELOPMENT SPECIALIST 10 Points Existing Existing Existing Existing New New program program program program, program nonprofit with with good some staff but lacks start-up excellent staff capacity capacity staff capacity capacity and track record 10 points 7 points 5 points 3 points 1 point 0 points SCORE SUBTOTAL POINTS NEW AGENCIES: Application for Colorado Division of Housing (CDOH) EMERGENCY SHELTER GRANT ASSISTANCE 2011 APPLICANT INFORMATION 1. APPLICANT 2. CDH Project Number For CDH Use only NAME: Catholic Charities and Community Services of the Archdiocese 3. Date Received of Denver. Inc. The Guadalupe Homeless Shelter of Weld County For CDH Use Only ADDRESS: 2500 Pt Avenue Bldg. CB 4. Current ESG Program Recipient? CITY: Greeley STATE: CO ZIP: 80631 CURRENT PRIOR NEVER 5. Name of Contact Person for Application 6. Phone: 7. FAX: 8. EMAIL: and Reports: (drop down box) Ms. Enita Kearns-Hout (970) 353-6433 (970) 353-3861 Ekearns-hout(Tccdenver.orq TYPE OF ORGANIZATION 9. Municipality/County: ❑ 10. Housing Authority: ❑ 11. Nonprofit Organization: Please attach 501 (c) (3) ruling. 12. Federal Identification Number: (Use drop down box) ----------— 18 Ett_I --- 1 0 1 6 18 _1 s l 6 1 7 1 9 I 13. Project Service Area: (List counties served)Weld 14. (A) How many years has your agency been in operation? 84 (B) How many years has your agency received ESG funding? 22 15. Population(s) Served (Check all that apply): ® Men ®Women ® Families ❑Youth 9 Domestic Violence ® Emergency - Maximum Capacity per Night: 38 (will increase 62 in FY 2011-12) to Maximum Stay: 4 Days or Months ❑ Day - Maximum Capacity: 0 Average Number of Clients Served per Day: 0 ❑ Transitional - Total Units: 0 Maximum Length of Stay: 0 Days 9 or Months 9 Average Stay: 0 Days 9 or Months 9 ® Homeless Prevention: - Number of Families and/or Individuals expected to Serve with ESG and Match Funds Each Year: 18 Arc you requesting NO16. Type and Characteristics of Programs for which ESG Assistance is Requested: • dollars for a new program in this request? SELECT ONE:If yes, program name: SIGNATURE OF AUTHORIZED OFFICIAL OR AGENCY REPRESENTATIVE 17. Name of Local Elected Official or Authorized 18. Title of Local Elected Official or Authorized Agency Representative: (drop down box) Representative: Mr. Stephen J Carattini Chief Operating Officer 119. Signature,Authorized Representative: 20. Dateg/z(Vi b m uLSd nti niaG eiceirie 'Jr.7 BUDGET Line item Expense: 21. Operations: T 22. Essential 23. Homeless 24. Administration Services: Prevention: Local gov't w sub Grant : Utilities $11,000 $0.00 $0.00 $0.00 Supplies $4,000 $0.00 $0.00 $0.00 Staff Operations $4,000 $0.00 $0.00 $0.00 Repairs and $1,000 $0.00 $0.00 $0.00 Maintenance Case Manager $0.00 $11,000 $0.00 $0.00 Rent/Mortgage $0.00 $0.00 $9,000 $0.00 Assistance $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25- SUBTOTAL $ 20,000.00 $ 11,000.00 $9,000.00 $ 0.00 26. TOTAL. REQUEST: $40,000 27. Match Source(s) and Amount: Name: The Catholic Foundation Amount:$40,000, (Additional Space on page 13) PROPOSED PROJECT BUDGET EXPLANATION AND DOCUMENTATION 28. Please provide an explanation of your proposed project budget and provide documentation of your need for requested categories of Operations, Staff Operations, Essential Services and Homeless Prevention. • The total projected project budget for Operations and Essential Services at the Guadalupe Shelter in Greeley is $525,776 for FY 2011-12. The Guadalupe Shelter will be moving to our new Guadalupe Center location in August 2011. Operations: • Utilities: Expenses required to operate the Guadalupe Shelter include heat,electricity,water,trash service and telephone service. The annual budget for utilities at the Guadalupe Shelter totals$31,600. This annual budget includes 80%of the utility costs at the new Guadalupe Center which will be occupied in August 2011. The request for$11,000 in ESG funding is to cover utility expenses. • Supplies: Expenses include food,janitorial supplies,kitchen supplies and other supplies required to operate the Guadalupe Shelter and to provide meals to the clients of the shelter. The annual budget for food and supplies at the Guadalupe Shelter totals$23,800. The supplies budget has increased due to our plans so serve additional meals at the new Guadalupe Shelter (breakfast, dinner and a health sack lunch) and an anticipated increase in the number of clients served (a maximum of 62 guests at our new shelter). We are requesting $4,000 in ESG funding to cover food and supplies expenses. • Staff Operations: Catholic Charities currently employs 2.7 FTE Overnight Staff who provide supervision and ensure the safety of all residents overnight. In addition, for the new shelter. we will be adding a 1 FTE Shelter Supervisor position which will oversee the shelter overnight, kitchen, and maintenance staff. We will also be adding an additional 1.5 FTE Overnight Staff for the operations of the new shelter. The annual salary and fringe benefits for these positions total $161,800. We are requesting $4,000 in ESG funding to cover the salary and fringe benefits for these positions. • Repairs & Maintenance: Expenses include repairs and maintenance to the new Guadalupe Shelter building,janitorial services, and repairs and maintenance to building equipment(kitchen appliances, heating system, etc.LAn additional maintenance expense that we have incurred has been spraying for bed bugs. We will be pro-active as we move into our new shelter to prevent any infestations. The annual budget for building and equipment repairs and maintenance at the new Guadalupe Shelter totals $9,500. We are requesting $1,000 in ESG funding to cover repairs and maintenance expenses. Essential Services: • Case Management: Catholic Charities currently employs a .5 FTE Case Manager who works with clients to develop a plan for transitioning into more permanent housing and who works with clients to prevent homelessness. Once we occupy our new shelter in August 2011, this position will be transitioned to 1 FTE to handle the anticipated increase in our client load. Case management services include individualized assessments of client needs and reasons for homelessness;informed resource and referral to services that help the client with life skills development,employment, housing, health and metal health needs; benefits assistance and self-and systems-advocacy. This Essential Service is necessary to help our clients to rise out of their crisis situation and into a more stable lifestyle. The annual salary and fringe benefits for this position total$47,200. We are requesting $11,000 in ESG funding to cover the salary and fringe benefits for this position. Homeless Prevention: Rent/Mortgage Assistance: Homeless prevention through the Emergency Assistance Program is another critical service that Catholic Charities provides in Weld County. Services include rent and mortgage assistance to individuals and families at immediate risk of losing their housing. During the last year,we were only able to fulfill 12%of the requests for emergency housing and utility assistance that came to our Weld County office. Our staff and volunteers are experienced in administering government and private grants and contracts and are trained on the eligibility requirements for each funding source. To ensure that clients meet HUD requirements for homeless prevention assistance,we require the client to show a demand for rent or an eviction notice from the landlord. We will also speak to the landlord to ensure that the Homeless Prevention payment will keep the tenant in the home for 30 days. We use the same process for the FEMA Emergency Food and Shelter Program (EFSP). The annual budget for our Emergency Assistance Program in Weld County is$306,820 with $41,000 devoted to rent/mortgage assistance. This budget includes an anticipated 40% reduction in FEMA EFSP funding. We are requesting$9,000 in ESG funding to cover rent/mortgage assistance. EXTENT AND URGENCY OF THE NEED 29. (A) What is the need to be addressed? How urgent is the need? Please provide local data or statistical information (waiting list, number of clients turned away, etc.) that supports the needs your agency will address. 2010 and the first few months of 2011 has brought no relief from either persistent poverty or the increasing number of individuals and families experiencing poverty. Data demonstrating this include: • Colorado's January,2011 unemployment rate rose to 9.1 percent.That is the highest rate on record since the Bureau of Labor Statistics began tracking state unemployment in the 1970s and the first time since the middle of the decade that Colorado's unemployment rate was higher than the national rate. 1 • Coloradans receiving food stamps increased by 6,000 people from the month before(December from November, 2010) , completing a quarter of particularly heavy growth. Overall, SNAP enrollment has increased 78 percent since the beginning of the 2007-09.2 • In the current fiscal year,total program enrollment in Medicaid and CHP+has grown by 35,000,or 6 percent. By contrast, the state population grew 0.9 percent.The combined caseload is growing six times as fast as the state population.3 • Colorado's five major food banks distributed more than 76 million pounds of food throughout the state last year,a 25 percent increase over the previous year.' Data demonstrating poverty in Weld County: • 37,848 Weld County children were enrolled in K-12 education.48.7 percent of them qualify for free or reduced-price lunch. • Currently the 2-1-1 Weld County database includes 1,600 resources. During 2010, more than 18,000 people dialed 2-1-1 for information and assistance. • Ninety percent of these needed help for rent and utilities payments, food assistance,disabilities services, senior basic needs issues, physical and mental health issues, unemployment or under-employment issues, lack of transportation,child care, veterans issues and homelessness. Increasing rates of poverty, little if any affordable housing,escalating unemployment, stagnant wages, rising foreclosures affecting renters and homeowners, unforeseen healthcare and disability expenses and increased food and utility costs are converging to force people, many for the first time,to seek the help of homeless service providers and other emergency services. In Colorado there is an increase number of working families who are requesting assistance. Colorado's low-income working families(200% of poverty level)are living closer to the edge than ever before. Fifty-two percent of homeless households with children reported one working adult in the last month, indicating that even with employment, homelessness is a very real threat to low-income families. The need for emergency shelter in Weld County often far exceeds the number of available beds. According to some estimates, Weld County has a homeless population of 2,500 to 3,000 annually, including single men, single women, and families with children.5 Current shelter capacity in the county is only 150 beds. In a survey conducted in May 2009, all shelters reported that their facilities were full and they had to turn away more homeless on a daily basis.6 Weld County is likely to experience more homelessness. ESG funds help us to serve the homeless population with food and shelter at full capacity 365 days a year. (II) Did you turn clients away in the last grant period of January 1, 2010 thru December 31, 2010? Yes If so how many, 111 primarily because of their criminal record as sexual offenders or because of illegal drug or alcohol use Where did they go. Those who are intoxicated are referred to North Range Behavioral Health—Detox facility ' Colorado Center on Law and Policy. March 11, 2011.hito.Rwww.cctponiir.e.orq puhlcarion library/pubrsingle.'923:colorado-recovery-watch-6 2 Ibid 3 Ibid ^The Denver Post.Report-Colorado Poverty Levels Rise, Colleen O'Connor.Posted'. 12/15,2010 I lartmann,J. (May 2009). Greeley'v Ilonreles.s Population Canting. Ibid. PROJECT PLAN 30 Describe your project plan to assist the target population as it directly relates to the need addressed in Line 29. Catholic Charities' Guadalupe Shelter provides emergency overnight shelter to homeless individuals and families with children. Guadalupe is the only shelter in Weld county that provides free emergency housing for all populations. For many it is the only place available to start re-integrating into the community from homelessness. The need for emergency shelter in Weld County often far exceeds the number of available beds. ESG funds help us to serve the homeless population with food and shelter at full capacity 365 days a year. Operations In response to community need, Catholic Charities(CC)is constructing a new 13,000 square foot, 3-story facility, the Guadalupe Community Assistance Center(the Center), which will centralize all Catholic Charities Weld County programs, improve accessibility for clients to receive services, and increase capacity to serve more people in need. The new Center will provide a safe,clean and welcoming environment to provide services efficiently and humanely. When the new Shelter opens in August, the CC will be extending it shelter hours from an opening time of 7 pm to opening at 5pm to better accommodate the needs of single women, families and children. Shelter services will include three meals, clean linens, shower and laundry facilities, hygiene products, computer resource room access, training provided by community partners, dedicated living room space on two floors and case management. Traditionally individuals stay at the shelter for up to two weeks and families a month, extensions available to those who are working hard to develop a self sufficiency plan. This concept will be more formalized by the utilization of the Levels Program that is new to Guadalupe but has proven effective at the Samaritan House in Denver and at the Mission in Larimer County. This 4 Levels program has specific expectations and timelines that enable residents to stay up to four months to accumulate savings for housing and develop a plan to move into sustainable housing. The first floor/lower level of the facility will include a dorm divided into six bedrooms for 24 homeless men. The third floor will include a dorm room for 6 single women and 6 family rooms that can accommodate up to 5 people each(or 6 if a crib is added) these bedrooms will provide flexible space to serve older adults, additional single women, or any other client with special needs. This floor has a designated Special Needs room where patients discharged from the hospital without housing arrangements,can covalence until safe housing can be found. Coordinating these services will be our shelter staff, North Colorado Medical Center social workers and volunteer health care professionals. This is a full accessible shelter that can serve the needs of homeless individuals with disabilities. Essential Services Unique to the Center are two resource rooms,one on the family floor and one on the floor for single men. The ten computers and technology support services are provided for by collaboration with the High Plains Library District. The computers will be available for classes, resume writing,job search and homework for the children or adults. CC has the most comprehensive non-government social service program in the County. Located on the first floor of the Center will be are the comprehensive individual, family and senior wrap-around services that support those who are low-income and at risk of experiencing homelessness, Homeless individuals as well as the general population of the community will have on-site case management, housing counseling, life skills classes, and job support services to provide them with the resources they need to stabilize, attain or keep their housing. On the main floor and reception floor is space dedicated to a community and training room,commercial kitchen, dinning room, Emergency Services and Directors offices. There will be space to accommodate service providers from other agencies such as food stamp technicians,mental health counselors and workforce development trainers, public health providers and tutors for children. This one-stop approach to service delivery in a community center model will be efficient to operate,welcoming to clients and conducive to greater collaboration among service providers. Through all programs we anticipate serving approximately 14% more clients in the new Center(from 4,400 to 5,000). The shelter will increase its capacity for nights of shelter by a maximum of 40% (from 38 to 59 beds and five cribs)and will be able to increase the number of clients served by 25D to 300 (from 520 to 770-820). Homeless Prevention: In addition to the community services listed above, there is a tremendous need in Weld County for rent/mortgage assistance that a prominent concern for Catholic Charities. With only being able to fulfill 12%of all rent requests in 2010, we are acutely aware that more needs to be done within our community to identify resources for our low-income residents. Our Regional Director is part of a 211 Regional Steering Committee looking for solutions for those who need rental and utilities assistance and can not be served with current support. PLAN FOR FINANCIAL STABILITY 31 l'rovide a plan for the future financial stability of the proposed project. (How will the program continue in the future if ESG funding is no longer provided?) Catholic Charities is committed to providing help and creating hope for the homeless through emergency shelter. case management and homeless prevention services. The programs have received support from a diverse mix of public and private sources including City of Greeley, FEMA-Emergency Food and Shelter Program, Energy Outreach Colorado, El Pomar Foundation, United Way of Weld County, the Daniels Fund in addition to individual, business and faith community donations which are also eligible for Enterprise Zone tax credits. Funding from the Colorado Division of Housing ESG is leveraged by these resources as well as our volunteer and in-kind support to create a positive impact on the community. Volunteers contribute hundreds of hours of their time each year cooking, delivering and serving meals in the shelter. The sustainability plan includes the continued solicitation of ongoing and new funding sources and donors, volunteer recruitment and solicitation of in-kind goods. The regional office's sustainability is supported by the development team located in the Denver office as well as the efforts of the Regional Director, who serves as the public face of Catholic Charities in Weld County and maintains and cultivates networks of partnerships with funders, other service providers and the community. While we make every effort to diversify and strengthen funding sources, funding provided by ESG is essential to our program. If Catholic Charities does not continue to receive ESG funds, we may have to reduce staff hours at the shelter or reduce the number of people receiving homeless prevention services. The agency's Community and Donor Relations Division will continue to research and solicit additional grants and other funding streams in order to avoid any cuts in service, but it is a reality we must have a plan for in the event of a funding shortfall. These strategies are the same for Operations, Essential Services, and Homeless Prevention. EXPERIENCE 32. Explain below any experience your organization or unit of local government has in implementing the activities that you have proposed in this application. Catholic Charities has been providing safety net services to the poor and marginalized in northern Colorado for over 35 years. The Mission has been in operation providing emergency shelter and supportive services to the homeless for over 20 years. The program has been administering ESG funds specifically for at least 11 years, and has administered other federal, state, county and municipal awards since it was established. The services at Guadalupe homeless shelter are modeled after Samaritan House, the largest homeless shelter program in the Rocky Mountain region, which Catholic Charities has successfully operated since 1986. Key staff administering ESG funds includes senior and leadership staff in the Larimer County Regional Office and accounting staff located at the Denver office. All staff have demonstrated experience and competence performing the work required of them to appropriately carry out ESG activities, track expenditures and report back on client impact and how dollars were spent. Key staff includes: Staffing: Enita Kearns-Rout, B.S.joined Catholic Charities as the Regional Director for Weld County in 2008. She has over 40 years experience working in the Human Services field as a direct service worker, supervisor and regional trainer. Ms. Kearns-Hout has worked for 10 years as a volunteer and board member on behalf of victims of domestic violence and A Woman's Place Shelter. For 40 years she has volunteered to fundraise to support the needy in the community. Ms. Kearns-Hout is responsible for managing the Emergency Assistance Program and overseeing all other Weld County Regional Office operations and administration. Jesus Flores has served as the Shelter Coordinator for Guadalupe Shelter for 8 years. He provides direct supervision of shelter staff, maintains the building, manages supplies and food. He develops relationships with community volunteers and donors and provides case management to clients. Jesus has two Bachelors degrees from the University of Colorado, one in Sociology and one in Spanish. Wanda Lehner has been on the shelter staff for over 5 years providing services and support to its residents. She is responsible for HMIS data entry and monthly reporting. She is Native American and a non-traditional college student. Kenneth Davis has been a shelter staff member for over 3 years. He provides services to clients and inputs data for HMIS • and central intake. Dan Walker, Grants Administrator, works out of the Denver office and serves as the Grants Administrator for all of the agency's shelter and community outreach programs as well as all the regional operations. He has worked for Catholic Charities for 8 years, starting at Samaritan House and then moving to the Finance Department. Dan provides financial oversight of agency budget and complete reporting for agency's public and private grants and contracts. He holds a BA in International Studies and a BS in Business Administration REPORT CHARACTERISTICS 2009-2010 ACTUAL UAI. From I 2010-2011 PROJECTED From HMIS? HMIJS? 33. Beds (including cribs) 38 I 38 34. Sleeping Rooms 5 5 35. Total Families Served 30 I 30 36.Total Persons in Families 80 80 37. Total Individuals Served 490 490 38.Total Nights 7753 7753 AVERAGE COST PER PERSON OR HOUSEHOLD SERVED WITH ESG FUNDING 39 What is the average cost per person served for each of your ESG-funded activities? Homeless Shelter: Because some clients stay 1 night and some stay up to 4 months it is difficult to calculate cost per client. An estimate based on 1,000 unduplicated individuals totals $525. (FY 2011-12) Homeless Erevention: $500 per householdEY 2011_12) -- ---- CLIENT PARTICIPATION REPORT 40. Client Paid Hours 0 41. Client Unpaid Hours 0 CONTINUUM OF CARE COORDINATION 42. Are ou a artici atin member of our local Continuum of Care ? YES_ SUPPORTIVE SERVICES Who provides the following services in your Do you have a written community? agreement to coordinate TYPE OF SERVICE (1) If it's your organization put an"X" in this services? Use the drop column beside the corresponding service; down box to (2) If it's another organization, please list their name 43. Information and Referral ® Organization Name 211 NA 44. Emergency ® Organization Name NA 45. Transitional Housing ❑ Greeley Transitional House, Room at the Inn No and North Range Behavioral Health 46. Permanent Housing(w/services) ❑ North range Behavioral Health, Connections No for Independent Living Greeley/Weld County Housing_Authority - 47_ Soup Kitchen Q Salvation Army No 48. Case Management ® Organization Name No 49.Transportation -❑Weld County Transportation No 50. Daycare ❑Weld County Department of Human Services _ No51. Medical treatment - I ❑ Sunrise Community Health Salud Family No Health Center-south county Weld County I Public Health 52. Substance Abuse Counseling f No ❑ North Range Behavioral Health - ---North Range No ------- ------ 53. Psychological Behavior Health 54. Employment ❑ Job services of Weld C County Labor Ready ' No Man Power Rocky Mountain SER 55 Life Skills/Budgeting In Consumer Counseling nunseling SerVicc No {+ 56_ Educational ❑ University of Northern Colorado Aims No College 57. Security Deposit • _ -- --� -- Z Organization Name 1-1PRP 58. Eviction Prevention --- -.- .. ® Organization Name i NA 59. Back Mortgage Payments i ❑ HPRP - No 60. Utility Assistance Payments x Organization Name I NA CONTINUUM OF CARE NARRATIVE 61. Explain how you coordinate homeless housing, essential services and homeless prevention activities with other local nonprofit agencies and governmental service providers to ensure coordinated case management, non-duplication of services AND access to mainstream resources such as TANF, Food Stamps, Housing Assistance, etc. within your community or Continuum of Care. Catholic Charities provides a continuum of care for the homeless and those at risk of becoming homeless. At Guadalupe clients receive not only emergency shelter and food, they can also access emergency financial assistance and case management that assists them in applying for housing, financial benefits and support in finding other resources. Catholic Charities is a founding member of the North Front Range Continuum of Care (COC). The COC, established in 1996, is made up of public and private agencies and faith communities in Weld and Larimer counties. The COC has provided Transitional Housing for families, Shelter Plus Care and three projects built addressing the needs of homeless with mental and physical disabilities. COO members meet quarterly to discuss coordination of case management, housing opportunities and strategies to overcome other barriers faced by the homeless we serve. As a result of these meetings there is a broad understanding of what each agency provides and what potential gaps in service exist. COC members support each other's applications and coordinate efforts to avoid duplication. Catholic Charities' Guadalupe Shelter fills an important service gap in the county as it is the only emergency shelter program serving all populations. The Catholic Charities Emergency Assistance Program is one of only two options for rental/mortgage assistance in Weld County that is public Funded. Faith Community Fund provide emergency assistance to working clients once in a lifetime. Other groups we participate in include the Furniture Bank, HESN, Interfaith Council, the Faith Community Outreach and Women to Women, a private emergency program for women only and once in a lifetime. Catholic Charities' Guadalupe Shelter and Emergency Assistance programs work with the following agencies to meet the needs of our clients in Weld County: • United Way 211 for referrals and services • Weld County Department of Human Services for referrals to food stamps, TANF, disability applications and birth certificates and child care services and list of licensed providers • Weld County Job Services for job placement, veteran's services,job searches, training programs and job fairs • Weld Food Bank for food baskets for clients related to all our programs • Salvation Army for meals for the hungry in the community, including breakfast and lunch during the week. • North Range Behavioral Health provides the PATH (Project in Assistance in Transitioning from Homelessness) staff that comes into the shelter and ongoing mental health services for single clients. NRBH also provides drug and alcohol abuse services. The New Guadalupe Center will have a interview space for counseling and group sessions at the Center. • Greeley Transitional Housing and Room at the Inn to help emergency shelter families move into transitional housing • Connections for Independent Living for additional services for those who are physically disabled • Weld/Greeley Housing Authority for Section 8 Vouchers and other forms of low-income housing • Consumer Credit counseling for budgeting and debt services • Colorado Legal Services for legal issues that are not criminal in nature • HPRP agencies (Catholic Charities is one of five agencies participating in Weld County)for referrals for back mortgage and rent, security deposits, and more intensive homeless prevention case • Weld County Public Health Department is considering providing services and classes at the New Center. • North Colorado Medical Center will provide collaborative services to the shelter and the hospital patients who are discharged to new Center/Shelter until a discharge plan can be made • High Plains Library District is providing ten computers to the new Shelter as well as printers. support services and client specific training FINANCIAL CAPACITY - 62 Explain your organization's financial control system and procedures, and explain how your agency will monitor its activities to ensure that ESG dollars are spent in a timely manner. Catholic Charities'long-term,proven fiscal management is evidenced through as consistent management of federal,state and local government contracts and successful OMB audits. CC's Accounting Department records all income and expense activities for the agency. Grants and contracts are administered within the framework of accrual-based accounting. Each year we benefit from an independent audit, including an OMB Circular A-133 version, conducted by Kundinger, McCutcheon, Corder&Engle, P.C. CC's full-time financial analyst is a compliance professional with many years of experience with reimbursement,draw-down and direct funding, and is adept with government and foundation reporting and ensuring that costs are allowable and acceptable. ABILITY TO COMPLY WITH HOMELESS MANAGEMENT INFORMATION SYSTEMS (HMIS) 63- When and where did your agency staff receive training on Homeless Management Information Systems (IIMIS)? Jesus Flores, Shelter Supervisor, and two shelter staff, Kenneth Davis and Wanda Lehner, received HMIS training from Beverly Cisse from Colorado Coalition for the Homeless at Catholic Charities' offices at 2500 First Ave, Bldg CB, Greeley, CO, 80631. Training took place in July 2008 and a follow-up training took place in September 2008. 64. List Computer(s) and printers that are/can be dedicated to HMIS: Models, Operating Systems, Storage Capacity Catholic Charities has a new Dell computer and HP laser jet printer dedicated to HMIS. 65. How do you ensure that client files are kept confidential? Client file confidentiality is assured through compliance with all HMIS and HIPA regulations. The client files for the HMIS system are locked in a fire and water proof file cabinet, and only trained and authorized staff have user accounts and passwords to access HMIS. No client information is released or shared without the client signing a release of information waiver. 66. Are you in compliance with HMIS? Please place an "X" in the box that best describes your current HMIS status. same ❑ I am a new applicant. ® My agency is entering all HUD-required HMIS data elements on a consistent basis. ❑ My agency is in discussions with my systems operator regarding my participation. We have not yet been trained on the HMIS system. ❑ My agency is a new State ESG Applicant, but we enter HMIS information for another Federal grant. ❑ My staff has been trained on HMIS, but I am waiting to upgrade equipment and or training before we fully participate. ❑ My agency is exempt from HMIS. • OTHER DOCUMENTS TO SUBMIT WITH ESG APPLICATION (See attached pages) ABILITY TO COMPLY WITH STATE'S INSURANCE REQUIREMENTS The State requires various insurance. Please use drop down box in each section indicating 'i I? if you have the required insurance or N0 if'you do not. You may provide an explanation after each section of challenges that you face. 1. -.The Contractor shall obtain, and maintain at all times during the term of the agreement, insurance in the following kinds and amounts: a. Workers Compensation Insurance as required by state statute and Employer's Liability Insurance covering all of the contractor's employees acting within the course and scope of their employment. YES l.a. Issues or Explanation: b. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalency, covering premises, operations, fire damage, independent contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability within minimum limits as follows: i. $1,000,000 each occurrence ii. $1,000,000 general aggregate; iii. $1,000,000 products and completed operations aggregate; and iv. $50,000 any one fire. YES 1.b. Issues or Explanation: c. Automobile Liability Insurance covering any auto (including owned, hired and non-owned autos)with a minimum limit as follows: $1,000,000 each accident combined single limit. YES 1-c.Issues or Explanation: 2. The State of Colorado is named(or will be named within 7 business days of the effective date of the contract)as additional insured on Commercial General Liability and Automobile Liability Insurance policies (leases and construction contracts will require the additional insured coverage for completed operations on endorsements CD 2010 11/85, CG 2037 or equivalent). Coverage required of the contract will be primary over any insurance or self-insurance program carried by the State of Colorado. YES 2. Issues or Explanation: 3. The Insurance includes(or will include within 7 business days of the effective date of the contract)provisions preventing cancellation or non-renewal without at least 45 days prior notice to the State by certified mail; YES :I. Issues or Explanation: • '1. The contractor will require all insurance policies in any way related to the contract, and secured and maintained by the contractor, to include clauses stating that each carrier will waive all rights of recovery under subrogation or otherwise, against the State of Colorado, its agencies, institutions, organizations, officers, agents, employees and volunteers. YES 1. Issues or Explanation: 5. All policies evidencing the insurance coverage required hereunder shall be insured by insurance companies satisfactory to the State. IYES 5. Issues or Explanation: E. The contractor shall provide certificates showing insurance coverage required by the contract to the State within 7 business days of the effective date of the contract. YES 6. Issues or Explanation: 7. Notwithstanding subsection "a'of this section, if the Contractor is a `public entity" agrees, within the meaning of die Colorado Government Immunity Act, CRS 24-10-101. et seq. as amended (Act"). the contractor shall at all times during the term of the contract maintain only such liability insurance by commercial policy or self-insurance, as is necessary to meet its liabilities under j the act and show proof of insurance upon request. ll-.a7 I>-te:.or Explanation'— MATCH CERTIFICATION SOURCES OF LOCAL MATCH Other Federal (including pass-through funds, e.g. City CDBG, County FEMA, etc.) NAME AMOUNT $0.00 $0.00 $0.00 State/Local Government Funding NAME AMOUNT $0.00 $0.00 $0.00 Private (including recipient) Funding Fund Raising/Cash (Catholic Foundation) $40,000.00 Loans $0.00 Building Value or Lease $0.00 Donated Goods $0.00 Donated Computers $0.00 New Staff Salaries $0.00 Volunteers ($5.00 per hour) $0.00 Volunteer Medical/Legal $0.00 Other (specify) $0.00 I certify that match funds have been identified and committed to support the proposed ESG project and have not been used to match previous ESG awards (i.e. the value of a donated building used as match in a 2009 award cannot be used as match in 2010). This form is a description of the sources and amounts of such match funds, which are not being used as match for any other federal program. _ Co Signature/Title Dale Additional Funds Documentation The list of all sources of additional funds not included as match to be used to carry out your proposed project. Be specific. Sources of Additional Funds Amount of Additional Funds United Way $26,750.00 Individual, Parish and Business Donations $13,000.00 FEMA-EFSP $12,000.00 Archbishop's Appeal $45,000.00 Private Grants $45,000.00 Enterprise Zone Donations $1,000.00 Total Additional Funds Committed to the ESG Process $142,750.00 Kit j ≥$.%. Weld County Housing Authority P.O. Box 130 Greeley,CO 80632 970 353-7437 COLORADO CERTIFICATION OF LOCAL APPROVAL BY LOCAL BOARD OF COMMISSIONERS FOR NON-PROFIT ORGANIZATIONS I Barbara Kirkmever, Chair, duly authorized to act on behalf of Weld County hereby approve the following project(s) proposed by Catholic Charities and Community Services of the Archdiocese of Denver, Inc.,Weld County Regional Office,which is located in Weld County. ATTEST: 1' �.a B Clerk to the Board ;y, Barbara Kirkme r, Chair •e" _t}O ' Board of County Commissioners By: _it//,L s,#J..�, J vL( %? 1 Weld County, Colorado au• D putt'Clerk o the Board ,r 1, ♦o 13 $' Date: 3 %,3,0/1C// Certification of Consistency with Consolidated Plan I Rebecca L. Safarik, Community Development Director certify that Catholic Charities and Community Services of the Archdiocese of Denver, Inc., Weld County Regional Office located in the City of Greeley is consistent with the Consolidated Plan for the City of Greeley �e 7/ Rebecca L. Safarik Community Developm Director Date of Certification MAR 3 1 2011 EMERGENCY SHELTER GRANT PROGRAM ASSURANCES AND CERTIFICATIONS Stephen Carattini Chief Operating Officer of Catholic Charities and Community Services aof the Archdiocese of Denver which is applying to the State of Colorado for funding through the Emergency Shelter Grant Program from the U.S. Department of Housing and Urban Development (HUD), hereby assures and certifies that: Amounts awarded under this program will be used only for these purposes: 1. Assist in the prevention of homelessness. 2. Assist in supporting the essential operating costs of s. 3. Assist in improving the quality of supportive services to the homeless. Projects will not require participation in religious services, as a condition for receiving assistance. All projects funded will develop and administer, in good faith, a policy designed to ensure the is free from the illegal use, possession or distribution of DRUGS and ALCOHOL,by its beneficiaries. Political activities will be prohibited in accordance with subsection 675 (e) of the Community Services Block Grant Act of 1981. The town, city, county or nonprofit organization certifies that matching supplemental funds required by the regulations at 24 CFR 576.71 and 576.85(a)(3), as mentioned by the amendments to Items 415(a) and 415(c) of the Stewart B. McKinney Homeless Assistance Act made by Section 832(e) of the Cranston-Gonzalez National Affordable Housing Act of 1990 (Public Law 101-625, November 28, 1990) will be provided. The amendment exempts the first $100,000 from the matching requirement and requires that the benefit of the $100,000 exemption be provided to those recipients from the State that are least capable of providing the matching funds. The requirements of 24 CFR 576.21(a)(4)(ii) which provide that the funding of homeless prevention activities for families that have received eviction notices or notices of termination of utility services meet the following standards: (A) that the inability of the family to make the required payments must be the result of a sudden reduction in income; (B) that the assistance must be necessary to avoid eviction of the family or termination of the services to the family; (C) that there must be a reasonable prospect that the family will be able to resume payments within a reasonable period of time; (D) that the assistance must not supplant funding for preexisting homeless prevention activities from any other source; (E) occur a week before eviction, foreclosure or termination. The requirements of 24 CFR 576.51(h)(2)(iii) concerning that submission by nonprofit organizations applying for funding of a certification of approval of the proposed project(s) from the unit of local government in which the proposed project is located. The requirements of 24 CFR 576.51(b)(2)(v) concerning the funding of emergency in hotels or motels or commercial facilities providing transient housing. The requirements of 24 CFR576.56(a)(3) concerning the provision of termination and/or grievance procedures for an individual or family who violates program requirements. The requirement of 24 CFR576.56(b) concerning the involvement of homeless individuals and families in providing work or services pertaining to policy-making and in operations of facilities or activities assisted under this part. The requirement of 24 CFR576.5 7 concerning the prohibition of conflict of interest or financial interest en decision-making by elected officials. appointed officials_ staff or board of directors except as may be grimed no IIl I) as provided in 570.611(d)_ The requirements of' 21 CFR .i56.-,1 concerning the i(n•,tinued use of buildings for which Vinerrency Grant funds are used for rehabilitation or conversion of buildings for use of emergency s for the honu'less; or when funds are used solely for operating costs or essential services. concerning the population to he served. The building standards requirement of 2-I CFR 576.75. The requirements of 24 CFR 576 7 7, concerning assi lance to the homele_-3- The requirements of 24 CFR 576.79. other appropriate provisions of 2I CFR Part 576, and other applicable Federal law concerning nondiscrimination and equal opportunity. The requirements of 24 CFR 576.80 concerning minimizing the displacement of persons, as a result of a project assisted with these funds. The requirements of 24 CFR 576.80 concerning the Uniform Relocation Assistance and Real Acquisition Policies Act of 1970. The requirement of the Cranston-Gonzalez National Affordable Housing Act (Public Law 101-625, November 28, 1990 contained in Section 832(e)(2)(C) that grantees develop and implement procedures the ensure the confidentiality of records pertaining to any individual provided family violence prevention or treatment services under any project assisted "under the Emergency Shelter Grant Program" will, except with written authorization of the person or persons responsible for the operation of such , not be made public." The requirement that local government will comply with the provisions of and regulations and procedures applicable under section 104(g) of the Housing and Community Development Act of 1974 with respect to the environmental review responsibilities under the National Environmental Policy Act of 1969 and related authorities, as specified in 24 CFR Part 58, and as applicable to activities of nonprofit organizations. The requirement that no Federal appropriated funds have been paid, by or on behalf of the local government or nonprofit organization, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal loan, the entering into of any cooperative agreement, and modification of any Federal contract, grant, loan or cooperative agreement. The requirement that if any funds, other than Federal appropriated funds have been paid or will he paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the local government or nonprofit organization shall complete and submit Standard Form-LIAlJ, "Disclosure Form to Report Lobbying," in accordance with its instructions. The requirement of disclosure specified in Subpart C of 24 CFR Part 12 regarding assistance from other HUD-funded programs. The requirement that the local government or nonprofit organization shall require that the language of the PROHIBITION OF THE USE OF FEDERAL FUNDS FOR LOBBYING CERTIFICATION be included in the award documents for all standards at all tiers including subcontracts, subgrant, and contracts under Grant, loans, and cooperative agreements and that all subrecipients shall certify and disclose accordingly. The requirement that (68 Fed. Reg. 43430) agencies receiving funding from the Emergency Shelter Grant Program become compliant with Homeless Management Information System (HMIS) as required by the Department of Housing and Urban Development. The required certification that the submission of an application for any emergency Shelter grant is authorized under applicable law and that the local government or nonprofit organization possesses legal authority to carry out emergency Shelter grant activities in accordance with applicable law and regulations of the Department of Housing and Urban Development. Stephen Caratiini _-. Chief Operating Officer Nano Title CDOH PERFORMANCE MEASUREMENTS AND OUTCOMES All ESC: proposals must comply with the CDOH Performance Measurements anti Outcomes. I have read the performance and outcome mea.;uremunts shown below and understand that these may differ from measurements required by IIUD (Please Use Drop Down Box) YES Name: Stephen J Car ttini Title: Chief Operating Officer Date: s.77.267/7 Signature Performance Measurements and Outcome Requirements Objective: Serve the lowest income and hardest to serve individuals and families meeting critical housing needs through state and federal initiatives by creating a suitable living environment or decent affordable housing. Funding Source: ESG Activity: ESG Funding Objectives/Outcomes: 1. End chronic homelessness and move homeless families and individuals into permanent housing. 2.Availability/accessibility for the purpose of creating suitable living environments. 3. Promote self-sufficiency, efficient use of funds and effective program administration. CDOH Performance Measures/Indicators (Applies to all ESG funded projects): • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • Recipient expended all ESG funds within the established grant timeframe. • Recipient met the deadline for submitting their signed grant agreement. • Recipient met the deadline for submitting evidentiary documents. • Recipient met the deadline for submitting performance reports. • Recipient meets required standards for documentation of homelessness. • Recipient complies with required record keeping methods. • Recipient complies with the due process of terminating ESG funded assistance of participant. • Amount of money leveraged. • Does recipient have findings from previous compliance reviews? CI)OH Performance Measures/Indicators specific to ESG-Funded and Transitional Housing: • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • The total number of adults and children served on an annual basis (reported under Homeless Assistance Services). • The number of persons served by race and ethnicity. CDOH Performance Measures/Indicators specific to ESG-Funded Homeless Prevention: • Number of persons assisted with ESG funds for eviction notices. • Number of persons assisted with ESG funds for utility termination notices. • Number of persons assisted with ESG funds for security deposits and/or first month's rent. • The total number of adults and children served on an annual basis (reported under Homeless Prevention Services). • The number of persons served by race and ethnicity. CDOH Performance Measures/Indicators specific to ESG-Funded Essential Services: • Number of homeless persons that received ESG funded services concerned with employment. • Number of homeless persons that received ESG funded services concerned with health. • Number of homeless persons that received ESG funded services concerned with substance abuse. • Number of homeless persons that received h:S(.1 funded services concerned with education • Number of homeless persons that become successfully independent of ESG funded services- • Number of homeless persons that return to their prior living situation • The total number of adults and children served on an annual basis ‘reported under I lomelrss Assistance Services). • The number of persons served by race and et bi:o:ity. COPY OF YOUR 501 (c)(3) Ruling s Revevue Seervite a eeire3eit ef the Treasury itat•mna P,O. Sox 2508 Cincinnatii, OH 45201 Person to Contact: • Date: July 12, 2010 Roger Meyer Toll Free Telephone Humber: 877-829-5500 United States Conference of Catholic E:rap!oYer Identification Number: 53-0196617 Bishops 3211 4th Street, NE Group Exemption Number: Washington, DC 20017-1194 0928 Dear Sir/Madam: This responds to your July 9, 2010, request for information regarding the status of your group tax exemption. Our records indicate that you wereued a me tax un rch 1946, that der section 501(c)(3) determination Maof the Internal you arecurrently exempt from federal nco On Revenue Code, and are not a private foundation within the meaning ea i c i(i) 509(a) of the Code because you are described ie sections 509(a)(1) d l (b)(1 e With your request, you provided a copy of the Official Catholic Directory for 2010, which includes the names and addresses i4usfi�ti ie nstitutions operates ed by instrumentalities e Roman Catholic educational, charitable, and 9 Church in the United States, t�s tax exemption.emption.ries, and possessions Your request h nd{catedbhatleach organizations under your group that no part of the net earnings subordinate organization is a non-profit organization, r thereof inures to the b nefit of any of legislation.vldual, and that no You have further represented tantial part that none of your activities is for promotion subordinate organizations is a private foundation under section 509(a), although ail ased subordinates do not all share the brdinete organizationsn the Official C tool c)lJr�reclory on your representations, the subordinate for 2010 are recognized as exempt under section 501(c)(3)of the Code under GEN 0928. deduct contributions to you and your subordinate organizations as provided Donors may Bequests, legacies, devises, transfers, or gifts to them or in section 170 of the Code. Beq„. .�..,, 9 t � yes if they meet the for their use are deductible for federal estate and rifts tax pulpo� applicable provisions of section 2055, 2106, and 2522 of the Code.ve Subordinate organizations 11nCe7Qt5r 1'SF2rt}'nOtptionS2p8 ate!ydo TlistEdlirl Publication l 78 exemption ,otters. Most subordinate organizations 7-.0 Business Master File. Donors may verify that a subordinate organization is included in your group exemption by consulting n`�y contacting you ectly IRS does Catholic dirnot verify irectoty,the `al subordinate listing approved by you, the inclusion of subordinate organizations under your group exemption. See IRS Publication 4573, Group Exemption, for additional information about group exemptions. Each subordinate organization covered inra groups eEIxemption the should oldthave central swn EIN. Each subordinate organization must use organization, in all filings with IRS. If you have any questions, please call us at the telephone number shown in the heading of this letter. Siwerely, _ Cindy Thomas Manager, Exempt Organizations Determinations o ALAIBh:MA4GOLORADO"ARIZONA"MAIINE TEXAS41TAH•ALASKA-rh 0 IONWA.°LOUT SIANA. W[SGJ!'ISI N•'TENNESSEE aIDAHO a z r, -el, 4al ' L 9.�1 � �) vi 1. 1 ,)). Z l`i-I zcry 1817 , 2010 - r, Ic .: t, ..„ yip_ ui *:- t rd. ,.i .,. Lanitrt ifir ., . 0 0 11 I‘Ct , 111Clart „. cfl ,,,, ,,, . f 1 Z 0 74 7 a CI atb gtii i . On (7"; (-) \--/C-- t, t: kit X \ U ® ., 0 ri , uo + '': -art f t t a .,:, 0 � iITe a z z z1TtIITI 2010 Published Annually by =, m Prm IC li2 . BLAND"MONTANA' Si c� . 11eDIkNA OKLAHOMA- RHODE i� U HAWAII-WASHINGTON"VI GINIA•VERMONT-WYOMING'OHIO' f11'CIhd1C1^,F15 : at II!; .,fiver A.rl,hllursis Dumomnsis Mast Rev:erenJ CI IAcO.L5 J.ClAPI Ci'.D F.h4.Car.,I).0. ..:7, J ,I /'c. L90, iel I 1 „Jul 1,,I IH6. PE" -J$elmpor Rapti Coy I./ ,l ii, 191811: app •.,1 •,chlashol .d • penv, l.i,y ,:' I l:n'+rr R:Cl,,'cop lit.]93]. Estr.111.1Stortn n v 1'640,154 :lu'F!di yp Stroud Mite:4011 1 p[pCq 9sJ/: Diocese August.318 lid? created nn hi 6,1“. _' K'k'q R.... N I loer l 111 3 come Must Reverend p i ludi 'tt)e 9^n northern t e: (wn ?.AHa npfh Idol P tell,rt L k D !F yl C Logan,d ]isho of (craw;; DD S_ll J k J t lmxd'my R bP f Ucnve- dm d M y]tl, 1985', �„1.1' Mlpi l M end. arhw'i ffeI(' NI . R nn appoo of Auxiliary Bishop of Denver and 112006 EPtular .. - SrAyw-fr Sum ( WPhiashington,Perkin,Weld d nco m Bishop of Casio,April ID,2008:ordained May 30, parishes and mrhd- tulhi Yuma For legal titles d P r ��` =� fora,consult the Chrmecry_ Postorul CC Ier: 1!110 S.Steele Si.,U,nner,CO 80210. Tel 31.13-722-4a87,Fru:30:3.115-2941. We!'ww,onrdules org I u:rhden Entail dcrOurrhdrn org STATISTICAL,f1VEHv1EW 6675 4 '114991 Slnl t .... L Perpo (' ll 1 Hospitals l 296,114 Elementary School:.Y v:m SOU 1 Total Ca ae -- 4 'Mail Students. Abb el1 Archbishops P " -' - 1 }1 alll 4 Centers 'Lit,1'20 Non-n•votl list Schools 1. 1 lice 12,.Lled HS Pi me Auxiliary Bishop,.A. • • ... I Iota l : C in ('-Total A l Students Education Ar t 140 Dolma theArrl 41 _ Itcl Irio t.nuc At n -._" it II il-Cl Scheel Student:. 4,257 Outside roomer n 1tln s>uu Priests-.Diocesan ick n,: 1 n 6 L tote•. ;314 Elementary Student;1 I. M '. - - - ,1 Ire L'0 ht Instruction 1'nJ D 51 ILIA.. t - 1'NI Students 168 Sµ Total A d to l u.- 'Duchene i, N Diocese: 6 23,31. 1'nsl. Reared,5"cy Al enL ... Nvtul l Diocesan florets 103 {'L I i t d 1 A 10 Print' . ... :9 Priests rl rcr a - l Ce u f Sn LJ Scn icee 1J Priests. 29 Itli pp '291 1 91912 Biomes'legal Y u rat P!' Tb l A .t+l .. 3Teethe" .. 94.1 Extern Y t U zm .. SrJ t C: ❑ dI d. L1,Transitio>+d,n t 4 ]03 Vtal Strati t . 4 1 t.l A -steel 34 Receptions t OctCho¢h: 111,510 Diocesan Priests "-'- (IlhcrltttiWho Institutions 1:1.)4! 9 Infant Sapu Totals oil Ym cnt DeaconsPCIllallent r 190 'total Assisted Minor Baptism'Ratak x24 Deacon: n n m c is b i t . ➢ 2 Adult Bapti Thuile •• 498 Total Brothers.... 272 Se .'-' f2 Received Full Communion , 7494 'total Sisters Students- from'flits Diocese 39 First Caw f:450 Students firma U0 Diocese. .- 9 Fist Comums th hest _ ,,_,,,.. ]l9 IDwesan Students in Other Rem ineince 73 MCa ilinpn 1 IIPJ Pn ) s - Total Seminarians - - "' '- 2 Catholic 311 With Resident t i sts 116 and Universities.... .. Intel Interfaith ... Resident--- P [ """' 24 `Total c0•Students 15041 1.111 ResidentReligion,r .-....' 24 nigh Schools, - .. 2 mbta1M P ' . ?(119 M "' 1 nigh Schools Diocesan and Parish. - 9,Jt Bead's _. 133809 New i Parishes Ministry d "" 'l'etd Stride la - -' 5 Total Catholic Population 2142613 }td Sisters. Ministry Persmn..l: 72 111214 t Students Schools.Private...... .. ... 3.019 Total Population -"RanBrothers............... . . ... 2]2 iomi, tary Schools, ...Mond 37 Suers.... ... . .... - Elementary Schuolc,Uim+aura and Mond,Welfare If died 1 Y (h 11 —1 VIIANtI hI Nn JCL. P hh ho of F ! ,o,rd Dr V t 1 4xv 1V e1N For lm, lh0:119, M t Revs. Jou'orl Else l f 14, 1991 I v > Au g . q ', Chief UP__ Ue✓II n.Ho .+ lIpi hanit Il D l of been" ofd. Dee 1 195e: can 1 i Y IL Erb 9 4] I U Stream l of j yt i i n& - IN'. J. ('.f NYI" 1 8.714 and Vitae Apostolic,L t I d T l' 1'"? PI \"' 11 I'F ei rb Y " Utah, se 1 9' -t P'sl ) of P. Melniiide duly .I, 1 9f OEM C{ I]ll.,Pt•'- rns died o D v 1Nani rre su t1RY] 4Tetart installed o 1414 I9F Denver 'rot"l . n, tie &ati c ThulwP MMI Itcr'. Jee-" n (.t T 95., 188 Titular Bishop of!Anvil, U1 n J l]l r Hon laird t Mons hug DD SIC 11419iLdie of eg 0, an 1 e Pontifical C Feb 21, 92. Vested R manes from Deunery to P t 01c l Lr 1 i succeeded L the Sc.H of a tp, 1e VJfr or l J t I L 1' u Revs. Snorrina F. 4 19of .1. Senor Taira., 1 n Pastoral Ca/On-1300- I.. S.. Deaner. Council—Very l 149'. died Out, .7 hny of 1 incoU..Ta1 7I6 3L 1`2D<1 KEVIN 1 AUUUs r+ V.F.-DANIEL 1 914.1 I \r: April 24 } Y( 0 i A>r D Ill_ 47near. . .IACTh M. 11 1 .0 VS.,Cl,rn?C AN I F 1 ' L.nsf to Se of Dunce:, SeptS + 11. 2 - i. r Ju S: IU1V u]As 8 antII Jul) m. 1911; 1 r UI_s ] 1 I '3 jce ncr,�l F: P]b'.It} ❑. F¢trlt \}; 1 9 ,GE _:ell,ar 911 I 1 ,: '_1 1hneur 1 Datong V> Teams ii 1 Ceereams,2 r 4 .n�n E ie.ig.til. Yul, - 11, ! rI _ F. e. 1I 1 I t +m. t yl . . .. ;.L n. __ (..KC❑ULIC CITl IICCIi IN THE 121. .`+ C r ) I1 NI ' 9) I 11 .'sic:. ff 1 r LF i - 1r, -L tin J Sitters, Hostel Oue 11 v Ill Haden - -.,19.3. C: 1,h. Health fat is I hi 1 311. I dssiatrJh iityNaming Hum . I b l Pp I t of the S '-.1 li l) of J 'n antiCollins, RIA24 I 1 9711404.50ltr liar Ili c4 lied Cxpauly 100 ld ss is 1411. D Ili., Il oar: Ministry, low. 0259. Homeless Sheller '1'nml Assisted 17E. Ma9 (Wheaton, ) ai Unita 12 ; Catholic Charities Weld Regional Office, 25)X1 11. InI INDEPENDENT DElAvilg 2101; R sid. family 1il Stilt liouxin: Ave.,Bldg.CB,Creaky,80831.Tel:970-253-0433; Rmriiie-Villa?Inc. (5992) Fox:910.363-3651- Emergency Assistance.Senior IJ)IFfDE:'ENDFNo AND ASSISTED LIVING Dc 80211..lp 1' Lm -1063; .Fax W. .415 Ava., -AddrIT;Nyex. Gardens at Si. Elizabeth (LOGO) Mailing Tao 303<SS506(t, Far 3¢I-ln5-P9G'u. Services, Case Mervgcarenq Immigration Su Eng1 : ,80 IDva 2635 I 32nd Ave., Ste. SOD, Sumo M. Milberg, Cledrnersen. Ttl Assisted VIC es 3 3. 4'S1 301]2. ' W. -99 . Er Toll Catholic Cllnritiu Guadalupe Shelter,1518 N.75th 4n;'ll iillXrlft:i4. Ave.,Grn:luy,801131.3421:970.363-3720. Fl nrnelery 403�NO+�fi103; F'aa. 303104919X. FuWnh Fin -. hall I - ❑nnJ G41f 0 .1 St., Shelter wewar,Lurd+di)- Heu.wx- 8021 I I:303-433-6763,F 3932 359.Web:antiw4 hChap. ❑ Ada aSrc wwwwII IIh C. Fa Si Clhal,.Charities N f Slope(V INM( rn,I C1 d Sl : 81061 Ill I711.140.20614 (H S l Jae Loath,le p-Kris.. pall I Contact D 1 W f G II)Sacred 19 is d Jesus andilliim cily, t. and Sisters fort Fn - fColorado Springs S, yi II). H Mni.A.o and 1 970-945d2985. I 1 't (HS/m us 1 ( I I d. t (Men y ( I. ,. II Units :4:1 I:lal Si.II Catholic Charities n Family l loosing C_ t 1981 }A ) L I f fGtl eott inslth IA I d. t:41 Potomac 101112.Te 19;Assist.' Colorado 1 affiliate ( Catholic M 1 2 LU t i' Inc., Iwx Perna St.,Ste..!, 30101119 1 041 4 t..:103.387-2431. Servant Adams al A Initiatives), Sisters( I 11 _nd l twine IID211 Id 5101Ilul-0 1 1 WIT 9' Iluo &Arapahoe enmities. Itle;A alhiving la 9 1 629 W U" Cl l uu. 1 I 1 Ara ho I II 1 - A -ua /_Ilse ll f. /li3l n 7 Nh) os IR - 5l Av4 11 h - t .I Ii ll l xes b i 1 f 1 r f 1 %neared r (en( IJU W Dyers I I St..A 110223.111 1Ma y Tel: 014'1.1 991 l IRO- 1194. 303.9n-52115;bor.3113-V42.0040. 0 I Denver 1:�n1- ad rCaliltl L Oh W. . riSr� (1 ISI ' (ll 'total ail lS Mary ,Paul M Xle S 1 e 1 /111111111.: ❑_ Ralph y R Joll'enue Counties. y I:.0 W '1tStoll1 Si Assisted ie l III P rr 0 -Tani Merry Holly 2 least 303-A30.3,100; 03- X.19.1'9 Dr`,,l Y 111111) n0 0114[ 14 f 1111.Cons t Afl(nde,16, Cr: I3thlit Ave.,utritiee 80204 3 L 303 X921(40. Aparuoi ity 18;'I l al F R i'}'to L ynndr ll Imo. I or ' 70; Inrp,fcrm GI R 1 s nt I I, 1 singles 1 I' :'I Ileac /c, Catholic CA l Sr. J 1 h Coop N'2f. ANn 11 L-LR'd CIA n do 1 I 140, 1't l Stall 3, burl A. : xl } tunyly St 80216.11*303 022 41,1-.s /4111:111,111$1 Assisted ',Janie, ; ' 1 u''. t' a Hd., 301299 1191x1. 'It. I'l1-.( n 111 1Po Snc 011112 GI 1 .-N 1 f !lousing (' pin awl see .1014130,l;, IG'r' 1f Golly Pork 11111101 19911 h 1 Y tfi -L. t W L- W A JUN 1 JIl X10- iron,AGII 11 ( L II Fart 1 Il nOSCI. Lm. 1 un 1111,11 XII 1 'I r all I 1 front Tub 910-4M 010 Small: ('('r -1 _2 1,W`h' ww y t. 'I- 211. rhlh, lair. Arnnm 3111 Sflvdnbl ulr u• t.Charily of SI W ne I IP_ (I is LI, II, l 1 'mu1 Shill' ' '151,3 wwweCatholic I . 11 DI A1G pr,1.011: Ac.:., AlIto... 1 A Il r 11 1 I f S I I I A 1 A II S n 1111.11 FCC Greeley,NI.C31 p.f ))p.340 11HN T1 et I , IY SSA gt 1 Pouf L N I 11 11 _ FCC. 111 .- 1 Hoer Plus. Mn I be) F1 S. 827 S P0'll fl lUfov II 4 :-15,- f / ' : Ilru I F 11 %DXI Far Sie03 t..7 1x1 1 'linty 1 ALL. 11919) 1300 5 Shad SL 812111 I'4 1111-71. Catholic t le µ0V 1I Tl a. I Pal I flat, IP II Ash StU 611 Lnt I S:L.ays UII IC I3' . L 1. 1114E .3114154III. Independent!S j)6� real176 MC1LF remml/Mn.S 1'.,Din Illd nas:anl Ily 1'151 IShillJ Will SI.r1 A t L II)Ifi 111111 y. Wu rMINa9 NM. Mire or Assiti !hers VYlestrainaler SL,. 10110,81)10) 1 1 30183-3100 Fax:191.891- IN]MONASTERIES AND RESIDENCES S OF 1101: LIl dnllrh f 1 with chronic I IS15 IES ND ROP1111N Ira. (1930)4621 W. N 1 L,r8ate).3. 'III sing a.'b r Ir 4406; 3034629271 1< I r t l Housing "Jmentalillness. Units F -H Ic t 11. il)s\Xu. Cs I Li' I + ra I MIA e . y for CW•lY u:d J'\bled, fotul (ml-Nuvi Villas 1 sow.' It I :. Fl ual/ 11999) lRIS Wy 1 L SL 90)112111 I I Ill. 1 Apartment%8'G 9htn1 Staff L. Address: 4045 Poem St SL A RUIl 301 4775136 1 , 82112!0 Wl' Villa M Inc. (1994) 9461 W. Rod NI, M. 1 ad Dr 419 1111,11 I n i b , ' www.midanicaps.org.1 N Revs. Charles L. I d lk, F,lloumne 'Pal.30.4 117 4404 Flo d d12597.. fen-families. - 0F.M.( I 1 : I M John r Inglis, Housing d 1;Bit for 8Murll and disabled. '111x11 Assisted 40{'112.9 942,14 f,. IMI C.A 11109,10 CNAIVIT'ICSb COMMUNITY CES OFM.(. I (wVa1nic,t ocation y Dr.6 A-chia.; Blaine p 1!Si (RI. JIa SPECIAL TRANSITIONAL IaiNAL lIOVSING UVN fX 011.111U1111 Cl 1 and Community S einiacu France f A Friary, 3559 Wy nl t St, 13sNBro Iay,l 01 l'1 Mailing Decatur 103'1 /2 Archdiocese of 1 4041 i 7'St 8091.Irr s Tel: es 84],'' c: Fax:30nl 1'-6925. Le) 11. It 'd.r N 112'1 SLaF2 In I( Revs I I' I n in Broadway,Y tl1900 809112.Il Dec M1 St.,fl020•I. 1111211 1 1'. 303-742-0878f I 1111 Int-11771. Ul h• f F Pn ( 1 Min nk(% N' ' 'I'p 3U9R161J0waseraercyltausirr Fu: to Shaman, Web: I L ' f Royce, ti Welt: .-O e. Slain:, . kC Provi p. -Who Hen, Y C, Arian e 1 - ' f 11 met a 1 ti. ie Shutters' Nina,Ue rke V P t' CTt s Coarse,-r m t 1r L1 )m ill t for Ithyndividual Homeless,I Emergency A r S'.- ohM.C I: Matthew f (9 l M(no- 'livid V s E r braising program leer l ) I 1' peal v Fly _ icy C, t li Y Mat Gottschalk, Il i'.M I M'h 1 S 'I Sus Denver 89x01 2844 I IS S S O F.M( p S Gallagher, ()KOROT Sacred limn Ilse ( Si' oll I Father Cl ml Anon' Priory, 3554 I1 1 Idt St. 191,20 d91(I. I umv., Exec Tel.ll301.196-030i, usis'I u n y,1 e r III L A Soil._ 11..Care r X Tel:303.212-5110;I M0.292-9140 Postulants $9C L9U1. Web. s II U Y M.. J t 1 I, elm S Canters for ti mid Suv cesO I M I. Mortar, 1 D . Fl :' t and f r A IM(1,(2 Sp,,,,,i,,1 . 5. In R Revs. ( F .k Ir thers I hla and f ' 04. 1L ,1C 13'. L 1084;'' 11 tU Lbw'WI I:nrd 1 lI (11 MC I 1 .. I Halls 11 0;l. Women and (I II- :assist tl l Charities r l S WI.' • IIY 11.4-,Stall f. St.,1111 2115.'1b1 UM-201-0241i k 3113.294-11523 Pestul tR Nudge,.1.YM( I Starry. 111 M Cop.,DirV. II 1.: Shelter 'Christopher 11,) I1•I AFFORDABLE1SENIORS, OR ❑FAMILIES,A SI'll Ii S ( fld ,. IL I F'. Ed s e Moue'', 3034 S. 003-I' F f1 AM.City.,PPP kV.611, '(18051 lla,, tOJ NJJ l tIIl 1 I Il elun FUIi SEN1UILS FAMILIES,AND 1'111: )/14{ tSt_ Ne 11ameleas 51111 101442 HA11 31031- 14 OPM( 1 11 burry If UIMS ,,, I)ISAItIPU rl I-'.(It I 11 - I r .h U lefty, 11s'r1VP. A ,S ..Ar /I p par 001X14ur: r 41141 a'S' 4I_1I 7I)::30:1.71. It 'n1 I 1 OFNI C' I' (11th 1. I l O.F.M( I L n t RI 1. }.- nc SL 481111181 Pl]0:19900911 eb l,NHcI : 014 e ail. 113X.1101MII. we.w• arhd1f. icon ( 0 (),I h, 71,0 Code:Serving 1 .)1 u y 1Ar IC. • Id.11y 1,0 'nl Yu 21k-''n. 1111 )l.ri::0x1 1117 21121 IUI I'. St., Xn II Tel. 1101,,rykl l Fathers.r VII then 11.01.1 1051 W. eedn AIH Y ( 304.743-4313. 4 910 Ave., 80211 1 I :W1-455-5220, I0. H.A Fens, IS ,Sc' 1 I t t Ily I..N.I adults It 1 .I-> t 1186 Far 300 1' 201 I F 1. Id 1 ,F A 0du. F n y Housing, Inc101 H) 4049 e nrYkminim:.0.J': 1 IL r II 1 A. I - St Sae.A,A0211. 1 1' 301.430.0215, 1 - Go5tha',tl d- ('A 1 N 9'I(..(Mayo!My 1)1r1 g D - 3113-A311.11985. 11 I f 4 1 St Ste..A, I N 28th St., 802.0 1•P 303.305.1420: K the df b W:f_ I Dr Mullet-hot 303-830-111115, 03-8 (H MIS4049 I 3111 304.1121 (1 I l ( 1 - hl Preschool scl 6 -C urea' r/ 110211.T.1.103-330 U. in Pao.103 9.10 x115 WcL_ le r fleet n 2 l y roes l lead d .tart K Nnrly 4. d Paul 11 A340 S.11 i :y DI I 80210.Tel: ,F - 1 R n .111171 1151. 12 s. I I R i ie r11 Catholic CI (mild Development C. tr, 1155 Yu1 CM Sum.;Pad 1.( .I. 1 M. Ithird 1nlyluYwoo,r;1,,l30J-Pf11 UG111 gut 14{11 Ki0.28X5. r 303. IC Ryan, CM'Thomas 1 Ni)s n, CM.; tt . F. lae1.w ce. lrl h !, I P IN.:t St., 0 9 'Fell 3011-1149- UC bur:vla 1129.6710. ( 1 ( 1 1 I Preschool Sr Joseph 11e.,11M M. 4]2)211'W1.3 Ina .0214;4U 5 I -.SL Sin A. Promo.,Caro, d Shut P.I' Iy II''u1 I)rnni Crime,2 Jf,n I11F 5 zot `9n- 1111- 701, F021www.uocl,303 610eus -F :UOJ tl!n 1514 With: Rut L^t N Tel: 303 1ilco> Inc1 0L, t. ht rt Gerald L Stookey, 0.1 Prior. 1f Jordan Plum01x15) ix:F,3'5 51 A, Catholic 1 :1l. VS 8S C 41 410. Cm 01 Revs Pbetha OI Loots fl we _ L. air Chanties 1 1 111 amili$sR'F 4045 Penns Mn. UJ N M t L I n )' H12una Flor 1 lIn (19 )4045 Pecos.S1.,5 C Jdl9 : Family 8 Services,4045 1 r Sc,3 11ss 0.L; Tllu nns Y. lynch, I f'. F k nrx,-I 303 s(5, ore- X09115 i I- m4 n 0y,s r Yo;,th R43'a AlpJahn C.McGreevy, (1 V .ell A.www.ar Pities Inc:1999)1045 Pecos os St.,Ste.A. Porter hx Y ::h k Senior A Psi era O.P.; 1 .Ii ;f l y A 9-Province f Sc Albert the Shen Priests X0211.TA'1 303.930-82 L5 Far303.830-2645.W 1::- Svices. +1N.I 'l; ❑ rs l Novices J ! ut. 3 F R r tlota C I ) p l S I';B 1 -no tiD l IY111 Jtl P. 5 2 C. 102 / 1265)1M'5 P St. S A S 40211 1 31 4 3x F -.303 9 4410. ..0117( 11 . 119 1 fel30s x300115 F 903 530 t 6:.We Catholic - 111 t Se c Pak Rd., 80211 J _), d R 4 IU', ' 3111-34A-0128. 111 f 541 (}{ - t www i 1 L H 'Maytag 1131 1 f IL0 p1 011 C Ifs:: 1 1 I 11,.lat min 1i SC., 1 eA e 30t.330.0:315. SIC :4.03.31041030. . ,h. [ Fit 115 .rz -w....2 r •w. . T� 1 P Ix L, " Ste r�1' n y -IL . s(1111 -,: 1 n va 5 , .-n 1 ... unl t,.- 1 COPY OF YOUR MOST RECENT AUDIT Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Combined Financial Statements and Supplementary Information June 30,2010 (With Independent Auditor's Report Thereon) Kurtdinger, Carder & Lriff, T.C. --- Cell ificu puiP0TCCAw¢n20: Plione(303'534-5'53 jar r303i e92 777‘; flvri;C,th inim 200 lknttc GrGmufa S0?a' Independent Auditor's Report Board of Directors Catholic Charities and Community Services of the Archdiocese of Denver, Inc.: We have audited the accompanying combined statement of financial position of Catholic Charities and Community Services of the Archdiocese of Denver, Inc. (Catholic Charities) as of June 30, 2010, and the related combined statements of activities, functional expenses, and cash flows for the year then ended. These financial statements are the responsibility of Catholic Charities' management. Our responsibility is to express an opinion on these financial statements based on our audit. The prior year summarized comparative information has been derived from the Catholic Charities' 2009 combined financial statements and, in our report dated November 24, 2009, we expressed an unqualified opinion on those financial statements. We conducted our audit in accordance with U.S. generally accepted auditing standards. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the combined financial statements referred to above present fairly, in all material es in its net assetstandits cash al flowstion forof the yearhthen endedc Charities inof June 30,co conformity witch 0, and generally accepted accounting principles. Our audit was performed for the purpose of forming an opinion on the basic financial statements taken as a whole. The supplementary information included in pages 22-24 is presented for purposes of additional analysis and is not a required part of the basic financial statements. Such information has been subjected to the auditing procedures applied in the audit of the basic financial statements and, in our opinion, is fairly stated in all material respects in relation to the basic financial statements taken as[a whole. Ku..tett,tatt_, Cotr•DEtr_ Ea6t.£ , C. November 18,2010 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Combined Statement of Financial Position June 30,2010 (With Summarized Totals for 2009) 2010 2009 Assets: $ 1 192 524 912,584 Cash and cash equivalents 1,892,324 58 Accounts receivable 353 1,824,699 1,572,840 Contributions receivable(note 2) 579,147 7 ,810 Other assets 21,008 32,0 294 Assets of discontinued operations(note 20) 362,281 388,875 458,188 Reserve cash,FLHC (note 10) 5.523 441 4,48,188 Investments (notes 3 and 4) 51730 ,764,158 Beneficial interest in assets held by others (notes 4 and 5) 63 1,268,363 69 35,795 Custodial accounts (note 9) 115 999 127,005 Deferred charges (note 12) 11578 12093 Property and equipment, net(notes 6, 11 and 12) $ 17,343,259 2 ,4 ,785 17,669,679 28,899,834 Total assets Liabilities: $ 645,866 469,374 Accounts payable 827 386 785,537 934 Accrued expenses 1,153 14,854 Liabilities of discontinued operations (note 20) 22 , 5 14, 55 Deferred revenue (note 7) 224,0 58 128,935 Liabilities under annuity agreements (note 8) 734 27,005 4 48 Custodial accounts(note 9) 23,999 1,22 , ],221,105 Notes and mortgages payable (note 11) 3,2 8,080 3,520,000 27115 Bonds payable (note 12) 7,115,311 6,981,218 Total liabilities Net Assets: Unrestricted: 11,918,952 Property and equipment, net of related debt1,98 11,782,291 96 1,938, Board designated (note 13) 1,936,106 1,276,844 3 .1 Undesignated ed 15,210,455 15,131,902 Total unrestricted net assets 4,658,393 5,333,178 Temporarily restricted(note 13) 1,658, 5,333,178 Permanently restricted (note 13) 21,453,626 21,453.536 Total net assets Commitments and contingencies (notes 14 through 19) 437 785 X8.899,834 Total liabilities and net assets $ 28 See accompanying notes to financial statements. 1 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Combined Statement of Activities Year Ended June 30,2010 (With Summarized Totals for 2009) Temporarily Permanently 2010 2009 Unrestricted Restricted Restricted Total Total Revenue,Gains and Support: Public support: Direct contributions $ 2,278,971 1,923,600 90 4,202,661 4,480,849 205,021 137,800 - 342,821 346,129 Wills and bequests 532,720 532,720 760,063 Contributed materials Archbishop's Catholic Appeal and other support(note 15) 530,000 42,000 572,000 560,000 Public and private grants 7,453,221 878,072 - 8,331,293 8,917,533 0 United Ways and 1,236,322 1,353,677 Combined Federal Campaign 474,463 761,859 - (84,619) (85,247) Change in net present value of annuities (84,619) _ _ 131,648 Fundraising events - - (41,869) Direct benefits to donors - - (54,370) (54,370) (291,184) Cancellation of pledges Net assets released from restrictions 4,496,486 (4,496,486) - - - Total public support 15,886,263 (807,525) 90 15,078,828 16,131,599 Revenue: 3,407,070 3,788,956 Program service fees 3,407,070 _ 678,544 678,544 744,288 Rental income and subsidy 307,517 132,740 - 440,257 (423,758) Interest and investment income (loss) ,_ 170395 Net gain on disposals 73,539 - - 73,539 155,785 039 Miscellaneous income Total revenue and gains 4,466,670 132,740 - 4,599,410 4,435,666 Total revenue,gains and support 20,352,933 (674,785) 90 19,678,238 20,567,265 Expenses: Program services: 8 7,527,678 7,817,953 Family&Children Services 7527,67 - - 5,835,763 7, 7,953 Shelter&Community Outreach Services 5,835,763 552,938 168,925 Western Slope 552,938703,689 Weld County 766,718 - - 918,686 Larimer County 984,423 - - 766,7 766,718 8 800,189 807,454 Farm Labor Housing Corporation 800,189 16,467,709 17,919,749 Total program services 16 467,709 - - Supporting services: 2,499,425 - - 2,499,425 2,430,127 General and administrative 1,303,312 1,303,312 1,088,934 Fundraising 3,802,737 3,519,061 Total supporting services 3,802,737 - Total expenses 20,270,446 - - 20,270,446 21,438,810 Change in net assets from 82,487 (674.785) 90 (592,208) (871,545) continuing operations - - (3,934) 1 Discontinued operations (note 20) (3,934) 90 (596,142) (1,1(247,910) 1 ) Change in net assets 78,553 (674,785) Net assets, beginning of year 15.131.902 5333,178 1,453,536 21 918,616 23.038,131 Net assets,end of year 5 15,210455 4.658.393 1.453,626 21,322,474 21,918,616 See accompanying notes to financial statements. 3 56'a 3 r J = cI p N O .o N O z _ _ _ m T _ a _ _ _ _ H P - O ., _ r N N O r v N m N - IN rt., — N n M1 O P O n N P O. 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U V U > O th . > v a J '=6. _ 5 ec n Y tz 0 '0 ._ ` V-J 6 o ri o r.,o m o v. - - 5 c 0 o i G .T O u y -' r 1 i_ m - L 5. _ _ v. _ J C J 2 c - _ 0 .. c 0 _ — n V. Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Combined Statement of Cash Flows Year Ended June 30,2010 (With Summarized Totals for 2009) 2010 2009 Cash flows from operating activities: $ (596,142) (1,119,515) Change in net assets Adjustments to reconcile change in net assets to cash provided by operating activities: 869,799 891,071 Depreciation n 64,289 64,732 Amortization (99,622) (19,395) Gifts of property ories (26,250) (20,000) Gifts of and equipment (179,280) (75,000) (90) ,10 0) Contributions restricted for capital projects Contributions restricted for endowment Realized and unrealized(gain) loss on investments (346,279) 346,g4290279) 600,886 (1 Actuarial loss on annuity obligations85,247 - (170,395) Gain on disposal of fixed assets Changes in operating assets and liabilities: 545,652 Decrease(increase) in receivables (10,686) 545,652 Decrease in contributions receivable 699,2072,906 9 Decrease(increase) in prepaid expenses and other assets 204,634 (78 (131) ) Increase(decrease)in accounts payable and accrued expenses94,100 15,615 Increase in deferred revenue 93 Net cash provided by operating activities 761,205 288,139 Cash flows from investing activities: 407,179 1,665,342 Proceeds from sales of investments (502,785)1 1,665,31 1) Purchases of investments (65,252) 11 Investments in reserve accounts 4,815 (1,723) 5 Sales of property,equipment and other assets 5 (291,834) 42,046 Purchases of property and equipment Net cash(used in)provided by investing activities (651,393) 46,220 Cash flows from financing activities: Proceeds from contributions restricted for: 473,766 104,305 Capital projects 90 g5 Endowment (110,090) (105,180) Payment of bonds 015,000) Payment of annuity obligations (119,045)5 (115,98,076 59, 09 Present value of liability for new gift annuity 5g 809 Payments on notes payable and capital lease obligations (79,759) 8 (78,784) ) Net cash used by financing activities 279,940 198,977 Net increase in cash and cash equivalents 07 Cash and cash equivalents at beginning of year 13,6507 Cash and cash equivalents at end of year $ 1 912 584 112,524 7 7 12, Supplemental disclosures: X7536 288.090 Interest paid See accompanying noses to financial statements. a Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements June 30,2010 (1) Summary of Significant Accounting Policies (a) General Catholic Charities and Community Services of the Archdiocese of Denver, Inc. (Catholic Charities) is organized as a Colorado not-for-profit corporation and was formed on April 27, 1928. Under the 1983 Code of Canon Law of the Roman Catholic Church, Catholic Charities is also public juridic person and accordingly, is subject to its Canonical Statutes. Catholic Charities operates various programs to assist and promote charitable, welfare, educational, health, and social services in the Denver-Metropolitan area, Weld and Larimer counties and in Western Slope counties within the territory of the Archdiocese of Denver(the Archdiocese). Some of the major programs in operation are: Family and Children Services —Denver Metro provides adoptive,child welfare, and counseling services to birth parents with unplanned pregnancies. It also provides miage and family counseling, adult developmentally disabled through the Carron d senior services, the Center, and service programs to assist low-income and high risk youth through the Rishel Beacon Neighborhood Center and various middle and elementary schools in the metro Denver area. In addition, Family and Children Services provide daycare programs and Head Start in metro Denver through several child care centers including the Margery Reed Mayo Center. Shelter and Community Outreach Services — Denver Metro provides temporary shelter and meals as well as case management for homeless persons at Samaritan House, the Father Ed Judy House, and St. Joseph's Home for Veterans in the metro Denver area. It also provides employment referrals and assistance,transitional housing services to individuals and families, and immigration assistance. In addition, emergency assistance is provided to individuals and families in need of basic necessities in metro Denver. Catholic Charities — Western Slope provides family transitional housing services, immigration assistance and advocacy, and emergency assistance to individuals and families in need of basic necessities including food, rent, and utilities to clients in the Glenwood Springs and surrounding western slope of Colorado. Catholic Charities — Weld County provides temporary shelter and meals as well as case management for homeless persons at the Guadalupe Shelter in Greeley. In addition, it also provides services to low-income seniors, and emergency assistance to individuals and families in need of basic necessities in Weld County and the surrounding area. Catholic Charities — Larimer County provides temporary shelter and meals as well as case management for homeless persons at The Mission in Fort Collins. In addition, it also provides transitional housing services, services to low-income seniors, and emergency assistance to individuals and families in need of basic necessities in Larimer County and the surrounding area. is tely corporated program, Farm Labor1993 to provngide Corporation arm labor hour ng)thatiss afeacleannand affordable and to formed ctasin lyto act as a catalyst to building more fame labor housing. The initial project for FI_HC, Plaza del Milord consists of a 40-unit housing complex. which includes a community center and child-care center located in Greeley. Colorado. Plaza del Co!, which consists of 42 independent housing units, housing up to 144 single occupants, is located adjacen' to Plaza del Milagro. 6 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements, Continued (1) Summary of Significant Accounting Policies,Continued (b) Basis of Accounting The accompanying combined financial statements of Catholic Charities have been prepared on the accrual basis of accounting and, accordingly, reflect all significant receivables, payables, and other liabilities. (c) Financial Statement Presentation Reporti_� n£Entity The accompanying combined financial statements include the accounts of FI.HC, a separate not-for-profit corporation. All material inter-organizational transactions have been eliminated in combination. Basis of P_ r_ esentatton Information regarding the financial position and activities of Catholic Charities is reported according to three classes of net assets: unrestricted, temporarily restricted, and permanently restricted. (d) Accounting Standards Codification has issued FASB Topic 105, The Financial Accounting Standards Board (FASB) Generally Accepted Accounting Principles, which establishes the FASB Accounting Standards Codification (FASB ASC) as the sole source of authoritative generally accepted accounting principles (GAAP). Pursuant to the provisions of this standard, Catholic Charities updated references to GAAP in its combined financial statements issued for the year ended June 30, 2010. The adoption of this standard did not impact financial position or results of operations. (e) Contributions and Contributions Receivable Catholic Charities accounts for contributions as unrestricted, temporarily restricted, or permanently restricted support, depending on the existence or nature of any donor restrictions. Donor-restricted support is reported as an increase in temporarily or permanently restricted net assets, depending on the nature of the restriction. When a restriction expires (that is, when a stipulated time restriction ends or purpose restriction is accomplished), temporarily restricted net assets are reclassified to unrestricted net assets and reported in the statement of activities as net assets released from restrictions. Unconditional contributions receivable are recognized as revenues in the period the pledge is received. Contributions receivable are recorded at net realizable value if expected to be collected in one year and at fair value if expected to be collected in more than one year. Conditional contributions receivable are recognized when the conditions on which they depend are substantially met. Donated marketable securities and other non-cash donations are recorded as contributions at their estimated fair values at the date of donation. Catholic Charities uses the allowance method to determine uncollectible contributions receivable. The allowance is based on prior years' experience and management's analysis of specific promises made. Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements,Continued (1) Summary of Significant Accounting Policies,Continued (I) Cash and Cash Equivalents Catholic Charities considers all unrestricted highly liquid investments with an initial maturity of three months or less and that are not part of the investment portfolio to be cash (note l equivalents. Bank beec accounts heled d as custodial cash and cash accounts equivalents. 9) or as reserve accounts ha(g) Investments Investments in marketable securities with readily determinable fair values and all investments in debt securities are stated at their fair values in the statement of financial position. Unrealized gains and losses are included in the change in net assets in the statement of activities. (h) Fair Value Measurements Catholic Charities has adopted the Fair Value Measurements and Disclosures Topic of FASB ASC, which requires the use of a fair value hierarchy that prioritizes the inputs to valuation techniques used to measure fair value into three levels: quoted market prices in active markets for identical assets and liabilities (Level 1), inputs other than quoted market prices unobservableb ere b erom the a le for the ss or lia bi or lity eithe eithl r directly or indirectly (Level 2),an(1) Accounts Receivable Accounts receivable consist of program service fees due primarily from government agencies and government grant and contract related receivables. The allowance for doubtful accounts is based on past experience and on analysis of the collectibility of current accounts receivable. Accounts deemed uncollectible are charged to the allowance in the year they are deemed uncollectible. Accounts receivable are considered to be past danued thased on contractual terms.at no allowance ford doubtful accounts is necessaryst believes the receivables are fully collectible, at June 30, 2010. (j) Concentrations of Credit Risk Financial instruments which potentially subject Catholic Charities to concentrations of credit risk consist principally of cash, cash equivalents, investments, accounts receivables and contributions receivables. Investments which potentially subject Catholic Charities to concentrations of credit risk include $3,137,629 held by the Archdiocese of Denver Irrevocable Revolving Fund Trust (Revolving Fund Trust) and invested on behalf of Catholic Charities. Catholic Charities also holds commercial bonds and stocks valued at rities places s2tmporary are uccasht to and moneynges tmarket accounts with factors. creditworthy, high-quality financial institutions. A significant portion of the funds are not insured by the FDIC or related entity. Catholic Charities is subject to the risk of loss from certain government receivables if the government determines that certain amounts are unallowable reimbursements, although this has not happened to date. Concentration of credit risk associated with contributions receivable exists of a as approximately 50%or of Catholic Charities' contributions receivable balance 8 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements,Continued (1) Summary of Significant Accounting Policies,Continued (k) Property and Equipment Property and equipment with initial cost or value of more than $1,000 are capitalized at cost or, if donated, the estimated fair market value of the asset at the date of donation. is ver the assets. Equipment lee leased under uted on a capittalt-line leasesis recorded at the present t value lives of the lease payments. Amortization of capitalized leases is included with depreciation on the combined financial statements. (1) Use of Estimates The preparation ning reined quires management to make estimatnancial statements in es and assumptions that affecity with generally t accounting principles q the reported amounts of assets and liabilities and disclosure of contingent assets and cial statements and the mounts of revenues and expenses during the reportie of combined ng period. Actual results couldod feafrom those estimates. (m) Advertising Catholic Charities uses advertising to promote certain programs and products. The costs of advertising are expensed as incurred. During fiscal year 2010, advertising costs totaled $185,178. (a) Contributed Materials and Services in statements at their Donated materials are reflected as contributions in the accompany g estimated values at date of receipt. Donated materials consisted of food valued at $532,720 contributed for shelter operations. Automobiles were donated for resale or scrap for which Catholic Charities received income from the proceeds in the amount of $70,201 and are included as direct contributions on the statement of activities. Catholic Charities receives the rent-free use of a cente from enver Housing Authority for the Mutroy Center, an office building community ding in Weld rCou the ntyfrom Weld assrooms, the County Ho, cafeteria,the , ral andBcomsuterclab atsces Colerogram, the use of and Rishel Middle schools for the thrSery sAfter ym, P Youth Services School program, and use of classrooms and the cafeteria at Johnson and Force Elementary Schools for the Youth Services After School program. No amount is recorded in the combined financial statements for this use. No ements for Catholic Charities pays formost services in the beq financial specific expertise.expertise. However, many services. individuals volunteer their time and perform a variety of tasks that assist Catholic Charities with specific assistance programs. (o) Functional Allocation of Expenses a funcotional bassissin these statement of functionaaexpensesother e`Accord nglities have b een summarized y, certain costs have been allocated among the programs and supporting services benefited. Catholic Charities and Community Services of the Archdiocese of Denver,Inc. Notes to Combined Financial Statements, Continued (1) Summary of Significant Accounting Policies,Continued (p) Tax Exempt Status ( )(,) Catholic Charities and FLHC are exempt from federal income tax under Section 501 c of the Internal Revenue Code through their inclusion in the United States Conference of Catholic Bishops group ruling and listing in the Official Catholic Directory. Accordingly, contributions to Catholic Charities and FLHC qualify for the charitable contribution deduction. Income from activities not directly related to Catholic Charities' or FLHC's tax exempt purpose is subject to taxation as unrelated business income. There was no unrelated business income subject to tax in fiscal year 2010. (q) Prior Period Information The accompanying combined financial statements include certain prior-year summarized comparative information in total but not by net asset class. Such information does not include sufficient detail to constitute a presentation in conformity with generally accepted accounting principles. Accordingly, such information should be read in conjunction with Catholic Charities' combined financial statements for the year ended June 30, 2009, from which the summarized information was derived. (r) Subsequent Events is required In accordance with the Subsequent Events Topic of FASB ASC, management to evaluate, through the date the combined financial statements are issued or available to be issued, events or transactions that may require recognition or disclosure in the financial statements, and to disclose the date through which subsequent events were evaluated. Catholic November 18,r2010 andthis is the date through which subsequent available vents to wer on ities' financial statements were e evaluated. (s) Reclassifications Certain amounts in the 2009 combined financial statements have been reclassified to conform to the 2010 presentation. (2) Contributions Receivable Contributions receivable by Catholic Charities at June 30, 2010, consist primarily of grants from foundations, agencies and individuals. FLHC has no contributions receivable at June 30, 2010. Payments are scheduled to be received as follows: $ 369,745 Due within one year 369,745 Due within one to five years 672,545 (8.6533) Less: Unamortized discount, calculated at 3% { 4 65 ) Allowance for uncollectibles g 579,147 Net contributions receivable IU Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements, Continued (3) Investments Investments are recorded at fair value. Unrealized gains and losses are reported as increases or decreases in unrestricted net assets because the gains and losses are unrestricted. Investments consisted of the following at June 30,2010: $ 3,137,629 Investments with the Revolving Fund Trust 137,629 Preferred stock index fund 96,710 Mutual funds invested in debt securities 182,713 3 Managed equity investments 866,905 Money market and cash equivalents $ 5.173,101 Investment income is summarized as follows: $ 93,978 Interest and dividend income 393978 Realized and unrealized gains on investments $ 440 Total investment income her holic entiti within the territory of the Archdioceseuto pooltfinancialenalesp esourcesarishes dtot obtain tcompetitive terms for depositing, tey. The Revolving Fund Trust hos title to the assets of the rust. However, the equitable and beneficial al ownership of the assets of the trust belong to and are owned by each entity participating in the Revolving Fund Trust pursuant to the terms and conditions of the trust agreement. (4) Fair Value Measurements The carrying amount reported in the statementable and financialother ac position liabilities,r cash h and i cas h equivalents, accounts receivable, accounts pay fair value because of the immediate or short-term maturities of these financial instruments. Catholic Charities follows the Fair Value Measurements and Disclosures topic of FASB ASC, awhich among nd reported attherfair vales requires standard establishes disclosures hierarchal disclosure framework which prioritizes and ranks the level of market price observability used in measuring investments at fair value. Market price observability impacted by a number of factors, including the type of investment prices lge active and the characteristics specific to the investment. Investments with readily available active quoted prices or for which fair value can be measured from actively quoted P will have a higher degree of market price observability and a lesser degree of judgment used in measuring fair value. Investments measured and reported at fair value are classified and disclosed in one of the following categories: Level 1 — Quoted prices are available in active markets for identical investments as of the reporting date. The type of investments included in Level I include mutual funds, listed equities, listed derivatives, cash, and cash equivalents. 1 ', Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements, Continued (4) Fair Value Measurements, Continued Level 2 —Pricing inputs are other than quoted prices in active markets, which are either directly or indirectly observable as of the reporting date, and fair value is determined through the use of models or other valuation methodologies. Investments which are generally included in this category include money market accounts, corporate and government bonds, less liquid and restricted equity securities and certain over-the- counter derivatives. Level 3 — Pricing inputs are unobservable for the investment and include situations where there is little, if any, market activity for the investment. The inputs into the determination of fair value require significant management judgment or estimation. Investments that are included in this category generally include limited partnership interests in corporate private equity and real estate funds, funds of hedge funds, and distressed debt. In certain cases, the inputs used to measure fair value may fall in to different levels of the fair value thin the on the lowesthierarchy. of input put that ich cases, s an significant to investment's level the fair value measurement. r value hierarchy is based The following table summarizes the valuation of Catholic Charities' investments by the above fair value hierarchy levels as of June 30,2010: Fair Value Measurements at Reporting Date Using Quoted Prices Significant In Active Other Significant Markets for Observable Unobservable Inputs Identical Assets Inputs Fair Value (Level 1) (Level 2) (Level 3) Revolving Fund Trust $ 3,137,629 3,137,629 Preferred stock index fund 796,790 796,790 Mutual funds 182,713 182,713 - Managed equity 866,905 866,905 Money market 189.064 189,064 Subtotal 5,173,101 5,173,101 Investments held at The 1 X68.363 1.268.363 Catholic Foundation 1268 363 Total $ 6 441 464 5.173.101 The changes in investments measured at fair value for which Catholic Charities has used Level 3 inputs to determine fair value are as follows: Investments at The Catholic Foundation (note 5) $ 1,135,799July 1, 2009 balance 135,799 Realized and unrealized gains on investments - Purchases - Distributions 5 1. 68363 June 30. 2010 balance The standard also requires disclosures for level 3 investments of the change in unrealized gain included in the change in net assets related to investments still held at the reporting date. Al June 30, 2010, this was an unrealized gain of S122.354. 12 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements, Continued (5) Beneficial Interest in Assets Held by Others Catholic Charities has entered into an agreement with The Catholic Foundation for the Roman Catholic Church in Northern Colorado (the Foundation), to hold and invest certain endowed funds, originally valued at $1,100,000. The funds deposited at the Foundation are to be held in perpetuity by the Foundation, to which variance power has been given. The Foundation shall distribute annually to Catholic Charities, as much of the net income of the Fund as Catholic Charities requests and the Foundation deems consistent with the agreement and the distribution policies of the Foundation. At June 30, 2010, the investments had a fair market value of$1,268,363. (6) Property and Equipment Property and equipment used in continuing operations consisted of the following at June 30, 2010: Catholic Charities FLIIC Total Land and land improvements $ 4,049,071 957,223 5,006,294 Buildings 11,984,295 6,837,281 18,821,576 Construction in progress 127,491 - 127,491 Furniture and equipment 1,480,424 461,917 1.942,341 17,641,281 8,256,421 25,897,702 Less accumulated depreciation $ (6,400,664) 102 642 ( , 4 ( , 3 ) (8,554.443) Property and equipment, net 9 (7) Deferred Revenue Grant and contract revenue is recognized as revenue when Catholic Charities incurs allowable reimbursable costs for the purpose specified by the grantor or contractor. Cash received in excess of the expended costs is recorded as unearned revenue, and allowable costs incurred in excess of cash le. ed of $223,035 consisted ofarants and program servic are recorded as a e feesOreceived but not yet expended nue at June 30, orOthe allowable purposes. (8) Charitable Gift Annuities Catholic Charities has received several charitable gift annuity contracts. These contracts require Catholic Charities to make fixed payments to the beneficiaries over their lifetimes. The obligation to make the periodic disbursements to the beneficiary becomes a general obligation of Catholic Charities. This liability is recorded at the net present value of the expected future payments, discounted at interest rates ranging from 4% to 6% over the expected lives of the beneficiaries, and totaled $734,998 at June 30, 2010. Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements, Continued (9) Custodial Accounts Catholic Charities maintains separate bank accounts on behalf of individuals for who at m dian or JCatholic Charities has been une 30, 2010, are shown as appointed oth n asset and a liability eon the sstatemen of e accounts totaling al position as all disbursements must be on behalf of the individuals for whom the accounts are maintained. (10) Reserve Accounts FLHC is required to make annual payments to a reserve account for Plaza del Milagro until roval for repair, replacement, or improvement of the property, to meet payments the balance reaches $400,000. The funds may be used with U.S. Department of Agriculture (USDA) app on equired payment to this reserve a oblgations, or o ountt was $40,000; notwithdrawalsr were ar made from this during the year. A similar account is required at Plaza del Sol into which F1.,HC was required to make annual payments of $41,380 to the reserve account for the Plaza del Sol until the balance were made to aza del Sol reserve during the year s ended June n 30,2010 Paymentsf 0of$16,350 were madee lfrom this account in fiscal year 2010. The following is a summary of the required reserve accounts at June 30, 2010: 51 14� Plaza del Milagro 15242 798 Plaza del Sol $ 2 (11) Notes and Mortgages Payable At June 30, 2010, notes and mortgages payable were all issued by FLHC and consisted of the following: Note payable to USDA Rural Development,interest at 1%, monthly payments of$1,575 to be made through September 2031, $ 360,395 secured by first lien on property-Plaza del Milagro Note payable to Weld County, interest at 3%,monthly payments of$1,194 through June 2033, secured by deed of trust-Plaza del Milagro 237,907 Development, accrued terest, Note st at 1%,o USDA Rural of$4.078 to bemade through May,2035, interest at monthly payments 1,075,715 secured by deed of trust—Plaza del Sot Note payable to Weld County, interest at 3%, monthly payments 76 7�7 of$555, to be made through August,2024, secured by deed of trust- Plaza del Sol Note monthly payments of$a 608 to be made through September o Housing and Finance Authority, t at 1%, 400 t 2033- Plaza del Sol Face value of below market rate notes and mortgages payable 2.150.968 18) Less discount S 1__s so 14 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements, Continued (11) Notes and Mortgages Payable, Continued The future undiscounted principal payments on these notes and mortgages for years ending June 30 are: 2011 $ 80,792 2012 81,843 2013 82,910 2014 83,997 2015 85,101 L 1,736,325 L years 2,150,968 Less discount (902,088) Net notes payable, FLHC $ 1 248 880 FLHC has received five loans with interest rates substantially lower than prevailing interest rates. These notes and mortgages have been discounted, depending on the market rate for similar loans at the time of borrowing. The discounts have been deducted from the face value of the notes and mortgages, and were recorded as restricted contributions in the years in which the loans were received (the years ended June 30, 1999, 2002, and 2004). The discount totals $902,088 at June 30, 2010. As this discount is amortized, a corresponding amount is released from temporarily restricted net assets. (12) Bonds Payable On May 30, 2007, the Colorado Educational and Cultural Facilities Authority issued Mortgage Revenue Refunding Bonds in the amount of$3,625,000, the proceeds of which were loaned to Catholic Charities for the purpose of purchasing real property located at 4045 Pecos Street, Denver, Colorado to serve as an administrative office building and the Company's headquarters. The bonds are payable in annual principal installments varying from $105,000 to $280,000, beginning June 1, 2008. Interest is payable semi-annually at rates ranging from 5.00% to 5.25%. The bonds are secured by a first mortgage on land and office building in Denver, Colorado. Bonds maturing after June 1, 2017, may be redeemed on any date after June 1, 2016 at a redemption price equal to the principal amount plus accrued interest to the redemption date. Debt service to maturity for the bonds for the fiscal years ending June 30 is as follows: Principal Interest Total 120,000 183,275 303,275 2011 $ 130,000 170,413_ 176,975 301,975 2013 12_ ,000 300,413 2014 2014 140,000 163,588 303,588 2015 45.000 156,237 301_237 Thereafter 2.750.000 1.155.325 3.905.325 Totals $ 3.410.000 2.005.813 5.415.813 Bond issuance costs totaling 5136.290 have been recorded as deferred charges and are being amortized on the straight-line basis over the term of the bond issue. Unamontzcd defered charges total $115.278 at June 30, 2010. 15 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements, Continued (13) Net Assets (a)Board Designated Net Assets Board designated net assets are set aside at the discretion of the board of directors and may be redirected at their discretion at a future date. The board of directors of Catholic Charities has designated net assets for future use as follows at June 30,2010: $ 868,000 Capital improvements 462,702 Margery Reed Mayo 67 702 Catholic Charities operations 4 7,702 Homelessness and housing 12,702 Northern operations $ 1,936.106 (b)Temporarily Restricted Temporarily restricted net assets at June 30,2010 consist of the following: Catholic Charities: Contributions promised by donors, but not yet received $ 2 579,147 7 Contributions restricted by donors but not yet expended 2518 Proceeds from the Lowry Settlement for homelessness 3 1,171.640 0 Subtotal 5 FLHC: Unamortized loan discount (note 11) 902.088$ 4.9 88 Total Net assets released from restrictions during fiscal year 2010 consisted of the following: Catholic Charities: $ 1,142,841 Collection of contributions receivable Restricted contributions expended per donor instructions 96,171 Subtotal 4,4 012 FLHC: 57.474 Amortization of below market rate note payable Total net assets released $4.496 486 In addition, unrestricted net assets generated by FLHC projects are restricted for use by that particular housing project. (c)Permanently Restricted Permanently restricted net assets consist of endowment fund assets that are subject to restriused. t restricted net assets consist only of the following endowment funds at June 30, 2010: Catholic Charities Endowment Fund-Samaritan House $ 1,0 00,000 Catholic Charities Endowment Fund-operations 00,00000.000 General Endowment 000 South West Emergency Assistance 26 20..700 Marjory Reed Mayo - equipment ?s5,0 0 Samaritan House - capital improvements $ 1 251.919 Total pern.anently restricted net assets 16 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements,Continued (13) Net Assets, Continued The State of Colorado adopted the Uniform Prudent Management of Institutional Funds Act (UPMIFA) effective September 1, 2008. Accordingly, Catholic Charities adopted FASB Staff Position, Endowments of Not-for-Profit Organizations: Net Asset Classification of Funds Subject to an Enacted Version of the Uniform Prudent Management of Institutional Funds Act, and Enhanced Disclosures for All Endowment Funds. Adopting this accounting practice resulted in the reclassification of earnings on certain endowment funds from unrestricted to temporarily restricted net assets. There was no effect on total net assets. Catholic Charities has interpreted the Uniform Prudent Management of Institutional Funds Act (UPMIFA) as requiring the preservation of the fair value of the original gift as of the gift date of the donor-restricted endowment funds absent explicit donor stipulations to the contrary. As a result of this interpretation and in the absence of explicit donor stipulations to the contrary, Catholic Charities classifies as permanently restricted net assets (a) the original value of gifts donated to the permanent endowment, (b) the original value of subsequent gifts to the permanent endowment, and (c) accumulations to the permanent endowment made in accordance with the direction of the applicable donor gift instrument at the time the accumulation is added to the fund. The remaining portion of the donor-restricted endowment fund that is not classified in permanently restricted net assets is classified as temporarily restricted net assets until those amounts are appropriated for expenditure by the Board in a manner consistent with the standard of prudence prescribed by UPMIFA. In accordance with UPMIFA, Catholic Charities considers the following factors in making a determination to appropriate or accumulate donor-restricted endowment funds: (1) The duration and preservation of the fund (2) The purposes of Catholic Charities and the donor-restricted endowment funds (3) General economic conditions (4) The possible effect of inflation and deflation (5) The expected total return from income and the appreciation of investments (6) Other Catholic Charities resources (7) The investment policies of Catholic Charities. Catholic Charities' endowment net assets consisted of the following as of June 30, 2010: Temporarily Permanently Unrestricted Restricted Restricted Total Donor-restricted endowment funds $ (4,522) 177.342 1.453.626 1.626 446 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements,Continued (13) Net Assets,Continued Following are the changes in the endowment net assets for the year ended June 30,2010: Temporarily Permanently Unrestricted Restricted Restricted Total Endowment net assets, $ (4 238) 45,140 1,453,536 1,494,438 beginning of year Investment return: 1 327 177 1,504 Investment income Net appreciation 132,564 - 132,564 (realized and unrealized) Total investment return 1327 132.741 - 134,068 - 90 90 Contributions Appropriation of endowment (1,611) (5391 (2,150) assets for expenditure Endowment net assets, $ (4.522 177.342 4 3 ') 1 626,446 end of year As of June 30, 2010, the portion of perpetual endowment funds that is required to be retained permanently either by explicit donor stipulation or by UPMIFA totals $1,453,626. Funds with Deficiencies From time to time, the fair value of assets associated with individual donor-restricted endowment funds may fall below the level that the donor or UPMIFA requires the Foundation to retain as a fund of perpetual duration. In accordance with generally accepted accounting eported in unrestricted net assets were f June principles,30,2 010.These deficiencies resultedficincies of this natre that are from $4,522 as from unfavorable market fluctuations. Return Objectives and Risk Parameters Catholic Charities' assets include donor-restricted funds that Catholic Charities must hold in perpetuity. Catholic Charities has adopted investment policies for endowment assets that attempt to provide a reasonable, predictable, stable and sustainable level of income that Charities'current needs spending policies reflectdes donoorrr�trice ons on the original h in assets and eg income over time Catholic Strategies Employed for Achieving Objectives To satisfy its long-term rate-of-return objectives, Catholic Charities relies on a total return strategy, in which investment returns are achieved through both capital appreciation (realized and unrealized) and current yield (interest and dividends). In addition, Catholic Charities relies on the strategies of the Catholic Foundation where a portion of the endowment is held. Catholic Charities targets a diversified asset allocation to achieve its long-term return objectives within prudent risk constraints. Distribution Policy and How the Investment Objectives Relate to Distribution Policy Catholic Charities has a policy of appropriating for distribution each year that amount of investment income which it deems prudent. 1£, Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements, Continued (14) Operating Leases Catholic Charities rents office space for administrative and program needs in various locations. Total minimum rental commitments under these written lease agreements are as follows for the years ending June 30: $ 80,093 2011 80,093 2012 80,093 2013 52.173 2014 $ 292 452 In dition, Catholic C s rents e for various programs 41 1 on a month to month basis. Total rent expense for the year ended June 30,20 0 was $171 (15) Related Party Transactions—Archdiocese and Related Organizations Catholic Charities has as its general purpose, the promotion of the chari able causes e ses of the ed with Archdiocese. In addition to investments,the following related party trans the Archdiocese for the year ended June 30,2010: (a) The Archdiocese contributed $572,000 to Catholic Charities through the Archbishop's Catholic Appeal and other support. (b) Archdiocesan Housing, Inc. (AHI), an entity related to the Archdiocese, shares a building with Catholic Charities and uses Catholic Charities' payroll services for its employees. AHI reimbursed Catholic Charities a total of$3,253,784 for salaries and related expenses, including $98,828 in employer matching under their 403(b) retirement plan. Furthennore, AH1 paid Catholic Charities $88,202 for shared occupancy costs. AHI also contracted with Catholic Charities to provide case management services at senior housing sites, for a total of$181,916. At June 30, 2010, Catholic Charities had receivables totaling$30,586 for these services. (c) The Archdiocese of Denver Risk Management and Property/Casualty Insurance Trust (the Trust) currently procures worker's compensation, property and general liability insurance coverage for Catholic Charities. Catholic Charities paid $321,063 to the Trust during the year ended June 30, 2010. At June 30, 2010, Catholic Charities has accounts payable of$41,106 to the Archdiocese for these and other services. (d) Catholic Charities purchases Archdiocese of Denver. This totaled $44,017 for the year ended June 30,2010. the (16) Retirement Plan Catholic Charities has established a retirement plan under section 403(b) of the Internal Revenue Service Code that is available to employees. Catholic Charities contributes 5% of employee salaries for employees with a year or more service. In addition, Catholic Charities matches 50% of the employee's elective deferral amount that does not exceed 2% of the total employee's compensation. Beginning in August 2009, through July 2010, the employer matching contribution was suspended. Total employer contributions under this plan for Catholic Charities employees were$323,098 for the year ended June 30, 2010. 19 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements; Continued (17) Land Use Restrictions In conjunction with the renovation of the Mission building in Ft. Collins that was partially funded by a grant of $46,235 from the City of Ft. Collins in 2006, Catholic Charities has agreed to continue to operate the building as a Community Development Block Grant eligible public facility for 90 years or refund the grant. Catholic Charities received a grant of $200,000 from Greeley Urban Renewal Authority (GURA) for the purchase of land in order to build and relocate the Guadelupe Center Homeless Shelter. If Catholic Charities ceases to use the property for this purpose, Catholic Charities must transfer the property to GURA or reimburse GURA for the fair market value of the portion of the property attributable to this grant at the time the property ceases to be used for this purpose. FLHC has received four loans with interest at rates below market (see notes 10 and 11). The loans require that the Plaza del Milagro and Plaza del Sol be maintained as low-income housing. In addition, FLI-IC has received an $85,000 loan from the Federal Home Loan Bank. This loan bears no interest and will be forgiven in full after 15 years, as long as FLHC is in compliance with the loan contract, which includes rental to eligible tenants, and continued ownership of the Plaza del Milagro. This loan was recorded as a contribution in the year it was received. A similar loan was received in July, 2003 for the construction of Plaza del Sol in as a statemene ts. The Plaza del Sol loan has terms that ount of $200,000, which was also arerthesame as the tPlaza ndel Milagro in prior t loan. (18) Mount Loretto Catholic Charities was involved in the development and construction of Mount Loretto, an affordable housing complex. Catholic Charities' interest in the property was transferred to a newly formed company, Mount Loretto LLC, in which Catholic Charities, through its membership in Loretto/Charities, LLC, has an interest of less than .01%. Mount Loretto, LLC received additional funding by issuing bonds through Colorado Affordable Catholic Housing Corporations and from tax credit investors. During the year ended June 30, 2004, Catholic Charities received funding totaling $600,000 from the State of Colorado for the construction of Mount Loretto. As a condition to the receipt of this funding, a covenant has been recorded to insure that the housing is to be rented to low income occupants for a term of 40 years. Should this condition not be met during the 40 year period, the $600,000 must be repaid. Similarly, during the year ended June 30, 2005 Catholic Charities received a grant of$600,000 from the City and County of Denver, and a tgrant of$294,000he property be rented ot�w nderal come oome Loan ccupants for terms of 30 and 15 years,respectivk. The terms of these grants euirely. that 1 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Notes to Combined Financial Statements,Continued (19) Courtyard Commons On April 4, 2006, Catholic Charities sold its property at 1122 Pearl Street, Denver, known as Courtyard Commons. The property was sold to Courtyard Commons, LLC, a limited liability company whose managing member is AHI Development, LLC. The property was sold for $840,000 comprised of $202,731 in payment of the existing CHAFA mortgages on the property, and a promissory note of $637,269. The promissory note bears interest of 4.79%, and requires that Courtyard Commons LLC make annual payments of $1,000, cash flows permitting. Because payment of the note is uncertain, Catholic Charities has determined that a gain on sale will be recorded under the cost recovery method only when payments are received. The balance of the note($483,526 at June 30, 2010) and accrued interest($106,732 at June 30, 2010) is due and payable in full in 2045. (20) Discontinued Operations During the year ended June 30, 2008, the SHARE program's operations were discontinued. Catholic Charities retains ownership of the land and building, which is held for sale. For the year ended June 30, 2010, Catholic Charities incurred additional net losses related to the discontinued operations totaling$3,934. At June 30, 2010, the assets of SHARE, consisting primarily of land and building, are carried at cost, $362,281 at June 30, 2010, and are shown as a current asset under the caption "Assets of discontinued operations" in the accompanying statement of financial position. Liabilities of SHARE, consisting of accounts payable amounting to $1,153 at June 30, 2010, are carried as a current liability under the caption "Liabilities of discontinued operations" in the accompanying statement of financial position. _1 Catholic Charities and Community Services of the Archdiocese of Denver, Inc. Combining Statement of Financial Position June 30,2010 Farm Labor Catholic Housing Charities Corporation Total Assets: Cash and cash equivalents $ 1,015,063 177,461 1,192,524 Accounts receivable 1,795,263 40,122 1,835,385 Contributions receivable 579,147 - 579,147 Due from(to) other fund 60,000 (60,000) - Other assets 14,263 6,745 21,008 Assets of discontinued operations 362,281 - 362,281 Reserve cash - 523,440 523,440 Investments 5,173,101 - 5,173,101 Beneficial interest in assets held by others 1,268,363 - 1,268,363 Custodial accounts 23,999 - 23,999 Deferred charges 115,278 - 115,278 Property and equipment, net 11,240,617 6,102,642 17,343,259 Total assets $ 21,647,375 6,790,410 28,437,785 Liabilities: Accounts payable $ 619,413 26,453 645,866 Accrued expenses 818,152 9,228 827,380 Liabilities of discontinued operations 1,153 - 1,153 Deferred revenue 223,035 - 223,035 Liabilities under annuity agreements 734,998 - 734,998 Custodial accounts 23,999 - 23,999 Notes and mortgages payable - 1,248,880 1,248,880 Bonds payable 3,410,000 - 3,410,000 Total liabilities 5,830,750 1,284,561 7,115,311 Net Assets: Unrestricted Property and equipment, net of related debt 7,830,617 3,951,674 11,782,291 Board designated 1,936,106 - 1,936,106 Undesignated 839,971 652,087 1,492,058 Total unrestricted net assets 10,606,694 4,603,761 15.210.455 Temporarily restricted 3,756,305 902,088 4;658,393 Permanently restricted 1;453,626 - 1;453,626 Total net assets 15,816,625 5,505,849 21;322,474 Total liabilities and net assets S 21;647,375 6,790,410 28.437.785 See accompanying independent auditor's report. or) Catholic Charities and Community Services Statement of Activities Year Ended June 30,2010 (With Summarized Totals for 2009) Temporarily Permanently 2010 2009 Unrestricted Restricted Restricted Total Total Revenue,Gains and Support: Public support: Direct contributions $ 2,278,771 1,923,600 90 4,202,461 4,480,849 Wills and bequests 205,021 137,800 - 342,821 346,129 Contributed materials 532,720 - - 532,720 760,063 Archbishop's Catholic Appeal and 530,000 42,000 572,000 560,000 other support - 8,320,684 8,917,533 Public and private grants 7,442,612 878,072 United Way and 1,236,322 1,353,677 Combined Federal Campaign 474,463 761,859 Change in net present value of annuities (84,619) - - (84,619) (85,247) - 31,648 Fundraising events - - (q1 869) Direct benefits to donors - -- (54,370) (54,370) (291,184) Cancellation of pledges Net assets released from restrictions 4,439,012 (4,439,012) - - Total public support 15,817,980 (750,051) 90 15,068,019 16,131,599 Revenue: 3,407,070 3,788,956 Program service fees 3,407,070 - Rental income 95,050 -- 95,050 103,791 439,904 (427,480) Interest and investment income(loss) 307,164 132,740 170 3958,173 95 Net gain on disposals 29,533 - - 29,533 70, 9 Miscellaneous income Total revenue and gains 3,838,817 132,740 - 3,971,557 3,723,835 Total revenue, gains and support 19,656,797 (617,311) 90 19,039,576 19,855,434 Expenses: Program services:Family&Children Services 7,527,678 - -- - 7,527,678 678 7,817,953 5,835,763 7 7,168,925 15 Shelter&Community Outreach Services 5,835,763 Western Slope 552,938 - - 552,938 556 918 503,042503,02 Weld County 766'718 984,423 918,686 Larimer County 984,423 - Total program services 15,667,520 - - 15,667,520 17,112,295 Supporting services: 2,437,659 2,437,659 2,347,182 General and administrative 1,303,312 1,303,312 088,934 Fund raising 3,740,971 - - 3,740,971 3,436,I 16 Total l expenses services 19,408,491 20,548,411 Total 19,408,491 - - Change in net assets from continuing operations 248,306 (617,311) 90 (368,915) (692,977) Discontinued operations (3,934) - (3,934) (247,970) Change in net assets 244372 (617,311) 90 (372,849) (940,947) Net assets,beginning of year 10362.322 4373,616 1,453,536 16,189,474 17.130.421 Net assets,end of year S 10.606,694 3,756,305 1.453,626 15,316,625 16,189,474 See accompanying ndependent auditor's report. Catholic Charities and Community Services Farm Labor Housing Corporation Statement of Activities Year Ended June 30,2010 (With Summarized Totals for 2009) Temporarily 2010 2009 Unrestricted Restricted Total Total Revenue,Gains and Support: 200 Direct contributions $ 200 -10,609 - 10,609 - Public and private grants 202,933 242,085 Rental income, tenants 202,933 2 380,561 398, 41 - Rental income, USDA subsidy 380,561 - Interest income 353 353 3,7224 - - - 29,259 Refund of property taxes 44,006 38,353 99 Miscellaneous income 44,006 - Net assets released from restrictions 57,474 (57,474) - Total revenue, gains and support 696,136 (57,474) 638,662 711,831 Expenses: Program services: 460,760 461,131 Plaza del Sol operations 460,760 339,429 - 339,429 346,323 Plaza del Milagro operations 800,189 - 800,189 807,454 Total program expenses Supporting services: 61,766 82,945 General and administrative 61,766 Total expenses 861,955 - 861,955 890,399 Change in net assets (165,819) (57,474) (223,293) (178,568) Net assets, beginning of year 4,769,580 959,562 5,729,142 5,907,710 Net assets, end of year $ 4,603,761 902,088 5,505,849 5,729,142 See accompanying independent auditors report. W-9 (Attached as a separate document in this packet) Give Form to the Request for Taxpayer requester.to not (Rev. D January toff 2011) Identification Number and Certification send to the IRS. Intern Rev the ervaSllly ice Internal Revenue Service Name las shown on your income tax return) Catholic Charities and Community Services of the Archdiocese of Denver Business name/disregarded entity name.it different from above oi a) at it • Check appropriate box for federal tax Partnership Trust/estate o• classification(required): ❑ Individual/sole proprietor ❑ C Corporation O S Corporation ❑ P ❑ ai c Q Exempt payee a o p y P= artnership)* o ❑ Limited liability company.Enter the tax classification(C=C corporation,S=5 corpora ion, a O N ❑ Other(see instructions)• E. o Requester's name and address(optional) 0 Address(number,sorest,and apt.or suite no.) & 4045 Pecos St. to City.state,and ZIP code a a Denver, CO 80211 List account number(s)here(optional) your Taxpayer Identification Number (TIN) __ given social secoritr number 1 Enter TIN p the appropriateo box.The ls, provided muci match ity nameSS ).o the'Name"line to avoid backup withholding.For individuals,this is your social security number ISSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Pan I instructions on page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. I Employer identification number Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose number to enter. 8 4 -I 0 .6 I S 16 16 17 9 Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am ry not subject to backup withholding tified by the nternal(IRS)that I am subject to backup withholding as a result of a failure to report all (b) venue lit interest estor dividends,or(c)othe IRS has nlotifed me Service that I am no longer subject to backup withholding,and 3. I am a U.S.citizen or other U.S.person(defined below). because you haver failed to report allt interestand dividends on your taxretucn For real real estate transactions,ied by the IRS that youitem 2 re r does not apply.ently subject to For m withholding cross out item 2 above it you hav ben mortgage interest n f ebt, ons to an ment RA),and paid,acquisition or other than merest andonment t secured properly,dddividends,you are not required too sign the certification,,but individual must provide your correct TIN.See the instructions on page 4. Sign Signature of e/ Date /��/�/ Here U.S.person i' Note.It a requester gives you a form other than Form W-9 to request General Instructions your TIN,you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9.noted. Definition of a U.S.person.For federal tax purposes.you are considered a U.S.person if you are:Purpose of Form considered An individual who is a U.S.citizen or U.S.resident alien. A pe rson person who is required to file an information velum with the IRS must A artnershi p,corporation,oration,company,or association created or obtain your correct taxpayer identiecation number(TIN)to report,for • P example,income paid to you,real estate transactions,mortgage interest organized ized in(other theUnited than a n foreign estate),or under the o laws of the United Stales. An•you paid,acquisition or abandonment of secured property.cancellation r • A domestic trust(as defined in Regulations section 301.7701-7). of debt,or contributions you made to an IRA. Use Form 1N-9 only it you are a U.S.person(including a resident Special rules for partnerships.Partnerships that conduct a trade or alien).to provide your correct TIN to the person requesting it(the business in the United States are generally required to pay a withholding requester)and,when applicable,to: tax on any foreign partners'share of income from such business. 1.Certity that the TIN you are giving is correct for you are waiting for a Further.in certain cases where a Form W-9 has not been received.a number to be issuedi. oacnership is required to presume that a partner is a oreign person, and pay the withholding tax Therefore.it you are a U.S person+:'tat is a 2. aim xe pti nth not backup upt to backup'withholding.rgl a.orpanne-in a partnership co du g a trade or business in the United 3. Claim exemption horn wthholarng if you are a U.S.exempt States-provide Form W-9 to the partnership to establish your U.S. payee. It applicable.you are also certifying that as a U.S. person, your allocable sure of any partnership income from 6 U.S..trade or business atus and avoid withholding on your share of partnership income. is not subject to Ina aitnholding tax on foreign partners' snare of effectively connected income. Ferro W-9 hios.t-7ot') DOCUMENTATION OF FUNDING MATCH Catholic Foundation 3801 E.. Florida Avenue, Suite 725 Denver. CO 80210 303.468.9885 phone 303.468.9889 fax www.t.hecathacfoundation.com February 4,2011 Dr.Jonathan Reyes President&CEO Catholic Charities of Denver 4045 Pecos Street Denver, CO 80211 Re: The Catholic Foundation Grant No. 11100.244 Dear Jonathan: I am pleased to inform you that on February 4, 2011 a Grant was approved to be paid anonymously from a Donor Advised Fund of The Catholic Foundation to the Catholic Charities of Denver (the "Grantee") in the amount of$100,000.00 (the "Grant".) We are delighted to support you with this financial assistance. Enclosed please find the Grant Check. Endorsement of this check indicates Grantee's acceptance of this Grant and the Grant Terms, Conditions and Understandings attached hereto(see reverse)and incorporated by reference(collectively the "Grant Agreement")Before endorsing this Grant Check it is important that you read and fully understand this Grant Award Letter and the attached Grant Terms, Conditions and Understanding? which together constitute the Grant Agreement by and between Grantee and The Catholic Foundation(the "Grant Agreement") By endorsing this Grant Check thereby accepting this Grant,the Grantee agrees to the following: • Grant Purpose:to be used to aid Catholic Charities'work addressing homelessness and emergency assistance for the poor in 2011. • Grant Period: February 4, 2011 to December 31, 2011. The funds must be used specifically for the designated Purpose(s) within the Grant Period. • The Catholic Foundation does not require a tax receipt for this grant.Letters of appreciation should be sent to The Catholic Foundation,3801 E. Florida Avenue,Suite 725, Denver, CO 80210. • it is our understanding that the Catholic Charities of Denver qualifies under Section 501(c)(3) of the Internal Revenue Code of 1954. If this is not Grantee's current designation or if there has been a change in your public charity status, the Grant Check together with Grant Agreement must be returned immediately to The Catholic Foundation. • Required reporting will be consistent with the Grant Terms,Conditions and Understandings on back. • This Grant Agreement also gives The Catholic Foundation your permission to use photographs, logos, published/printed information,and any other materials you supply,without further notice,in press releases and/or publications. Should you have any questions regarding the Grant, please contact Teresa Devine at 303-468-9885. Thank you for spreading the light of Jesus and making such a difference in the lives of so many ,7 deserving individuals. - - 1g rz: Sincerely, -- , • Nf . •�-.,:,�6t` , r.� `,. I-f' I \�S t I�� C' SI tF l �� II � , . �� p hJiD"'Crl - r u �?VICE President L '; �fr' 7 Application for Colorado Division of Housing (CDOH) EMERGENCY SHELTER GRANT ASSISTANCE 2011 APPLICANT INFORMATION 1 OrDONT 2. CDH Project Number For CDH Use only NAME: Greeley Transitional House 3.Date Received ADDRESS: 1206 10th Street For CDH Use Only CITY: Greeley STATE: CO ZIP: 80631 4. Current ESG Program Recipient? CURRENT PRIOR ❑ NEVER 5. ;ct } 'tr >ta , =ra, , rt :; , 36acs, 6. Teki": 7. 8. '-S n':-(drop down box) Mrs. Jodi Hartmann (970)352-3215 (970)352-0130 jhartabowestoffice.net TYPE OF ORGANIZATION 9. ❑ 10. :It ,, }- c'iyd ..S4f y': ❑ 11. : iu i C.el +3 i n'..4; fni;` Please attach 501 (c)(3) ruling. 12. s r t ai ,a ix6a+ : t u.!:; : Use dro: down box) 8 4 — 1 0 4 5 9 5 8 13. .,a(-a ;' ,-', -- :(List counties served)Weld County B . .K4 io t ;.,1 !4•`.a §'§‘' le.zi ,ii.. . Unknown—approx. 16 years? 15. -•••••).a• •,oitt§ § �:-r*, (Check all that apply): ❑ Men 0 Women ® Families ❑Youth 0 Domestic Violence 16. I` 'i,t .:oiri `Jr:,.:i«. 'tidn:: ,S - .tau=.vii dilil ! P & {,:'.. ,•i« ] .I< y ::1•: N Emergency - Maximum Capacity per Night: 55 Maximum Stay:60 Days N or Months 0 ❑Day - Maximum Capacity: 0 Average Number of Clients Served per Day:0 ❑Transitional - Total Units:0 Maximum Length of Stay:0 Days D or Months 0 Average Stay:0 Days ❑ or Months 0 ® Homeless Prevention: - Number of Families and/or Individuals expected to Serve with ESG and Match Funds Each Year: 20 Are you requesting dollars for a new program in this request? NO If yes,program name: SIGNATURE OF AUTHORIZED OFFICIAL OR AGENCY REPRESENTATIVE 17. _t ral elr a e`d1ffiaial" r" ' t$'orted 18. T"tde pf ttrett fleetitf'tlfficial roar Autironzed .,,3 w_� .rte u- .;� , . ___._...._. _... _ __ _� <.zrr sra�-.'F�*�.;� ....._ .. AgendSeprese native (drop down box) RgprcSentattve Mrs. Jodi Hartmann Executive Director 19. Signature of iorized Representative: 20. Date: 3/28/2011 /off E iI: jhart@gwestoffice.net BUDGET Liar eiul spegse 21 Operations1i 22 Essential 244' ni anon tan =t Staffing-Shelter $2,500.00 $0.00 $0.00 $0.00 Operations Repairs&Maintenance $1,000.00 $0.00 $0.00 $0.00 Utilities &Telephone $5,000.00 $0.00 $0.00 $0.00 Property Insurance $2,500.00 $0.00 $0.00 $0.00 Case Management $0.00 $3,000.00 $0.00 $0.00 Security Deposit $0.00 $0.00 $1,000.00 $0.00 Assistance $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 - $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25. $11,000 $3,000 $1,000 $ 0.00 26. ill?"t .; :; a.3 $15,000 27. Name: United Way of Weld County Amount: $15,000.00, Name Amount $0.00 (Additional Space on page 13) PROPOSED PROJECT BUDGET EXPLANATION AND DOCUMENTATION Please also provide the following: • If you are requesting Operations,please identify any operating staff for which you are requesting funding. • (b)If you are requesting an increased level of funding or a new service under Essential Services,you must demonstrate that a new/increased level of need exists and ESG funding will not replace governmental funding. • (c)If you are requesting Homeless Prevention funding,please explain how you will ensure that your clients meet HUD requirements for homeless prevention assistance. All requests should be eligible, necessary and reasonable. You may also use the following page for the budget if necessary. (When typing below, please do not use the return (enter) key. Line will automatically wrap around) BUDGET PAGE EXPLANATION AND DOCUMENTATION) (28 C0NTINOED)YOU MAY BEGIN YOURRUDGET EXPI ANTION ON TEAS PAGE: (When typing below. pleas= do not rce the return tent ; he}. Line will r tomatic.allc- wrap ar( und) OPERATIONAL/OPERATIONAL STAFFING: Staffmg—Shelter Operations: Will be used to help pay for the part-time House Managers who provide client oversight, security and maintenance after normal business hours to insure 24/7 on-site safety and supervision. Funds will partially pay for one of the five part-time staff members employed in this position,Emma Lee Muniz. Repairs&Maintenance: Will be used to pay for routine repairs and maintenance at the shelter facility including appliance repairs(we have a total of 20 major appliances), lawn maintenance,small repairs,and cleaning supplies. Utilities&Telephone: Will provide partial funding for gas,electric, and water&sewer costs for the shelter facility. Facility Insurance: Will provide partial funding of shelter commercial/liability policy. ESSENTIAL SERVICES: Case Management-Emergency Shelter Clients: Will provide partial funding for case manager to provide goal setting,and referrals and information for employment,health,nutrition,education,child care,transportation,job training,budgeting, social services assistance,and permanent housing for client families. Case manager will act as mediator and liaison with landlords to prevent homelessness and to insure clients comply with lease agreements. HOMELESS PREVENTION: Security Deposits: Will be used to provide security deposit assistance necessary to prevent client families from becoming homeless due to inadequate resources to pay deposits upon leaving the emergency shelter. Assistance will only be given to those clients who have been living in the emergency shelter and have found permanent affordable housing upon leaving the shelter. Funds requested will enable us to assist 20 client families with a$50.00 security deposit assistance. EXTENT AND URGENCY OF THE NEED 29. (A)RTlia£is the neecrtiz b esseil Hgi�u.,. �—s.the n'"ed�r; a> proved _ ot`Ytatasit €l xfor%txoawa txna:hsn... .. ,of clients turn`gd`away,etc. . at.iip oP rts:.thg rt tea genoy, ill address: (When typing helms, please do not use the return (enter) key. Line will automatically wrap around) The target populations for GTH's services are the low income and working poor Weld County families who are highly motivated to work to overcome the bathers that are preventing them from attaining self-sufficiency, primarily employment and affordable housing. Demographically the population served by these programs will be primarily a young(67%of adult clients are age 30 or younger), low-income(98%of clients are living at or below 150%of the federal poverty level),majority Hispanic population(73%of clients are Hispanic). Most of the families served are single-parent households(predominantly women), and a significant majority of the individuals served are children(about 175 a year). Approximate 90%of our clients come from Greeley, 5% from other Weld County communities, and 5%from the Denver/metro area or from out of state. The need for emergency shelter and supportive services for homeless families has never been greater. The Greeley Transitional House has seen first-hand how poverty,unemployment,foreclosure, insufficient affordable housing, and overall economic uncertainty can wreak havoc on the stability of a household. The Greeley Transitional House's programs address this problem and affect change. The poverty rate in Weld County has climbed 40 percent since 2000 and an estimated 15.6 percent of residents were living below the poverty line in 2006 (U.S. Census). The number of families living in poverty has also escalated with the recession. In a recent Greeley Tribune article, the Greeley Housing Authority director estimated that close to 25 percent of families living east of 23rd Avenue in central Greeley live below the poverty line. Forty-two percent(42%)of the school-aged children in Weld County qualify for free and reduced price lunches in public school compared to 34.8%across the state (Colorado Children's Campaign). Even in the 2005 Compass report, Weld County Assessment of Needs and Strengths, 75 percent of key informants believed that unemployment or underemployment were serious community issues; 64.2 percent of household respondents said that inadequate wages were an issue. Those struggling to make ends meet often cannot pay their rent or house payment. The county has one of the highest foreclosure rates in the nation with one in every 29 homes undergoing some stage of the foreclosure process in the past several years. In an August 2008 report,the Colorado Division of Housing stated that Weld County had one new foreclosure filing for every 52 households in the first half of 2008. These statistics indicate financial education is necessary. A 2008 Financial Literacy Survey from Princeton Survey Research Associates International found that 41 percent of young adults in Generation Y(ages 18 to 29)do not pay their bills on time every month. The same study also found that parents and one's family are the biggest influence on one's financial education. For people trying to break the cycle of family poverty,it is especially difficult without in-depth support and education. Generational poverty is becoming a significant influence in the households applying to the Greeley Transitional House. A majority of the public does not have sufficient emergency funds, defined as three to six months of income saved. When a financial emergency strikes,many families need external support and call United Way's 2-1-1 resource center.According to United Way of Weld County, callers to the 2-1-1 had 4,859 needs expressed in 2009; 835 (17%)of which could not be met. Seventy-four(74%)percent of those unmet needs were for mortgage,rental or utility assistance. At the end of 2008,over half of all calls were for utility assistance. Families who called had utility bills ranging from$289 to$2,000,including overdue amounts. Moreover,it is not uncommon for adults to default on an account and then open a utility or phone account in an older child's name,thereby ruining the young adult's credit even before he or she has a chance at self-sufficiency. Inadequate living wages are also a significant issue in Weld County. According to the U.S. Bureau of Labor Statistics, Weld County had the largest drop in average weekly wages in the country in the first half of 2009, declining 32 percent. Because of this large decline, Weld County was ranked among the lowest in the country (#330)and had the lowest weekly wage among Colorado's largest counties at$686 (compared to Denver$1,011, and Larimer County,$723). (B)Did you turn clients away in the last grant period of January 1, 2010 thru December 31, 2010? YES If so how many, 12 where did they goto live with friends or family or in other shelters, did you refer them to another agency?YES PROJECT PLAN 30. a crilie-yo'i„≥ oJgc ?ia` .to ass z li g tiso:kVioarAtti die&c£17 ref (co;tli ir;ed acl E etlis` Lin 2_ (When typing below, please do not use the return (enter) key. Line will automatically wrap around). (Be sure to include the geographical areas and specific activities that you plan to provide). If this proposal is requesting funding for more than one activity(Essential Services, Operations/Staff Operations,Prevention), describe each separately. Our plan to address the need stated in Line 29 is to provide emergency shelter and essential services to assist homeless families in helping themselves—to move from crisis to self-sufficiency. While Greeley has a sizable stock of subsidized low income housing, that inventory is at near capacity with waiting lists at public housing and in many subsidized units. In addition,there are many who apply to our program who do not qualify for low income housing because of poor credit and poor housing histories. By serving these families at the shelter for up to 60 days we are able to give them time to find employment and repair their housing histories as well as supportive services to help prevent them from returning to homelessness. Further,by living in an emergency shelter they are placed on a priority status with the Housing Authority for low income housing assistance(if they meet all eligibility criteria of the Housing Authority). OPERATIONS/STAFF OPERATIONS: This plan is accomplished by providing temporary emergency shelter(up to 60 days)at our 12 bedroom emergency shelter facility in Greeley. Client families are housed in individual bedrooms with full baths,and then share a kitchen and living room with three other families.Funds requested will help pay for some of the operating costs for the emergency shelter services,including 24/7 staffing for security and client compliance,repairs&maintenance costs,utilities&telephone costs,and facility insurance. ESSENTIAL SERVICES: While living at the shelter families receive weekly intensive case management which involves immediate and long-term goal-setting,life-skills training,and commitment to a self-sufficiency plan. Our intake/enrollment process is designed to identify families who are highly motivated to move from a position of instability and dependence on public programs to emotional stability and economic self-sufficiency as rapidly as possible. Families enter the program initially because they are homeless. Working with their case manager,the clients set goals for improving their situation—primarily through securing employment(if unemployed)and "permanent"affordable housing. The adults attend life skills classes two evenings a week while living at the shelter. Examples of topics covered in these classes include parenting,credit management,employment skills(i.e. interviewing/resume development),community resources(e.g. Partners,Boys& Girls Clubs, Weld Food Bank), etc. The children and adolescents meet weekly with a Child/Adolescent case manager for referrals, mentoring,tutoring, and other services targeted to the unique needs of homeless children and youth. The funds requested partially cover the costs for this full-time professional case manager position. HOMELESS PREVENTION: Funds are requested to help families with up to$50.00 of their security deposit(if needed)when moving into permanent housing after leaving the shelter thus ensuring that families are not at risk of continued homelessness resulting from inability to meet all of the security deposit requirements. PLAN FOR FINANCIAL STABILITY 31 Provide a plah,the futu a aI stability ofjh roposed`proiect:, (lIory will the program _.. t;on+ nue in the fu ure if ESG funding n�lonaer,provide ?) (t.\11. typing belo E s.• do not use ,ha return (enter) key. Line ,;-ill automatically- wrap around) If this proposal is requesting funding for more than one activity(Essential Services, Operations, Prevention), describe each. OPERATIONS/STAFFING OPERATIONS: If ESG funding is no longer provided,the organization will look to other historiacal sources of funding including private foundations, individual and corporate donors, and possibly United Way funding. The organization continually works on increasing the number of special events we sponsor each year and increasing our direct mail efforts to increase individual donors. Our Executive Director and Board of Directors monitor our funding sources closely and will respond with increased fundraising in any way we can. However, it should be noted that all of our current sources of funding as described in this application are critical to our being able to maintain services at the current level in order to meet the community need. Any dramatic reduction in funding could necessitate reducing services,including emergency shelter, if additional funding cannot be secured. ESSENTIAL SERVICES: Same HOMELESS PREVENTION: If ESG funds were not available, assistance with security deposits would likely not be available unless new private foundation or public funding specifically for that purpose could be obtained. EXPERIENCE 4" ' ' ' 'f,l, iii . (When typing below, please do not use the return (enter) key. Line will automatically wrap around) Specifically, include the years of experience of staff and/or organization that will be administering the ESG funds. Where your organization and staff lack experience, explain how you will obtain the technical assistance needed to administer and complete the project. Experience of Staff that will be administering the ESG Funds: The organization has been receiving ESG funding for 15+years,and the Greeley/Weld Housing Authority has been administering the funds on our behalf for at least that long as well. Jodi Hartmann,the Executive Director and administrator of the funds for Greeley Transitional House has been administering ESG funds for the past six years,and has over 20 years'experience writing and administering federal,state,and private foundation grants. The fl se Manager providing Essential Services and overseeing the Homeless Prevention activities has been with Greeley Transitional House for 14 years and has provided ESG services and oversight for eight years. In addition,Jodi Hartmann has attended all mandatory Division of Housing ESG trainings since joining the organization and stays current on all program requirements as provided by Division of Housing. REPORT CHARACTERISTICS 2009-2011OAMAL Iii 2010=20f1 PIi 1JECTED Pia MS? frog? 33.Beds(including cribs) 23 23 34.Sleeping Rooms 12 12 35.Total Families Served 93 90 36.Total Persons in Families 271 300 37.Total Individuals Served 0 0 38.Total Nights 10,986 10,850 AVERAGE COST PER PERSON OR HOUSEHOLD SERVED WITH ESG FUNDING (Total Activity Budget I#Unduplicated Clients) CLIENT PARTICIPATION REPORT 40. 7, >�� _��,', :too,_ 0 41. 5,250 CONTINUUM OF CARE COORDINATION 42. YES 1 Who provides the following services in your Do you have a written SUPPORTIVE SERVICES community? agreement to coordinate (1) If it's your organization put an"X"in this services? Use the drop TYPE OF SERVICE column beside the corresponding service; down box to (2) If it's another organization, please list their Answer"Yes"or"No°or"NA" name (Not Applicable) 43. Information and Referral ❑Organization Name United Way 211 Not Applicable 44. Emergency ®Organization Name SET.FCT ONE: 45.Transitional Housing ®Organization Name SELECT ONE: 46. Permanent Housing(w/services) ®Organization Name SELECT ONE: 47.Soup Kitchen ❑ Organization Name Salvation Army,various Not Applicable churches 48. Case Management ®Organization Name SELECT ONE: 49. Transportation ❑Organization Name Greeley/Evens Transit Not Applicable 50.Daycare ❑ Organization Name Private Childcare Not Applicable Providers 51.Medical treatment ❑ Organization Name Monfort Family Clinic, Not Applicable Family Physicians,North Colo.Medical Center 52. Substance Abuse Counseling O Organization Name North Range Behavioral Not Applicable Health,North Colorado Psychcare 53. Psychological ❑ Organization Name North Range Behavioral Not Applicable Health,North Colorado Psychcare 54.Employment ❑ Organization Name Weld Co. Employment Not Applicable Services,Private employers 55. Life Skills/Budgeting ❑ Organization Name Various community Not Applicable providers; Consumer Credit Counseling of No. Colorado 56.Educational ❑ Organization Name Aims Community Not Applicable College, various GED/Voc.EdJJob training programs in the community _ 57.Security Deposit 0 Organization Name SELECT ONE: 58.Eviction Prevention ❑ Organization Name Catholic Charities Not Applicable Emergency Assist. Program, Faith Community Services Fund 59.Back Mortgage Payments ❑Organization Name None in community SELECT ONE: 60.Utility Assistance Payments ❑ Organization Name LEAP,Energy Outreach Not Applicable Colorado, Emergency Food &Shelter Program, Faith Community Services Fund CONTINUUM OF CARE NARRATIVE :[.,. ,y:{Ifl� .„; yillL e,i�. !._. �, ��;.of Pl E'<tbAl it . y.;. (When � ' " �� • � en typing below, please do not use the return (enter) key. Line will automatically wrap around) Greeley Transitional House works closely with other homeless safety net providers in Weld County, and is an active participant in the Northern Front Range Housing Continuum of Care(Jodi Hartmann serves as Secretary of the Continuum). GTH cooperates with A Woman's Place(safe house/shelter for victims of domestic violence), Room at the Inn(church-sponsored emergency shelter for families),and Catholic Charities' Guadalupe Shelter(an overnight emergency shelter for primarily homeless single men and women and a few families)to provide referrals and information. Each of these shelters serves a different niche of the homeless population, and little duplication of services occurs. However,the availability of these services provides our agencies with options for homeless families when we are full. Families will often stay at one of the other shelters until there is room at GTH because it is a longer-term,more stabilizing program for families. We fmd that all of these programs compliment our programs rather than compete for duplication of services. Unfortunately,there is more need in the community, particularly for homeless families,than all of these agencies/programs combined can meet. GTH works closely with the Greeley/Weld county Housing Authority to enroll our clients in housing programs for which they are eligible, and many of our families fmd permanent housing through this agency. We also work closely with a variety of low-income,federally-subsidized housing providers in the community to find affordable housing for our residents. In addition,we work closely with the Weld County Department of Human Services to ensure that our clients enroll in programs for which they are eligible(TANF,Food Stamps,Medicaid,etc.)in order to assist the clients in maximizing resources in order to acquire and sustain permanent affordable housing. All of these agencies(including GTH)are members of the United Way of Weld County Housing&Emergency Services Network(HESN),which meets bi-monthly to discuss community needs and responses, communicate activities within each organization,and to coordinate new programs to meet emergency needs. FINANCIAL CAPACITY- 62. Fanlan a yout o anaaatao finan aai control system an#pFeEedail4,a explaig how yo fir ' w L moint7oi atareWcntaekto-egsa a£ESe dollars`are ap@nt 1p s lim__ er, (When typing bolos', please do not use the return (enter) key. Line will automatically wrap around) The Board of Directors is responsible for the financial health and integrity of the corporation. • The Executive Director is responsible for establishing and implementing accounting and reporting procedures, which reflect sound fiscal management and provide for appropriate accountability to the Board of Directors and the public. • The Executive Director,Assistant Director and the Administrative Coordinator are bonded. • A checking and interest bearing savings account,petty cash checking account and all other investments are maintained with a financial institution in Weld County. • Financial records are maintained in accordance with generally accepted professional accounting practices and procedures and in a form and format appropriate to the requirements of an annual audit. • The Executive Director is responsible for submitting a proposed annual budget at the October Board meeting of each calendar year for the next year. Board of Directors will be responsible for final approved budget on an annual basis. • Routine and/or recurring expenses for operations of The Greeley Transitional House program which fall within the annual budget limitation approved by the Board of Directors are paid by the Executive Director as due. Drafts for such bills bear the co-signatures of the Executive Director and a member of the Executive Board. • Intermittent and unusual expenses that do not exceed$100.00 shall be paid from petty cash. A petty cash checking account not to exceed The Executive Director along with the Accountant prepares a Financial Report for submission to the Board of Directors at its regular monthly meeting which details monthly and year-to-date expenditures. • The Executive Director and the Executive Board of Directors arrange for an independent an independent audit of the corporation's financial records at the end of each calendar year, if and as required by funding sources. The auditor of auditing firm provides their findings to the Board of Directors. • ESG grant expenses are processed following the same procedures outlined above. Reimbursement for request is submitted after funds have been expended in each of the funded categories. • A separate expense account and income account have been established to record ESG expenses and matching income. ESG expense reimbursement requests are submitted quarterly after expenses have been incurred, and all grant-related expenses are typically incurred by the third quarter of the grant period to insure that all ESG dollars are spent in a timely manner. ABILITY TO COMPLY WITH HOMELESS MANAGEMENT INFORMATION SYSTEMS (HMIS) (When typing below, please do not use the return (enter) key. Line will automatically wrap around) We have received training periodically from the Colorado Coalition for the Homeless(CCH)Balance of State HMIS Coordinator over the last four years,and when we have had staff turnover. The trainings were held both at our agency and at CCH. The most recent training occurred in the fall of 2010 at GTH. ;inn �ns� GTH recently purchased a new computer and printer for use with the HMIS system: Model: Dell Latitude E6510 laptop Operating System: Windows 7 Home Premium Processor: Intel Core i3 (380M) Hard Drive: 585 GB(64-bit operating system) RAM: 4.00 GB Printer: Brother MFC-8890ow all-in-one The only staff that have access to the client files and the HMIS system are the case managers who enter the HMIS data into the system with secure passwords. Files are kept in locked file cabinets in offices that are locked when not in use,and only permanent, full-time staff have access to those offices by key. All employees are required to sign a confidentiality agreement upon employment at GTH. 66. a a a t:1 Please place an"X" in the box that best describes your current HMIS status. O I am a new applicant. ®My agency is entering all HUD-required HMIS data elements on a consistent basis. ❑ My agency is in discussions with my systems operator regarding my participation. We have not yet been trained on the HMIS system. ❑My agency is a new State ESG Applicant,but we enter HMIS information for another Federal grant. ❑My staff has been trained on HMIS,but I am waiting to upgrade equipment and or training before we fully participate. ❑My agency is exempt from HMIS. OTHER DOCUMENTS TO SUBMIT WITH ESG APPLICATION (See attached pages) ABILITY TO COMPLY WITH STATE'S INSURANCE REQUIREMENTS The State requires various insurance. Please use drop down box in each section indicating YES if you have the required insurance or N() if you do not. You may provide an explanation after each section of challenges that you face. 1. "The Contractor shall obtain,and maintain at all times during the term of the agreement,insurance in the following kinds and amounts: a. Workers Compensation Insurance as required by state statute and Employer's Liability Insurance covering all of the contractor's employees acting within the course and scope of their employment. Yes l.a.Issues or Explanation: b. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalency,covering premises, operations,fire damage,independent contractors,products and completed operations,blanket contractual liability,personal injury,and advertising liability within minimum limits as follows: i. $1,000,000 each occurrence ii. $1,000,000 general aggregate; iii. $1,000,000 products and completed operations aggregate;and iv. $50,000 any one fire. Yes 1.b.Issues or Explanation: c.Automobile Liability Insurance covering any auto(including owned,hired and non-owned autos)with a minimum limit as follows: $1,000,000 each accident combined single limit. Yes 1.c.Issues or Explanation: 2. The State of Colorado is named(or will be named within 7 business days of the effective date of the contract)as additional insured on Commercial General Liability and Automobile Liability Insurance policies(leases and construction contracts will require the additional insured coverage for completed operations on endorsements CD 201011/85,CG 2037 or equivalent). Coverage required of the contract will be primary over any insurance or self-insurance program carried by the State of Colorado. Yes 2. Issues or Explanation: 3. The Insurance includes(or will include within 7 business days of the effective date of the contract)provisions preventing cancellation or non-renewal without at least 45 days prior notice to the State by certified mail; Yes 3. Issues or Explanation: 4. The contractor will require all insurance policies in any way related to the contract,and secured and maintained by the contractor,to include clauses stating that each carrier will waive all rights of recovery under subrogation or otherwise,against the State of Colorado,its agencies,institutions,organizations,officers,agents,employees and volunteers. Yes 4. Issues or Explanation: 5. All policies evidencing the insurance coverage required hereunder shall be insured by insurance companies satisfactory to the State. • Yes 5. Issues or Explanation: 6. The contractor shall provide certificates showing insurance coverage required by the contract to the State within 7 business days of the effective date of the contract. Yes 6. Issues or Explanation: 7. Notwithstanding subsection"a'of this section,if the Contractor is a"public entity"agrees,within the meaning of the Colorado Government Immunity Act, CRS 24-10-101, et seq,as amended("Act"),the contractor shall at all times during the term of the contract maintain only such liability insurance by commercial policy or self-insurance, as is necessary to meet its liabilities under the act and show proof of insurance upon request. Yes 7. Issues or Explanation: igs�rucYolis.4oE;:Gomplefaor`�of 141ar��i,�_e_,rtlfc�fion All applicants are required to complete the Match Certification form. Eligible forms of match are as follows: ▪ The value of salary paid to staff to carry out the ESG Program. • The value of the time and services contributed by volunteers to carry out the program at a rate of $5.00 per hour. • Volunteers providing professional services such as medical or legal services valued at the reasonable and customary rate in the community. • The value of any donated material or building. • The value of any building lease using a method to reasonably calculate fair market value. • Award letters from foundations, organizations, private individuals, and other government sources. **Note: These awards must overlap the ESG funding period to be eligible. ** MATCH CERTIFICATION SOURCES OF LOCAL MATCH (Attach supporting documentation for available match- Documentation should reflect funding availability during the ESG contract year.) l1 NAME AMOUNT _ $0.00 PILO $0.00 NAME AMOUNT $0.00 $0.00 $0.00 et'rir'^(lir.Jli .rI i^ i:1 l,?'dhil z^li;itl!k. Fund Raising/Cash $0.00 Loans $0.00 Building Value or Lease $0.00 Donated Goods $0.00 Donated.Computers $0.00 New Staff Salaries $0.00 Volunteers ($5.00 per hour) $0.00 Volunteer Medical/Legal $0.00 Other (specify)United Way of Weld County $15,000.00 I certify that match funds have been identified and committed to support the proposed ESG project and have not been used to match previous ESG awards(i.e.the value of a donated building used as match in a 2009 award cannot be used as match in 2010). This form is a description of the sources and amounts of such match funds,which are not being used as match for any other federal program. I JC t i,_._ a-Ct-- `t—t. 3/28/11 Si' atullre/Title Date 4 Additional Funds Documentation The list of all sources of additional funds not included as match to be used to carry out your proposed project Be specific. Sources of Additional Funds Amount of Additional Funds Private Foundations $ 91,500 City of Greeley $ 7,000 United Way of Weld County $ 50,000 Donations $ 40,500 Fundraisers $ 78,000 Other Public Funding $ 100,000 $0.00 $0.00 $0.00 Total Additional Funds Committed to the ESG Process $367,000 Weld County Housing Authority P.O. Box 130 Greeley, CO 80632 970 353-7437 COLORADO CERTIFICATION OF LOCAL APPROVAL BY LOCAL BOARD OF COMMISSIONERS FOR NON-PROFIT ORGANIZATIONS I Barbara Kirkmeyer, Chair, duly authorized to act on behalf of Weld County hereby approve the following project(s) proposed by Greeley Transitional House,which is located in Weld County. ATTEST: s • i'_.. a B Clerk to the Boar I =, Barbara Kirkmeyer,Chair S ��'• Board of County Commissioners By: //,viii/. ��.��,� r %L � Weld County, Colorado Deputy Cler o the Board � 4.a ; Date:3/-3 C / >Zec Certification of Consistency with Consolidated Plan I Rebecca L. Safarik, Community Development Director certify that Greeley Transitional House located in the City of Greeley is consistent with the Consolidated Plan for the City of Greeley “ Rebecca L. Safarik Community Developm Director Date of Certification .3)3//a0/ / EMERGENCY SHELTER GRANT PROGRAM ASSURANCES AND CERTIFICATIONS Jodi Hartmann(name of chief elected official or appropriate non-profit signatory)Executive Director of Greeley Transitional House (town, city, county or nonprofit organization)which is applying to the State of Colorado for funding through the Emergency Shelter Grant Program from the U.S. Department of Housing and Urban Development(HUD),hereby assures and certifies that: Amounts awarded under this program will be used only for these purposes: 1. Assist in the prevention of homelessness. 2. Assist in supporting the essential operating costs of s. 3. Assist in improving the quality of supportive services to the homeless. Projects will not require participation in religious services,as a condition for receiving assistance. All projects funded will develop and administer, in good faith, a policy designed to ensure the is free from the illegal use,possession or distribution of DRUGS and ALCOHOL by its beneficiaries. Political activities will be prohibited in accordance with subsection 675 (e) of the Community Services Block Grant Act of 1981. The town, city, county or nonprofit organisation certifies that matching supplemental funds required by the regulations at 24 CFR 576.71 and 576.85(a)(3), as mentioned by the amendments to Items 415(a) and 415(c) of the Stewart B. McKinney Homeless Assistance Act made by Section 832(e)of the Cranston-Gonzalez National Affordable Housing Act of 1990 (Public Law 101-625, November 28, 1990) will be provided. The amendment exempts the first $100,000 from the matching requirement and requires that the benefit of the $100,000 exemption be provided to those recipients from the State that are least capable of providing the matching funds. The requirements of 24 CFR 576.21(a)(4)(ii) which provide that the funding of homeless prevention activities for families that have received eviction notices or notices of termination of utility services meet the following standards: (A)that the inability of the family to make the required payments must be the result of a sudden reduction in income; (B) that the assistance must be necessary to avoid eviction of the family or termination of the services to the family; (C)that there must be a reasonable prospect that the family will be able to resume payments within a reasonable period of time; (D) that the assistance must not supplant funding for preexisting homeless prevention activities from any other source; (E) occur a week before eviction, foreclosure or termination. The requirements of 24 CFR 576.51(b)(2)(iii) concerning that submission by nonprofit organizations applying for funding of a certification of approval of the proposed project(s) from the unit of local government in which the proposed project is located. The requirements of 24 CFR 576.51(b)(2)(v) concerning the funding of emergency in hotels or motels or commercial facilities providing transient housing. The requirements of 24 CFR576.56(a)(3) concerning the provision of termination and/or grievance procedures for an individual or family who violates program requirements. The requirement of 24 CFR576.56(b)concerning the involvement of homeless individuals and families in providing work or services pertaining to policy-making and in operations of facilities or activities assisted under this part. The requirement of 24 CFR576.57 concerning the prohibition of conflict of interest or financial interest in decision-making by elected officials, appointed officials, staff or board of directors except as may be granted by HUD as provided in 570.611(d). Grant funds are used for rehabilitation or conversion of buildings for use of emergency s for the homeless; or when funds are used solely for operating costs or essential services, concerning the population to be served. The building standards requirement of 24 CFR 576.75. The requirements of 24 CFR 576.77,concerning assistance to the homeless. The requirements of 24 CFR 576.79, other appropriate provisions of 24 CFR Part 576, and other applicable Federal law concerning nondiscrimination and equal opportunity. The requirements of 24 CFR 576.80 concerning minimizing the displacement of persons, as a result of a project assisted with these funds. The requirements of 24 CFR 576.80 concerning the Uniform Relocation Assistance and Real Acquisition Policies Act of 1970. The requirement of the Cranston-Gonzalez National Affordable Housing Act (Public Law 101-625, November 28, 1990 contained in Section 832(eX2)(C) that grantees develop and implement procedures the ensure the confidentiality of records pertaining to any individual provided family violence prevention or treatment services under any project assisted"under the Emergency Shelter Grant Program" will, except with written authorization of the person or persons responsible for the operation of such,not be made public." The requirement that local government will comply with the provisions of and regulations and procedures applicable under section 104(g) of the Housing and Community Development Act of 1974 with respect to the environmental review responsibilities under the National Environmental Policy Act of 1969 and related authorities,as specified in 24 CFR Part 58, and as applicable to activities of nonprofit organizations. The requirement that no Federal appropriated funds have been paid, by or on behalf of the local government or nonprofit organization, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal loan,the entering into of any cooperative agreement, and modification of any Federal contract, grant,loan or cooperative agreement. The requirement that if any funds, other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the local government or nonprofit orgeniPation shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying,"in accordance with its instructions. The requirement of disclosure specified in Subpart C of 24 CFR Part 12 regarding assistance from other HUD-funded programs. The requirement that the local government or nonprofit organization shall require that the language of the PROHIBITION OF THE USE OF FEDERAL FUNDS FOR LOBBYING CERTIFICATION be included in the award documents for all standards at all tiers including subcontracts, subgrant, and contracts under Grant,loans,and cooperative agreements and that all subrecipients shall certify and diarlose accordingly. The requirement that(68 Fed.Reg. 43430)agencies receiving funding from the Emergency Shelter Grant Program become compliant with Homeless Management Information System(HMIS)as required by the Department of Housing and Urban Development. The required certification that the submission of an application for any emergency Shelter grant is authorized under applicable law and that the local government or nonprofit organization possesses legal authority to carry out emergency Shelter grant activities in accordance with applicable law and regulations of the Department of Housing and Urban Development. !Jodi Hartmann Executive Director ( Na, e Title C�� d li^;' r .,,.•:� 3/28/11 Signature' Date COOK PERFORMANCE MEASUREMENTS AND OUTCOMES All ESG proposals must comply with the CDOH Performance Measurements and Outcomes. I have read the performance and outcome measurements shown below and understand that these may differ from measurements required by HUD. (Please Use Drop Down Box) YES Name: ' H ann it :Executive Director Date:3/28/11 Signature 4,1/49, -z , Performance Measurements and Outcome Requirements Objective: Serve the lowest income and hardest to serve individuals and families meeting critical housing needs through state and federal initiatives by creating a suitable living environment or decent affordable housing. : ESG ESG Funding 1. End chronic homelessness and move homeless families and individuals into permanent housing. 2.Availability/accessibility for the purpose of creating suitable living environments. 3. Promote self-sufficiency,efficient use of funds and effective program administration. • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • Recipient expended all ESG funds within the established grant timeframe. • Recipient met the deadline for submitting their signed grant agreement. • Recipient met the deadline for submitting evidentiary documents. • Recipient met the deadline for submitting performance reports. • Recipient meets required standards for documentation of homelessness. • Recipient complies with required record keeping methods. • Recipient complies with the due process of terminating ESG funded assistance of participant. • Amount of money leveraged. • Does recipient have findings from previous compliance reviews? • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • The total number of adults and children served on an annual basis(reported under Homeless Assistance Services). • The number of persons served by race and ethnicity. 1:6)p. ... • Number of persons assisted with ESG funds for eviction notices. • Number of persons assisted with ESG funds for utility termination notices. • Number of persons assisted with ESG funds for security deposits and/or first month's rent. • The total number of adults and children served on an annual basis(reported under Homeless Prevention Services). • The number of persons served by race and ethnicity. GDOEPerformanceeasures/Indicators,specifico ESG' uuled Essential Services: • Number of homeless persons that received ESG funded services concerned with employment. • Number of homeless persons that received ESG funded services concerned with health. • Number of homeless persons that received ESG funded services concerned with substance abuse. • Number of homeless persons that received ESG funded services concerned with education. • Number of homeless persons that become successfully independent of ESG funded services. • Number of homeless persons that return to their prior living situation • The total number of adults and children served on an annual basis(reported under Homeless Assistance Services). COPY OF YOUR 501(c)(3) Ruling I�p�q� I RS I]eVamer o',,La iea;inV it L Inlern:il Revenur Servi.e P .O . Box 2508 , Room 4010 In reply refer to : 4077550282 Cincinnati OH 45201 Aug . 26 , 2008 LTR 4168C 0 84- 1045958 000000 00 000 00020196 BODC: TE GREELEY TRANSITIONAL HOUSE INC TRANSITIONAL HOUSE 1206 10TH ST Zil GREELEY CO 80631-3702064 010363 Employer Identification Number : 84- 1045958 Person to Contact : Barb Herald Toll Free Telephone Number : 1-877-829-5500 Dear Taxpayer : This is in response to your request of July 31 , 2008, regarding your tax-exempt status . Our records indicate that a determination letter was issued in June 1987 , that recognized you as exempt from Federal income tax , and discloses that you are currently exempt under section 501 (c) (03) of the Internal Revenue Code . Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a) ( 1) and 170 (b) ( 1 ) (A) (vi) . Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106 , and 2522 of the Code . If you have any questions , please call us at the telephone number shown in the heading of this letter . Sincerely yours , Ltd Cindy Westcott Manager , E0 Determinations COPY OF YOUR MOST RECENT AUDIT \ �" � � � � \ {k , a Sdw y m2 \ /» 2\ GREELEY TRANSITIONAL HOUSE, INC. _ \/ FINANCIAL STATEMENTS _� \ \\\ r \ YEAR ENDED DECEMBER 5, 2O 9a d2 08 \\ \ \/\\ / •• Bartels & Company, LLC CERTIFIED PUBDC� �, wzsa , e., w . : e . Greeley, mea , ��, ; s-wm fax I I 1 I 1 I GREELEY TRANSITIONAL HOUSE,INC. FINANCIAL STATEMENTS YEAR ENDED DECEMBER 31,2009 and 2008 I I I I I I I I II -1 , I INDEPENDENT AUDITORS'REPORT I To the Board of Directors Greeley Transitional House, Inc. Greeley, Colorado We have audited the accompanying statements of financial position of Greeley Transitional House, Inc. (a nonprofit organization) as of December 31, 2009 and 2008, and the related statements of activities,changes in net assets,cash flows and functional expenses for the years then ended. These financial statements are the responsibility of the Organization's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Greeley Transitional House, Inc., as of December 31, 2009 and 2008 and the changes in its net assets and cash flows for the years then ended in conformity with accounting principles generally accepted in the United States of America. 4.21-4 1 (.49-frn 4+/; C July 6, 2010 I I I 1 I 7251 W.20th Street•Building D-1 •Greeley,CO 80634•(970)352-7500•(970)352-2281 fax•www.bartelscpa.com 1 Greeley Transitional House, Inc. Statements of Financial Position IDecember 31, 2009 and 2008 I 2009 2008 - Assets Current Assets ICash and cash equivalents $ 10,441 $ 18,316 Grants and donations and advances receivable 17,444 100 Prepaid expenses 396 IDeposits 288 576 Total Current Assets 28,569 18,992 I Land, Buildings and Equipment Land 78,800 78,800 Buildings 439,451 439,451 I Building Improvements 85,193 21,559 Automobile 3,420 3,420 Equipment and Furniture 24,600 24,600 631,464 567,830 I Less accumulated depreciation (78,555) (61,418) 552,909 506,412 ITotal Assets $ 581,478 $ 525,404 I Liabilities and Net Assets Current Liabilities Current Portion of Note Payable $ 1,797 $ 1,296 I Line of Credit 10,093 Accounts payable 3,231 6,863 Deferred revenue 10,000 I Payroll withholding and taxes payable 5,524 9,467 Accrued compensated absences 6,453 8,089 Total Current Liabilities 27,005 35,808 INote Payable-Long-Term 20,824 22,955 Net Assets IUnrestricted: Designated for Fixed Assets 530,071 461,970 Undesignated I 530,071 461,970 Temporarily Restricted 3,578 4,671 Permanently Restricted I Total Net Assets 533,649 466,641 • Total Liabilities and Net Assets $ 581,478 $ 525,404 I ISee accompanying notes and auditors'report 1 Greeley Transitional House, Inc. Statements of Activity and Net Assets For the Years Ended December 31,2009 and 2008 I 2009 2008 Temporarily Temporarily I Unrestricted Restricted Total Unrestricted Restricted Total Revenue Public Support Donations 158,594 1,800 160,394 $ 140,578 $ 2,734 $ 143,312 I Other Revenues Governmental Grants 159,922 159,922 87,301 87,301 United Way Funding 70,997 70,997 66,603 66,603 Fund Raising Events 66,241 66241 55,569 55,569 I Investment Income 4 4 3 3 Other Income 386 386 389 389 Total 225,225 232,719 457,944 196,539 156,638 353,177 Net Assets Released from I Restrictions 233,812 (233,812) 153,938 (153,938) Total public support and revenue 459,037 (1,093) 457,944 350,477 2,700 353,177 Functional Expenses IProgram Services 304,464 304,464 304,756 304,756 Management and General 45,113 45,113 30,712 30,712 Fundraising 41,359 41,359 43,607 43,607 ITotal Functional Expenses 390,936 390,936 379,075 379,075 Increase(Decrease)in net assets 68,101 (1,093) 67,008 (28,598) 2,700 (25,898) Net assets,beginning of year 461,970 4,671 466,641 490,568 1,971 492,539 I $ 530,071 $ 3,578 $ 533,649 $ 461,970 $ 4,671 $ 466,641 I I I I I I I ISee accompanying notes and auditors'report 2 Greeley Transitional House, Inc. Statements of Functional Expenses I For the Year Ended December 31, 2009 IProgram Management Fund Total Services and General Raising Expenses ' Salaries and Wages $ 175,895 $ 19,073 $ 16,954 $ 211,922 Payroll taxes 14,796 1,604 1,426 17,826 Depreciation 16,109 514 514 17,137 Utilities 17,869 570 570 19,009 I Employee Benefits 12,325 1,337 1,188 14,850 Program Expenses 22,424 22,424 Insurance 6,178 325 6,503 I Professional fees 13,526 20,289 33,815 Repairs and Maintenance 8,869 8,869 Telephone 3,336 192 307 3,835 IAdvertising 515 514 1,029 Office Expenses 2,394 138 220 2,752 Training 1,964 112 156 2,232 Household Supplies 1,831 1,831 IInterest 3,175 101 101 3,377 Travel Expenses 1,064 1 064 Rental Expense 200 6 6 212 I Employee Appreciation 1,283 74 118 1,475 Dues 201 104 305 Donor Recognition 414 414 I Postage 510 29 47 18 586 Other Expense 223 ,824 19,047 Bank Charges 422 422 I" $ 304,464 $ 45,113 $ 41,359 $ 390,936 I I I I I I ISee accompanying notes and auditors' report 3 dip Greeley Transitional House, inc. Statements of Functional Expenses IFor the Year Ended December 31, 2008 IProgram Management Fund Total Services and General Raising Expenses I Salaries and Wages $ 192,472 $ 20,870 $ 18,551 $ 231,893 Payroll taxes 15,673 1,700 1,511 18,884 Depreciation 15,013 479 479 15,971 Utilities 16,650 531 531 17,712 I Employee Benefits 11,649 1,263 1,122 14,034 Program Expenses 13,327 13,327 Insurance 7,324 386 7,710 IProfessional fees 2,323 3,484 5,807 Repairs and Maintenance 11,771 11 771 Telephone 3,349 193 308 3,850 I Advertising 507 507 1,014 Office Expenses 2,501 144 230 2,875 Training 2,516 143 200 2,859 I Household Supplies 2,491 2,491 Interest 2,945 94 94 3,133 Travel Expenses 2,187 2,187 Rental Expense 200 6 6 212 I Employee Appreciation 1,049 60 96 1,205 Dues 279 138 417 Donor Recognition 605 605 1 Postage 507 29 47 583 Other Expense 23 879 19,320 20,222 Bank Charges 313 313 I $ 304,756 $ 30,712 $ 43,607 $ 379,075 I I I I I I ISee accompanying notes and auditors'report 4 i'x Greeley Transitional House, Inc. Statements of Cash Flows IFor the Years Ended December 31, 2009 and 2008 2009 2008 ICash Flows From Operating Activities: Increase(Decrease)in net assets $ 67,008 $ (25,898) I Adjustments to reconcile change in net assets to net cash provided by operating activities: Depreciation 17,137 15,971 I In Kind Donations of Property and Equipment (26,031) (Increase)decrease in operating assets: Grants and donations receivable (17,344) 8,187 I Prepaid expenses and deposits (108) 1,164 Increase (decrease)in operating liabilities: Accounts payable (3,632) 5,092 il Deferred revenue 10,000 Payroll Taxes Payable (3,943) 7,635 Accrued Compensated Absences (1,636) 6,558 Net Cash Provided By(Used In)Operating Activities 67,482 (7,322) I Cash Flows Provided By Investing Activities Purchase of property and equipment (63,634) (655) Net Cash(Used In)Investing Activities (63,634) (655) Cash Flows From Financing Activities IAdvances from Line of Credit 118,281 98,351 Payments on Line of Credit (128,374) (88,258) Mortgage Loan Payments (1,630) (5,675) Net Cash Provided By(Used In) Financing Activities (11,723) 4,418 Net Increase(Decrease) in Cash and Cash Equivalents (7,875) (3,559) I Cash and Cash Equivalents - Beginning of Year 18,316 21,875 ICash and Cash Equivalents -End of Year $ 10,441 $ 18,316 ISUPPLEMENTAL DISCLOSURES: Interest paid $ 3,377 $ 3,133 INONCASH INVESTING AND FINANCING ACTIVITIES: In Kind Donations of Equipment $ 26,031 In Kind Donations of Services $ 26,000 $ 3,322 I IllSee accompanying notes and auditors' report 5 ,11 ' 'It E1.',l_,EY IRANYI I l0US I:'.; Notes to Financial Statements December 31, 2009 and 2008 Note 1 — Summary of Significant Accounting Policies Nature of Activities The Greeley Transitional House, Inc. operates a temporary housing facility for homeless families in Greeley, Colorado. iBasis of Accounting The financial statements have been prepared on the accrual basis of accounting in accordance with generally accepted accounting principles. Financial Statement Presentation The Organization prepares its financial statements using guidelines established by the Financial Accounting Standard Board, "Accounting for Contributions Received and Contributions Made"and "Financial Statements of Not-for-Profit Organizations" codified in FASB ASC 958. FASB ASC 958-605-25 {SFAS No. 116} requires an organization to recognize as revenue contributions, including unconditional promises to give, when received. Unconditional promises made are also required to be recognized at the time the recipient has a right to expect that the promised assets will be transferred in the future. FASB ASC . 958-225-45 {SFAS No. 116} also requires not-for-profit organizations to distinguish between contributions received that increase permanently restricted net assets, temporarily restricted net assets and unrestricted net assets, and requires recognition of the expiration of donor-imposed restrictions in the period in which the restrictions expire. FASB ASC 958-210-45 {SFAS No. 117} requires classification of net assets,revenue, expenses, gains, and losses based on the existence or absence of donor-imposed restrictions. It requires that the amounts for each of the three classes of net assets (permanently restricted, temporarily restricted and unrestricted)be displayed in the statement of activities and changes in net assets, and the change in cash and cash equivalents to be reported in a statement of cash flows. Public Support and Revenue Grants and other contributions of cash are reported as temporarily restricted support if they are received with donor stipulations that limit the use of the donated assets. When a donor restriction expires, that is, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the statement of activities as net assets released from restrictions. I 1 6 GREELEY 1 a/,NSi3 TONAL licL'SF, INC. Notes to Financial Statements December 31, 2009 and 2008 Note 1 —Summary of Significant Accounting Policies (Continued) Donated material and equipment are reflected as contributions in the accompanying statements at their estimated values at date of receipt. Donations of property are reported as unrestricted support unless the donor has restricted the donated asset to a specific purpose. 1 For the years ending December 31, 2009 and 2008, $26,000 and$3,322 has been reflected in the statements for donated office administration and computer repair services. $25,000 of the donated services for the year ending December 31, 2009 was for an office administrative assistant provided by United Way through the Americorps VISTA program. In addition, a substantial number of volunteers have donated significant amounts of their time in the Organization's program services and its fund-raising campaigns for which no amounts have been reflected in the statements since no objective basis is available to measure the value of such services. 1 Income Tax Status The Organization qualifies as a tax-exempt organization under Section 501 (c) (3) of the Internal Revenue Code and, therefore, has no provision for federal income taxes.The Organization has no unrelated business income for the years ended December 31, 2009 and 2008. The Organization has not recognized any interest or penalties related to income taxes in the statements of activities or the balance sheets. The Organization, as an exempt entity, does not have unrecognized tax benefits. U.S. Federal information returns filed for the years ended December 31, 2006 through December 31, 2008 are open for audit. Cash and Cash Equivalents The Organization considers all highly liquid investments purchased with a maturity of three months or less to be cash equivalents. The Organization places its temporary cash investments with a high credit quality financial institution. At times, such balances and temporary investments may be in excess of FDIC insurance limits. As required by law and grant agreement, separate bank accounts are maintained for raffle ticket sales and for rent assistance from the Colorado Coalition for the Homeless. tEstimates The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. 7 7 GRELL'_Y TRANSITIONAL MOUSE, INC. Notes to Financial Statements December 31, 2009 and 2008 Note I --Summary of Significant Accounting Policies (Continued) Building and Equipment Building and equipment are valued at cost or fair market value at date of acquisition. Depreciation of buildings and equipment is provided on a straight-line basis over a useful life of 7 to 40 years. Recorded amounts for property are based on cost or approximate market value at date acquired, if acquired by gift. Donations of property are reported as unrestricted support unless the donor has restricted the donated asset to a specific purpose. Maintenance, repairs and minor renewals that do not significantly improve or extend the lives of the respective assets are charged against operations when incurred. Additions, improvements and major renewals are capitalized. The cost and accumulated depreciation of assets sold, retired or otherwise disposed are removed from the respective accounts and any gain or loss is reflected in operations. Functional Expenses The expenses of providing the various programs and other activities have been summarized on a functional basis in the Statement of Functional Expenses. Expenses are charged to program services and supporting services based on direct expenditures incurred. Any expenditures not directly chargeable are allocated to a program based on related salary expenses. Advertising Expenses The Organization expenses advertising costs as they are incurred. Advertising costs were $1,029 and $1,014 for the years ended December 31, 2009 and 2008, respectively. Subsequent Events The Organization has evaluated subsequent events through July 6, 2010, the date the financial statements were available to be issued. Note 2—Temporarily Restricted Net Assets The temporarily restricted net assets as of December 31, 2009 consist of$1,971 restricted for rent assistance for clients, $1,000 for playground equipment, $500 for educational toys, and $107 for a garden. The temporarily restricted net assets as of December 31, 2008 consist of$1,971 restricted for rent assistance for clients and $2,700 for capital improvements. 8 GREELEY TRANSI IL)NAL HOUSE, INC. Notes to Financial Statements December 31, 2009 and 2008 Note 3 —Mortgage Payable Detail Payee Current Long,Term Total Wells Fargo, Interest Rate 7.95%, due January 4, 2022, secured by real estate at 1206 10th Street, Greeley, Colorado $1,797 $20,824 $22,621 Debt maturities are as follows: 2010 $ 1,797 2011 1,945 2012 2,106 2013 2,279 2014 2,467 Thereafter 12.027 22 621 Note 4—Note Payable—Line of Credit Payee Current Long Term Total Wells Fargo, Interest Rate 2% over prime, annually renewable $50,000 line of credit, unsecured $0 $0 $0 Note 5—Funding Sources The Organization receives grants and donations from state and local governments,private foundations, corporations, churches, and individuals. A significant amount of funding is received from the United Way of Weld County. Grants and donations from the United Way of Weld County comprised approximately 20.51% and 18.86% of total revenue for the years ended December 31, 2009 and 2008, respectively. Grants and donations from the Greeley/Weld Housing Authority comprised approximately 7.28% and 12% of total revenue for the years ended December 31, 2009 and 2008, respectively. A grant of CDBG(Community Development Block Grant) funds for building improvements from the Greeley Urban Renewal Authority was approximately 12.70% of the total revenue for the year ended December 31, 2009. 9 GREELEY 17'..^,iS1TIONAL HOUSE, INC. Notes to Financial Statements December 31, 2009 and 2008 Note 6—Retirement Plan The Organization has a defined contribution retirement plan, which covers substantially all of its employees. Employees become eligible to participate after completing an initial probationary hiring period. Monthly contributions to the plan must be a minimum of $25 of each participant's compensation. The Organization contributed$1,736 as a match to the plan for the year ended December 31, 2008. Effective June 30,2009, the plan was replaced by Simple IRAs. The Organization contributed$7,429 as a match to the Simple IRAs for the year ended December 31, 2009. Note 7—Endowment Fund The Organization established an endowment fund with The Community Foundation of Greeley and Weld County in 2007. The endowment fund has been restricted for acquisition or renovation of a capital asset or for unexpected financial needs that are not likely to recur. A majority vote of the board of directors is required to request a distribution from the endowment fund and the request is solely advisory and subject to the approval of the Community Foundation. As of December 31, 2009, there are no distributions available because the fund has not sufficiently recovered from the market downturn. The endowment fund is a component fund of the Community Foundation and the Community Foundation is the legal owner of all assets contributed to any of its component funds. Therefore, the market value of the gifts are not recorded as an asset on the Statement of Financial Position. A summary of endowment account activity is as follows: 2009 2008 Beginning Balance $ 9,007 $ 10,613 Contributions 1,000 Interest and dividends 300 328 Gains (Losses) 1,368 (2,254) Investment and administrative fees (369) 380 11,_3( LAM Note 8—Commitments and Contingencies The Organization has a pending workers compensation claim that was filed by a current employee. The claim is being covered by workers compensation insurance. The effect of the claim can not be estimated until final workers compensation rates are established later this year. 10 W-9 (Attached as a separate document in this packet) W-r Form °'� Request for Taxpayer Give Form to the (Rev.January 2011) Identification Numher and Certification requester.Do not Department or the Treasury send to the IRS. Memel Revenue Service Name(as shown on your income tax return) Greeley Transitional House N Business nain9rds,egaided entity name,if different from above co C Check appropriate box for federal tax aclassification(rewired): 0 Incfrridual/sole p oprielo ❑ C Corporation O s corpPartnershipacol 0 Partnership ❑Trust/estate no uu ❑ Limited liability company.Enter the tax classification(C�corporation,SS corporation,P=Potrtarsttip)► ❑ExerPt Payee C n OOthe(see instructions)► 501(c)(3)nonprofitCorporation S Address(number,street aid apt or sate no.) Requester's mane aid address(optional) u S 1206 10th Street o City,state,and ZIP code to Greeley,CO 80631 List account number(')here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN hi the appropriate box.The TIN provided must match the name given on the"Name-line (Social'scatty number to avoid backup withholding.For individuals,this is your social security number(S,SN).However,for a resident alien,sole proprietot or disregarded entity,see the Part I instructions on page 3.For other - - entities,it is your employer identification number(EIN).If you do not have a number,see How to get a Mon page 3. Note.If the account Is In more than one name,see the chat on page 4 for guidelines on whose Employer merrtifiaubn number number to enter. 8 4 - 1 0 4 5 9 5 8 Part II Certification Under penalties of perjury,I certify that 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me).and 2. I am not subject to backup withholding because:(a)I em exempt from backup withholding,or 0)1 have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a talkie to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. 1 am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross Out Item 2 above If you have been notified by the IRS that you we currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,Item 2 does not apply.For mortgage Interest paid,acquisition or abandonment of seared property,cancellation of debt contributions to an ihdvidual retirement arrangement(IRA),and generally,payments other interest and dividends,you we not required to sign the certification,but you must provide you correct TIN.See the instructions ors on page 4. o - (� n Sign signattn of Here us.person► Date► ,the/// General Instructs Note.If a requester gives you a form other than Form W-9 to request section references are to tie nteme Revenue Code unless otherwise you'TIN,you must use the requesters form it it is substantially similar this to Form W-9. noted. Definition of Purpose of Form a a s person it youare:U.S.person.For federal te x purposes,you A person who is required to Se an information return with the IRS must •An individual who Is a U.S citizen or U.S.resident alien, obtain your correct taxpayer identification number mM to report for •A partnership,corporation,compay,or association created or example,income paid to you,real estate transactions,mortgage interest organized it the tithed States or tinder the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or cormiWfiahs you made to an IRA Use Form W-9 only if you are a U.S.person(including a resident •A trustdefined b Regulations section 301.7701-7). alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when apprtcable,to: business in the United States are generally required to pay a withholding 1.Certify that the TIN you are giving (a you we waiting for a tax on any foreign partners'share of income from such business. is correct Further,in certain cases where a Form W-9 has not been received,a number to be Issued), 2.Certify that you are not subject to backup withholding,or partnership bwdthtolding Therefore,if you auired to presume that a fire a U.is a foreign r person, n exemption from backup withholding tperson Uniet is a 3.e..if a you we a U.S., ,inaprovide partnership m9conducting othe a trade or estaess in the U.S. payee. sha�'la,you we also certifying that as aU.S.U.S.person,yourpartnership o arnbisn your U.B. allocable share of any partnership income from a . trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.10231X Form W-9(Rev.1-2W 1) A UJOMAn'S 970.351.0476 Administration 1970.356.4226 24-hour Crisis Line 1866.356.4226 toll free March 25,2011 Thomas Teixeira Greeley Weld Housing Authorities P.O. Box 130 Greeley CO 80632 Dear Tom, Enclosed you will our application (one original and 2 copies)for ESG 2011/12. Please let me know if you need any further information, or have any questions. Sincerely, • Lotte Muster Executive Director PO Box 71,Greeley,CO 80632 I www.awpdv.org I info@awpdv.org IDOur Mission:to shelter and help empower victims/survivors of domestic abuse to become safe,secure and self-reliant; and through education and collaboration,to mobilize our community to help prevent domestic violence. Application for Colorado Division of Housing (CDOH) EMERGENCY SHELTER GRANT ASSISTANCE 2011 APPLICANT INFORMATION TEMIIM 2.CDH Project Number For CDH Use only NAME: A Woman's Place 3.'DateReceived For CDH Use Only ADDRESS: P.O.Box 71 CITY: Greeley STATE: CO ZIP: 80632 4.Current ESG Program Recipient? CURRENT• PRIOR E NEVER 7. EN 8. L ' s tE l c:,.:k F, - (drop down box) Ms. Lotte Muster (970)351-0476 (970)351-6686 director(aawpdv.orq • TYPE OF ORGANIZATION 9. mi: O 10. ❑ 11. _; Please attach 501 (c)(3)ruling. 12. ' (Use drop down box) 8 :� --- 0. 8 lai 5 9 6 13. : (List counties served)Weld Coun 14. (A) .,` `.... �:.•`MCiv �.ti .�L` ii:i�l .ii�i�:F•. ti.:. S�}V9i ti 15. • . (Check all that apply): El Men sa Women IZI Families Youth El Domestic Violence ® Emergency - Maximum Capacity per Night:2A Maximum Stay: 30 Days Et: or Months 0 Day - Maximum Capacity: 0 Average Number of Clients Served per Day:0 O Transitional - Total Units: 0 Maximum Length of Stay: 0 Days O or Months ❑Average Stay:0 Days O or Months Q O Homeless Prevention: - Number of Families and/or Individuals expected to Serve with ESG and Match Funds Each Year: 0 Are you requesting dollars for a new program in this request? SELECT ONE: If yes,program name: SIGNATURE OF AUTHORIZED OFFICIAL c, ' ;. NCY REPR ENTATIVP ' .... ,, _ 4� ;:, l �ae� 17. Ii;tetf 4. 81•,��{P�F':Cl,e�p�:�f2i�;,1 � 1Gui; �.L[ cA c �1�K Milk Y�.�i 18. � I: �) •;ki.� f:�t � L, d �t�s G�jf �! j;a ;: Gr, 6i x�ti, xk,r• : (drop down box) Ms. Lotte Muster Executive Director 19. 20. „ /4-1/.-.c,'<- 7i, i:•,'k director(kawpdv.org 1 BUDGET 1 it tia 'a t Tb.lite. 4 i 0`I-tai.3# .1'.Kt 'f'' ,314ii l.` d :`Q'01,¢� ff.iikttc: Case Management $0.00 $10,000.00 $0:00 $0.00 Utilities $6,000.00 $0.00 $0:00 $0.00 Repairs/Maintenanoe $4,000.00 $0.00 $0.00 $0.00 Insurance $5,000:00 $0.00 $0.00 $0.00 $0':00 $0.90 $0.00 $0:00 $0:00 $0;00 $0.00 $0,00 $01400 $0.00 $OSO $0:00 ' $141*O9 $t1.0 $0.90 $0:00 " WO $0#OO $0:0`0 $0:00 c:.i,. tab sOme so fl sea r $moo $9.00 $0X9 $0,$}0 s. " Me OM $0,00 $00 25. $15,000.00 $10.000.00 $0.00 $ 0.00 26. ) �, '; $25,000.00 27. , .. tj , .,: r Name: City of Greeley Amount: $8,000.00, Name El Pomar Amount $1,250.00, Name Cash on Hand Amount $15,750.00 (Donations/Corp drives) (Additional S•ace on •a•e 13 i ,YY : 'i"` ,ts ; e ate ' 4 t rt Fea ,.. ,, C, an "' & x vAli ap '� C Fi,t,-,-/-:,6 � , yC .Tr i 'b o E ® E 9a ' a -'a'ft- 1 2 a§ ' '5P l�aiiiii `- v iti �'Y F Ja :'::$^.' s r, t=a , ,.. ,[n ✓ � .-, ,. �e,. r 9 .. tit <- .:C.e•`-l. F..� �.4�a� .Sub�#-�.�% ." Please also provide the following: • If you are requesting j0erstgng,please identify any operating staff for which you are requesting funding" • (b)If you are requesting an increased level of funding or a new service under Essential Services, you must demonstrate that a new/increased level of need exists and ESG funding will not replace governmental funding. • (c) If you are requesting iipine1ess °rg'vegtion funding, please explain how you will ensure that your clients meet HUD requirements for homeless prevention assistance. All requests should be eligible, necessary and reasonable. You may also use the following page for the budget if necessary. ; (When typing below, please do not use the return (enter) key. Line will automatically wrap around) BUDGET PAGE XPLANATION AND D DOCUMENTATION) 2 fa oRrINIIEDMPIMA1(`��,t f0LIBI81,)DOE,X I0A.Gt: (When typing rng below, please do not use the return (enter) key. Line will automatically wrap around) Item 21). Operations: the cost of utilities, repairs, maintenance and insurance, a critical function of safe house operations, have increased as a result of inflation, and of the national economic crisis. Statistics from 2010 AWP shelter services indicate that women and children seeking shelter are frequently staying for longer periods of time than in previous years. AWP is requesting an increase in funding from ESG for operations to assist with the ongoing demand for our shelter services. Item 22) Essential Services: Case management, is an essential service provided to AWP clients as part of our Safety and Self Sufficiency Program. All AWP staff provide critical support and resources for clients at a time when jobs, housing, food assistance, legal assistance and medical access have been drastically reduced. Due to the economic necessity of reducing the number of AWP staff, all staff, including day, evening, weekend and overnight advocates as well as the Executive Director, are providing case management for clients. Funds from ESG will be applied to the following positions: Two overnight advocates$2000/each; 4 day/evening/weekend advocates$ 1500/each ,t . .5. EXf AND URA , THE.NEED 29. A r (When typing below, please do not use the return (enter) key. Line will automatically wrap around) Domestic violence impacts all communities, and ours is no exception. The Courts in our Nineteenth Judicial District see an average of 100 domestic violence related cases per month, and our Weld County law enforcement agencies respond to far more domestic violence related calls every year. The urgent need for our services is apparent as every area of service at A Woman's Place increased in 2010. Our agency received over 8,880 crisis calls, and sheltered women and children for 3,125 nights of shelter last year. It is difficult to estimate the number of unreported domestic violence crimes that occur every year in Weld County, but based on National and Colorado statistics we know that more than one in four women will experience domestic violence at some point in their lifetime, and that victims of domestic violence living in rural communities like ours have a much greater risk of isolation and lack of access to services. We strive to serve as many victims of domestic violence with this program as possible, offering services free of charge, and throughout Weld County. (B)Did you turn clients away in the last grant period of January 1, 2010 thru December 31, 2010? NO If so how many,0 where did they go N/A,did you refer them to another agency? NIA ler', .. S 41' ., SQ �� ..,.�#.; F.M,r a #a d: d.a�.' i x_ , "tir,. , . .t� � a..y��. 30. 1) iett,,✓Sic. ra a`t°rya,•t' ;,,:att '.1 ;_4irll :'>tN [ • tgr`i i G_ • ri °"at itiiii& ,t *yTr (When typing below,please do not use the return (enter) key. Line will automatically wrap around). (Be sure to include the geographical areas and specific activities that you plan to provide). If this proposal is requesting funding for more than one activity (Essential Services, Operations/Staff Operations, Prevention), describe each separately. Operations: The total planned operating budget of AWP for 2011 is $483,940.00. This proposal seeks funding for a portion of Utilities, Repair/Maintenance, and Insurance costs. Essential Services: AWP is requesting funding in the area of essential services for case management based at the shelter in Greeley. A Woman's Place offers a continuum of services for women and children who are victims/survivors of domestic violence. Our services include: screenings, intakes and crisis intervention 24 hours per day, 365 days per year. Case management includes prevention and treatment counseling services, crisis and domestic violence support for victims of domestic violence; educational and support groups for residents and nonresidents; individual and group education/support for children and adolescents at risk for domestic violence; parenting support and education; 24 hour phone coverage for crisis, domestic violence advocacy, and information/referral; and legal advocacy. Our services support the goals of the agency to promote our clients'self-sufficiency. All our services are free, confidential, and offered in English and Spanish. We have contracted with a 24 hour confidential interpretation service that provides translations in over 150 languages. In 2005 we created a 30 day self-sufficiency program designed to assist women and their children to lead safer lives and access resources necessary to becoming economically independent. In 2007 we expanded our legal advocacy services, including establishing a presence in the courthouse where we can be more available to victims of domestic violence seeking protection orders. In 2008 we began offering Prevention and Treatment Counseling, providing group and individual domestic violence counseling services for resident and nonresident clients, and programming for youth and children at risk for domestic violence. . (When(When typing below,please do not use the return (enter) key. Line will automatically wrap around) If this proposal is requesting funding for more than one activity (Essential Services, Operations, Prevention), describe each. AWP actively maintains a diversified funding stream which includes govemment grants, foundation grants, fund raisers and donations. Ours is a project that responds to a genuine and critical need in the Weld County community, and we have a demonstrated record in ethical, responsible and knowledgeable service provision. In 2009, in anticipation of the national economic crisis the Executive Director and the Board created a pro-active strategy in order to keep the agency in a sound financial position. The Financial Committee began meeting on a quarterly basis to examine the budget and make necessary adjustments to the budget.We made the decision to close our outreach office and consolidate services in the safehouse and the courthouse. In addition, AWP has reduced staff and expenses to the extent possible without compromising the quality of services provided. We maintain an operating reserve that is available for emergencies. We expect to have continued funding from grantors such as OVP (the combined VAWA, VOCA), VALE Weld and DVP, and hope to have continued funding from city grants, EFSP and the County. We will continue to research and apply for new grants to support our operations. In addition, our donations and fund raisers continue to grow, with two ongoing annual events, Cheers, and the Friends GALA. In 2006 A Woman's Place co- founded, with three other agencies(A Kid's Place, c.a.r.e. and Eldergarden) For Goodness Sake. For Goodness Sake is a collaboration that assists us with resource sharing, raising awareness of our agencies in the community and has a fundraising component. u a, `'), 't1 , 3 � a- fi .gip <., fit4*�}IiPT�rr Y ?L N tea c µ2'J #Y Ykwf'dk a x xs i`1 Y •hR{'{`x9#`i>+'„i'a 93, 32. � iji i Ault, :: a10 i a atai afidar7.etg trit _e gA� 1.4-4 v � �.: a o t'i '1""""F'-! . � " t , '.l� . ��(When typing below, please do not use the return (enter) key. Line will automatically wrap around) Specifically, include the years of experience of staff and/or organization that will be administering the ESG funds. Where your organization and staff lack experience, explain how you will obtain the technical assistance needed to administer and complete the project. AWP has received and managed funding from ESG since 1994. The activities proposed in this application are ongoing and the agency has been in operation for three decades. All staff members work under the supervision of Executive Director, Lotte Muster, a licensed Master's level counselor who earned her M.A in Community Counseling and her LPC and LAC licensures. She has over 20 years of counseling experience with populations impacted by domestic violence, including mental health related issues and substance abuse. She has worked in a substance abuse and domestic violence offender treatment agency as well as in private practice addressing issues in domestic violence, substance abuse and mental health, including trauma. In addition, she has supervised staff and treatment providers as a clinical supervisor and has worked as a consultant for A Woman's Place since 2006 before taking a full-time position as a director in clinical supervision and programming. Since January 23, 2010, she has held the position of Executive Director. AWP currently has 11 staff members including 8 individual/family and child/legal advocates and one counselor. Plus one counselor position to be filled. All Counselors have regular supervision and must have a Master's degree or be working toward a Masters degree. All Advocates must either have a Bachelors degree or be working toward that degree, or have an Associates Degree. All staff and volunteers who work directly with clients must have an initial 15 hours of training in victims' advocacy. In addition, staff attend regular trainings including, but not limited to, Victims Rights, Victims Compensation, Cultural Awareness/Diversity, Child Abuse reporting, and trainings sponsored by COVA and CCADV. All staff are required to attend domestic violence trainings offered locally and also those conducted by A Woman's Place and regularly scheduled in- services to keep current on issues related to domestic violence. 33. Beds (including cribs) 28 28 " 34.Sleeping Rooms 8 $ 35. Total Families Served 100 100 36.Total Persons in Families 305 305 37. Total Individuals Served 119 120 38. Total Nights 2838 2500 AVERAGE COST PER PERSON OR HOUSEHOLD SERVED WITH ESG FUNDING 39. ,'e°� t,8r b " t x: m z a "e ,,)t !-)74; )lA'a dt t7x .k,;Lrfi k ^?_` '4 W br I r-srd.L q. ;"' (.S=ill Total annual expense $483,940/2400 nights of stay= 193,60 per client night (Total Activity Budget/#Unduplicated Clients) CLIENT PARTICIPATION REPORT 40 ryt�< ( ice 1 0 5 41. `, yillc.f3tt, 0 CONTINUUM OF CARE COORDINATION 42. 1.04;1ki .,11; Xf5 liS, ro#t' aXsF e4f1=tsrtoll, as .c`4:tly SELECT ONE: / Who provides the following services in your Do you have a written SUPPORTIVE SERVICES community? agreement to coordinate (1) If it's your organization put an "X"in this services? Use the drop TYPE OF SERVICE column beside the corresponding service; down box to (2) If it's another organization, please list their Answer"Yes"or"No"or"NA" name (Not Applicable) 43. Information and Referral Organization Name Not Applicable 44. Emergency 0 Organization Name . Not Applicable 45.Transitional Housing 0 Organization Name Greeley Transitional Not.Applicable House 46. Permanent Housing(w/services) 0 Organization Name Weld County Housing Not Applicable Authority 47.Soup Kitchen 0 Organization Name Not: plicabe 48. Case Management gi Organization Name. NotAblicable 49. Transportation eB'Organization Name- Not Applicable 50.Daycare 0 Organization Name Natlpplicable 51.Medical treatment 0 Organization Name North CO Medical Not Applicable' Center 52.Substance Abuse Counseling 0 Organization Name North Range Behavioral Not iplieable' Health 53. Psychological ba,4 Organization Name ;` Nett'lirable 54.Employment 0 Organization Name Weld County Job Not.Applicable Services 55.Life Skills/Budgeting >Za Organization Name g NotApplicabie 56.Educational 0 Organization Name Weld County Schools Not Applicable 57.Security Deposit 0 Organization Name Not Applicable 58.Eviction Prevention 0 Organization Name Weld County Housing Not Applicable Authority 59.Back Mortgage Payments 0 Organization Name Weld County Housing Not Applicable Authority 60.Utility Assistance Payments 0 Organization Name Weld County Dept. of Not Applicable Human Services/LEAP CONTINUUM OF CARE NARRATIVE 1, F 3� ')�'t last! 11)14,)... l t 1 IPI ' t t. a � �ti z d�� Yi av fd� R t� ",l i.t . . iti.1 rfr , 1,I��},.!,e �!,b I lit �i��)I1t a.i a,W3;�t4f..�`aal' l ^ t t t:)eTt)-�7u �.�llr ';.r. t,1 �F, T.�1ri;r. I p i,1 _�,4 �.. ,1Ql% ii. .1`kyY IeY ♦ ort:F, .rv'C i�'t1f3 ii1143 r Y :'iiFt4valt so,Fu'' ;i'1 �Y eyiF"stm<{..,;el f 4O Mi. F 'Ott. :: (When typing below, please do not use the return (enter) key. Line will automatically wrap around) A woman's place is the only agency in Weld County that provides safe shelter and a range of services to victims of domestic violence. AWP works closely with many agencies in Weld county. We co-founded 'For Goodness Sake' in 2006, along with A Kid's Place, c.a.r.e., and Eldergarden. This collaborative provides information sharing, promotes community awareness, and works together to ensure non-duplication of services, and also to ensure that our clients have the full benefit of services provided by each agency. Our staff members attend CCADV, COVA, CCADV, and Latina Outreach meetings and the DV Coalition in order to maintain active information and resource sharing between agencies. We work actively with Weld Social Services in identifying areas of need in domestic violence prevention and service provision. We serve as a resource for Healthy Marriages and the Fatherhood Initiative. Advocates and counselors provide extensive case management services that include assisting clients to access resources such as TANF, food stamps, housing assistance, medical care, mental health and substance abuse care, job searches, educational resources and emergency transportation. We partner with Crossroads Safehouse in Fort Collins (serving Larimer county)to use their staff attorneys to provide additional legal advocacy services to our clients. 71 . , . VIE S _. . n 't S a� -,t,,., (When typing below, please do not use the return (enter) key. Line will automatically wrap around) In order to ensure financial accountability A Woman's Place has contracted out the position of bookkeeper. The bookkeeper has no signing authority. The Executive Director has"read only"access to QuickBooks. The Executive Director reviews all financials daily, weekly, and monthly. These controls ensure that all financial transactions are reviewed by a third party and the Executive Director on a regular basis. The board treasurer reviews the financials on a monthly basis and the financials are also reviewed at every board meeting. A Woman's Place also engages the services of an outside auditor yearly. Our 2010 Audit will be conducted in May, 2011. All grant funds are entered into a spreadsheet that articulates what the funds are designated for, and what the grant cycle is. In addition a face sheet is created for each grant that summarizes grant cycle, designation of funds, matching funds, due dates of billings and reports and any other information that is relevant to the grant award. ' ABILITY TO COMPLY WITH HOMELESS'MANAGEMENT INFORMATION SYSTEMS(HMIS) (When typing below,please do not use the return (enter) key. Line will automatically wrap around) 63. .ore -.. .a4t .. .ie.. ;t` eP rate . 7 to ,.,' ': :.ba< < tre:tn nr .kgt4!} t . t4(I1);st t( !.t As a domestic violence shelter A Woman's Place is not required to report to HMIS. A Woman's Place attends Emergency Food and Shelter grant meetings with the United Way of Weld County and other local collaborative meetings to ensure that it is kept informed of the many issues that result from/and contribute to homelessness. NA A Woman's Place is bound by law to keep confidentiality. We limit identifying information kept in client files; all clients are assigned a number and the client files are stored in a locked cabinet. Only direct services staff of A Woman's Place has access to these files. Any demographic information kept on the computer system of A Woman's Place for grant purposes does not include any identifying information. All grant related information, including critical information for statistics, is kept in a separate file that contains no identifying information. 66. Please place an"X" in the box that best describes your current HMIS status. I am a new applicant. My agency is entering all HUD-required HMIS data elements on a consistent basis. My agency is in discussions with my systems operator regarding my participation. We have not yet been trained on the HMIS system. Q My agency is a new State ESG Applicant, but we enter HMIS information for another Federal grant. O My staff has been trained on HMIS, but I am waiting to upgrade equipment and or training before we fully participate. ZMy agency is exempt from HMIS. 8 OTHER DOCUMENTS TO SUBMIT WITH ESG APPLICATION (See attached pages) 9 a = ".w P . 4 ABILITY TO-COMPLY?x WITH STATE'S INSURANCE REQUIREMENTS , The State requires various insurance. Please use drop down box in each section indicating YES if you have the required insurance or NO if you do not. You may provide an explanation after each section of challenges that you face. 1. "The Contractor shall obtain,and maintain at all times during the term of the agreement, insurance in the following kinds and amounts: a. Workers Compensation Insurance as required by state statute and Employer's Liability Insurance covering all of the contractor's employees acting within the course and scope of their employment. Yes l.a.Issues or Explanation: b. Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalency, covering premises, operations, fire damage,independent contractors,products and completed operations,blanket contractual liability,personal injury, and advertising liability within minimum limits as follows: i. $1,000,000 each occurrence ii. $1,000,000 general aggregate; iii. $1,000,000 products and completed operations aggregate; and iv. $50,000 any one fire. Yes 1.b.Issues or Explanation. , c.Automobile Liability Insurance covering any auto(including owned, hired and non-owned autos)with a minimum limit as follows: $1,000,000 each accident combined single limit. tat 1.c.Issues or Explanation 2. The State of Colorado is named(or will be named within 7 business days of the effective date of the contract)as additional insured on Commercial General Liability and Automobile Liability Insurance policies(leases and construction contracts will require the additional insured coverage for completed operations on endorsements CD 2010 11/85, CG 2037 or equivalent). Coverage required of the contract will be primary over any insurance or self-insurance program carried by the State of Colorado. 2. Issues or Explanation 3. The Insurance includes(or will include within 7 business days of the effective date of the contract)provisions preventing cancellation or non-renewal without at least 45 days prior notice to the State by certified mail; Yes 3. Issues or Explanation: 4. The contractor will require all insurance policies in any way related to the contract, and secured and maintained by the contractor,to include clauses stating that each carrier will waive all rights of recovery under subrogation or otherwise,against the State of Colorado, its agencies,institutions,organizations,officers, agents,employees and volunteers. Yes 4. Issues or Explanation: _, 5. All policies evidencing the insurance coverage required hereunder shall be insured by insurance companies satisfactory to the State. Yes 5. Issues or Explanation: 6. The contractor shall provide certificates showing insurance coverage required by the contract to the State within 7 business days of the effective date of the contract. Yes 6. Issues or Explanation: 7. Notwithstanding subsection"a'of this section, if the Contractor is a"public entity" agrees,within the meaning of the Colorado Government Immunity Act, CRS 24-10-101, et seq, as amended("Act"), the contractor shall at all times during the term of the contract maintain only such liability insurance by commercial policy or self-insurance, as is necessary to meet its liabilities under the act and show proof of insurance upon request. Yes 7. Issues or Explanation: I0 Cac�tii( ra ₹•)r't ,iron);}ir •)0,.,t443,`ttaes`.i tl}rfj All applicants are required to complete the Match Certification form. Eligible forms of match are as follows: • The value of salary paid to staff to carry out the ESG Program. • The value of the time and services contributed by volunteers to carry out the program at a rate of $5.00 per hour. • Volunteers providing professional services such as medical or legal services valued at the reasonable and customary rate in the community. • The value of any donated material or building. • The value of any building lease using a method to reasonably calculate fair market value. v • Award letters from foundations, organizations, private individuals, and other government sources. **Note: These awards must overlap the ESG funding period to be eligible. ** 1.1 MATCH CERTIFICATION SOURCES OF LOCAL MATCH (Attach supporting documentation for available match. Documentation should reflect funding availability during the ESG contract year.) ! iiti �: :`el-!R.�i I}oEe•.liI tli1 l my L- •..ai�po;i�eii•V i�i.l1"_�.. ..;•! R, �_%D) ?�� c:e01,iio) ;4,l1 ,) r;_ , NAME AMOUNT $0.00 $0.00 • $0.00 NAME AMOUNT City of Greeley $8,000.00 Award Letter attachment 1 $01)0 Fund Raising/Cash El Pomar Foundation-Karl E. Eitel Fund $1,250.00 October 2010-October 2011 Award Letter Attachment 1 Annual Fundraising Events (Cheers/Friends of AWP) $15,250 Cash on Hand from 2010 events available for 2010-11 Loans $0i00 Building Value or Lease $0.00 Donated Goods $0.00 Donated Computers $0.00 New Staff Salaries $0.00 Volunteers ($5.00 per hour) $0.00 Volunteer Medical/Legal $0.00 Other (specify) $0.00 I certify that match funds have been identified and committed to support the proposed ESG project and have not been used to match previous ESG awards (i.e. the value of a donated building used as match in a 2009 award cannot be used as match in 2010). This form is a description of the sources and amounts of such match funds, which are not being used as match for any other federal program. 12 Additional Funds Documentation The list of all sources of additional funds not included as match to be used to carry out your proposed project. Be specific. Sources of Additional Funds Amount of Additional Funds Vale pending OVP 76,720.00 City : Dacono,Winsor 6,000.00 EFSP 10,028.00 United Way 16,700.00 Foundation Grants Monfort 50,000.00 Verizon 7,000.00 Women's Fund of Weld County 1,500.00 Bomberger Foundation 2,500.00 Daniels Fund 25,000.00 Donations/Corn drives 2010 33,867.00 Friends of AWP 2010 55,000.00 Total Additional Funds Committed to the ESG Process 284,315.00 City of '`~� zsc, rce e lr . � . December 14, 2010 Ellen Szabo Executive Director A Woman's Place P.O. Box 71 Greeley, CO 80632 Reference: City of Greeley 2011 Partnering Agency Contract Dear Ms. Szabo, Please signed both of the enclosed copies of the 2011 contract and return to the person indicated below. She will obtain the appropriate signatures from the City of Greeley Representatives and return one signed original to you. If you have any question reference the terms and conditions please call me at 970-350- 9663. Return to: Sheri Dem City of Greeley Budget Office 1000 10th Street Greeley. CO 80631 970-350-9735 Sincerely, Juan O. Cruz Police Captain Greeley Police Department • 2875 West 10th Street, Greeley,CO 80634 • (970) 350-9605 We promise to preserve and improve the quality of life for Greeley through timely, courteous and cost-effective service. CITY OF GREELEY COMMUNITY SERVICES FUNDING AGREEMENT ESSENTIAL SERVICE CONTRACT THIS AGREEMENT is entered into as of this 1st day of January, 2011 by and between the City of Greeley, a home rule municipality (the City) whose address is 1000 10th Street, Greeley, CO 80631 and A Woman's Place, Inc. (the Recipient) whose address is P.O. Box 71, Greeley, CO 80632. BACKGROUND A. Recipient filed an application with the City for funds for the purpose of conducting the program and furnishing the services described in its application (summarized in the attached Scope of Services); and B. The City has determined that the Recipient's proposed use of funds further a municipal and public purpose; and C. This Agreement describes the mutual understanding between the Recipient and the City relative to the conditions under which City funds are therefore provided to the Recipient. II. AGREEMENT A. Scope of Services. The Scope of Services to be rendered by the Recipient is as follows: ■ Emergency shelter, case management, group/individual support, domestic violence education, self sufficiency skills, legal advocacy, and community outreach for victims of domestic violence at no cost to women and children who are victims/survivors of domestic violence; • Services described will be provided 365 days/year, 24 hours/day. The Recipient agrees to perform the Services as described in the Scope of Services and represents that it has the authority and capacity to perform the services in compliance with the provisions of this Contract. In addition to the described Scope of Services, Recipient agrees to the following conditions in exchange for the use of City funds for the described services as part of this Agreement: 1. Service to Greeley Residents: The Recipient shall not use the funds received from the City from this Agreement to serve persons living outside of the City; 2. Advertising. Recipient shall include the wording "Sponsored in part by the City of Greeley" on all promotional, advertising, invitations, and other printing or media material for Recipient's Programs and services for which City Funds are made available under this Agreement: 1 3. Special Conditions: In the course of providing the Scope of Services Recipient shall also adhere to the following special conditions: • Agency staff and representatives will cooperate fully with law enforcement as may be requested relative to the reporting, resolve or bearing witness to any criminal incidents or activity that may arise in the course of serving its target population 4. Compliance with CRS standards limiting services to United States citizens, permanent residents of the United States, or lawfully present in the United States pursuant to federal law(see Section L of this Agreement). B. City's Responsibilities. With this agreement the City designates a representative of the City authorized to make all necessary decisions required of the City on behalf of the City in connection with execution of this Contract and disbursement of funds. C. Grant Award. If Recipient is not in default in any part of the terms of this Agreement, and subject to paragraph G below, the City may provide funds to the Recipient as follows: 1. Twelve(12) monthly installments in equal amounts, totaling a maximum of $16,000 upon receipt of the following information: a. Description of those services provided for the month as described in the attached Scope of Services; b. Detailed accounting of the use of the funds as requested for reimbursement by City; c. Description or estimate of the number of Greeley residents served and method of ascertaining participation or benefit; d. Evidence, as appropriate, that persons served were legally present in the United States at the time the service was provided. Upon satisfactory showing of need, City may advance to Recipient,once during the term of this Agreement, an amount not to exceed one monthly installment The final monthly installment shall be paid not later than thirty (30)days from the final request for payment following services rendered by the Recipient. Any funds remaining that had been authorized for services provided in this contract and not expended by December 31, 2011 or drawn as of February 1, 2012 shall be reprogrammed by the City at its sole discretion. D. Term. The City's obligation to provide funding under this Contract shall begin on the date this Contract is executed by the City (the "Effective Date") and end on December 31, 2011, unless terminated as set forth in paragraph G below. The City shall not pay any costs or expenses incurred by the Recipient before the Effective Date of this Contract. E. Applicable Law. This Agreement is made subject to and incorporates herein, as if set out in full, the Charter and Ordinances of the City of Greeley, and all applicable Federal and State Laws and regulations, and Recipient agrees to abide by and comply with same. 2 1 O\ J ' • %i A��O ROBERT J. HILBERT Senior Vice President.Administration October 27, 2010 Ms. Lotte Muster Executive Director A Woman's Place, Inc. P.O. Box 71 Greeley, CO 80632 Dear Ms. Muster: The Trustees of El Pomar Foundation are pleased to advise you they have approved a Merit Grant of $2,500 to increase your therapeutic support and education for mothers and their children seeking domestic violence services. This grant has been made at the recommendation of our Karl E. Eitel Fund Committee in recognition of your continuing achievements in service to the youth of Colorado. The Karl E. Eitel Fund was established in 1998 in honor of Karl E. Eitel, a former Trustee of the Foundation. It seeks to provide support to organizations that are making a significant impact on issues that confront Colorado's young people. This grant is contingent upon the enclosed General Grant Terms and Conditions. Please acknowledge your acceptance of this grant in the space provided at the bottom of your General Grant Terms and Conditions and MAIL ONE COPY to the Foundation by Wednesday, November 10, 2010. You and a guest are invited to attend El Pomar Foundation's Merit Grants Reception on Thursday, December 16th, at Penrose House (1661 Mesa Avenue, Colorado Springs) from 4:30 p.m. — 5:30 p.m., at which time your check will be presented to you. Please RSVP to meritgrantsna elpomar.orq or 719-577-7038. If you are unable to attend this reception, the grant check will be sent to your organization. The Trustees extend their best wishes for your organization's continued success. Sincerely, fat daieve- )44d. LEL Robert J. Hilbert Judy M. Bell Chairman, Karl E. Eitel Fund RJH:mrc 2300 EL POMAR FOUNDATION AWPI / 20284 in I AM duct COI OI lAl1O:;1111N(;;;.COI OIIAOO H(19U6 III (719)6:1,1 //.13 IAX (119)4,I ' OBI enc: e,II.uI rinII 4Gclpnm.unnl www Hpnn1.r rnq a Weld County Housing Authority P.O. Box 130 Greeley,CO 80632 970 353-7d37 COLORADO CERTIFICATION OF LOCAL APPROVAL BY LOCAL BOARD OF COMMISSIONERS FOR NON-PROFIT ORGANIZATIONS I Barbara Kirkmever, Chair, duly authorized to act on behalf of Weld County hereby approve the following project(s) proposed by A Woman's Place Inc.,which is located in Weld County. B G� Oti ATTEST: Clerk to the Board/ 'g Barbara KirkmeyeriChair 1/42 Board of County Commissioners By: ��7//./_ ��/��i �"'� Weld County, Colorado Deputy Clerk o the Boa •fir ~� Date: 1/i C/ iAt' // Certification of Consistency with Consolidated Plan I Rebecca L. Safarilc, Community Development Director certify that A Woman's Place located in the City of Greeley is consistent with the Consolidated Plan for the City of Greeley Rebecca L. Safarik Community Develop nt Director Date of Certification 3/31/2011 EMERGENCY SHELTER GRANT PROGRAM ASSURANCES AND CERTIFICATIONS Lotte Muster (name of chief elected official or appropriate non-profit signatory)A Woman's Place, Inc of (town, city, county or nonprofit organization) which is applying to the State of Colorado for funding through the Emergency Shelter Grant Program from the U.S. Department of Housing and Urban Development(HUD), hereby assures and certifies that: Amounts awarded under this program will be used only for these purposes: 1. Assist in the prevention of homelessness. 2. Assist in supporting the essential operating costs of s. 3. Assist in improving the quality of supportive services to the homeless. Projects will not require participation in religious services, as a condition for receiving assistance. All projects funded will develop and administer, in good faith, a policy designed to ensure the is free from the illegal use, possession or distribution of DRUGS and ALCOHOL by its beneficiaries. Political activities will be prohibited in accordance with subsection 675 (e) of the Community Services Block Grant Act of 1981. The town, city, county or nonprofit organization certifies that matching supplemental funds required by the regulations at 24 CFR 576.71 and 576.85(a)(3), as mentioned by the amendments to Items 415(a) and 415(c) of the Stewart B. McKinney Homeless Assistance Act made by Section 832(e) of the Cranston-Gonzalez National Affordable Housing Act of 1990 (Public Law 101-625, November 28, 1990) will be provided. The amendment exempts the first $100,000 from the matching requirement and requires that the benefit of the $100,000 exemption be provided to those recipients from the State that are least capable of providing the matching funds. The requirements of 24 CFR 576.21(a)(4)(ii) which provide that the funding of homeless prevention activities for families that have received eviction notices or notices of termination of utility services meet the following standards: (A) that the inability of the family to make the required payments must be the result of a sudden reduction in income; (B) that the assistance must be necessary to avoid eviction of the family or termination of the services to the family; (C) that there must be a reasonable prospect that the family will be able to resume payments within a reasonable period of time; (D) that the assistance must not supplant funding for preexisting homeless prevention activities from any other source; (E) occur a week before eviction, foreclosure or termination. The requirements of 24 CFR 576.51(b)(2)(iii) concerning that submission by nonprofit organizations applying for funding of a certification of approval of the proposed project(s) from the unit of local government in which the proposed project is located. The requirements of 24 CFR 576.51(6)(2)(v) concerning the funding of emergency in hotels or motels or commercial facilities providing transient housing. The requirements of 24 CFR576.56(a)(3) concerning the provision of termination and/or grievance procedures for an individual or family who violates program requirements. The requirement of 24 CFR576.56(b) concerning the involvement of homeless individuals and families in providing work or services pertaining to policy-making and in operations of facilities or activities assisted under this part. The requirement of 24 CFR576.57 concerning the prohibition of conflict of interest or financial interest in decision-making by elected officials, appointed officials, staff or board of directors except as may be granted by HUD as provided in 570.611(d). The requirements of 24 CFR 576.73 concerning the continued use of buildings for which Emergency Grant funds are used for rehabilitation or conversion of buildings for use of emergency s for the homeless; or 16 when funds are used solely for operating costs or essential services, concerning the population to be served. The building standards requirement of 24 CFR 576.75. The requirements of 24 CFR 576.77, concerning assistance to the homeless. The requirements of 24 CFR 576.79, other appropriate provisions of 24 CFR Part 576, and other applicable Federal law concerning nondiscrimination and equal opportunity. The requirements of 24 CFR 576.80 concerning minimizing the displacement of persons, as a result of a project assisted with these funds. The requirements of 24 CFR 576.80 concerning the Uniform Relocation Assistance and Real Acquisition Policies Act of 1970. The requirement of the Cranston-Gonzalez National Affordable Housing Act (Public Law 101-625, November 28, 1990 contained in Section 832(e)(2)(C) that grantees develop and implement procedures the ensure the confidentiality of records pertaining to any individual provided family violence prevention or treatment services under any project assisted "under the Emergency Shelter Grant Program"will, except with written authorization of the person or persons responsible for the operation of such , not be made public." The requirement that local government will comply with the provisions of and regulations and procedures applicable under section 104(g) of the Housing and Community Development Act of 1974 with respect to the environmental review responsibilities under the National Environmental Policy Act of 1969 and related authorities, as specified in 24 CFR Part 58, and as applicable to activities of nonprofit organizations. The requirement that no Federal appropriated funds have been paid, by or on behalf of the local government or nonprofit organization, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal loan, the entering into of any cooperative agreement, and modification of any Federal contract, grant, loan or cooperative agreement. The requirement that if any funds, other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the local government or nonprofit organization shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The requirement of disclosure specified in Subpart C of 24 CFR Part 12 regarding assistance from other HUD-funded programs. The requirement that the local government or nonprofit organization shall require that the language of the PROHIBITION OF THE USE OF FEDERAL FUNDS FOR LOBBYING CERTIFICATION be included in the award documents for all standards at all tiers including subcontracts, subgrant, and contracts under Grant, loans, and cooperative agreements and that all subrecipients shall certify and disclose accordingly. The requirement that(68 Fed. Reg. 43430) agencies receiving funding from the Emergency Shelter Grant Program become compliant with Homeless Management Information System (HMIS) as required by the Department of Housing and Urban Development. The required certification that the submission of an application for any emergency Shelter grant is authorized under applicable law and that the local government or nonprofit organization possesses legal authority to carry out emergency Shelter grant activities in accordance with applicable law and regulations of the Department of Housing and Urban Development. Lotte Muster Executive Director Name Title Signature Date 77 CDOH.PERFORMANCE.MEASUREMENTS AND OUTCOMES All ESG proposals must comply with the CDOH Performance Measurements and Outcomes. I have read the performance and outcome measurements shown below and understand that these may differ from measurements required by HUD. (Please Use Drop Down Box) YES Name: Lotte Muster 'tie:Executive Director Date:_✓ �� Signature Performance Measurements and Outcome Requirements Objective: Serve the lowest income and hardest to serve individuals and families meeting critical housing needs through state and federal initiatives by creating a suitable living environment or decent affordable housing. IMERIMME: ESG : ESG Funding 1. End chronic homelessness and move homeless families and individuals into permanent housing. 2.Availability/accessibility for the purpose of creating suitable living environments. 3.Promote self-sufficiency,efficient use of funds and effective program administration. • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • Recipient expended all ESG funds within the established grant timeframe. • Recipient met the deadline for submitting their signed grant agreement. • Recipient met the deadline for submitting evidentiary documents. • Recipient met the deadline for submitting performance reports. • Recipient meets required standards for documentation of homelessness. • Recipient complies with required record keeping methods. • Recipient complies with the due process of terminating ESG funded assistance of participant. • Amount of money leveraged. • Does recipient have findings from previous compliance reviews? • Number of homeless persons receiving case management who move into safe and stable housing. • Average cost per person receiving ESG assistance. • The total number of adults and children served on an annual basis (reported under Homeless Assistance Services). • The number of persons served by race and ethnicity. {{ • Number of persona assisted with ESG funds for eviction notices. • Number of persons assisted with ESG funds for utility termination notices. • Number of persons assisted with ESG funds for security deposits and/or first month's rent. • The total number of adults and children served on an annual basis (reported under Homeless Prevention Services). • The number of persons served by race and ethnicity. r r7.i if r.cvr _irVue rlc7 �e ., � V .Y:` � ia: rVY-1,l�'. r ,•^6t, • Number of homeless persons that received ESG funded services concerned with employment. • Number of homeless persons that received ESG funded services concerned with health. • Number of homeless persons that received ESG funded services concerned with substance abuse. • Number of homeless persons that received ESG funded services concerned with education. • Number of homeless persons that become successfully independent of ESG funded services. • Number of homeless persons that return to their prior living situation • The total number of adults and children served on an annual basis (reported under Homeless Assistance Services). • The number of persons served by race and ethnicity. 1%; COPY OF YOUR 501 (c)(3) Ruling 19 '1� 117 I lvpm hncul ii the.n," ly J RS I,larval Revenue Service P. O . Box 2508 Cincinnati OH 45201 In reply refer to : 0248459775 Dec. 17, 2008 LTR 4168C EO 84-0811596 000000 00 000 00014946 BODC: TE A WOMANS PLACE INC PO BOX 71 GREELEY CO 80632-0071715 4 Employer Identification Number : 84-0811596 Person to Contact : MISS CSINSI Toll Free Telephone Number : 1-877-829-5500 Dear TAXPAYER: This is in response to your request of Dec. 08, 2008 , regarding your tax-exempt status. Our records indicate that a determination letter was issued in MAY 1980 , that recognized you as exempt from Federal income tax, and discloses that you are currently exempt under section 501 (c) (3) of the Internal Revenue Code . Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a) (1) and 170 (b) ( 1) (A) (vi) . Donors may deduct contributions to you as provided in section 170 of the Code . Bequests, legacies , devises, transfers , or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106 , and 2522 of the Code. If you have any questions, please call us at the telephone number shown in the heading of this letter . Sincerely yours , 11(ia— Michele M. Sullivan , Oper . Mgr . Accounts Management Operations I • - J • internal Revenue Service Department of the Treasury District Director P. O. Box 2508 Cincinnati, OH 45201 Date: November 22, 1999 Person to Contact: Tonya Martin 31-03017 Customer Service Representative A Womans Place, Inc. Telephone Number: P.O. Box 71 877-829-5500 Greeley, CO 80632-0071 Fax Number: 513-263-3756 Federal Identification Number: 84-0811596 Dear Sir or Madam: This letter is in response to your telephone call requesting a copy of your organization's determination letter. This letter will take the place of the copy you requested. Our records indicate that a determination letter issued in January 1976 granting your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or Its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of-the organization's annual accounting period. The law imposes a penalty of$20 a day, up to a maximum of$10,000, when a return is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal insurance Contributions Act (social security taxes) on remuneration of$100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations are not automatically exempt from other federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. -2- A Womans Place, Inc 84-0811596 Your organization is not required to file federal Income tax returns unless it is subject to the tax on unrelated business Income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code. The law requires you t,4make.your organization's annual return available for public inspection without charge for three years after the due date of the return. You are also required to make available for public inspection a copy of your organization's exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liable for a penalty of$20 a day for each day you do not make these documents available for public inspection (up to a maximum of$10,000 in the case of an annual return). Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records. If you have any questions, please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status. Sincerelygesels-1 C. Ashley Bullard District Director COPY OF YOUR MOST RECENT AUDIT A WOMAN'S PLACE, INC. FINANCIAL STATEMENTS December 31, 2009 and 2008 A WOMAN'S PLACE, INC. TABLE OF CONTENTS INDEPENDENT AUDITOR'S REPORT 1 FINANCIAL STATEMENTS Statements of Financial Position 2 Statements of Activities 3 Statements of Functional Expenses 45 Statements of Cash Flows 6 Notes to Financial Statements 12 Rickards Lo_n ' u1on, LLP • Certified Public Accountants and Consultants INDEPENDENT AUDITOR'S REPORT To the Board of Directors of A Woman's Place, Inc. Greeley,Colorado We have audited the accompanying statements of financial position of A Woman's Place, Inc. as of December 31, 2009 and 2008 and related statements of activities, functional expenses, and cash flows for the years then ended. These financial statements are the responsibility of the Agency's management. Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audit in accordance with auditing standards generally accepted in the United States of America as established by the Auditing Standards Board. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of A Woman's Place Inc.'s internal control over financial reporting. Accordingly, we express no such opinion. An audit also includes examining,on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of A Woman's Place, Inc. as of December 31, 2009 and 2008 and the results of its operations and its cash flows for the years then ended in conformity with accounting principles generally accepted in the United States of America. t'1enJ. Q.a0L 4st i LCrP Greeley, Colorado August 11, 2010 4631 W. 20th St. Rd.,Ste. 101 Greeley, CO 80634 (970) 304-9420 (970) 304-9421 ((ax) kit Collin, Windsor Cheyenne www.drepas font (970)493-6869 (970)493.686'1 (107)631 55'/8 A WOMAN'S PLACE, INC. STATEMENTS OF FINANCIAL POSITION As of December 31,2009 and 2008 • 2009 2008 ASSETS Cash and cash equivalents $ 143,395 $ 47.211 Accounts receivable, net 38,141 27,581 Prepaid expenses and other assets 16,272 Investments 14.126 Property and 336,698 326,300 p y equipment, net 536,083 554,877 Total assets $ 1,070,589 $ 970,095 LIABILITIES AND NET ASSETS Liabilities Accounts payable $ 3,640 $ 3,144 Accrued liabilities 19,237 16,395 Deferred revenue 887 Total liabilities 22,877 20,426 Net Assets Unrestricted 1,047,712 949,669 Total net assets 1,047,712 949,669 Total liabilities and net assets $ 1,070,589 $ 970,095 See areompanying notes to linancial statements. • A WOMAN'S PLACE,INC. STATEMENTS OF ACTIVITIES For the Years Ended December 31,2009 and 2008 2009 2008 Temporarily Temporarily - Unrestricted Restricted Total Unrestricted Restricted Total Public Support and Revenue Contributions $ 125,779 Foundations $ - S 125.779 S 122,361 S - $ 122,361 122,887 122,887 106,313 1,500 103.1 I3 United Way 24.770 24,770 Fundraising and special events,net of 23,189 - 23,189 costs of direct benefits to donors of $2,527(2009)and$4,739(2008) 14,853 - 14,853 17,840 Grants and contracts 291,723 291,723 283,535 - 17,840 In-kind donations 13.857 - - 283,535 Net investment earnings(loss) 17,744 - 13'857 16'400 - 16,400 Miscellaneous 17,744 (29.882) - (29,882) 3.592 - 3.592 16 16 - Net assets released from restrictions - - 4,854 (4.854) Total public support and revenue 615205 - 615,205 544,626 (3,354) 541,272 Expenses Program services: Shelter 179,525 - 179,525 206,197 Case management and advocacy 156,829 156,829 162,600 162,600 - 206,197 Outreach 25,771 - 25,771 19,034 19,034 Total program services 362,125 - 362,125 387,831 Supporting Services - 387,831 Management and general 134,373 134373 139,599 Fundraising 20664 - 20,664 18905 139,599 - 18,515 Total supporting services 155,037 - 155,037 158,504 158,504 Total expenses 517,162 - 517,162 546,335 - 546,335 Change in Net Assets 98,043 - 98.043 (1.709) (1354) 5,063) Net Assets,Beginning of Year 949,669 949,669 951,378 3.354 954,732 Net Assets,End of Year $ 1.047,712 $ - $1,047,712 $ 949,669 $ - $ 949,669 See accompanying notes to financial statements. t , A WOMAN'S PLACE,INC. STATEMENT OF FUNCTIONAL EXPENSES For the Year Ended December 31,2009 Program Services Supposing Scrrices Case Management/ Management Shelter Advocacy Outreach and General Fundraising Total Personnel expenses $ 108,060 $ 133.078 $ 17,316 $ 83,325 S 17,535 $ 359,314 Advertising - - - 3,603 947 4,550 Conferences,conventions and meetings - - - 25 25 - Contract labor 1.913 6.660 - 9.848 90 18.511 Insurance 6,861 7.597 2.350 3.655 516 20,979 Membership dues - - - 1,410 1.410 Occupancy 11,581 1350 1.350 1,499 545 16.325 Other assistance - 4.387 - - - 4,387 - Postage and chipping - _ Professional fees _ 970 176 1.146 Repairs and maintenance - - 1 ,030 - 10.830 7.960 1 - 1,030 375 9365 Supplies 88I 108 191 4,046 70 5,296 Telephone 969 2.976 2.976 4.623 11.544 Travel - 24 24 245 137 430 Other 2,511 649 234 2,283 273 5,950 Total expenses before depredation andin-Idnd 140,736 156.829 24,441 127,392 20.664 470.062 Depreciation 24,932 - 1.330 6,981 - 33,243 in-kind program expenses 13.857 _ 13.857 Total expenses $ 179,525 $ 156,829 $ 25.771 $ 134,373 S 20,664 $ 517,162 See accompanying notes to financial statements. 4 r A WOMAN'S PLACE,INC. STATEMENT OF FUNCTIONAL,EXPENSES For the Year Ended December 31,2008 Program Services Supporting Services Case Management/ Management Shelter Advocacy Outreach and General Fundraising Total Personnel expenses $ 142,519 $ 134.466 $ 11.691 $ 84,979 $ 14.599 $ 388,254 Advertising Contract labor - - 3.143 500 3.643 1230 11,513 10.281 Insurance 3,195 3,186 1.535 1,178 58 23.082 Membership dues _ - 9,094 Occupancy - - 2,109 - 2,109 10.711 1,575 1,575 1,386 504 Other assistance - 8.246 .246 1 8 Postage and shipping - - 8,246 - Professional fees - -- 663 575 1.266 Repairs and maintenance 9.967 9,712 - 9,712 - Supplies 3.556 160 - 1.352 493 11,812 46 Telephone 800 2,458 2,458 4,623 167 10,339 10,339 - 279 327 565 - 1,171 Other 754 717 16 4,942 2,009 8,438 Total expenses before depredation and In-Idnd 172,732 162,600 17,914 133,719 18,905 505,870 Depreciation 21,000 - 1.120 5,880 - In-kind program expenses 12,465 - 28.005 Total expenses2 - 12,465 S 206.197 $ 162,600 $ 19,034 $ 139,599 S 18.905 $ 546,335 See accompanying notes to financial statements. 5 A WOMAN'S PLACE,INC. STATEMENTS OF CASH FLOWS For the Years Ended December 31,2009 and 2008 2009 2008 Cash Flows From Operating Activities Change in net assets $ 98.043 $ (5,063) Adjustments to reconcile change in net assets to net cash provided by operating activities: Depreciation 33,243 28,000 Realized loss on investment 134 _ Net unrealized(gain) loss on investments (6,714) 42,761 Contribution of equipment - (3,935) (Increase)decrease in operating assets: Accounts receivable (10,560) 44,472 Prepaid expenses and other assets (2,146) (3,619) Increase(decrease) in operating liabilities: Accounts payable 496 (8,169) Accrued liabilities 2,842 (4,014) Deferred revenue (887) (39,113) Net cash provided by operating activities 114,451 51,320 Cash Flows From Investing Activities Purchase of property and equipment (14,449) (27,595) Purchase of investments (206,612) (87,657) Proceeds from the sale of investments 202,794 24,780 Net cash(used) by investing activities (18,267) (90,472) Net increase(decrease)in cash and cash equivalents 96,184 (39,152) Cash and Cash Equivalents- Beginning of Year 47,211 86,363 Cash and Cash Equivalents - End of Year $ 143,395 $ 47,211 Supplemental Disclosures of Non-Cash Operating Activities: In-kind contributions $ 13,857 $ 16,400 In-kind expenses • $ 13,857 $ 12,465 Contribution of equipment $ - $ 3,935 Sec accompanying notes to financial slaleinculs. 6 A WOMAN'S PLACE, INC. NOTES TO FINANCIAL STATEMENTS December 31,2009 and 2008 Note 1. Summary of Significant Accounting Policies Organization A Woman's Place (the Agency), is a non-profit organization formed in 1978 to provide services to women and their children who are victims of family violence. All areas of Weld County are served. A staff of professionals, student interns and volunteer/advocates operate a safehouse facility for short- term crisis housing and provide advocacy, case management and support. Included in the services are a 24-hour help line, a children's program, community education, outreach, case management, legal advocacy, and outreach and support groups. Basis of Presentation The Agency reports information regarding its financial position and activities according to three classes of net assets: unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets. Accounting Standards In June 2009, the Financial Accounting Standards Board issued FASB Statement No. 168, The FASB Accounting Standards Codification and the Hierarchy of Generally Accepted Accounting Principles. This Statement establishes the FASB Accounting Standards Codification (ASC) as the source of authoritative U.S. generally accepted accounting principles recognized by the FASB to be applied by all nongovernmental entities. This Statement is effective for financial statements issued for interim and annual periods ending after September 15, 2009. The Agency has adopted ASC for the annual period ended December 31, 2009. Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. Cash and Cash Equivalents The Agency maintains bank accounts at a commercial bank. The balances in those accounts may, at times, exceed the Federal Deposit Insurance Corporation insurance limit. The Agency has not experienced any losses in such accounts. For purposes of the statements of cash flows, the Agency considers cash and cash equivalents to include all cash on hand and demand bank deposits. Investments All investments in marketable securities are recognized at fair value using quoted prices in active markets for identical assets or liabilities with readily determinable fair values. Investment income or loss (including gains and losses on investments, interest and dividends) is included in the statement of activities as an increase or decrease in unrestricted net assets unless the income is restricted by donor or law. All money market funds and certificates of deposit, regardless of maturity, are considered lo he investments. 7 A WOMAN'S PLACE, INC. NOTES TO FINANCIAL STATEMENTS December 31,2009 and 2008 Note 1. Summary of Significant Accounting Policies(continued) Accounts Receivable Unconditional contributions receivable are recognized as revenues in the period the pledge is received. Conditional contributions receivable are recognized when the conditions on which they depend are substantially met. Grants receivable are recognized based on the ratio of program expenses incurred to total anticipated program expenses. The Agency uses the allowance method to determine uncollectible contributions receivable. The allowance is based on prior years' experience and management's analysis of specific promises made. The allowance was $840 for the year ended December 31, 2008. Management has determined no allowance was necessary for the year ended December 31,2009. Property and Equipment Property and equipment purchased by the Agency are stated at acquisition cost. Donations of property and equipment are recorded at fair value on the date received. Depreciation is computed using the straight-line method over the estimated useful lives of the assets (twenty-five years for buildings, three to five years for furniture and equipment, and five to ten years for leasehold and building improvements). The Agency uses a capitalization limit of$1,000. Revenue Recognition Grants and Contracts Grants and contracts from federal, state and local governments and private foundations are considered exchange transactions and recorded as revenue when eligible expenses are incurred. Receivables from funding agencies represent amounts due for eligible expenses incurred prior to year end. Advances from funding agencies represent cash received in advance of incurring eligible expenses. Contributions Contributions restricted by the donor for particular programs are recorded as temporarily restricted revenue and included in temporarily restricted net assets until expended. Support that is restricted by the donor is reported as an increase in unrestricted net assets if the restriction expires in the reporting period in which the support is recognized. The Agency has no permanently restricted assets for the years ended December 31, 2009 and 2008. In-Kind Donations Donations of materials and supplies to the Agency are recorded at estimated fair value when received. Donated office and facility space is recorded at the estimated value of comparable space in the community. The estimated value of donated services are recorded when the services provided require specialized skills, are by persons possessing those skills, and would typically be purchased if they were not donated. While instrumental to the Agency's delivery of program services, most of the volunteer services provided to the Agency do not meci the accounting criteria to be recorded in these financial statemcros. A WOMAN'S PLACE, INC. NOTES TO FINANCIAL STATEMENTS December 31,2009 and 2008 Note 1. Summary of Significant Accounting Policies (continued) Functional Allocation of Expenses The costs associated with each of the Agency's program and supporting services have been summarized in the statements of functional expenses. Certain costs have been allocated among the programs and supporting services benefited. Advertising Expenses Advertising costs are expensed as incurred. Advertising expenses were $4,550 and $3,643 for the years ended December 31,2009 and 2008, respectively. Income Taxes The Agency qualifies as a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code. Accordingly,no provision is made in these financial statements for income taxes. In December 2008, the Financial Accounting Standards Board issued ASC 740-10-65-1, "Effective Date of FASB Interpretation No.48 for Certain Nonpublic Enterprises." ASC 740-10-65-1 permits an entity within its scope to defer the effective date of ASC 740-10-65-1, Accounting for Uncertainty in Income Taxes, to its annual financial statements for fiscal years beginning after December 15, 2008. The Agency adopted the standard dining the fiscal year ending December 31, 2009. The Agency's income tax filings are subject to audit by various taxing authorities. The Agency's open audit periods are 2006 through 2008. In evaluating the Agency's tax provisions and accruals, interpretations and tax planning strategies are considered. The Agency believes their estimates are appropriate based on current facts and circumstances. Subsequent Events Management has evaluated subsequent events through August 11, 2010, the date on which the statements were available to be issued. Note 2. Investments The Agency had the following investments as of December 31, 2009: Unrealized Cost Market Gain/(Loss) Money market funds $ 37,345 $ 37,345 $ _ Certificates of deposit 155,000 155,000 Bonds ' 78,780 73,574 (5,206) Mutual funds 92,252 70,779 (21,473) $ 363,377 $ 336.698 $ (26,679) 9 A WOMAN'S PLACE, INC. NOTES TO FINANCIAL STATEMENTS December 31,2009 and 2008 Note 2. Investments(continued) The Agency had the following investments as of December 31, 2008, Unrealized Cost Market Gain/(Loss) Money market funds $ 78,101 $ 78,101 $ _ Certificates of deposit 150,000 150,000 _ Bonds 60,000 41,631 (18,369) Mutual funds 87,518 56,568 (30,950) $ 375,619 $ 326,300 $ (49,319) Income(losses) from cash and investments is summarized as follows for the year ended December 31, 2009 2008 Interest and dividends $ 10,896 $ 12,935 Net realized loss 134 _ Net unrealized gain(loss) 6,714 (42,817) Net investment income (expense) $ 17,744 $ (29,882) Note 3. Property and Equipment Property and equipment consisted of the following at December 31, 2009 2008 Land $ 22,490 $ 22,490 Facility 638,599 643,597 Furniture and equipment 57,737 52,345 718,826 718,432 Less: Accumulated depreciation (182,743) (163,555) $536,083 $554,877 10 A WOMAN'S PLACE, INC. NOTES TO FINANCIAL STATEMENTS December 31,2009 and 2008 Note 5. Grants and Contracts Governmental grants and contracts are generally subject to audit by the federal government or other grantors. The ultimate determination of amounts received under these programs generally is based upon allowable costs reported to and audited by the government or grantor. Until such audits have been completed and final settlement reached, there exists a contingency to refund any amount received in excess of allowable costs. Management is of the opinion that no material liability will result form such audits. Following is a summary of grant awards to the Agency and the corresponding amount expended in 2009: Grant Award Grant Period Expended Domestic Violence Program $ 80,000 7/1/09-09/30/10 $ 26,667 $ 58,200 7/1/08-06/30/09 $ 29,768 Town of Windsor $ 4,384 1/1/09-12/31/09 $ 4,384 $ 5,000 1/1/09-12/31/09 $ 5,000 City of Greeley $ 22,500 1/1/09-12/31/09 $ 22,500 City of Evans $ 5,000 1/1/09-12/31/09 $ 5,000 Emergency Shelter Grant $ 16,153 7/1/09-6/30/09 $ 8,076 $ 11,000 8/24/09-6/30/09 $ 5,500 General Assistance Program(CSBG) $ 19,120 7/01/09-02/28/10 $ 14,340 Emergency Food and Shelter Grant $ 10,900 1/01/09-9/30/09 $ 10,900 Emergency Food and Shelter Grant/RA $ 10,535 1/01/09-9/30/09 $ 10,535 United Way Safety Net $ 22,150 7/01/08-06/30/09 $ 11,075 $ 20,000 7/1/09-6/30/10 $ 10,000 VALE $ 75,780 7/01/09-6/30/10 $ 37,890 $ 68,052 7/1/08-6/30/09 $ 34,026 VALE Equipment Grant $ 10,000 1/01/09-12/31/09 $ 10,000 VAWA $ 9,914 4/1/09-12/31/09 $ 9,914 VAWA-RA $ 21,752 9/01/09-02/28/11 $ 4,833 VOCA $ 39,281 I/I/09-12/31/09 $ 39,281 A WOMAN'S PLACE, INC. NOTES TO FINANCIAL STATEMENTS December 31,2009 and 2008 Note 6. Retirement Plan The Agency has a defined contribution plan, which covers substantially all of is employees. Employees are eligible for participation upon earning $5,000 of eligible wages. The plan entrance date is January P'. Employer matching contributions are 100% up to 3% of wages and employees are 100% vested at the start of participation. Employer contributions were $3,589 and $4,044 for the years ended December 31, 2009 and 2008, respectively. 12 W-9 (Attached as a separate document in this packet) Form W'9 Request for Taxpayer Give Form to the (Rev.January 2011) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service Name(as shown on your income tax return) A Woman's Place, Inc. of Business name/disregarded entity name,if different from above d m m . Check appropriate box for federal tax c o classification(required): ❑ IndNidual/sole proprietor ® C Corporation ❑S Corporation ❑ Partnership ❑ Trust/estate ac_ O F c ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► ❑Exempt payee ,q c L, ❑ Other(see instructions)► U IE Address(number,street,and apt.or suite no.) Requester's name and address(optional) U a PO.Box 71 N City,state,and ZIP code N Greeley,CO 80632 List account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line I Social security number to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other - - entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer Identification number number to enter. 8 4 - 0 8 1 1 5 9 6 Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. I am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 4. Sign Signature of •Here U.S.person► . Date► Y743/4/General Instructions Note.If a requester gives you a form other than Form W-9 to request our TIN you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is a foreign person, 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U.S.person that is a 3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.10231% Form W-9(Rev.1-2011) Hello