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2002-12-10 Info Packet of 11/21
CITY COUNCIL INFORMATION PACKET (~ITY OF IOW^ CITY November 21,2002 w~vw.icgov.org IP1 Tentative Future Meetings and Agendas IP2 Memorandum from City Manager: New Water Plant Start-up IP3 Letter from Karen Kubby [Emma Goldman Clinic] to City Manager: Payment of actual tax portion for Fire and Police Departments IP4 Letter from David J. Forkenbrock to City Manager: City Employee Recognition IP5 Memorandum from City Clerk: No Information Packet Next Week IP6 Memorandum from Community and Economic Development Coordinator and Assistant City Attorney: Termination of CDBG Agreement with Torus Precision Optics IP7 Memorandum from Leaf Rake Committee: Leaf Rake Day 2002 iP8 Response from City Clerk to Paul Rollins: No Smoking Policy IP9 E-Mail from Council Member Pfab: City Alleyways IP10 November-December 2002 ECICOG Express [VVilburn] Invitation: Foreign Policy Town Meeting December 5 Human Service Agency Funding Requests FY04 I PRELIMINARY/DRAFT MINUTES IPll Human Rights Commission: October 15 IP12 Public Art Advisory Committee: November 7 IP13 Telecommunications Commission: October 28 CITY COUNCIL INFORMATION PACKET CITY OF IOWA CITY November 21,2002 www.icgov.org IP1 Future Meetings and Agendas IP2 m from City Manager: New Water Plant Start-up IP3 Letter from ~n Kubby [Emma Goldman Clinic] to City M~fiager: Payment of actual tax and Police Departments ,,/ IP4 Letter from David Manager: City,Employee Recognition IP5 Memorandum from Clerk: No Information Packet Next Week IP6 Memorandum from m unity and Economic ~evelopment Coordinator and Assistant City Attorney: erminafion of CD/~G Agreement with Torus Precision Optics / IP7 Memorandum from Leaf L/~af Rake Day 2002 IP8 Response from City Clerk to Paul s o Smoking Policy IP9 E-Mail from Council Member Pfab: Ci/~,, /Alleyways IP10 NoYember-December 2002 £ClCO~ fi×Press [Wilbum] / PR£LIMII~RY/DRAFT MINUTES lP11 Human Rights Comm[ss October 15 lP12 Public Art Ad¥iso~ ¢/~mittee: November 7 lP13 Telecom~ Commission: October 28 -" ~"=~~.. City Council Meeting Schedule and November21,2002 OTY OF ~OW^ OTY Work Session Agendas 11-21-07 www.icgov,org I IP1 I I TENTATIVE FUTURE MEETINGS AND AGENDAS I · THURSDAY, NOVEMBER28 Thanksgiving Holiday - City Offices Closed · FRIDAY, NOVEMBER29 Thanksgiving Holiday - City Offices Closed · MONDAY, DECEMBER 9 EmmaJ. HarvatHall 6:30p Special Council Work Session · TUESDAY, DECEMBER 10 Emma J. Harvat Hall 7:00p Special Council Formal Meeting · WEDNESDAY, DECEMBER 25 Christmas Holiday - City Offices Closed · MONDAY, JANUARY 6 Emma J. Harvat Hall 6:30p Regular Work Session · TUESDAY, JANUARY 7 Emma J. Ha/vat Hall 7:00p Regular Council Formal Meeting Meeting dates/times/topics subject to change FUTURE WORK SESSION ITEMS Regulation of Downtown Dumpsters Downtown Historic Preservation Age of Consent City of Iowa City MEMORANDUM , Date: November 18, 2002 To: City Council From: City Manager Re: New Water Plant Start-up As we come to the end of a multi-year process of planning, designing and construction Iowa City's new water treatment facilities, our start-up plans are now underway. In November we will begin pre-startup of our new water purification plant. It is difficult to predict a timeline for each step in our transition. Similar transitions in other utilities have taken several months. To rush could risk adverse water quality, and that is not acceptable. As startup nears completion we will be notifying our customers when they can expect new water at their faucets. We will also provide information needed to make adjustments in homes and businesses as changes occur in the water distribution system. We have created a public information plan to communicate with staff and customers as we make our way through startup. Components include: Press Day where local media will be invited to view and tour the water plant and site - anticipated sometime in December [] Bill stuffers highlighting the new water plant and anticipated changes in water quality [] Internet information on the Iowa City website concerning steps in the startup process and anticipated impacts [] InfoVision pictorials and pieces regarding the startup process and new plant information [3 Video pieces are being created that illustrates the construction process from beginning to end [3 Posters, handouts, pamphlets and displays at the new water plant building for tours, [] Speaking engagements with City staff, Neighborhood Associations, commercial and industrial business groups, service groups, etc. We will keep you informed. mgr~rnemos\stadup.doc ~ GOLDMA__N_ CLINI_ __C Women s Health Project 319/337-2112 phone 227 North Dubuque, Iowa City, Iowa 52245 319/337-2745 fax emmagold~avalon, net 'l.,~ kubby~pobox, com / j www.emmagoldman, com Steve Atkins 410 E. Washington St. Iowa City, IA 52240 November 18, 2002 Dear Steve, The Emma Goldman Clinic is property tax exempt. Knowing that a significant percentage of the property in Iowa City is tax exempt and the consequences to the General Fund that can come from this circumstance, we enclose a check for $1,231.93. This amount is the actual tax asking for our portion of the City of Iowa City's Fire and Police Departments that would be paid if we were paying property taxes in September of 2002. As we highly value the services of these departments and have a higher need for these services then the average organization, we felt it was our obligation to pay our full share of their operations. In peace, Karen Kubby Executive Director Cc: Andy Rocca, Fire Chief R.J. Winkelhake, Police Chief IP4 2813 Hickory Trail Iowa City, IA 52245 November 13, 2002 Mr. Stephen Atkins, City Manager City of Iowa City 410 E. Washington St. Iowa City, IA 52240 Dear Steve: I am writing to call attention to an employee of the City of Iowa City who has performed a difficult task in outstanding manner. James Protasky of the Engineering Division was the inspector for the new subdivision being developed on the east end of Hickory Trail. Some of my neighbors were not entirely pleased to see the development occur, and with the constant flow of construction equipment through the current subdivision all summer, occasionally problems arose. Jim always went the extra distance to hear neighbors' concerns and to work out solutions that met their needs, as well as those of the contractors. Jim not only worked well with both parties, he always displayed good humor and took a no-nonsense approach, delivering on every assurance he gave. The many special things he did, like ensuring that lawn sprinkler heads were properly restored when a section of the street in front of our home was demolished and repaved, meant a lot to the neighbors and us. I noticed that the several contractors who carried out the construction displayed a genuine respect for Jim. They mentioned to us that he is regarded as a tough but very fair and competent inspector. It always was apparent that he takes a lot of pride is his work. I think the City of Iowa City and the residents of our community are fortunate to have a public employee of Jim Protasky's exceptional quality. Please pass on to him our thanks for ajob well done. Best regards. Sincerely, David J. Forkenbrock City of Iowa City MEMORANDUM DATE: November 21, 2002 TO: Mayor and City Council FROM: Marian K. Karr, City Clerk RE: No Information Packet Next Week Due to the Thanksgiving holiday there will be no information packet next week (November 28). City of Iowa City MEMORANDUM DATE: November 15, 2002 TO: City Manager FROM: Steven Nasby, Community and Economic Development Coordinator~ Andy Matthews, Assistant City Attorney.~.// RE: Termination of CDBG Agreement with Torus Precision Optics Tn 1998, the City of [owa City awarded Torus Precision Optics (Torus) a $75,000 Community Development Block Grant (CDBG) loan to purchase equipment at would enable them to expand their operations and create a minimum of eight new jobs. Unfortunately, the company was unable to fulfill the requirements of the CDBG agreement due to a number of internal and external economic factors. As such, we have formally terminated our CDBG agreement with Torus. The remaining balance on the CDBG loan was $54,408.70 that is secured by a lien on two milling machines. We obtained a third-party evaluation of the value of the milling machines, which was approximately $18,000. In August, we received an inquiry about the machines from Cedar Rapids Tool and Die, ]~ncorporated. This inquiry resulted in an offer of $14,000 with all associated moving costs to be paid by Cedar Rapids Tool and Die, Inc. We contacted Torus giving them a right of first refusal. Torus decided that their new business model did not require them to productively use the two milling machines so they declined to match the offer. On November 6, the milling machines were sold and the City has received a $14,000 payment for the milling machines. The termination of the CDBG agreement with Torus included consent to judgement (that will be filed with the court) for the unpaid balance of the original CDBG loan, which is $40,408.70 ($54,408.70 unpaid CDBG loan balance minus $:~4,000 sale of milling machines). Andy Matthews, Assistant City Attorney, is working with the Community Development Division on the judgement and legal procedures necessary to finalize and close out this project. Tf you have any questions or need additional information please let me know. Cc: Karin Franklin, Director of Planning and Community Development Andy Matthews, Assistant City Attorney File City of Iowa City MEMORANDUM I I Date: November 20, 2002 To: City Council From: Leaf Rake Committee (Jill Wenger, Barb Coffey, Joyce Carroll) Re: Leaf Rake Day 2002 On November 15 and 16 the City of Iowa City sponsored its 7th Annual Volunteer Leaf Rake Day, a project to rake the yards of Iowa City Senior Citizens. Thanks to the City employees listed on attachment sheet, Leaf Rake Day 2002 was a success! This year we raked 34 yards with the help of 90 volunteers (68 City employees and 22 of their friends/family members. From the comments of homeowners, our efforts were very much appreciated! Ct,gy [b.r 2002 Lea,t: Ra, k,e,, 'Da,y: Airport: Housing: Planning & Community non O'Neil Julia Tallman Development: Cable TV: Robin Butler John Adam Kevin Crawley Mary Copper Jeff Davidson Carri Fox-Rummelhart Marcia Kligaman Steve Long City Attorney's Office: Bob Miklo Eleanor Dilkes Brenda Rotherham Sarah Holecek Linda Severson Library: City Manager's Office: Maeve Clark Police: Steve ^tkins Susan Craig Mike Brotherton Dale Hailing Barbara Curtin Matt Johnson Finance: Kara Logsden Public Works: Barb Coffey Rick Fosse Brian Cover Tom Hansen Dianna Furman Steve Julius Roxanne Gustaveson Parks & Recreation: Janet Lower Tad Johnston Lynn Blades Barb Meredith Leigh Lewis (2 shifts) Joyce Carroll Kumi Morris Deb Mansfield Ann Maurer Cindy Coffin Kevin O'Malley Matt Eidahl Senior Center: Tyna Price Marilyn Kriz Susan Rogusky Christine Weinard Mike Moran Jill Wenger Steve Roberts Transit: Lanny Wilkerson Terry Trueblood Brian Berentsen non Logsden 11-21-02 I Marian Karr ~ IP8 From: Marian Kart Sent: Wednesday, November 20, 2002 11:29 AM To: proll~ns@groundround.com Subject: No Smoking policy The City Council accepted your email correspondence concerning the City's no smoking policy on their agenda November 5, 2002~ At the work session of November 4 Council discussed your suggestion prohibiting smoking in new establishments for the first year of operation, and then evaluating the mix at that time. After discussion there was not a Council majority interested in making changes to the ordinance. Thank you for your interest and we will attempt to keep all establishments informed of any changes that may be considered in the future. Sincerely, Marian K. Karr, City Clerk Marian Karr From: Rollins, Paul [prollins@groundround.com] Sent: Thursday, October 17, 2002 11:00 AM To: council@iowa-city.org Subject: No smoking policy To Whom It Hay Concern: I am writing on behalf of the Iowa City Ground Round in regards to the no smoking policy implemented on March 1, 2002. We have seen a 20% decline in sales since this policy has been implemented, while the Coralville restaurants continue to prosper from this policy. I know we are not the only Iowa City establishment that is suffering from this. What disturbs me the most about this policy is that new restaurants in Iowa City can offer smoking for up to one year. This policy effects the current Iowa City restaurants even more than the smoking ban itself. It puts businesses like ours, that have been doing business in this community for twenty years, on an uneven playing field. I would like you to reconsider the policy of new restaurants in the Iowa City area being able to offer smoking. I understand that this is re-evaluated after one year to determine their liquor/food mix. My Suggestion would be no smoking the first year, then re-evaluate their mix and determine if they should be able to allow smoking. I think this would make the playing field more level and give an opportunity for current establishments to compete with the new restaurants. Thank you for your consideration in this matter. Sincerely, Paul Rollins Regional Director American Hospitality Concepts, Inc. Cell: 563.590.8515 Fax: 563,875.8055 Marian Karr From: Marc Light [marc-light@uiowa.edu] Sent: Monday, November 18, 2002 9:56 PM To: iplab@avalon.net Cc: cou ncil@iowa-c[ty.org Subject: hello Dear Mr. Pfab: I enjoyed our chat on the phone earlier this evening! To recap our discussion: There are a number of alleyways that intersecting north Linn Street that are hazardous to pedestrians: - the alleyway that runs between St. Mary's and Devotay, - the alleyway that intersects Linn by the Hamburg Inn No. 2 (both the east and west sides of Linn are problematic). As a pedestrian approaches these alleyways on the sidewalk, it is impossible to see if a car is approaching due to "corner" buildings. The pedestrian does not think to look or stop since the sidewalk continues without curb or sign. On the other hand, many drivers view Linn Street as the reasonable place to slow down and thus drive THROUGH the sidewalk without slowing down. After a couple of close calls, I now always remember to peer around the corner before crossing. Will my 5 and 7 year old daughters be so lucky as they get older and walk downtown alone? Obviously, I am busy trying to teach them the dangers of alleyways in Iowa City. However, a sign either for the drivers or for the pedestrians or for both might make my job easier! I also voiced a concern about a possible side effect of making all bars 21-and-older. Namely, that the underage partiers would find other places to party and those places would likely be rental properties in city neighborhoods. I live in and own a house on the corner of Davenport and Linn streets and such a rise in the frequency of long loud parties would be devastating to our neighborhood. I am not for or against making all bars in Iowa City 21 and up. I simply would like the likely side effects to be considered and if possible addressed. Sincerely, Marc Light 225 E Davenport Street Page 1 of 1 Marian Karr From: Ross Wilbum Sent: Friday, November 15, 2002 12:53 AM To: Marian Karr; *City Council; Karin Franklin; Jeff Davidson Subject: FW: Latest Issue of ECICOG Express ..... Original Message From: Doug Elliott [mailto:ecicog~ia.nct] Sent: Thursday, November 14, 2002 2:37 PM To: ECICOG Express Subscribers Subject: Latest Issue of ECICOG Express The latest issue of the agency's electronic newsletter, the ECICOG Express, is attached. In order to read the newsletter, you must have Adobe Acrobat Reader to open the attached pdf file. If you already have Adobe Acrobat Reader, it will automatically open the pdf file. You do not need to download it again. If you need to download the free Adobe Acrobat Reader software, click on (or go to on the Internet): http:llwww.adobe.comlproductslacrobatlreadstep2.html. Your Adobe Acrobat Reader program will open automatically once it is installed. If you are unable to download Adobe Acrobat Reader, or choose not to, respond to this email and request a faxed or hard copy of the ECICOG Express. If you do not wish to receive this newsletter, respond to this email and request that your name be removed from the distribution list. Douglas D. Elliott Executive Director ECICOG 108 Third Street SE Suite 300 Cedar Rapids, IA 52401 (319) 365-9941, x22 (voice) (319) 365-9981 (fax) *** eSafe scanned this email for malicious content *** IMPORTANT: Do not open attachments from unrecognized senders 11/15/02 NOVEMBER-DECEMBER 2002 FCI Director's Notes Meet ),our legislator in November GRO moves to Monticello Onceagain, ECICOGwillhostm~opcnnousc A [l~ulc iii Mtmtlccllo will bc Ibc next project under thc Green Rehabilitalion lbr for legislat0fS in conjunc/i0n wi~ fl~e Novem- ~r board meeting. ~ns year, ECICOG s O;~ nership (GRO) pt ogram GRO p~u;~dcs solD, al'lb~ dable housing wlfilc pro- join~dBy t~0wa League ogCities~d ~e rooting thc usc ol cns irtmmcntall), responsible ct)nst~ uction techniques and prod- I6wa'Stat~'A~s~iation of Counties in hosfin I'hc bungalow style home has three be(booms and is located on a large It)t Thc h~>mc is structurally from strand, and its cu~ent condi- Board of Di- tio~ provides thc opportu- [ hll on nity tk~r utilizing many grccn building p~oducts m~d tcch- Hall. tuques wSll ~lhc Cbt5 of Monti- ccl lc~ has partnered with y folloMng ~e t:( '1('( )(J, tt) piowdmg see- mlude an lng thc rchabilitati~m proc- ess. These include x~aiving city utility fi'es, providing ~!~ctions thL~e~egeveral ncwlcgislalms ir gas and t'lcctrical service. ~COG r~i~ %e °P~nhouse is mi and assisting with property bpp6n~ffity~/o~l~al 0ffi~ials to ~0mc beaer mainlenance. ECIC()G is acquaidbd wi~nd~:~egls]ators and t~ khare cspcci;d I5 ;tpprccia~i, c or'thc City's commitment 1o 11~c project, priofif~eS.{hm~i!:!~istaibrs prior t0 the begin- Rchabditafion x~ ill proceed through thc winter, with an estimated corn- h~g o[tfi~:ne~t t~ ~imve Session, pict.tm in early spt rog. For mt)xe intbm~ation on GRO, contact Marie I)cVt its ~ ;:H0¢ei~/s~ y~u.there, (cxt ?0) at F('I('t)(; Regional vehicle signage program implemented At its Scplcmbcr meeting, thc ECI- a I~r~!ptlsal llom Sien Design of Washington, Iowa, Io apply the new East ( cntra] Iowa Trtu~sit logo and provider signage lo regiona} vehicles Although thcrc arc 73 vehicles in die regional llccl, thc new signagc will only be applied Io 14 newer xch ic les. 'Ih c signagc The new l;'CITR,4~55'lTlogo attd provider 5(gnttg, e were recetttO' applied to thix vehicle utilized b), xchiclcs. ECICOG hosts statewide meetings serviCes The lo,va Association of Regional Councils (IARC) is the statewide association fbr Iowa's regional plan- ning agencies. In October, IARC held training sessions for staff and a board of direc- lore meeting at thc ECl- COG offices and the His- tory Center in Cedar Rap- ids. Staff Notes l'h¢ ECICOG Board of Directors mid staffcon~atulate Lisa (Carlson) Trcharne. ECICOG phmner, who m~u'fied Tom Treh~e on October 26, 2(g)2. Tom is thc Plan nine and ~vclopment ~rector lbr thc City of M$ion. Lisa canfimdh, use her business cards and agency n met ~g. which wcrc printed cariicr lhis year in m~ficipafion of her marriage He~ email address, however, will stay Ire same Icecicog(a)imv.net. Trace) Mulcahey, E( ICOG grants adnfinistrator, h~ts beco~ne ce~ified as a ~ad l ainl ]nspeclor~Risk Assessor Mulcahey completed 40 hours in courscwork ~d three wfitlcn leers to become certified. She also completed training on a Niton Xqay Flourcsccncc (~{F) maclfinc. Calendar No~ember 16 Region 10 RI A Technical Advisory Committee meeting, Johnson County SEATS ofl~ccs, 2000 James Street, Coral No,emi,er 26 E( ICOGi 512 7th Strcet,B°ale Coralville,°f Dircclors2:00Mccting,p.m C oralvillc City Hall, EC / {~ Slmcl, Coralvillc, 4:00 pm to 6:00 pm ~ ~ Nmembcr 28-29 ECI( OG offices closed in observance ofThanksgMng holi- ~p~ day I)ecembcr 12 14CICOG SW~I AC' meeting kxafion TBA, 1:00 pm. ~tst Central lm~a Council ut Goxremments. December 30 ECICOG Executive Committee Meeting (in lieu of ~11 FCICOG board), E( ICOG offices, 108 Tired Street SI, Cedar Rap- I08 Third Street SI!, Suite 300 ids, 10:00 am. (tentatixe) Cedar Rapids. loxs152401 December 25 I~CICOG offices closed in observance of Christmas holiday 319 365 9941 January I. 2003 ECl( 'OG o['ficcs closed in observance of New Year's e mail ecicog(,iia ecl From Council Member Vanderhoef (distributed 11/25 special) United States Department of State Foreign Policy Town Meeting Thursday, December 5, 2002 6:30-9:15 p.m. Kirkwood Community College Cedar Hall-Room 234 6301 Kirkwood Boulevard, SW Cedar Rapids, Iowa Cosponsors Town Meeting ~5.'~0 ~ The State Deparanent Town Meeting is designed to provide a fonm~ to increase awareness and public anderstandh~g of current foreign policy p.m. Registration issues, to encourage public engagement in the policy process and to provide an oppommity to exclmnge views with Deparm~ent of State officials who fommlate and in~plement policy. 6:30 p.m. Welcome & Remarks United States Department of State The U.S. Depamnent of State is the lead agency in advancing U.S, objectives and interests in shaping a freer, more secure, and more 6:45 p.m. KeeplngBad StuffFrom Bad prosperous world. The agency's responsibility is to fomarlate and People: What Nonproliferation implemem U.S. foreign policy and represem the U,S, abroad. Is All About Kirkwood Community College From its founding in 1966, Kirkwood Commumty College has grown to be one of the leading two-year colleges in America. Its fall 2002 7:45 p.m. Break enrollment of nearly 14,000 students makes it the third largest institution of higher learning in Iowa and gae state's largest community college. 8:00 p.m. Opportunities In International CMC (Council for International Visitors to Iowa Cities) Trade , Established in 1984, CIVIC coordinates professional, international exchange and training programs for visith~g academic, governmental and business leaders from around the world. 9:00 p.m. Closing Remarks Cooperating Organizations 9:15 p.m. Adjourn Additional Information Cedar Rapids Chamber of Commerce Iowa City Area Chamber of Commerce To attend please complete the registration form. All registration forms must be received by Monday, Iowa City Johnson County Senior Center December 2 Please direct all inquiries to KLrlcwood League of Women Voters Connnunity College 319-398-4939. University of Iowa, International Programs For more reformation about the Town Meeting visit the website at www slate.gov/r/pa/pil/towmneetlinwa2002 or For more infom~ation about Department of State, visit wv~v. state gov CITY OF CORALVILLE CITY OF IOWA CITY - JOHNSON COUNTY UNITED WAY FY04 HUMAN SERVICE AGENCY FUNDING REQUESTS CONTENTS PAGE Agency Hearing Schedule .............................................................................................................. i Current Local Allocations ............................................................................................................. ii Coralville Funding History .............................................................................................................. iii Iowa City Funding History ............................................................................................................. iv Johnson County Funding History .................................................................................................. v United Way Funding History ......................................................................................................... vi United Way Designated Giving .................................................................................................... vii Conflict of Interest Statement ...................................................................................................... viii Overview of Funding Request Form ............................................................................................. ix Program and Financial Information by Agency: Arc of Johnson County ............................................................................................. 1 Big Brothers Big Sisters ............................................................................................ 16 Boy Scouts ............................................................................................................ 34 Crisis Center .......................................................................................................... 52 Dental Care for Kids ................................................................................................ 71 Domestic Violence Intervention Program (DVIP) ........................................................................ 82 Elder Services, Inc ..................................................................................................................... 100 Emergency Housing Project (EHP) ........................................................................................... 121 Evert Conner Center .................................................................................................................. 141 4 C's (Community Coordinated Child Care) .............................................................................. 157 Free Lunch ................................................................................................................................ 174 Free Medical Clinic .................................................................................................................... 186 Girl Scouts ........................................................................................................... 204 Goodwill Industries of Southeast Iowa ...................................................................................... 221 Greater Iowa City Housing Fellowship ....................................................................................... 238 jccoghsJag fundg/fy04jIfundingto¢ HACAP - Hawkeye Area Community Action Program ............................................................... 252 Handicare .................................................................................................................................. 268 Hillcrest Family Services ............................................................................................................ 285 ICARE ........................................................................................................................................ 306 lC Hospice ................................................................................................................................. 326 Legal Services ........................................................................................................................... 340 LIFE Skills, Inc ........................................................................................................................... 363 MECCA - Mid-Eastern Council on Chemical Abuse .................................................................. 380 MYEP ........................................................................................................................................ 397 Mental Health Center ................................................................................................................. 417 National Alliance for the Mentally Ill - JC ................................................................................... 437 Neighborhood Centers (Broadway/Pheasant Ridge/Clear Creek) of Johnson County ............. 455 Nest of Johnson County .......................................................................................... 474 Pathways ADHC ........................................................................................................................ 489 Rape Victim Advocacy Program ................................................................................................ 509 Red Cross .................................................................................................................................. 525 School Children's Aid ................................................................................................................. 545 Special Care Dental Program (Geriatric Mobile Dental) ............................................................ 558 Table to Table ............................................................................................................................ 573 United Action for Youth .............................................................................................................. 587 Visiting Nurse Association (VNA) .............................................................................................. 603 Youth Homes ............................................................................................................................. 625 jccoghs/agfundg/fy04jt fundingtoc HUMAN SERVICE AGENCY FUNDING HEARING SCHEDULE FOR FY04 All hearings to be held at the Lepic-Kroeger Realtors Office, 2346 Mormon Trek Blvd., Iowa City REQUESTS: I JOHNSON UNITED DATE: TIME: AGENCY: CORALVlLLE IOWACITY COUNTY WAY Wed., Nov. 20 7:00 DVIP (p. 82) x x x x 7:30 MECCA (p. 380) x x x x 8:00 ICARE (p. 308) x x x 8:30 Crisis Center (p. 52) x x x x Wed., Dec. 4 7:00 Red Cress (p. 525) x x x x 7:30 EHP (p. 121) x x x x 8:00 HACAP (p. 252) x x x x 8i30 RvAP (~i ~0D> x x x x Wed., Dec. 11 7:00 MYEP (p. 397) x x x x 7:30 BBBS (p. 16) x x x x 8:00 Youth Homes (p. 625) x x x x 8i~0 UAY (p. 587) x x x x Wed., Dec. 18 7:00 Elder Services (p.100) x x x x 7:30 Free Medical Clinic (p. 186) x x x 8:00 The Arc (p. 1 ) x x x 8:30 Handicare (p. 268) x x Wed., Jan. 8 7:00 4Cs (p. 157) x x 7:30 Neighborhood Centers of JC (p. 455) x x x 8:00 Visiting Nurses (p. 603) * x 8:30 LIFE Skills, Inc. ( p. 363) x Wed., Jan. 15 7:00 Greater lC Housing Fellowship (p. 238) x 7:30 Mental Health Center (p. 417) x 8:00 Nat. All. for the MI - JC (p. 437) x 8:30 Hillcrest (p. 285) x Wed., Jan. 22 7:00 Boy Scouts (p. 34) x 7:30 lC Hospice (p. 326) x 8:00 School Children's Aid (p. 545) x 8:30 Wed., Jan. 29 7:00 Table to Table (p. 573) x 7:30 Free Lunch (p. 174) x 8:00 Goodwill Industries (p. 221 ) x 8:30 Special Care Dental (p. 558) x Wed., Feb. 5 7:00 Evert Conner Center (p. 141) x 7:30 Pathways (p. 489) x 8:00 Legal Services (p. 340) x 8:30 Wed., Feb. 12 7:00 Nest of Johnson County (p. 474) x 7:30 Girl Scouts (p. 204) x 8:00 Dental Care for the Kids (p. 71 ) x 8:30 Inclement Weather Makeup Night is Wed., Feb. 19 · County funding determined by Johnson County Board of Health jccoghs/fy04hearing$¢hedulegno~ebook} CURRENT LOCAL ALLOCATIONS Coralville Johnson County Iowa City United Way Agency FY03 FY03 FY03 UW03 Alliance for the Mentarly Ill $2,414 Arc of Johnson County $ 1,925 * 23,751 Big Brothers/Big Sisters 4,043 $26,250 (;41,011 38,485 Crisis Center 5,335 67,752 40,600 90,751 Dental Services for Kids 0 Domestic Violence Intervention 3,300 54,065 54,256 48,738 Elder Services, Inc. 3,080 19,665 $62,063 43,744 Emergency Housing Project 1,430 I 1,400 14,000 30,340 Evert Conner Center 100 4O's 17,566 Free Lunch 5,108 Free Medical Clinic 1,650 92,297 6,584 96,140 Goodwill 67,680 Greater Iowa City Housing Fellowship 6,901 HACAP 3,025 22,500 8,635 10,675 Handicare 2,500 22,793 Hillcrest 9,376 ICARE 1,100 20,000 9,350 16,097 Iowa City Hospice 5,975 Legal Services 31,044 LIFE Skills 2,897 Lutheran Social Service 0 MYEP 2,750 3,500 43,483 100 MECCA 1,980 309,000 29,962 38,921 .Mental Health Center * 23,999 Neighborhood Centers 66,025 62,856 92,457 Pathways 7,804 Rape Victim Advocacy 2,640 13,230 12,200 22,867 Red Cross 1,100 ,500 12,984 School Children's Aid 9,594 Special Care Dental Program 16,414 Table to Table 7,073 United Action for Youth 2,750 97,275 65,000 51,033 Visiting Nurse Association 97,500 74,692 Youth Hemes 825 61,560 19,999 TOTAL $39,433 8938,519 8455,500 8948,512 · The Arc and Mental Health Center are now funded on a fee for service (individual billing) instead of a black grant. Preliminary Recommendations CITY OF CORALVILLE HUMAN SERVICE AGENCY FUNDING FY04 Increase Funding Allocated % Increase Dollar Percent Agency FY02 FY03 02 to 03 Request Increase Increase Arc of Johnson County $1,750 $1,925 10% $ 2,000 $ 75 4% Big Brothers/Big Sisters 3,675 4,043 10% 4,164 121 3% Crisis Center 4,850 5,335 10% 5,550 215 4% Domestic Violence Int. 3,000 3,300 10% 3,480 180 6% Elder Services Inc. 2,800 3,080 10% 5,000 1,920 62% Emergency Housing Project 1,300 1,430 10% 2,500 1,070 75% Free Medical Clinic 1,500 1,650 10% 2,000 350 21% HACAP 2,750 3,025 10% 3,025 0 0% Handicare 1,000 2,500 150% 5,000 2,500 100% ICARE 1,000 1,100 10% 2,187 1,087 99% MYEP 2,500 2,750 10% 3,000 250 9% MECCA 1,800 1,980 10% 2,079 99 5% Rape Victim Advocacy 2,400 2,640 10% 2,772 132 5% Red Cross 1,250 1,100 -12% 1,500 400 36% United Action for Youth 2,500 2,750 10% 3,000 250 9% Youth Homes 750 825 10% 1,000 175 21% TOTAL CONTINUATION $34,825 $39,433 13% $48,257 $8,824 22% iii jccoghs/ag fundg/fund-c3a .doc Preliminary Recommendations CITY OF IOWA CITY HUMAN SERVICE AGENCY FUNDING FY04 Increase Agency Funding Allocated % Increase FY02 FY03 FY02 to FY03 Request Dollar Percent Big Brothers Big Sisters (; 41,011 $ 41,011 0% $ 42,241 8 1,230 3% Crisis Center 40,600 40,600 0% 41,818 1,218 3% Domestic Violence Int. 54,256 54,256 0% 56,968 2,712 5% Elder Services Inc. 62,063 62,063 0% 65,000 2,937 5% Emergency Housing Project 10,000 14,000 40% 56,000 42,000 300% Free Medical Clinic 6,284 6,584 5% 6,913 319 5% HACAP 8,635 8,635 0% 8,635 0 0% ICARE 11,000 9,350 -15% 10,935 1,585 17% MYEP 43,483 43,483 0% 47,000 3,517 8% MECCA 29,962 29,962 0% 31,460 1,498 5% Neighborhood Centers 62,856 62,856 0% 72,284 9,428 15% Rape Victim Advocacy 14,850 12,200 -18% 12,810 610 5% Red Cross 5,500 5,500 0% 6,038 538 10% United Action for Youth 65,000 65,000 0% 68,250 3,250 5% TOTAL AGENCY CONTINUATION $455,500 $455,500 0% $526,352 $70,842 16% CONTINGENCY 10,000 TOTAL CONTINUATION (;455,500 8465,500 0% 8526,352 870,842 16% New Requests 4Cs 8 6,000 N/A The Arc 2,000 N/A Youth Homes 2,000 N/A TOTAL NEW REQUESTS 8 10,000 N/A TOTAL CONTINUATION PLUS NEW REQUEST 8455,500 8465,500 0% 8536,352 880,842 17% jccoghs~agfundg\fund-ic3.doc Preliminary Recommendations JOHNSON COUNTY HUMAN SERVICE AGENCY FUNDING FY04 Increase Allocated Allocated % Increase A~lency FY02 FY03 02 to 03 Request Dollar Percent Big Brothers Big Sisters $ 26,250 $ 26,250 0% $ 27,037 $ 787 3% Crisis Center 75,640 67,752 -10% 67,752 0 0% Domestic Violence Int. 54,065 54,065 0% 56,768 2,703 5% Eider Services, Inc. 21,850 19,665 -10% 45,000 25,335 129% Emergency Housing Project 12,000 11,400 -5% 48,600 37,200 326% Free Medical Clinic 102,552 92,297 -10% 96,911 4,614 5% HACAP 25,000 22,500 -10% 22,500 0 0% ICARE~ 20,000 0 -100% 0 0 N/A MECCA 309,000 309,000 0% 324,450 15,450 5% Neighborhood Centers 66,025 66,025 0% 75,929 9,904 15% Pathways 40,000 0 -100% 0 0 0% Rape Victim Advocacy 14,700 13,230 -10% 13,892 662 5% United Action for Youth 97,275 97,275 0% 102,000 4,725 5% *Visiting Nurse Assn.~ 97,500 97,500 0% 100,425 2,925 3% Youth Homes 68,400 61,560 -10% 63,407 1,847 3% TOTAL $1,030,257 $938,519 -10% $1,044,671 $106,152 11% New Requests MYEP ' $4,000 Red Cross 7,500 Total New Rec]uests $11,500 Total Continuation Plus New Request $1,030,257 $938,519 -10% $1,056,171 $117,652 13% ~These agencies' funding is recommended by the Johnson County Board of Health to the Board of Supervisors. *In FY02, $19,000 of local funds were replaced with public health nursing state funds to be used for case management. V jccoghs~agfundg\fund-jc3.doc UWFY02 UWFY03 UWFY04 Focus Area Special Needs Total Special Needs Total Agency Allocation Allocation Allocation Allocation Allocation Allocation Dollar % UWFY02 UWFY02 UWFY02 UWFY03 UWFY03 UWFY03 Increase Increase 4 C's $3,000 $9,000 $30,193 $500 $18,066 $2,434 14% Alliance for the Mentally III $2,500 $2,414 $2,586 107% Arc of Johnson County $1,530 $34,671 $23,751 $3,249 14% Big Brothers Big Sisters $1,525 $11,000 $51,572 $4,470 $11,000 $53,955 $5,759 15% Crisis Center $1,000 $93,080 $6,616 $97,367 $11,485 13% Dental Services for Kids $0 $0 $1,000 N/A DVlP $49,960 $1,000 $49,738 $3,522 7% Eider Services $3,000 $47,383 $5,576 $49,320 $10,508 24% Emergency Housing Project $1,000 $32,100 $5,000 $35,340 $21,210 70% Evert Conner Center $100 $100 $900 900% Free Lunch Program $800 $6,090 $500 $5~608 $1,892 37% Free Medical Clinic $1,000 $98,548 $5,000 $101,140 $8,034 8% Girl Scouts of the MS Valley $0 $21,760 N/A Goodwill $4,000 $72,670 $5,577 $73,257 $12,320 18% Gr. lC Housing Fellowship $7,000 $599 $7,500 $3,099 45% HACAP $15,675 $10,675 $0 0% Handicare $3,000 $26,364 $571 $23,364 $26,167 115% Hawkeye Area Boy Scouts $0 $0 0% Hillcrest $9,711 $9,376 $2,624 28% ICARE $16,500 $1,065 $17,162 $5,773 36% Iowa City Hospice $6,125 $5,975 $1,525 26% Legal Services $1,753 $33,575 $31,044 $17,874 58% LIFE Skills $3,000 $103 $3~000 $7,103 245% MYEP $11,910 $100 $11,900 11900% MECCA $2,500 $42,374 $3,458 $42,379 $5,570 14% Mental Health Center $1,273 $25,873 $23,999 $2,001 8% Neighborhood Centers $5,000 $98,811 $4,906 $5,924 $103,287 $21,543 23% Pathways $8,000 $196 $8,000 $4,196 54% Red Cress $2,200 $20,129 $2,000 $14,984 $6,783 52% RVAP $1,000 $24,440 $22,867 $1,143 5% School Children's Aid $9,936 $342 $9,936 $2,906 30% Special Care Dental $17,000 $16,414 -$414 -3% Table to Table $7,250 $1,000 $8,073 $5,484 78% The Nest of Johnson County $0 $0 $0 0% United Action for Youth (UAY) $5,000 $56,779 $4,906 $10,000 $65,939 $15,967 31% Visiting Nurse Association $75,785 $3,458 $78,150 $5,803 8% Youth Homes $20,500 $19,999 $600 3% Total $36,38"1 $22,200 $t,055,604 $54,343 $29,424 $'1,032,279 $254,306 27% jccog hs/agfu ndg/U hired Way xfs UNITED WAY DESIGNATED GIVING Designated Designated Designated Designated A_~ency UWFY00 UWFY01 UWFY02 UWFY03 Alliance for the Mentally III $2,227 $2,893 $3,478 $2,799 Arc of Johnson County 1,812 2,064 2,455 1,810 Big Brothers/Big Sisters 7,513 8,705 9,089 10,265 Boy Scouts 11,115 7,922 15,956 16,362 Compassionate Friends 853 705 699 Crisis Center 8,842 8,993 10,475 9,273 Dental Services for Kids 2,998 2,106 1,629 1,729 Domestic Violence Intervention 11,813 13,348 15,657 13,661 Elder Services, Inc. 3,993 5,034 6,896 7,907 Emergency Housing Project 2,519 2,529 3,387 3,340 Evert Conner Center 2,631 1,811 1,408 1,293 4C's 2,597 3,076 2,911 3,853 Free Lunch Program 4,412 4,339 4,163 3,641 Free Medical Clinic 6,889 9,107 11,723 10,085 Girl Scouts 3,124 2,332 3,294 4,978 Goodwill 2,477 2,379 3,595 2,988 Greater Iowa City Hsg. Fellowship 2,546 507 437 1,308 HACAP/Headstart 1,407 2,059 2,251 3,158 Handicare 3,600 3,378 4,956 4,717 Hillcrest 566 684 1,142 477 Hospice 14,531 69,178 41,226 32,023 ICARE 5;445 3,559 5,126 3,816 Legal Services 1,304 1,521 2,835 2,545 LIFE Skills 1,295 1,685 3,468 2,400 Lutheran Social Service 2,189 2,993 1,698 MYEP 2,178 3,093 2,720 1,105 MECCA 1,491 1,872 2,136 2,767 Mental Health Center 1,520 2,037 3,088 2,385 Neighborhood Centers 709 1,078 2,227 377 Nest of Johnson County, The 1,383 1,143 2,246 4,613 Pentacrest/Pathways 704 1,199 3,542 3,730 Rape Victim Advocacy Program 2,418 4,355 4,660 3,584 Red Cross 6,863 6,929 8,337 18,006 School Children's Aid 6,035 3,637 3,891 3,005 Special Care Dental Program 1,057 1,180 1,700 1,935 Table to Table 2,362 3,657 4,943 3,346 United Action for Youth 3,489 4,465 5,871 6,092 United Way 0 0 0 Visiting Nurse Association 8,198 8,454 11,049 8,413 Youth Homes 2,908 3,507 4,465 2,293 Non-United Way Agencies 47,188 14,425 67,692 87,317 TOTAL $200,127 $224,092 $288,523 $293,396_ United Way of Johnson County Citizen Review Panel Conflict of Interest Policy Approved 10-9-01 The United Way of Johnson County Citizen Review process involves volunteers from many different parts of our community. These volunteers make funding decisions that address community needs and ensure accountability to United Way donors. Citizen Review Panel volunteers may experience conflicting and competing interests. However, volunteers must make every attempt to formulate decisions free of undue influence, conflict of interest, or any appearance thereof. They must represent the best interests of the community at large and must not advocate for, or present inappropriately, any personal or professional interests on behalf of organizations with which they or their family or friends may be associated. They must not use privileged information acquired during the Citizen Review Panel process for personal or professional gain or for the benefit of any other organization with which they may be affiliated. Application A conflict of interest occurs when a volunteer is associated in any way with an organization that is seeking funds from United Way, or that may be affected or benefited by a United Way action or decision. Potentially conflicting roles include personal, professional, volunteer, or business relationships with agencies seeking funds through the Citizen Review process. Disclosure The burden of disclosure of a conflict of interest or the appearance of a conflict of interest is on the volunteer. Before each meeting of the Citizen Review Panel, volunteers will be asked to disclose any potential conflict of interest regarding the agencies to be reviewed at that meeting, as well as the nature of the conflict of interest. Disclosures should include: 1) board memberships or volunteer activities; 2) business relationships; 3) staff, volunteer, or board memberships of family members; 4) any other possible conflict of interest. Conduct A volunteer who has a conflict of interest regarding an agency being reviewed by the Citizen Review Panel should abstain from any vote related to that agency. A volunteer may, however, clarify a point of discussion on the agency if the information is knowledge based, but not opinion based. Misuse of Information Agencies provide the United Way Citizen Review Panel with budget, program, and personnel information for review purposes only. Volunteers are entrusted with this information in order to make informed decisions. Volunteers who gain information by virtue of their role as Citizen Review Panel members must not use that privileged information for personal or professional gain or to the benefit of any other organization with which they may be affiliated. IOverview of the FY04 Human Service Agency Request for Funding ApplicationI Background: This section addresses much of the "logistical" information regarding the agency, i.e. programs and services the agency provides, accreditation the agency has received, and how funds received by the agency has and will be used. Another important aspect of this section is the history of the agency. Each agency that is a part of this funding process began due to a need addressed by the community. This section gives the agency a chance to share their story along with current and future plans the agency is a part of. Client Profile: Section two looks at the breakdown of who the agency serves, and how and where they receive such services. Information regarding client profile includes, residency (i.e. Johnson, Iowa City, Coralville), age, gender, and ethnicity. This section also addresses how people are considered eligible to be clients of the agency, as well as potential fees the client may be responsible for. Community Relations: This section looks at the client's and the community's responses to the agency and its services, particularly looking at such criteria as referral sources and collaborations with other services in the county. Other items section three addresses are similarities and differences of the agency in relation to other agencies in the area. Strategic Planning and Agency Effectiveness: Section four addresses the many ways an agency must be prepared for change---changes within the service population as well as in the community. This section looks at challenges and opportunities the agency faces as well as the different strategies the agency is taking in relation to these challenges/opportunities. One important part of this section is to look at how the agency measures the success of its services and how they use the outcome of that success. This section also looks at how the agency responded to recommendations from UWJC from FY03. Board Governance: This section looks particularly at the role of the board in relation to the agency, including a board roster, information regarding board meetings and training, as well as the part the board takes in financial management of the agency. Personal and Staff Development: This last section of the narrative looks at the staff of the agency including information regarding benefits, salaries, and full-time equivalents. This section asks the agency to include an attachment of the organizational set-up of its agency, its hieramhy, etc. This section also addresses staff development and training opportunities. Financial Management: The final three pages of the request include a financial summary of the agency. Information included in this section is the agency's assets, liabilities, income, and expenses. The section also addresses the agency's restricted funds, in-kind support, and grants. Section 1: Background Agency Name: The Arc of Johnson County Address: 1700 S. 1~t Avenue, Suite 16, Iowa City, IA 52240 Phone: (319)351-5,1kL7.~..~ t Director Name: Barbara Bolton Signat~t~*--.,~ Bd. Pres Name: Jim Clayton Signatul;~ Request Completed By: Barbara Bolton and Staci S. Nelson ~/ Date: October 4, 2002 Check Your Agency's Budget Year: 1/1 - 12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC 34,668 23,751 27,000 1.80% Does not include designated ivin or S ecial Needs Grants FY 02 FY 03 FY 04 City of Iowa City 0 0 2000 0.13% Johnson County 0 0 0 0 City of Coralville 1,750 1,925 2000 0.13% What were local funds used for this year: 1,946 hours of Respite Services for individuals and groups with no other funding source. What will next year's local funds be used for? Community Programs and Respite Services for individuals and groups with no other funding source. Agency Mission Statement: The Arc of Johnson County is committed to being a leader in offering information, services, and advocacy to individuals with developmental disabilities, their families, and community: to promote informed choices and the realization of their goals relating to where and how they live, learn, work and play. Summarize your programs and services for which you are requesting funding: Respite Care Respite is defined as caring for a person with a disability in order to give primary caretakers some relief. This allows families time away during periods of stress or crisis, to tend to business, or simply to take a break from caretaking. Respite Care will be available both in group and individual settings for persons not eligible for other funding. Community Programs The annual educational and legislative forums historically hosted by The Arc have been fully funded by United Way allocations. These forums provide community members access to information and the opportunity to share in a dialog with local leaders in the areas of education and legislation as it relates to the persons served by The Arc. List any accreditation and licensure your agency currently has. Explain. CARF Accreditation process started September 2002, expected accreditation October 2003. Medicaid Home and Community Based Waiver Services Certifications to provide Respite, Supported Community Living and Supported Employment services, which are reviewed annually for renewal. Agency Name: The Arc of Johnson County Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Throughout its 45-year history, Thc Arc of Johnson County has acted as an advocate for the rights of persons with mental retardation and developmental disabilities. When the notice appeared in the Iowa City Press Citizen over 44 years ago asking persons interested in the welfare of individuals with mental retardation to come to a meeting, Johnson County had no educational, recreation, employment, or residential programs for individuals with mental retardation and developmental disabilities. Johnson County in 2002 has programs in all four areas. The Arc has been instrumental in creating these programs which provide individuals with mental retardation and developmental disabilities with services non-disabled people may take for granted. Many services The Arc developed now exist as separate entities. The Special Education program and Goodwill Industries of Southeast Iowa were nurtured by The Arc. In June 1971, Systems Unlimited Inc. was founded by seven members of the Arc who had been charged with the responsibility for making residential services available on the community level. Special Populations Involvement (SPI) came about because of cooperative planning started in 1959. During the late 1980s and into the early 1990s The Arc helped local families access daycare settings for children with disabilities. Johnson County Department of Human Services, during those years, transferred funding to The Arc to secure daycare as a part of the integrated family plan. The Arc also coordinated summer program opportunities for children and young adults to assist in keeping children living in their family home. Until 1992, The Arc owned a building that was leased to Systems Unlimited for its adult day program. That program outgrew the space and moved. The Arc sold the building and relocated its own office to Eastdale Plaza. The relocation was completed during 1993. The agency also changed its name fi.om "The Association of Retarded Citizens of Johnson County" to "The Arc of Johnson County." The Arc has changed its name on the state and national level as well. This change recognizes the need for person-first language, "people with mental retardation" versus "mentally retarded people". In the 1990s The Arc became a provider of Managed Care through the Medicaid Waiver Home and Community Based Services when these contracts became increasingly utilized as a funding stream for Support Services. Through these contracts the Arc has been able to provide Respite Care, Supported Community Living, Home and Vehicle Modifications, and Job Placement and Supported Employment for the diagnosis areas of Mental Retardation, I11 and Handicapped, and the Brain Injury Waivers. This provision of services created initial and ongoing significant growth in the amount of services the Arc has and continues to provide. Current programs and services at The Arc include Advocacy, Information and Referral, Community Awareness and Education, Supported Employment, and Family and In Home Services. The recent significant growth of The Arc leads to focusing future plans on: · Best practices in service provision · CARF Accreditation · Standardized practices through policy and procedure revisions and implementation · Quality assurance and outcomes measurements · Researching unmet community needs · Short and long range planning for fiscal viability of the agency jccoghs\fundingform.doc 2 Agency Name: The Arc of Johnson County Section 2: Client Profile ~ ~ FY01 'Y02 1. How m any Johnson County residents (Including lC & 1 Unduplicated Count 104 115 Coralville) did your agency serve? 2. How many lowa City residents did your agency serve? 2 Unduplicated Count 74 77 3. How many Coralville residents did your agency serve.'? 3 Unduplicated Count 22 20 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 36 Female: 67 Caucasian 84 6-17 77 ' Male 110 African American 4 18-29 21 Asian 3 30-61 34 American Indian 2 62-75 0 Hispanic 2 >75 0 Other or Not Specified 80 Footnote, Section 2, Client Profile The Arc of Johnson County experienced a 98% turnover in employees between November of 2001 and July of 2002. The numbers documented in files were lacking in some areas for client profiles. The numbers recorded here are accurate, though incomplete in some categories. 3. Briefly describe your service population. The Arc of Johnson County serves children, adults and the families of persons with mental retardation and developmental disabilities, throughout their life span in all aspects of their lives. During the past Fiscal Year, these persons and their families were residing in Johnson County and 16 additional counties in Iowa. Residents outside of Johnson County receiving services numbered 24, of those 13 were in Washington County. Of the remaining 11, 9 were l~om separate counties, as noted in #6 below. 4. How do you determine eligibility for services? By diagnosis and funding requirements. 5. Are there fees for your services? Yes X No__ If yes, please describe your fee structure: Medicaid, County, and Private Pay fee reimbursements are set by cost reporting requirements which compare program revenues to actual costs and this in turn calculates the hourly unit rates. Division of Vocational Rehabilitation fees are contractual outcome based payments. 6. Do you provide services to areas outside of Johnson County? Yes Area{s) served: Washington, Cedar, and Iowa Counties are included in County contracts. Decatur, Hardin, Henry, Jasper, Linn, Marshall, Pottawattamie, Poweshiek, and Tama Counties have each had 3 or fewer persons served in the past year with Medicaid Waiver services. jccoghs\fundingform.doc 3 Agency Name: The Arc of Johnson County Services Provided: Advocacy, Information and referrals, Respite for monthly Parent Support Group, Sabbath Sunday Promotional Information, Natural Ties Support Group, Supported Community Living, Respite Care for individuals and groups, Consumer Directed Attendant Care, Home and Vehicle Modifications, Supported Employment and Administration of the Children At Home Grant. Funding Sources: Medicaid Home and Community Based Waiver Services, County Funding, Division of Vocational Rehabilitation Services, Private Pay, Children At Home Grant. Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client · Satisfaction Surveys sent to all recipients of services (b) Community · Satisfaction surveys sent to employers of persons receiving supported employment. · Developed and sent surveys on a new project, Margie's Kitchen, through The Arc, Center for Development and Disabilities, and Handicare mailings in September 2002to assess the need and interest in a cooking day with respite provided for families. 2. Briefly summarize your findings: · During September 2002 we began to receive responses, we expect results summarized in time for the United Way hearings. 3. What changes have been made in response to these findings? · Changes will occur when responses are summarized. Footnote, Section 3, Community Relations The Arc staffcreated satisfaction surveys and will have summations of them for the hearings. Surveys of unmet needs are also being distributed to current customers. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Families and Consumers 5% Other County MH/DD Services 5% State of Iowa DHS 10% DVRS 10% Johnson County MH/DD Services 70% jccoghs\fundingform.doc 4 Agency Name: The Arc of Johnson County 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? 6. Supported Employment Services: Goodwill Industries, Employment Plus, and Employment Systems. In Itome Services: Life Skills, Reach for Your Potential, Systems Unlimited, and Handicare. 7. Describe what distinguishes your agency and/or its services fi.om other agencies that provide similar services in Johnson County. The Arc of Johnson County is an advocacy and information and referral source, as well as a service provision agency. The Arc serves both the individual with mental retardation / developmental disabilities and the family through the life span, supporting them in all aspects of their lives. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Handicare and Center for Development and 1. Margie's Kitchen is a joint project with the Disabilities intention of providing a place for groups of parents to gather for the creation of nutritious, low cost pre-cooked meals. Childcare on site will be provided through Respite Services with The Arc. Parents will be offered educational and recreational activities as well. 2. Community Coordinated Childcare 2. Toy Library Agency Membership for the use of Independent Contractors of The Arc to access while providing services in Respite or Supported Community Living. 3. Employment Plus 3. Coordinate employment services for persons with dual diagnosis of Mental Retardation and Mental Illness with joint expertise, credentials and funding. jccoghs\fundingform.doc 5 Agency Name: The Arc of Johnson County Section 4: Strategic Planning and Agency Effectiveness I. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staWmg, finances, service delivery) Challenges/Opportunities Strategies 1. Revitalization efforts developed in response 1. The Board of Directors and Employees to a 98% turnover in Employees liom 11/01 - began to address this need by assessing each 7/02. The Arc chose to refocus on Mission, operational component of The Arc in Programs, and Collaborations. To insure the December of 2001. Expertise of community longevity of the agency, the careful rebuilding partners in areas needing immediate attention of a foundation of best practices in all was gained. Maintenance of provision of operations is occurring, quality services to individuals and families occurred. Strategic Planning will occur formally in February 2003, 2. Evaluate outcomes of qualitative services to 2. CARF Accreditation process has begun, guide the development of new services and Contract regulations are in review, Medicaid increase customer satisfaction with current Review of services will occur in July 2003. services. Internal research into outcome measurements. 3. Growth in services provided through The Arc 3. Funding, both long and short term, through has been significant the last few years. The wise stewardship of current assets and challenge is to balance the growth with stability diversification of funding for services and of the agency as a viable service provider over advocacy over time. time. Footnote, Section 4, Strategic Planning and Agency Effectiveness The agency has acted upon the recommendations of the United Way Citizen Review Panel and will Develop a Strategic Plan in February of 2003. The agency has invested in consultants and staffpersons to Review and assess the agency and bring it forward with continued quality service provision. A Commitment has been made to bring the agency back to a leadership position in the Johnson County Area of providers, through careful assessment, planning and development of sound management and clinical practices. 2. In what way will the needs of your service population change in the next five years? · Aging · Increasing incidence of multiple diagnosis and medical fi.agility 3. How do you plan to address these changes? · Collaborate to share funding and programmatic expertise · Recruit providers with medical knowledge · Train employees and providers in areas of aging, and multiple diagnosis 4. Describe the evaluation methods you use to measure the success of your services? · Formal Satisfaction surveys of internal and external customers jccoghs\fundingform.doc 6 Agency Name: The Arc of Johnson County 5. What are the results of these evaluations (outcomes)? · Current surveys will be sent in October 2002, with results available at the hearings. 6. How do you plan to use the evaluation results to enhance/extend your services? · Be responsive to results as defined by the customer. 7. How do your programs/services impact the community? · Increased physical and mental health and well being of persons served and of their families. · Integration of persons with disabilities into their community. · Increased community awareness of persons served, of their needs, rights and responsibilities as community members. · Reduction in entitlement use as persons receiving Supported Employment services become working citizens. · Provision ora stable and reliable work force pool for employers to recruit fi.om. 8. How did the agency respond to the UWJC recommendations fi.om last year? 1. Board active involvement in planning and oversight as the agency moves forward: The Board members' direct involvement in oversight and management through a 98% turnover in employees of The Arc through the last fiscal year kept The Arc fi~nctioning to meet client and family service needs. The Board members researched information needed in the recruitment and hiring of 8 staff persons in 5 months. Personnel Policies were reviewed and amended by the Board, as were Job Descriptions. Staff salary ranges are currently in Board Personnel Committee review for comparables. Board Committees each have assigned projects, from researching office space needs, to increasing advocacy efforts, to long term financial planning. 2. External audit for the agency: A Financial Review of FY01 report was completed May 9, 2002. This report stated that: "...we are not aware of any material modifications that should be made to the accompanying financial statements in order for them to be in conformity with accounting principles..." A full Financial Audit of FY02 is in process, a report is expected by November 1, 2002. 3. Board engagement in the development of a strategic plan to guide the agency: The Board of Directors are negotiating with recommended facilitators of Strategic Planning for a plann'mg session in February of 2003. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? 83% jccoghs\fundingform.doc 7 Agency Name: The Arc of Jolmson County 4. How is the board involved in strategic planning and governance of the agency? · Strategic Planning will occur in February 2003. · Governance is through setting policy for The Arc in Committees or as a full Board. 5. What type of training/orientation do board members receive? · Initial orientation by the Executive Director. Monthly training on The Arc programs and operations by The Arc staffpersons. · Monthly guests on the Board agenda (e.g, local CPC, Investment Bankers, Auditors, etc.) 6. Does your agency have written policies and procedures for financial management? Yes If yes, date of last board approval? August 23, 2002 7. Have you filed the annual report with the Secretary of State? Yes. If yes, date filed? 1/25/01 8. Have you filed the IRS form 990 for the most recent year? Yes. If yes, date filed? 11/13/01. If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? RSM McGladrey & Pullen, LLP How much did the audit cost? FY01 Review - $5,000 and FY02 Full Audit - $8,500. If material weaknesses are noted in the audit, what is your plan for addressing them? FY02 Audit Report is expected November 1, 2002. FY01 Review no weaknesses noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers X a. fiduciary liability a. 1,000,000 b. employment practice liability b. 1,000,000 General Liability X 2,000,000 Umbrella Liability X 2,000,000 Professional Liability X 2,000,000 Property or Renters X 122,290 Vehicle X 1,000,000 Footnote, Section 5, Board Governance The Arc Board of Directors has seen The Arc through what might have been a crisis for the agency, by reviewing and implementing policy to guide the revitalization efforts implemented by the employees, board members, and independent contractors. jccoghs\fundingform.doc 8 Agency Name: The Arc of Johnson County Section 6:Personnel and StaffDevelopment 1. State the length of employment of the Executive Director and his/her qualifications. Eight months Qualifications: Masters degree in Rehabilitation Counseling with 20 years experience in the areas of rehabilitation services development, planning and provision; education and research; hiring, training and supervision of employed personnel and volunteers. Twelve years service provision and coordination to persons with disabilities, with an emphasis in Mental Retardation and Developmental Disabilities. Additional experience in Total Quality Management, CARF and CORE Accreditation processes. 2. StaffSalaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X X In Board Committee Review I I 1 Administrative Assistant X X X In Board Committee Review I 1 1 Employment Specialist X X X In Board Committee Review 2 2 2 Family Services i X X X In Board Committee Review 2 2 3 Coordinator Job Coach X X X In Board Committee Review I I 1 Receptionist X In Board Committee Review .5 .5 .5 Facilities Management X In Board Committee Review .25 .25 .25 TOTAL FTEs 7.75 7.75 8.75 Footnote, Section 6, Personnel and StaffDevelopment The Arc Board of Directors is presently developing staff salary ranges through the Personnel Committee. These ranges will be available for the United Way hearings. 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 7.25 FTE's and 250 Independent Contractors. 4. How much was spent on staffdevelopment in the last fiscal year? $5500.00 5. How much is budgeted for staff development in this fiscal year? $6794.00 jccoghs\fundingform.doc 9 Agency Name: The Arc of Johnson County 6. What training and support opportunities are offered to staff?. Training begins with Orientation to The Arc and the position filled. Support is offered through formal individual clinical supervision weekly. Program staff meet as a group on average twice monthly. All staff meetings occur weekly. Other support is provided through peer and supervisory consultations on an as needed basis. In House formal training is provided to all staff a minimum of once monthly. The FY03 In House training schedule includes 15 confirmed training sessions of 1.5 - 2.5 hours in duration. These include topics such as: StaffBenefits, Ethics Seminar, Medicaid - The Basics, and training by other agencies to learn about community resources. Attendance at local, regional and national conferences to network, and increase skill and knowledge are encouraged. Each staff member at the Arc is scheduled to attend one off site conference during FY03. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 2.33% Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board 4/02 last reviewed? 10. Does your board X annually evaluate the director's performance? 11. Does your agency X have job descriptions for every position? If yes, date of last 2/02 board approval? 12. Is there an annual X performance review for every staff?. jccoghs\fundingform.doc 10 Agency: The Arc of Johnson County Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) FY 00 FY 01 FY 02 Current Assets Cash $60,429 $133,913 $308,056 Investments $107,753 $128,617 $116,460 Receivables < 90 days $21,257 $124,168 $148,242 Other $2,595 $31,099 $33,467 Total Current Assets $192,034 $417,797 $606,225 Other Aeaests Property $54,581 $49,647 $44,714 Equipment $32,079 $33,773 $38,811 less depreciation ($28,271) ($24,993) ($27,864) Receivables > 90 days $31,274 $0 $0 Other $0 $0 $0 Total Non.current Assets $89,663 $58,427 $55,661 Total Aeaets $281,697 $476,224 $661,886 FY 00 FY 01 FY 02 Current Llabilitlea Accounts Payable $1,013 ($1,688) $17,339 Payroll Taxes Payable $41 $56 $5.004 Contracts Payable $646 $4,956 $9,143 Mortgage Payable-6 months $0 $0 $0 Total Current Liabilities $1,700 $3,324 $31,486 Other Liablliflea Mortgage Payable-Balance $0 $0 $0 Other $15,512 $37,242 $85,509 Total Other Liabilities $15, 512 $37,242 $85,509 Total Liabilities $17,212 $40,566 $116,995 NetAses~s $264,485 $435,658 $544,891 Liabilitlea & Net Aeaets $281,697 $476,224 $661,886 Footnotes to Section 7, Part A (Balance Sheet) In FY0I, The Arc went through a r~orgalaiTat, ion p~riod that included a change in accountants. A vendor was inadvertently ov~paid and this resulted m a negative balance in Accounts Payable. 2. Contracts Payable consisted of Cafeteria Plan Payable amotmts in FY00 and FY01. In FY02 Contracts Payable consisted of the Cafeteria Plan Payable and State Memberships and Dues Payable. The increa~ in Contracts Payable for FY02 was due to the coxnbmtion of an increase in usage of the cafet~ia plgan axed the addition of State Memberships and Dues. 3. The increase in Oth~r Liabilities for FY02 was due to The Arc b~ing notified of a fee reimbursement in the mount of $84?637. Agency: The Arc of J~Ohnson County FY02 FY03 FY04 B~. Income & Expenses Income Local Funding Sources __ __ Iowa City ..... $o $o __ $2.00o Coralville $1,750 $1,925 $2,000 United Way - Allocation ..... $31,941 $24,561 - Designated Giving $2,077 $1,749 $1,850 ~Grants-Federal, State, Foundation $33,156 $32,473 $37,000 Net Sales of Service $723,320_ $972,918 $1,118,856 Net Sales of Materials $o __~. $9 $0 Contributions/F undraising _ _$10,576 $3,000 $5,000 Investment Income ($7,603) ($2,500) ($1,500) Other $1,170 $0 $0, Total Income $796,387 $1,034,126 $1,19_2,881 Expenses __ Wages & Salaries $188,044~ $252,656 $260,133 Benefits $37,032 $4~__,438 $53,32.6. O_c_cupancy $13,638 $14,047 $14,609 ~Non-occupancy. $35,542 $35,686 $37,113 Other $470,087 $596,164 $7_42,205 $744,343 $942,891 $1,t07,386 C. Fund Balance Revenue _$796,387 $1,034,126 $1,t92,881 ~arryover Balance from previous yea_r $440,362 $352,406 $302,641 Total_Operating B~udget $1,238,749 $1,386,532 $1,495,52_2_. Less Total Expenses $744,343 _ $942,891 $1,1o7,386 Ending Fund Balance $492,406 $443,641 $388,136 Less Restricted Balance (exj~_lai~n) $140,~_0 $141,000 $51,000 Carryover Fund Balance $352,406 $302,641 $337~,136 Footnotes Section 7, Part e (Income and Expense) 4. Last year The Arc experienced a loss oc their investments due to the decline in the value of their stocks. Based on the current economy The Afc mq~cts to continue to shOW a loss in the current and next fiscal years. Wages and salar~s increased significantly this year ~lue to the fact that additional staff was added after the reorganization period to meet the increased ~ernand for services. The Arc of Johnson County Board of Directors July 2002 Jim Clayton, President Dr. Mary F. Hacker, Executive, Personnel, & Budget/Finance Membership/Nominating Iowa City, IA Iowa City, IA Business O~vner University of Iowa Physician 2001-2203 2002-2004 Mimi Haithcox, Vice-President Jonathan Jordahl, Governmental Executive, Persormel, Affairs Membership/Nominating, Coralville, IA &GovemmentaI Affairs University of Iowa Employee Iowa City, IA 2001-2003 Business Owner 2000-2004 Todd Nickel[ Membership/Nominating & Fundraising Jeff Barta, Treasurer Iowa City, IA Executive, Personnel, Budget/Finance, Proctor and Gamble Engineer & Fundraising 2002-2004 Solon, IA Investor Keith Ruff, Membership/Nominating 2002-2004 Iowa City, IA Evert Conner Center Employee Al Dix, Secretary 1997-2003 Executive, Personnel, & Budget/Finance Iowa City, IA John Sti~nmel HyVee Manager Iowa City, IA 1998-2004 HyVee Employee 2001-2003 Lori Bears, Governmental Affairs Iowa City, IA Veterans Administration Employee 1997-2003 Nancy Brown Iowa City, IA Goodwill Employee 1999-2003 Tim Clancy, Budget/Finance Iowa City, IA Note: The by-laws provide for two-year Target Employee terms, with three consecutive terms 1997-2003 allowed. Agency: The Arc of Johnson County The Arc of Johnson County Organization Chart MemberShip Board of Directors Executive Director Ad ' 't t ..... mmls ra lye smstant ami y Services Coordinators Employment Specialists Job Coach /' ~....~.~ (2) (2) Receptionist Facilities Manager Independent Contractors (250) Appendix B Section 1: Background Agency Name: Big Brothers Big Sisters of Johnson County Address: 4265 Oak Crest Hill Rd. SE Iowa City 52246 Phone: 337-2145 Director Name: Scott Hansen Signature: ~?~ ~_~ ~ Bd. Pres Name: Michael Pitton Signature: ./~,//J~>'"~'~ / Request Completed By: Scott Hansen Date: b~eptember 27, 2002 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30__X_ 10/1-9/30 4/1/0i- 4/1/02- 4/i/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $40,572 $42,955 $44,244 14% Does not include designated ~ecial Needs Grants FY 02 FY 03 FY 04 City of Iowa City $41,011 $41,011 $42,241 13% Johnson County $26,250 $26,250 $27,037 8% City of Coralville $3675 $4043 $4164 1% What were local funds used for this year: The significant in-kind support from Johnson County Extension allows us to use more of our funds for direct service. Local funds are used to support salaries and benefits for the program staff and cover costs for program liability insurance. The staff is necessary to recruit, screen, train and supervise the volunteers who work directly with the youth, as well as grant writing and fundraising. What will next year's local funds be used for? Local funds will continue to be used to support the salaries for program staff. By adding new programs to successful existing ones, we will be looking at adding to our staff and increase the amount of children we serve. We have also seen a dramatic increase in program insurance which includes: Health, Dental, Liability and Auto. Agency Mission Statement: The mission of BBBS is to advocate for a strong community through positive adult/youth relationships by providing opportunities for youth to develop a sense of self worth and responsibility. Agency Name _Big Brothers Big Sisters of Johnson County Summarize your programs and services for which you are requesting funding: One-to-one match program- The purpose of the one-to-one match program is to provide youth with adult mentors who can assist them in becoming competent, confident and caring individuals. We serve primarily youth from single parent homes but will serve youth from two parent homes when deemed appropriate. Professional staff screen and train the volunteers, interview families and provide on-going supervision for ail matches. Group Activity Program- The school year Group Activity Program (GAP) matches youth on our waiting list and youth in outlying areas in Johnson County with adult volunteers for an eight-week match. Typically the volunteers are students from the University of Iowa and the youth are from rural communities in Johnson County. Activities take place in a small and large group settings. Focus On Girls Group- The Focus On Girls Group (FOGG) is a program providing regular activities for matches of Big Sisters and their pre-teen to teen Little Sisters. This past summer, Lynn Sidwell, case manager facilitated a program with Stories 2000 where the Big and Little Sisters read a book by current Big Sister Barbara Moss. After reading the book together, the matches discussed the topics of the book and created a life story of their own. One meeting was spent talking to the author. The program concluded with a party where the participants shared their life stones. Matches received their own autographed copy of the book. Faith Based Program- The Faith Based Program is collaboration with faith-based organizations. Volunteers are recruited through local faith organizations and are matched with Littles on our waiting list. Information is placed in the faith organization's bulletins, newsletters and mentioned at weekly forums/services. Special orientation and training opportunities are made available. School Based Mentoring (Buddies)- The School Based Mentoring program is new to the agency. This program is a collaboration between Big Brothers Big Sisters, the Iowa City Community School District and local businesses and agencies. Youth from local elementary schools are matched with someone from the business community or local agencies such as the Retired Senior Volunteer Program to meet once a week at the child's school for the duration of the school year. We are working closely with Proctor and Gamble and Mark Twain Elementary School for the first pilot program and will likely expand to include more schools and businesses in the future. This program along with the Faith Based program is possible through a grant from Big Brothers Big Sisters of America. The grant requires a 50% match of local funds. List any accreditation and licensure your agency currently has. Explain. Big Brothers Big Sisters of Johnson County is affiliated with Big Brothers Big Sisters of America (BBBSA). As part of the affiliation agreement, we must complete an agency evaluation every five years. We must also comply with the Standards and Procedures as set forth by BBBSA. The Standards and Procedures include the volunteer and child intake process, match supervision, policies and procedures and Board governance. j cc oghs\funding form. doc 2 Agency Name Big Brothers Big Sisters of Johnson County Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Big Brothers Big Sisters of Johnson County is now in its 26th year of offering youth mentoring in Johnson County. The program continues to grow locally as we reach out to more kids through rural mentoring opportunities, school based mentoring and faith based mentorin9. Our history includes: The Iowa City PALS program was created after Johnson County Extension lost urban funds for a "big sister" program and an Optimist "uncles" program ended. The PALS program became a youth program of Johnson County Extension and received in-kind support from Extension. The proposal to the City Council stipulated that PALS would have its own Advisory Board, professional staff and would be responsible for salaries and operating costs. In January of 1976, the city Council approved $7,000 allocation and a part-time Director was hired. During the first year the Director contacted Big Brothers Big Sisters of America for assistance in joining the national organization. Provisional status was granted in 1979 and in 1980 the "Iowa City" part of the name was dropped and the Board approved the acceptance of clients outside of the Iowa City/Coralville metro area. Big Brothers Big Sisters of Johnson County received full affiliation from Big Brothers Big Sisters of America in 1986. In 1983 the Group Activity Program (GAP) was first organized to offer service to those children waiting for a one- to-one match. Due to lack of funding and lack of support by Big Brothers Big Sisters of America, the program was discontinued in 1984. This program is an example of Big Brothers Big Sisters of Johnson County being ahead of its time. By 1989, the critical need for a group program was apparent and the climate had changed. The National organization was very supportive and funds from local service clubs helped to re-launch the program. In 1991 GAP received the first Exemplary Program Award granted by Big Brothers Big Sisters of America. Other agencies across the country were encouraged to replicate the GAP in their communities. GAP has grown from serving 30 youth in 1989 to 413 in FY02. Service dubs, churches, grants, United Way and money from the Juvenile Justice Youth Development Program have all helped to support the GAP. In 1996 we were able to fund a gender specific program for girls through state grant money. Focus on Girls was initiated to address the problem of increasing numbers of female juvenile offenders. Each girl is matched with a Big Sister and together they participate in small group activities as well as one on one activities. Community Service, career exploration and positive recreation are the core of the program. This past summer, we offered a reading program where a Big Sister and Little Sister read an assigned book together and shared what they thought about the book with each other and a group of Bigs and Littles. The program concluded with a pizza party and an opportunity to meet with the author of the book, current Big Sister- Barbara Moss. Our one-to-one program reached the 200 mark in matches in FY99 and has continued to exceed that mark frequently. We are proud of this number but we are consistently concerned about the children on our waiting list. Volunteer recruitment continues to be one of our top priorities. We will hold a volunteer recruitment dinner in October of 2002. We are very excited to begin our relationship with local businesses, the Iowa City Community School District and Faith Based Organizations as we begin School Based and Faith Based Mentoring Programs. We are also excited to continue providing rural mentoring opportunities to youth in rural Johnson County. The grant from Big Brothers Big Sisters of Iowa will help us reach our goal of 40 new rural matches this year. We look forward to another Bowl for Kids' Sake on February 22 AND 23, 2003. This will be the 20th anniversary for this very fun and important fundraiser. Last year was the largest net profit of any Bowl For Kids' Sake to date and we look at topping that this year! j ccoghs\funding form. doc 3 Agency Name Big Brothers Big Sisters of Johnson County Section 2: Client Profile ~ FY01 ?Y02 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 718 728 Coralville) did your agency serve? 2. How many lowa City residents did your agency serve? 2 Unduplicated Count 401 410 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 100 65 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 9 Female: 360 African American 106 6-17 716 Male 368 Asian 47 18-29 12 Caucasian 488 30-61 Hispanic 22 62-75 Multi-racial 38 >75 Native American 8 Other 19 3. Briefly describe your service population. Our service population is children age 6-14, in Johnson County who need an additional adult relationship in their lives. This includes primarily single parent families but we do not exclusively serve this population. 4. How do you determine eligibility for services? Eligibility is determined through the review of written applications from the parent/guardian and interviews of parent and child(ren). Professional case managers determine if families meet the program criteria. 5. Are there fees for your services? Yes No X If yes, please describe your fee structure: 6. Do you provide services to areas outside of Johnson County? Area(s) served: Washington County Services Provided: We are conducting the Group Activity Program at the Riverside (Iowa) Elementary School. Funding Sources: This program is funded through the State Association for Big Brothers Big Sisters of Iowa. j ccoghs\funding form.doc 4 Agency Name Big Brothers Big Sisters of Johnson County Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client At the end of every group meeting we ask for anonymous written evaluations. At the year point for every one-to-one matches, participants are asked to complete Program Outcome Evaluations. Volunteers are asked to submit written reports at the end of each GAP session. Case managers follow up with all one-to-one matches throughout the lifetime of the match. (b) Community No formal way of assessing community satisfaction. 2. Briefly summarize your findings: Generally, when volunteers are able to fulfill their commitments, satisfaction is very high for all concerned. When this does not happen it results in frustration. 3. What changes have been made in response to these findings? We continue to carefully screen participants in the program and monitor all matches. 4. Who are your referral sources to your agency? Please list the main soumes and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred -Parents/guardians/family members 80% -School personnel; including teachers, 20% counselors, social workers, Other social service agencies; Department of Human Services, private counselors 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? We are aware of no other agency providing similar services. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Our "specialty" is screening, training and supporting adult volunteers to be mentors to children. j ccoghs\funding form.doc 5 Agency Name _Big Brothers Big Sisters of Johnson County 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Iowa City Community School District 1. School based mentoring program at Mark Twain Elementary School, the school district is helping with planning, space, staff time 2. Juvenile Justice Youth Development 2. Coordinate prevention services with a number of local agencies. 3.Lone Tree and Oxford schools and churches, North Liberty Rec. Center, Hills school 3. Provide space and ideas for the Group Activity Program j ccoghs\funding form. doc 6 Agency Name Big Brothers Big Sisters of Johnson County Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Waiting List- We are consistently seeing the 1. Recruitment dinner planned for October need for the program through a lengthy waiting 2002. Increase public awareness through list and the amount of time some children may television, radio, newspaper and bus posters. spend on the waiting list prior to finding an Distribution of new brochures throughout the appropriate match, community. 2. Funding for existing and successful 2. As grants become more and more a part of programs (specifically the core program), future programming it remains difficult to acquire funding for existing programs. We are putting a lot of time and effort into our annual fundraiser Bowl For Kids' Sake and adding a Sponsor A Match Fundraiser for large donations. We are also looking at ways to become connected with the Community Foundation to begin and grow an agency endowment. The challenge remains to expand programming without jeopardizing existing programs, which are proven effective. 3. The School and Faith Based Mentoring 3. School and Faith Based Mentoring programs are an exciting way to engage more volunteers in the program that may not have been able to participate in the core program, but are able to volunteer during the workday with their employer's support. This is a great opportunity to reach out and help more children through a positive ment0ring relationship. The challenge will be to come up with the funds to keep the program going. This program is funded through a grant with Big Brothers Big Sisters of America and requires a 50% match. j ccoghs\funding form.doc 7 Agency Name _Big Brothers Big Sisters of Johnson County 3. In what way will the needs of your service population change in the next five years? With the severe budget cutbacks being experienced by the State of Iowa, the downturn in the economy, and other economic uncertainties, we are expecting an increase in referrals from families experiencing multiple forms of stress. We contemplate this will put greater demands on the agency to find volunteers and also to provide those volunteers with the extra support they need. As the trend of single parent families continues to grow across the state of Iowa, we see a need for more and more children to have a positive impact from a responsible adult that may not be found in their current familial structure. We also see a need for more mentoring opportunities in some of the rural communities around Johnson County. We currently have after school programs in Lone Tree, Hills, North Liberty, Oxford and Iowa City. We will work hard in the upcoming years to provide more community based matches in these areas, as this is our proven mentoring program and seems to have the most impact over a longer time period. 4. How do you plan to address these changes? We will continue to attempt to recruit volunteers with a focus on males to decrease the growing waiting list of boys. Educating the public of the need for youth mentoring is also another top priority as we set out to educate Johnson County that we are the experienced and results driven mentoring organization in this area. Education through public speaking, advertisements and word of mouth will be heavily counted on to help more children in the future years. To address the need of youth mentoring in rural communities, we will continue to work hard to provide more community based one to one matches in these areas as this is the most effective program for long range prevention programming. 5. Describe the evaluation methods you use to measure the success of your services? A. We use a Program Outcome Evaluation tool for all matches (one-to-one) on an annual basis. B. Group Activity Program (GAP) youth, volunteers, and parents receive an evaluation survey at the end of each GAP session. C. Committee of the Board conducts an annual review of case files; and case managers conduct a quarterly review. D. Every five years Big Brothers Big Sisters of America conducts a two-day site evaluation, reviewing all aspects of the program. jccoghs~hndingform.doc 8 Agency Name _Big Brothers Big Sisters of Johnson County 6. What are the results of these evaluations (outcomes)? A recent program outcome evaluation conducted with matched volunteers in the Big Brothers Big Sisters of Johnson County found significant benefits for children involved in the program: 97 % increased trust in volunteer 93% were able to avoid substance abuse 83% improved self-confidence 63% improved relationships with adults 57% improved school performance 7. How do you plan to use the evaluation results to enhance/extend your services? We evaluate each volunteer/child relationship monthly. A program outcome evaluation is conducted annually. Our professional case managers make recommendations to improve the relationship and utilize the quality volunteer to the best of their abilities. We also look at each program on an annual basis to check for quality and effectiveness. 8. How do your programs/services impact the community? By partnering a child with a responsible adult in a healthy mentoring relationship, we are facilitating a very positive impact on Johnson County. Kids are growing up with positive role models are less likely to skip school, abuse alcohol or drugs. They show improved self-esteem and get along better with teachers and peers. This program helps foster a positive lifestyle for many children as they transition into adulthood. 9. How did the agency respond to the UWJC recommendations from last year? Decreasing the waiting list was a top priority. Some of the waiting list is beyond our control. The more kids who need our program, the more kids we have on our waiting list. However, we were able to look at certain needs of our waiting list, like boys for example, and focus some recruitment efforts in that targeted area. We will continue to recruit volunteers of both sexes for the program. We hope to attract more volunteers through our school and faith based programs as well as our recruitment rally in October and a postcard recruitment campaign. j ccoghs\funding form.doc 9 Agency Name _Big Brothers Big Sisters of Johnson County Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? 12 4. How is the board involved in strategic planning and governance of the agency? The board plays a crucial role in strategic planning and governance. The committee structure currently includes a Planning Committee (responsible for the overall strategic plan of the agency). The board recently played a major role in developing new by-laws and personnel policies in conjunction with the Johnson County Extension Council. 5. What type of training/orientation do board members receive? All board members must complete a board member training/orientation session prior to becoming a voting board member. The training/orientation session covers such topics as by-laws, personnel policies, program insurance, and relationship with ISU Extension, fundraising and other pertinent program information. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? _Yes, June 2002 7. Have you filed the annual report with the Secretary of State? If yes, date filed? No, since we are a program of ISU Extension, this is not necessary. 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? _No, this is not necessary per our relationship with ISU Extension. If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes x No __ If yes, Who completed the audit? How much did the audit cost? N/A An independent auditor on behalf of Johnson County ISU Extension performs an annual audit. If material weaknesses are noted in the audit, what is your plan for addressing them? No material weaknesses were noted in the most recent audit. j c coghs\funding form. doc 10 Agency Name Big Brothers Big Sisters of Johnson County 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability b. employment practice liability x $1 Million General Liability x $5,000 per person Umbrella Liability Professional Liability x $1 million each wrongful act 2 million total limit. Property or Renters N/A N/A Vehicle x Non-owned Automobile coverage- 1 million Sunshine Van Bodily Injury- 1 million Medical Payments- $ i 0,000 j ccoghs~funding form. doc 11 Agency Name _Big Brothers Big Sisters of Johnson County Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. The Executive Director was hired in November of 2001. Scott Hansen was the previous Director of Big Brothers Big Sisters of Muscatine County, IA. He has held the positions of Secretary, Treasurer and Vice-President of Big Brothers Big Sisters of Iowa (State Association). Scott is a 1998 University of Iowa graduate with a B.S. in Recreational Management. He has worked with at-risk youth in the Iowa City Community School District and the San Diego Zoological Society. 2. StaffSalaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director (1) X X X $40,000- $41,200 1 I 1 Program Director (1) X X X $31,365- $39,000 1 .80 .80 Case Manager (3) X X X $23,000- $34,000 3 3 3 G.A.P. Coordinator (1) X X X $23,000- $24,700 1 1 1 TOTAL FTEs 6 5.80 5.80 jccoghs\fundingform.doc 12 Agency Name Big Brothers Big Sisters of Johnson County 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 6 4. How much was spent on staff development in the last fiscal year? .~280 5. How much is budgeted for staff development in this fiscal year?_$750 5. What training and support opportunities are offered to staff? Staff is encouraged to attend the State and Regional Big Brothers Big Sisters conferences, which offer training in subjects related to job requirements. Staff is also encouraged and required to keep in close contact with other agencies in the area regarding trends in mentoring and non-profit agencies. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3% Yes No If no, brief explanation 9. Does your agency x have personnel policies? If yes, date board last reviewed? June2002 10. Does your board x annually evaluate the director's performance? 11. Does your agency x have job descriptions for every position? If yes, date of last board approval? June2002 12. Is there an annual x performance review for every staff?. j ccoghs\fundingform.doc 13 Agency: Big Brothers Big Sisters I Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) FY00 FY01 FY02 Current Assets Cash $21,613 $28,323 $54,902 Investments $0 $0 $0 Receivables < 90 days $0 $0 $0 Other $0 $0 $0 Total Current Assets $21,613 $28,323 $54,902 Other Assests Property _ Equipment $9,000 $9,000 $9,000 [ less depreciation $0 ($3,000) ($6,000) 1 Receivables > 90 days Other Total Non-current Assets $9,000 $6,000 $3,000 Total Assets $30,613 $34,323 $57,902 FY 00 FY 01 FY 02 Current Liabilities Accounts Payable Payroll Taxes Payable $0 $0 $0 Contracts Payable $0 $0 $0 Mortgage Payable-6 months $0 $0 $0 Total Current Liabilities $0 $0 $0 Other Liabilities Mortgage Payable-Balance $0 $0 $0 Other $0 $0 $0/ Total Other Liabilities $0 $0 $0 Total Liabilities $0 $0 $0 NetAssets $30,613 $34,323 $57,9021 I Liabilities & Net Assets $30,613 $34,323 $57,902 14 ~Agency: Big Brothers Big Sisters of Johnson Cour FY02 FY03 ! FY04 B. Income & Expenses Income Local Funding Sources I Iowa City $41,011 $41,011; $42,241 Coralville $3,675 $4,043 $4,165 Johnson County $26,250 $26,250 I $27,037 United Way - Allocation $40,572 $42,955 $44,244 - Designated Giving $8,243 $10,265 $10,000 United Way Special Needs Grant $11,000 $11,000 I $11,000 Grants-Federal, State, Foundation $40,101 $59,098 I $52,652 Net Sales of Service $0 $0 ! $0 Net Sales of Materials $0 $0 $0 Contributions/Fundraising $108,612 $105,725 i $108,500 investment Income $0 $0 ! $0 Other $8,408 $5,065 I $3,600 Total Income $287,872 $305,412 1 $303,439 Wages & Salaries $181,688 $205,088 15215,472 Benefits $23,924 $21,984 $28,800 Occupancy $0: $0 i S0 In-Kind Support- J.C. Extension Non-occupancy $0 $0 I $0 Other $53,677 $40,318 i $43,573 Prog. Insurance, Dues and fundraising $259,289 $267,390 I $287,845 ~xpenses make up the bulk of this amt. C. Fund Balance Revenue $287,872 $305,412 15303,439 Carryover Balance from previous year $28,323 $54,902 i $89,867 TotaIOperating Budget $316,195 $360,314 S393,306 Less Total Expenses $259,289 $267,390 1 $287,845 Ending Fund Balance $56,906 $92,924 15105,461 I Less Restricted Balance (explain) Carryover Fund Balance $56,9061 $92,924 i$105,461 15 Agency:Big Brothers Bi~g~Sisters D. Bd/Donor/Funder Restricted F. De~natsd for: FY02 FY03 FY04 None _ Total Restricted Funds $0 $0 $0 E. In Kind Support: t FY02 FY03 FY04 ServicesNolunteers 1912 Volunteers/69,339Hrs. x $10.00 ~ $693.394 $763.114 $786.007 Material Goods Office Suj~plies $5.775 $6.600 $7.000 Space, Utilities. etc OfficeSpace and Utilities $8.995 $9.895 $10.079 Other: [Pleasefootnote) Telephone and Office equipment $9.370 $10.307 $11.207 Total In-kind Support $717.534 $789,916 F. Grants Description/Purpose FY02 FY03 United Way~ecial Needs _one Tree After School Program $11,000 $11,000 Juvenile Justice Youth Developme Group Activity Program $15.658 $15.658 21Century Grant After School Program in Hills $20.000 $15,000 Big Brothers Big Sisters of Americ. Faith and School Based Mentoring $0 $10.000 Big BrothersBigSisters of Iowa Rural Mentoring $0 $25.000 Total Grants $46.658 $76.658 Big Brothers Big Sisters of Johnson County- Board List Name City Occupation Term & End Date Office Committee{s) Bill Burger i.C. V.P. US Bank 2nd term, end:10/04 Vice Pres. Ross DeValois I.C. V.P. Mid Amer. Sec. 1st Term, end: 10/04 Comm. Chair Exec, Plan, Fund Becky DeWaard Crvl. Hills Bank 1st Term, end: 10/02 Secretary Exec, Recr. Kressa Evans I.C. Small Bus. Owner 1st Term, end: 10/04 P.R., Recruit Gary Fabian I.C. Accounting 2nd Term, end: 10/02 BFKS Jodi Gibson I.C. Juvenile Court off. 2® Term, end: 10/04 Plan, P.R., Recr. Deborah Gilbert I.C. Administrator 1st Term, end: 10/03 Prog, Plan Bob Goodfellow I.C. Small Bus. Owner 1st Term, end: 10/04 Fund Kurt Kastendick I.C. V.P. Iowa State Bank 1st Term, end: 10/02 Treasurer Exec, Prog Dale Mathias Crvl. Manager- Retail 1st Term, end: 10/03 P.R., Fund Chip Miller I.C. Realtor 2® Term, end: 10/03 BFKS Michael Pitton l.C. Lawyer 1st Term, end: 10/02 President Exec, P.R. David Rust i.C. Retired 1st Term, end: 10/04 Comm. Chair Exec, Fund, Prog Mindy Paulson I.C. School Principal lS~Term, end: 10/04 Prog. John Schneider I.C. Director 2® Term, end: 10/02 Fund, Plan, P.R. Dave Siebert I.C. V.P. ACT 1,t Term, end: 10/04 Comm. Chair Exec, PR, Recr. Morris Stole Kalona School Counselor 1s" Term, end: 10/02 P.R., BFKS Bill Terry I.C. Retired Extension Liason Plan, P.R. Yvonne Wernimont Crvl. Planner- U of I 1st Term, end: 10/04 Comm. Chair BFKS Committee Key: Corem Chair- Commitlee Chair E~ec- Executive Committee Plan- Planning Committee BFKS- Bowl For Kids' Sake Recr- Recruitment PR- Public Relations/Marketing Prog- Program and Personnel 17 Appendix B- Organizafiona~ Ch~ Big Brothers Bi g Si sters Extension Council t Area Extension E_.ducation Director ~----~ I I Personnel Committee Program Committee I Finance Cornmittie County Extension Education Field Dh'ector Specialists I , BBBS Advisory Board & ~ BBBS Executive Director I Office Coordinator Committees I C°untyY°uth I Coordinator Office Assistant~ BBBS Program Director 4-H Intern BBBS Staff-Case Managers, GAP Director, Intems I8 Section 1: Background Agency Name: HAWKEYE AREA COUNCIL, BOY SCOUTS OF AMERICA Address: 660 32nd Avenue SW Phone: 319-862-0541 .~ Cedar Rapids, lA 52404-3910 t...~/~ ~ Director Name: T. Edmund Brandon Signature: Bd. Pres Name: David L. Blankeaship Signature: ~2~t~-~-~ '/~,~e-~3 Request Completed By: Carl Whiting Date: 26 September 2002 Check Your Agency's Budget Year: 1/l-12/31 XX 7/1-6/30 10/1-9/30 4/1/01 - 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated $ 0 $ 0 $ 0 n/a giving or 5 Grants FY 02 FY 03 FY 04 ~ of lowa City $ 0 $ 0 $ 0 n/a Johnson County $ 0 $ 0 $ 0 n/a ~ of Coralville $ 0 $ 0 $ 0 n/a What were local funds used for this year: Donor-desi[~nated funds received were used for leader trainin~ and program development. What will next year's local funds be used for? Donor-desi_gnated funds will be used for leader training and program development. Agency Mission Statement: The mission of the Hawkeye Area Council is to help our youth develop into wholesome, capable, contributing and personally fit adults, by instilling in them the values expressed in the Scout Oath and Law. Scout Oath: On my honor I will do my best to do my duty to God and my country and to obey the Scout Law; tO help other people at all times; to keep myself physically strong, mentally awake, and morally straight. Scout Law: A Scout is Trustworthy, Loyal, Helpful, Friendly, Courteous, Kind, Obedient, Cheerful, Thrh°ty, Brave, Clean, and Reverent. Summarize your programs and services for which you are requesting funding: Please see Appendix C List any accreditation and lieensure your agency currently has. Explain. The Hawkeye Area Council is chartered annually by the National Council of the Boy Scouts of America to provide the programs of Scouting through collaborations with local Chartered Partner Organizations through June 30, 2003. Agency Name: Hawkeye Area Council, Boy Scouts of America Agency Itistory: (Using one p~ge only, please summarize the history of yoar agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) BRIEF HISTORY OF THE HAWKEYE AREA COUNCIL The Scouting movement was incorporated in the United States in 1910 after its founding in Great Britain in 1908. Scouting's programs of outdoor skills, citizenship, lifesaving, and personal development were quickly adopted in Eastern Iowa. Professor A. E. Wilcox formed a troop in 1910 that served the Iowa City area. Britton Dawson similarly gave leadership to a troop that served Marion and Cedar Rapids. In 1918, a group of Iowa Citians, cooperating with the University of Iowa, conducted Scout leader training in a camp along the Iowa River. This event prompted the Iowa City group to found the Iowa City Area Boy Scout Council in 1918 with Dr. Samuel T. Orton as President. Eighteen acres of land were acquired for a Boy Scout camp near Central City in 1930. The Howard H. Cherry Scout Reservation now encompasses over 480 acres. Scouting had a marked growth with the introduction of the Cub Scout program in 1933. During WWII, area Scouts performed invaluable service to their country, including salvage of waste and the distribution of posters and ration books. In 1952, the now Iowa River Valley Council merged with the council based in Cedar Rapids to form the Hawkeye Area Council serving Johnson, Linn, Benton, Jones, Iowa, Cedar, and Washington Counties. Dean Allin Dakin of Iowa City who served as the first president of the Hawkeye Area Council spearheaded this merger. Since the formation of the Hawkeye Area Council, Scouting in eastern Iowa has continued to grow with the addition of the co-ed, career-oriented Exploring program in 1968; Tiger Cubs for first- grade boys in 1983; and the co-ed Venturing program in 1998 to provide expanded outdoor adventure and skill development opportunities for high school-aged boys and girls. With the formation of the Learning for Life subsidiary in the 1990's, the council again saw substantial growth in youth participation. The council was the catalyst in the formation of the Youth Leadership Program in Iowa City and other Eastern Iowa towns. This program helps several hundred youth in grades 5-12 with leadership development opportunities through the Community Corrections Improvement Association. Since a change in Council leadership in 1997, the Council has made great strides in improving both program offerings and needed program facilities. The Council is involved in a major improvement program for camping and training facilities at the Cherry Scout Reservation. A new emphasis on quality training for leaders has been undertaken with special seminars on working with AD/HD youth and similar important topics beginning in Fall 2002. The Council is continuing to expand its program opportunities to an increasing number of youth across Eastern Iowa. Involvement of the entire Eastern Iowa community in the fulfillment of our mission is the goal of the Hawkeye Area Council. Through the hard work of our over 160 chartered partner organizations, the council will continue to work toward that goal. j ccoghs\funding form.doc 2 Agency Name: Hawkeye Area CouocJlI Boy Scouts of America Section 2: Client Profile 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 2,825 2,875 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 2,147 2,188 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 384 392 Age (use agency's Gender Etlmicity (use agency's breakdown) breakdown if needed) 5-9 701 Female: 780 Caucasian 2,645 10-14 860 Male 2,095 Indian/Alaskan Native 14 15-17 587 African American 26 18-19* 202 Hispanic 26 20-55* 445 Multicultural 49 >55 * 80 Asian/Pacific Islander 115 · Figures include adult volunteers and challenged youth over 21 year of age. 3. Briefly describe your service population. Boys and Girls fi.om 1st grade through age 21, and adult volunteers. 4. How do you determine eligibility for services? Youth must meet specific age/grade/gender criteria to participate (depending on program) and must accept the principles delineated in program-associated oaths, laws, and promises. Adult volunteers must accept the principles delineated in program-associated oaths, laws, and promises and be approved by the chartered partner organization leadership. 5. Are there fees for your services? Yes XX No__ If yes, please describe your fee structure: Thc National membership fee is $7/year ($10/year beginning in January 2003). The Council does not have a membership/participation fee, nor does it keep any of the National fee for local use. 6. Do you provide services to areas outside of Johnson County? Area(s) served: Counties of Benton, Linn, Jones, Iowa, Cedar, and Washington Services Provided: Please see Appendix C Funding Sources: The Hawkcye Area Council receives both an allocation and donor-designated funds from the United Way of East Central Iowa. The Council also receives contributions through the Friends of Scouting program. Other income is realized through the annual popcorn sale; camping & activity fees; literature, badge, and uniform sales; and other sources. jccoghs\funding form .doc 3 Agency Name: Hawkeye Area Council, Boy Scouts of America Section 3:Communit~ Relations 1. How do you assess satisfaction with your services? (a) Client: We assess client satisfaction by examining member retention, youth rank advancement, leader training and awards, and youth activity level. (b) Community: We assess community satisfaction by examining levels of financial support, volunteer support, involvement of collaborating organizations and agencies, and support for service projects like "Scouting for Food." 2. Briefly summarize your findings: Our client and community satisfaction indicators ail show marked increases during the past five years. These include increases in youth accomplishment, a higher level of community support, volunteer participation and training, and a significant increase in the Council's level of interagency collaboration on community issues. 3. What changes have been made in response to these findings? We have changed our outreach methods to reflect a need to contact families directly. We have also improved our staffing to provide a more involved and interactive Council representative to work with Johnson County. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred We use various direct recruiting methods, n/a 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Girl Scouts of the Mississippi Valley provides similar character and values-driven youth programming in Johnson County. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. The Council offers co-ed programs to all youth age groups. The Girl Scouts do not. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Girl Scouts of the Mississippi Valley 1. We coilaborate in camp usage and development with GSMV as a founding member of the Camp Partnership of Iowa. 2. University of Iowa 2. We coilaborate in providing special seminars on youth developmental disabilities and other topics, also athletic event staffing. 3. Over 30 chartered partner organizations 3. This group of collaborative efforts directly (Please see Appendix D for list) provides Scouting program opportunities to Johnson County youth. jccoghs\fimdingform.doc 4 Agency Name: Hawkeye Area Council, Boy Scouts of America Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency Js addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. The Council is experiencing financial 1. The Council is developing and enhancing growing pains due to expanded program, volunteer-driven income streams. improved facilities, and increased membership. 2. As program has expanded, the need for 2. The Council has added additional staffto increased staffhas become more apparent, accommodate the needs of increased numbers of volunteers and youth. 3. A change in the lC School's policy 3. The Council is continuing to develop new regarding distribution of literature by non- and effective recruiting methods that do not governmental groups introduced a challenge to use school literature distribution. the Council's traditional recruiting methods in Iowa City. 2. Ia what way will the needs of yonr service population change in the next five years? The demographics of our potential youth and volunteer population will include the growing population of various ethnicities and national origins in Eastern Iowa. 3. }Iow do you plan to address these changes? The Council will develop and utilize program and recruitment models appropriate to the changing demographic patterns. This includes increased sensitivity regarding event and meeting planning, volunteer training curriculum, camping activities, and other program features. 4. Describe the evaluation methods you use to measure the success of your services? The Council, with the assistance of community volunteers, has developed and adopted an outcome measuring system to help the Council fully assess and document the need for Scouting's program services and the impact of those services onthe targeted population. The Council has completed its pilot year of operating under this system. Goals & objectives are outlined in Appendix E. 5. What are the results of these evaluations (outcomes)? The outcomes are discussed in Appendix E. 6. How do you plan to use the evaluation results to enhance/extend your services? The Council is reviewing the pilot year of outcomes information to determine ways to enhance and extend services based on insights gained through the process. 7. How do your programs/services impact the community? Please see Appendix F. 8. How did the agency respond to the UWJC recommendations from last year? The Council did not receive recommendations bom the UWJC last year. jccogh s\fimdingform .doc 5 Agency Name: Hawkeye Area Council, Boy Scouts of America Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. Please see Appendix A. 2. How often does your board meet? The Board meets quarterly. The Executive Committee during all other months except July. 3. What is your average attendance at board meetings? Board: 35 of 54 members Executive Committee: 10 of 13 members. 4. How is the board involved in strategic planning and governance of the agency? The Council is in the final year of its current strategic plan. A board task force is forming to extend the plan. Strategic program planning is already underway under the guidance of the Vice President for Program. (See narrative in Appendix A concerning board governance.) 5. What type of training/orientation do board members receive? When a person is nominated to serve on the Executive Board, they are visited by the Scout Executive and receive a general orientation regarding the role ora board member. Each year, the Council conducts a full-day training session to stimulate participation in Council governance. 6. Does your agency have written policies and procedures for financial management? If yes, date oflnst board approval? 12/2001 7. Have you filed the biennial report with the Secretary of State? If yes, date filed? 6/11/2001 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? 7/18/2002 9. Does your agency have a yearly audit? Yes. X. .... No~ If yes, who completed the audit? How much did the audit cost? Clifton Gunderson, LLP $5,200 If material weaknesses are noted in the audit, what is your plan for addressing them? No materials weaknesses were noted. However, the auditor did make recommendations for improvements to our financial management processes. The Board has approved a plan of action addressing each recommendation. The Board will monitor these improvements. 10. Insurance Coverage: (check what coverage your agency has) Insurance Cheek if agency has Amount Directors & Officers - a. fiduciary liability X $1 million b. employment practice liability X $15 million General Liability X $15 million Umbrella Liability X $15 million Professional Liability X $15 million Property or Renters X $4.1 million Vehicle (e×~ss coverea ~y umb~lla liabilily) X $500,000 jccoghs\funding form.doc 6 Agency Name: Hawkeye Area Council, Boy Scouts of America Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Ed Brandon has served as the Scout Executive/CEO of the Hawkeye Area Council since July 1997. Brandon came to Eastern Iowa after successfully serving as the Director of Finance Services for the Chicago Area Council. Brandon's 27-year professional Scouting experience began in 1975 and includes service as a District Executive in Peoria, Illinois; Munster, Indiana; and Cincinnati, Ohio. Brandon holds a Master's Degree bom Indiana University. 2. Staff Salaries &Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Scout Executive / CEO* X X X $75K - $95 K 1 I 1 Assistant Scout Executive* X X X $45 K - $60 K 1 I 1 District Director* X X X $45 K - $60 K 1 1 1 Senior District Executive* X X X $30 K - $40 K I I 2 District Executive* X X X $30 K - $35 K 2 2 1 Executive Assistant X X X $18 K - $22 K I 1 1 Accounting Specialist X X X $12 $14 / hr 1 I 1 Registrar X X X $8 ~ $9 / hr I I 1 Scout Shop Manager X X X $15 K - $20 K 1 ! 1 Scout Shop Clerk X $8 - $9 / hr 0.5 0.5 0.75 Administrative Assistant X $8 - $9 / hr 0.5 0.5 0.5 Allsop Outdoor Education Canter Director X X X $25 K - $30 K 1 1 1 Ranger X X X $32 K - $37 K + housing 1 I 1 Assistant Ranger X X X $8 - $10 / hr + housing I I 1 TOTAL FI'Es (does not include seasonal camp staff) 14 14 14.25 * Salary ranges for these positions determined by Boy Scouts of America personnel system. jccoghs\fundingform.doc 7 Agency Name: Hawkeye Area Council, Boy Scouts of America 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? One FTE resident staffmember. An equivaJent of 4 other FTE are provided in other direct service, administration, and support roles. 4. How much was spent on staff development in the last fiscal year? $18,040* 5. How much is budgeted for staff development in this fiscal year? $22,000* 6. What training and support opportunities are offered to staff?. At least one BSA-approved professional development opportunity is afforded each staffmember each year. Specialized training is provided as needed based on evolving staffroles and responsibilities. 7. Please attach current organizational chart as Appendix B. Please see Appendix B. * training for all staff, including program training for seasonal camp staff 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 4% - 8% Yes No If no, brief explanation 9. Does your agency have personnel policies? X lfyes, date board last reviewed? November_2001 * 10. Does your board evaluate the X director's performance? 11. Does your agency have job descriptions for every position? X If yes, date of last board approval? November 2001 * 12. Is there an annual performance X review for every staff?. * reviewed as a part of the Council's annual personnel and compensation planning process jccoghs\funding form .doc 8 HAWKEYE AREA COUNCIL BOY SCOUTS OF AMERICA Executive Board Officers and Johnson County Members EXECUTIVE BOARD OFFICERS - all terms are annual (calendar year) Name Council Position O~cupation' Business Affiliation City David Cedar Blankenship President President Aegon USA Realty Advisors Rapids Cedar James Wood Vice President - Program Agent Millhiser Smith Agency Rapids Vice President - Cedar Rocky Chapin Administration Business Consultant Self-employed Rapids Vice President- Greg Kelly Membership/Relationships Director, Technical Services Integrated DNA Technologies Coralville Cedar Tom Phelan Vice President - Finance President Phelan's Interiors Rapids Cedar Aaron Randolph Council Commissioner Senior Vice President SCI / Wells Fargo Rapids Cedar Frank Coe Treasurer Vice President Aegon USA Realty Advisors Rapids EXECUTIVE B( lARD MEMBERS FROM JOHNSON COUNTY - all terms are annual (calendar),ear) Name Council Position Occupation Business AffiliatiOn City Robert Bowlsby Executive Board Director of Athletics Department of Athletics, U of I Iowa City Rex Brandstatter Executive Board Real Estate Broker Remax Premier Properties Coralville David B},water Executive Board Vice-President Economy Advertising Iowa City Bishop, Southeast Iowa Evangelical Lutheran Church Iowa City Dr. Phil Hougen Executive Board Synod of America Vice President for Grog Kelly Membership/Relationships Director, Technical Services Integrated DNA Technologies Coralville Executive Board Executive Committee Larry McConahay Executive Board Buildin,cj Contractor Independent Contractor Iowa City William Olin, Jr. Executive Board Orthodontist Private Practice Iowa City Lorna Ont~es Executive Board Thesis Examiner Graduate School, U of I Iowa City Risk Management Business Manager, Robert Ontjes Committee U of I Iowa City Executive Board Info-Tech Services (retired) District Committee Chair Vice President and General Doug Parsons Executive Board Manager Frohwein / Office Plus Coralville Executive Committee NARRATIVE Executive Board - The day-to-day operations of the Council are guided by the Council Key-3 comprised of the Council President, Scout Executive/CEO, and Council Commissioner (in charge of volunteer service). This group meets weekly and relates to the Executive Committee those issues needing action by the Council. The Executive Committee makes recommendations to the full Executive Board. The Council's very active Executive Board is involved in the formulation of all financial policy and program planning. Approved plans are forwarded to vadous Council volunteer operating committee for implementation. This involves the further involvement of volunteers at the district and unit levels. Council staff provides support for this volunteer-driven governance process. Executive Board members are nominated by representatives of collaborating chartered partner organizations and current members of the Executive Board. Annually, a Council Nominating Committee reviews the nominations and presents a slate of officers and members for election by the Executive Board, chartered partner organization representatives, and Members-at-Large of the Council. 9 Appendix A HAWKEYE AREA COUNCIL BOY SCOUTS OF AMERICA STAFF ORGANIZATION CHART Scout Executive/CEO I I I I Senior District Executive North Star District '1 I District Executive~ Wauhawk District I I District Executive- Wapsiketa District I Agency Name: Hawkeye Area Council, Boy Scouts of America Pro.qram Services The Hawkeye Area Council collaborates with over 160 partner organizations, enabling these community organizations, agencies, churches, schools, and other groups to usc the programs of Scouting to further their own youth outreach, leadership, character development, and service missions. Scouting's efforts to teach our youth problem-solving and ethical decision-making skills is part of the integrated program structure that builds on the capabilities of families and communities to meet the developmental needs of all their children. The Hawkeye Area Council's Scouting programs are very adaptable and serve the special needs of young people who are 'at risk' by affording them the opportunity to learn llfe skills and by helping them achieve their full potential by reinforcing positive values, The values contained in these program models develop character, personal fitness, leadership skills, and the fundamentals of responsible citizenship. The Hawkeye Area Council's program models include: Venturers - Our newest program provides young men and women ages 14 through 21 with a comprehensive youth development curriculum designed with activities related to challenging outdoor adventure, leadership development, and community service. Boy Scouts - a program for boys aged 11 through 18 designed to achieve the aims of Scouting through vigorous outdoor program and peer group leadership with the counsel of properly qualified adult leaders. Cub Scouts - a family and home-centered program for boys in grades two through five. The grade four and five program, Webelos, models participation in more challenging activities that begin to prepare the youth for more advanced programs. Cub Scouting's emphasis is on quality experiences with proper adult supervision. Tiger Cubs - a year-round program for first grade boys and their adult partners that stresses shared leadership, applied community learning experiences, and family understanding. Each boy/adult pair meets for family activities and meets at least twice each month with other pairs for Tiger Cub group activities. Learning for Life - Explorine - designed for young men and women ages 14 through 21 to gain insight into a variety of aspects of leadership, personal development, and career awareness through its school-to-career emphasis. Exploring promotes the conditions necessary for the growth of adolescents. Learning for Life - In-School - an educational program designed to help schools and youth- serving community organizations prepare boys and girls in elementary and sccondary school to handle today's complex society. Learning for Life helps build confidence and can help youth learn to make ethical decisions and develop positive personal values. 11 Appendix C HAWKEYE AREA COUNCIL BOY SCOUTS OF AMERICA JOHNSON COUNTY UNITS Iowa Army National Guard Iowa City New Horizons Methodist Chumh Coralville Alpha Phi Omega Service Fraternity Iowa City Optimist Club North Liberty Church of Jesus Christ of Latter Day Saints, First Ward Iowa City United Methodist Men Oxford Noon Optimists Coralville ~himek Area Parents Iowa City United Methodist Church Coralville Regina Education Center Iowa City first Christian Church Coralville Regina Elementary School Iowa City First United Methodist Church Iowa City Rotary Club of Coralville - North Corddor Coralville Gloria Dei Lutheran Church Iowa City American Legion Post 460 Solon Grace Fellowship Church Iowa City Optimist Club Solon Greenwood Manor Convalescent Center Iowa City Sons of the American Legion Lone Tree Hill Town & Country Club Hills St Andrew Presbyterian Church Iowa City Hoover Area Parents Iowa City St Mark's United Methodist Church Iowa City Church of Jesus Christ of Latter Day Hope United Methodist Church Iowa City Saints, Third Ward Iowa City Church of Jesus Christ of Latter Day Saints, Second Ward Iowa City American Legion Post 721 Coralville Loyal Order of Moose Iowa City Johnson County Sheriff's Department Iowa City Mark Twain PTO Iowa City U of I College of Dentistry Iowa City The Chartered Or~lanization Relationship The National Council of the Soy Scouts of America charters local organizations, businesses, agencies, and churches to use the programs of the Boy Scouts of America as their youth program models. Those Chartered Partner Organizations form and operate a local Boy Scout Council to provide common support for al~ Scouting units in the area served by the local council. '['he Chartered Partner Organizations provide meeting places and adult leadership for their Scouting programs within the guidelines of the Boy Scouts of ^merica. The local counci~ provides support in the areas of leader training, youth advancement pregrems, events and activities, camping facilities and progrems, member recruiting, and other services. The local council is governed by an Executive Board of community volunteers and representatives of the local Chartered Partner Organizations. The work of the many volunteers is supported by a small group of professional Scouters and program staff led by a Scout Executive/CEO. The Hawkeye Area Council serves thousands of youth through this chartered organization relationship. 12 Appendix D Program: Hawkeye Area Council, Boy Scouts of America - Comprehensive Youlh Development Goal 1..: Applied Leadership Responsibility - Produce a measurable improvement in the ability of youth participants to assume Scouting and Non-Scouting leadership responsibilities as a result of padicipation in Scouting programs. Program Activities Related to This Goal: Bo), Scouts, Venturing, Learning for Life/Exploring, Youth Leadership Program, special programs Objective Indicator(s) Data Collection Method Findings/Outcome (may be more than one per outcome) (how/where get information) FY 2002 - Produce a 10% Pre- and Post-test results regarding Council records documenting An increase of 12% in personal increase in participation in participation in leadership activity in school, youth leadership activities and leadership activities by youth leadership activities by youth church, community, and Scouting validated Eagle Scout applications~ padicipants is being projected. durin9 the pro~ram year. from institutional records. FY 2003 - Produce a 10% Pre- and Post-test results regarding Council records documenting Year-to-year comparison of increase in the assumption of participation in leadership activity in school, youth leadership activities and statistics to determine percent leadership roles in Scouting and ! church, community, and Scouting validated Eagle Scout applications, change. non-Scouting participants by ~ from institutional records. Scouting youth during FY 2003. How did your a~ency/program use the findings related to Goal 1 ? These findings are being used to replicate modelable program features used by the Scouting ~roups most successful in increasing leadership participation. Council now has Youth Advisory Council. Program: Hawkeye Area Council, Boy Scouts of America - Comprehensive Youth Development Goal 2~: Improved Behavior & Reduced Delinquency - Produce a measurable reduction in the expressions of anti-social behavior and delinquent recidivism by impacted youth through activities and programs of Scou!ing. (ScoutReach Program) Program Activities Related to This Goal [: Youth Leadership Program, Learning for Life/In-School, Boy Scouts, Venturing Objective Indicator(s) Data Collection Method Findings/Outcome (may be more than one per outcome) (how/where get information) FY 2002 - Produce a 25% Pre- and Post-test information gathered from Blind statistical information on Blind statistical information on decrease in anti-social behavior by parents, youth, Scouting volunteers, and targeted youth from juvenile target youth not available, participants indulging in such criminal justice authorities, if possible, justice authorities. Of 3 of 405 YLP padicipants behavior during the program year Case evaluation of Youth were involved in documented Leadership (YLP) participants, criminal acts in 2000-2001. FY 2003 - Create opportunities for Pre- and Post-test information gathered from Case evaluation information from Pre- and Post-test information at least 50 targeted, at-risk youth parents, youth, Scouting volunteers, and collaborating organizations using will be compared to determine to benefit from positive role criminal justice authorities concerning anti- Scouting models, benefit from participation. models. ScoutReach Target Area: social behavior and delinquent recidivism. ~Oak Hi~t/We[[in~toa Heights areas. Fro~ram attributes contributing to Iow anti-socia~ behavior and to replicate them in ScoutReach target areas. Program: Hawkeye Area Council, Boy Scouts of America - Comprehensive Youth Development Goal .3: Leadership Development - To expand the Youth Leadership Program to an increased number of potentially at-risk ),outh who have Potentially the most to benefit from a leadership development program. Program Activities Related to This Goal: Youth Leadership Program, Learning for Life Objective Indicator(s) Data Collection Method Findings/Outcome (may be more than one per outcome) (how/where get information) FY 2002 - Increase the level of Program enrollment information and anecdotal Youth Leadership Program Participation level increased participation from 327 to 360 in the information obtained from school nominations administration statistics, from 327 to 405 from 2000 to Youth Leadership/Learning for Life for participation. 2001. Program during the program )/ear FY 2003 - Increase retention of Program enrollment information and anecdotal Youth Leadership Program FY 2003 data will be compared Youth Leadership Program information obtained from school nominations administration statistics, to FY 2002 data to determine participants by at least 5% during for padicipation, percent change. FY 2003. How did your agency/program use the findin~ls related to Goal 2 ? The Council is using participation information to improve program retention efforts. The Council is using selected pro,]ram attributes to improve the meaningful involvement of at-risk youth in other Scouting programs. Program: Hawkeye Area Council, Boy Scouts of America - Comprehensive Youth Development Goal4: Community Collaborations & Padnerships - Establish new collaborations with community organizations, enabling them to use Scouting's program models as tools to further their youth outreach and development missions. Program Activities Related to This Goal _4: Cub Scouts, Boy Scouts, Venturing, Learning for Life/In-School, Learning for Life/Exploring Objective Indicator(s) Data Collection Method Findings/Outcome (may be more than one per outcome) (how/where 9et information) FY 2002 - Contact at least 30 Contact logs, correspondence, and Examine logs, correspondence, Thirty-seven potential potential community partner collaboration agreement documentation, and collaboration agreement collaborative partners were organizations and formalize documentation, contacted with 12 new collaborations with at least 12. agreements established. FY 2003 - Contact at least 30 Contact logs, correspondence, and Examine logs, correspondence, The number of contacts and new potential community partner collaboration agreement documentation, and collaboration agreement collaborative partners will be organizations and formalize documentation, determined. collaborations with at least 12 Row did your agency/procJram use the findings related to Goal 4 ? The Council will continue its outreach efforts to other community organizations to ~nable them to use Scouting as a tool to reach both their current and-potential youth audiences, The Council will maintain its heavy emphasis on collaborative ~nd cooperative program efforts with other youth-serving, community organizations. Agency Name: Hawkeye Area Council, Boy Scouts of America Proflmm Need and Impact The Role of Our United Way Partnership The negative influences on the development of our young people are many. They include child abuse, racial/ethnic discrimination, poverty, low self-esteem, crime victimization, poor family support, low literacy, and other negative pressures. Scouting addresses these influences on our youth through preventive, family and peer-centered guidance and character and leadership development activities. Youth who are raised in non-nurturing environments are potentially at risk for many social difficulties. They are more likely to be physically unhealthy, fail in school, be unemployed, and be caught in the cycle of poverty, particularly in minority, rural and urban low-income areas. Scouting attempts to reduce the impact of these barriers on the development of this diverse youth population by providing cost-effective alternatives to the negative behaviors many times displayed by such at-risk children. Our society has many fine programs designed to create a law-abiding, 'positive follower' mentality in youth. Scouting works to develop an environment that encourages 'positive leader' development. Without Scouting, many children will be left without the skills to offer resistance to negative influences and without the skills necessary to become self-assured and self-reliant achievers. Scouting works to remove or mitigate negative influences through program activities, including counseling, support for achievements, values education, life skills development, and outdoor skills. Scouting encourages fairness and the development of an individual's abilities to become self-sufficient. The United Way of Johnson County is a vital part of the Council's funding mix, providing stability and planned growth opportunities. Our partnership with the United Way ensures that no youth will be deprived of participating in Scouting and Learning for Life programs due to an inability to pay. The Council uses United Way funding to fund our core youth development activities through the funding of program and supervisory personnel positions and through the provision of program and support materials for targeted youth. The Council's long-term strategy is to use United Way funds to leverage other funding and to continue developing alternative revenue streams. These include program-associated donors, activities, facilities use revenue, and others. The stability of our relationship with United Way enables the Council to engage in new and developing programs fi.om sources not affiliated with the United Way. This places the financial risk for program innovation with the new funding source, while keeping United Way at the forefront of the program development process. 15 Appendix F Agency Name: Hawkeye Area Council, Boy Scouts of America Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) FY 99 FY 00 FY 01 Current Assets Cash $37,219 $133,399 $402,080 Investments (short-term) $117,416 $61,161 $0 Receivables < 90 days $60,015 $592,023 $163,300 Other * $177,798 $278,032 $262,630 Total Current Assets $392,448 $1,064,615 $828,010 Other Assests Property $1,389,597 $1,651,168 $2,241,521 Equipment ** $470,751 less depreciation ($901,055) ($794,660) ($829,238) Receivables > 90 days $39,000 $127,336 $89,000 Other*** $401,599 $1,037,305 $335,352 Total Non-current Assets $929,141 $2,021,149 $2,307,386 Total Assets $1,321,589 $3,085,764 $3,135,396 FY 99 FY 00 FY 01 Current Liabilities Accounts Payable **** $133,524 $438,666 $291,633 Payroll Taxes Payable $0 $0 $0 Contracts Payable $0 $0 $0 Mortgage Payable-6 months $0 $0 $0 Total Current Liabilities $133~524 $438,666 $291,633 Other Liabilities Mortgage Payable-Balance $0 $0 $0 Other $0 $0 $0 Total Other Liabilities $0 $0 $0 Total Liabilities $133,524 $438,666 $291,633 NetAssets $1,188~065 $2~647,098 $2,843,763 Liabilities & NetAssets $1,321,589 $3,085,764 $3,135,396 · includes temperadly restricted funds, inventories, prepaid expenses, and ot~er assets cluded ~n property in FY99 and FY 00 · ** includes long-term investments, and restricted assets .... includes deferred revenue, custodial accounts, and other liabilities 16 Financial Management Agency Name: Hawkeye Area Council, Boy Scouts of America Unrestricted Operatino Fund Data B. Income & Expe~__-,~_ FY00 FY01 Budget FY02 /ncome Local Funding Sources $0 $0 $0 ~owa C~7 $0 $0 $o Coralville $0 $6 $0 Johnson County $0 $6 $0 United Way - Allocation (UWECI) $160,398 $162,816 $178,253 - Designated Giving * $19,161 $40,402 $62,990 Grants-Federal, State, Foundation $5,167 $15,550 $27,000 Net Sales of Sen/ice $6 $6 $6 Net Sales of Materials $316,151 $316,059 $322,000 Contributions/Fundraising $200,943 $172,122 $243,800 Investment Income ($41,341) ($20,187) $10,500 Other $256,838 $360,042 $287,437 Total Income $917,317 $1,046,804 $1,131,980 Wa~les & Salaries $441,863 $472,466 $556,365 Benefits ** $94,130 $121,918 $120,199 Occupancy $39,656 $62,044 $54,100 Non-occupancy $313,044 $520,065 $352,837 Other $10,480 $18,430 $9,325 Total Expenses $899,173 $1,194,923 $1,092,826 ~. Fund Balance FY00 FY01 Budget FY02 Revenue $917,317 $1,046,804 $1,131,980 Carryover Balance from previous year*** $100,332 $202,420 $69,315 Total Operatinl~ Budget $1,017,649 $1,249,224 $1,201,295 Less Total Expenses $899,173 $1,194,923 $1,092,826 Ending Fund Balance $118,476 $54,301 $108,469 Less Restricted Balance (explain) $6 $6 $0 CarP/over Fund Balance $118,476 $54,301 $108,489 donor-designated funds fn3m the United Way of Johnson County and the United Way of East Central Iowa · * includes taxes & w°rkers' c°mpensati°n insurance premiums I '** FY01 includes net asset adjustment 17 Financial Management Agency Name: Hawkeye Area Council, Boy Scouts of America D. Bd/DmlorlFunder Restricted Funds in Operating, Capital, or Endow me~t Projected Funds Designated for: FYO0 I=Y01 FY02 Bd-Designated Operatin[I Investments Operating Cash Flow Support $77,640 $24,27(] $30,000 3onor-Desi~nated Endowment Fund Various Operafin~l Purposes $321,117 $326,117 $350,000 :)onor-Desi~nated Campaign Gifts Various Capital Development Purposes $107,336 $518,683 $525,000 Total Restricted Funds $506,093 $869,070! $905,000 Projected E. In-ldnd Support (Operating Fund) Descriixlon/Purpose FY00 FY01 FY02 Use of maintenance equipment, electrical Services/Volunteers* installations, minor remodeling] $1,10(~ $2,600 $2,65(~ Office supplies, program supplies, food, expendable office equipment, maintenance Material C_-mods matadals, rec~nition i~rns, etc, $24,682 $27,712 $35,000 Space, Utilities, et¢ Warehousin~l space (Popcem Sate) $5,000 $5,000 $5.000 Other: (please footno~) Donated vehicle use $6,000 $6,000 $6,000 Total In-kind Support $36,782 $41,312 $48,650 Projected F. Operating Fund Grants Description/Purpose FY00 FY01 FY02 Oporatinl;I Camp Pro,ram - Field Sports $2.000 $0 $2,000 )perating Disability Pro,ram Assistance $0 $14,500 Operating] Ecology & Environment Education $2,500 $5,000 $9,253 Operatin9 Camperships $2,500 $2,500 $2,500 Operating ScoutResch UCoen Outreach Pro,ram $0 $0 $2,500 Operating Youth P~otection Training/Adult Leader Tm~] $1.300 $3,300 $850 Total Grants $8,300 $25,300 $17,103 '_This does not include the time donated by over 3,000 volunteer to ~rovide the estimated 700,000 contact hours of prog~m to youth, 18 Financial Management Agency Name Crisis Center of Johnson County Section 1: Background Agency Name: Crisis Center of Johnson County Address: 1121 Gilbert Court, Iowa City, IA. Phone: (319) 351-2726 Director Name: Ross Wilbum Signature: _~1~ ~-'9 &~ Bd. Pres Name: Christopher Eland Request Completed By: Ross Wilbum Date: 9/27/02 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC 93,080 97,367 10 2,2 3 6 2 2 % Does not include designated ivin or S ecial Needs Grants FY02 FY03 FY04 City of Iowa City 40,600 40,600 41,818 9 % Johnson County 75,640 67,752 67,752 15 % City of Coralville 4,850 5,335 5,550 1 ~ What were local funds used for this year: Local funds support operating costs (salaries, crisis lines, insurance,etc), transient services, and help support our supplemental food program. What will next year's local funds be used for? Same as prior question. Agency Mission Statement: The Crisis Center provides basic emotional and material support through trained volunteers and staffin an accessible, nonjudgmental, and caring environment. The Crisis Center responds-immediately, effectively, and compassionately-as it has since its establishment in 1970. Extensive community support has made it possible for the Center to serve those in need in the past; continued support will make it possible in the future. Summarize your programs and services for which you are requesting funding: Crisis intervention counseling is available 24 hours a day every day. Information & referral is provided for many issues. Suicide prevention and intervention services are a component of our telephone hotline & staff outreach. Food Bank services are for Johnson County residents needing emergency and supplemental food assistance. Transient services are provided to people who are temporarily stranded in our community. List any accreditation and licensure your agency currently has. Explain. The Crisis Center is a member of the American Association of Suicidology (AAS) and a member of the Iowa Association of Information & Referral Services (AIRS). Our program directors are licensed social workers. jccoghs\fundingform.doc I Agency Name Crisis Center of Johnson County Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) The Crisis Center was established in 1970. During the Center's 32-year history, we have responded to community needs. Telephone "hotline" counseling and suicide prevention began for a few evening hours in 1970, and this service continues to be the foundation of the Crisis Intervention Program. Walk-in counseling was added in 1972, and the Center was first able to offer 24-hour cotmseling in 1976. In addition to other Crisis Intervention Program services, the Crisis Center and its volunteers serve as the after hours contact for the United Way, the University of Iowa Counseling Service, the ICARE, and other agencies. The Crisis Center Food Bank began with a food pantry in 1978, which was three years after the Center initiated transient services for stranded families and individuals. The Food Bank/Emergency Assistance Program was expanded in 1983 to include a free clothing program with the cooperation of Goodwill Industries. The Crowded Closet now donates vouchers for household items and clothing on a daily basis. In 1991, the Crisis Center began distributing emergency diapers, in response to community requests. The Help-At-Hand program was developed in 1992 to help people struggling in poverty work towards self-sufficiency. The Help- At-Hand program encourages Food Bank clients to establish goals and enhance skills with budgeting, job hunting, and interviewing. Participants in this program also attended a winterization/Y2K readiness workshop in the winter of 1999. In September 2000, the Johnson County Student Hunger Drive was conceived, planned, and executed by Johnson County high school students. Students gathered 19 and 23 tons of food for the Food Bank in 2000 and 2001 respectively. A community garden began the summer of 2001 as a joint project with Table to Table, through the assistance of an Americorps volunteer. The Crisis Center purchased the former Crowded Closet property at 1121 Gilbert Court, Iowa City, in October 1997. After completing extensive renovations, the Crisis Center moved into the new building in September 1998. The entire building project was paid for with Community Development Block Grant funding and money raised through the "More Than Just Bricks and Mortar" campaign. The Crisis Center depends upon approximately 150 trained volunteers annually to provide direct services to clients; replacing them with paid employees would require more than 29 additional full-time staff members. Six full time staff members now coordinate the work of the volunteers. There began a transition period in staff with the hiring of a new Executive Director in July 2000. A new Food Bank/Emergency Assistance Program Director started in November 2000. A new Crisis Intervention Program Director started in June 2001. The board of directors made a commitment to add one additional staff member, in order to more effectively support services and staff. A new position, Volunteer Coordinator, was created and a staff member was hired in August 2002. A corporation made up of all volunteers governs the Crisis Center, a 501 (c) (3) non-profit agency. The 15-member board of directors consists of eight community members and seven active volunteers. The Crisis Center completed its first strategic plan (covering 1996-2000) in 1996. The second strategic planning process (covering 2001-2006) began in November of 2000 and was completed in January 2001. An annual review of the strategic plan is done to keep us moving in our identified strategic directions. Several objectives have been completed and have moved us towards our vision. The local/state economy, welfare reform, affordable housing issues, managed health care, and other conununity concerns will continue to influence the demand for Crisis Center Services. j ccoghs\fundingform.doc 2 Agency Name Crisis Center of Johnson County Section 2: Client Profile ~ FY 01 Fy 02 1. How many Johnson County residents 1 Unduplicated Count 13,35 16,3 (Including IC & Coralville) did your agency serve? 6 10 2. How many lowa City residents did your agency 2 Unduplicated Count (a,b) (a,b) serve? 3. How many Coralville residents did your agency 3 Unduplicated Count (a,c) (a,c) serve? (a) Due to the nature of telephone contact, (anonymous calling) it is impossible to know which areas of the county clients are calling (Crisis Line contacts totaled 5,512 for FY 01 and 5,548 for FY 02). (b) We served 1,813 Unduplicated Iowa City households with Food Bank/Emergency Assistance. (c) We served 762 Unduplicated Coralville households with Food Bank/Emergency Assistance. (d) We served 921 Unduplicated Other Johnson County households with Food Bank/Emergency" (e) We served 903 Unduplicated Transient households with Food Bank/Emergency Assistance Age (use agency's Gender (1) Ethnicity (use agency's breakdown if needed) (1) breakdown)(1) 0-5 3,767 Female: 6,995 Caucasian 9,749 6-12 755 Male 3,767 People of Color 1,013 13-18 430 19-21 968 22-35 2,044 36-62 2,367 63+ 431 (1)=Client profile table information includes Johnson Count residents and transient numbers. It does not include the demographics of the 5,548 anonymous crisis ~ntervention program statistics. 3. Briefly describe your service population. The Crisis Intervention Program serves anyone needing support or assistance. We received 5,548 total contacts for crisis intervention services. Of the total crisis intervention contacts, 3,565 were first time contacts, 1,411 were repeat contacts, and 572 were regular client contacts or people who we have a contract with that guides their use of our services. Also, 1,964 of the total contacts occurred after regular business hours between 5:00pm and 8:00am. 1,121 of the contacts occurred on Saturday or Sunday. People contact the Crisis Intervention Program for a variety of reasons. The 2,107 crisis counseling contacts involved people wanting support for depression, relationship issues, as well as suicide concerns. Thirteen of the contacts were "suicides in progress", where the caller had taken some medication or had a weapon and a specific plan to use it to end their life. Crisis Intervention volunteers make extensive referrals to other county resources. 504 contacts involved counseling by a trained volunteer and the contact ended with a referral to another agency. People will call the crisis lines with a specific request for information about a community resource or support. 2,924 contacts in FY 2002 were requests for information and referral. j ccoghs\fundingform.doc 3 Agency Name Crisis Center of Johnson County The Food Bank Program. served 2,965 Johnson County households, 712 of which (households) have been in the area for more than two years. Of these households, 2,698 reported an income at Level 1 poverty threshold ($18,850 for a household size of 4 people). Another 220 households reported an income at Level 2 poverty (50% of median income). Of the total households served by the food bank, 2,081 are renters and 2,695 requested supplemental food. The remaining households received a variety of emergency assistance (diapers, utility assistance, or clothing assistance). There were 1,314 single parent female headed households. The Food Bank also provided emergency assistance to 903 transient households, including 96 who received Veteran's assistance. 4. How do you determine eligibility for services? Anyone who believes they are in crisis may receive services. Therefore anyone is eligible for crisis intervention counseling. We collect income information in the Food Bank program and in FY 02, 2,698 households met the Level 1 poverty threshold. 220 households were at Level 2 (50% of the median income level) and 46 households were at Level 3 (80% of the median income level. Also, we collected income levels for transients. 769 households were at the Level 1 poverty income and 122 households were at 50% of the median income (Level 2). Some of our churches (or funders who contribute money for emergency assistance) put restrictions on the amount of help (and the type of help) a household may receive. We monitor and screen individuals for this type of help. 5. Are there fees for your services? Yes No X If yes, please describe your fee structure: N/A 6. Do you provide services to areas outside of Johnson County? Yes, but only for people stranded in Johnson County. We don't know if people outside of the county call the crisis lines unless they tell us; it would be a long distance call for them. Area(s) served:Transients from out of county & out of state. Services Provided: We help link people who get stranded in Johnson County to resources to get them back on their way towards their final destination. We have a voucher arrangement with Greyhound/Trailways. We also will provide portable food and diapers for their journey to the next destination. Funding Sources: Many of the area churches assist us with services to transients. On occasion, someone who received transient assistance (bus ticket, food, or small car repair) will send a contribution through the mail upon their return home. j ccoghs\fundingform.doc 4 Agency Name Crisis Center of Johnson County Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: We survey clients in the Fall about our services and their life circumstances. In addition, volunteers on the board and through the Corporation meetings provide feedback about our services. (b) Community: We survey other community agencies and the churches about our services. 2. Briefly summarize your findings: The Crisis Center enjoys the support of area churches, the university community, and area businesses. In general, agencies believe that the volunteers are well trained for their tasks and that appropriate referrals are made to their organizations. In last year's client satisfaction survey, 98% of the almost 300 respondents felt they were satisfied with service and treated with respect by the volunteers. People get frustrated when we are unable to assist with the overwhelming number of requests for emergency assistance. 3. What changes have been made in response to these findings? We continue to invite speakers from other organizations to help with our in-service training. Twice our volunteers and staff have taken a tour of another agency, so that we are aware about other agency resources. There are clients among our volunteers and we try to educate all volunteers about the range of services we can offer and situations where we cannot be of assistance. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Soume of Referral % of clients referred Self referral/advertisements -92% of Crisis Intervention contacts, 21% of Food Bank contacts Family/friends -4% of Crisis Intervention contacts, 18% of Food Bank contacts Organization -4% of Crisis Intervention contacts Community Mental Health Center -142 Food Bank contacts DHS -113 Food Bank contacts Emergency Housing Project -247 Food Bank/Emergency Asst. contacts 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? The Rape Victim Advocacy Program and the Domestic Violence Program have a help line that is available all day, every day. United Action for Youth has a Teen Peer Helper Line available during selected hours and an on-call counselor available all day, every day. The Salvation Army, the Common Fund, & HACAP offer various forms of food and utility assistance. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. The Crisis Center's help line and walk-in counseling offer a broad range of counseling support options including suicide intervention (as opposed to the specialized assistance for the issues of rape and domestic violence). In addition, the Crisis Center jccoghs\fundingform.doc 5 Agency Name Crisis Center of Johnson County serves as the after hours contacts for the University of Iowa Counseling service, the Iowa Center for Aids Resources and Education, the information & referral services of the United Way of Johnson County. There continue to be after hour contacts from mental health center clients, for those who choose not to utilize Foundation II in Cedar Rapids (the Mental Health Center's after hour service provider). The only utility that the Common Fund will provide assistance with is water bills. Crisis Center provides transient transportation assistance, whereas Salvation Army provides local assistance. HACAP has a regional food reservoir, however we provide food locally and have made purchases of food from their regional reservoir. There are a few churches who give out food, however Crisis Center provides a more thorough assessment of other needs. 7. Outsideofreferrals, list up to 3 primary collaborations. Briefly describe the nature ofeach collaboration. Collaborations Briefly describe 1 .Table to Table 1 .We share a walk-in cooler/freezer. We are a distribution point for some of the food items they rescue. We share a community garden that they established on-site at the Crisis Center. Until recently, they were a member of America's Second Harvest and would occasionally order some food for us through them until it became cost prohibitive. Crisis Center's executive director has helped serve as a mentor for their director as part of the United Way's Agency Director Mentorship Program. 2.Local Homeless Coordination Board 2.We have a staff representative that meets with area homeless service providers to discuss issues, has lent support to homeless grant project applications, and is now getting into policy advocacy. 3.Trinity Episcopal Church & St. Andrews 3. Two examples of churches that provide Presbyterian funds for emergency assistance needs, but they ask for the Crisis Center to assess the household's resources and to identify other matching funds jccoghs\fundingform.doc 6 Agency Name Crisis Center of Johnson County Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1 .The growth in numbers/diversity of clients 1.We are working to increase effectiveness and increasing request for services of internal operations & external services overwhelming staffing levels by: a. Hired a Spanish speaking volunteer coordinator. b. Obtained funding to build food warehouse on-site, hopefully to reduce staff/volunteer time out of building. c. Continue to work with area churches to gather resources (volunteer & material goods) for unmet needs. 2. We have had confused community relations (public being unaware of our services & unclear 2.We are working to engage the community policy about volunteers disclosing their status more in the services that we offer by: as volunteers at the Crisis Center). a. Having staffand volunteers participate in more in community education forums b. Utilized more University groups to sponsor food drives (Vietnamese Student Association & the Hawkeye Football & Basketball programs) c. Participated in "ambassador" visits to other agencies 3. We have internal communication challenges with 6 full time staffand over 150 volunteers. 3. We have increased the effectiveness of internal operations (communication) by: a. Implemented a list serve to have e- communications with volunteers. b. Improved internal newsletter, making it easier for people to submit information & used it for increasing utilizing the special skills of our volunteers c. Staff having a morning "check-in" about Items in bold and underlined are "Strategic the days activities Directions" that were identified in our 5-year Strategic Plan. 2. In what way will the needs of your service population change in the next five years? The US Census Bureau reports that the number of people without health insurance significantly increased due to a large decrease in job-based coverage and insurance rate increases. 41 states are planning to limit Medicaid spending in the coming years. Employers who continue to offer work jccoghs\fundingform.doc 7 Agency Name Crisis Center of Johnson County based insurance will face rising health insurance costs will pass those on to workers. Tightening family resources will contribute to family stress and pressures. 3. How do you plan to address these changes? The supplemental food we offer helps people use their money for other living expenses. As our funding sources allow, we will try to assist with utility/rent type assistance on a short term basis. We have two volunteers trained by the Hawk-I health insurance program. They will work to educate parents with children about the no cost or low cost program in order to get their children covered. 4. Describe the evaluation methods you use to measure the success of your services? We do a client satisfaction survey annually for the Food Bank/Emergency Assistance clients. Due to the nature of the anonymous calls for the Crisis Intervention program, we do not assess their satisfaction by survey. Volunteers do record if they believe the client's need for contacting the Crisis Center was met. Monthly we track our level of service provision. We set annual service provision goals & objectives. 5. What are the results of these evaluations (outcomes)? Crisis Intervention Services Objective A. In FY02 provide crisis intervention counseling to 7.000 people through 24-hour telephone service and walk-in service from 11 am to 11 pm daily. Results: · Provided 5,548 client contacts · Provided community outreach and education services to 15,436 people Trained 32 new crisis intervention volunteers (60 hour training) Objective B. In FY02 provide information and referral to 3,500 people on the crisis lines. Results: · Provided 5,031 referrals and information Objective C. In FY02 provide suicide intervention to 300 people through phone and walk-in service. Results: · Provided direct suicide interventions to 127 people · Provided counseling to 243 people who indicated depression as their presenting problem Objective D. In FY02 provide suicide prevention services to 250 individuals in area high schools & other community venues. Results: · Provided suicide prevention services to 352 individuals in schools and community settings Objective E. In FY02 provide community education and outreach through training sessions, presentations, and other special events to more than 3,500 people. Results: · Provided education and outreach to 15,436 people Food Bank Services jccoghs\fundingform.doc 8 Agency Name Crisis Center of Johnson County Objective. In FY02 provide households & individuals with food assistance during approximately 20,000 client contacts (385 households a week). Results: Provided 30,564 client contacts · Increased Food Bank volunteer pool to 118 volunteers (up from 65) · Provided walk-in case management services for 1,084 people (budgeting, enrolling in public assistance programs, etc) Emergency Assistance Objective A. In FY02 provide non-financial support to promote independence from assistance programs whenever appropriate through the Help-at-Hand/Case management services. Evaluate the needs and concerns of 2,000 households and provide on-going support. Results: · Provided case management/evaluated needs of 2,965 households · 52% had problems with enough food · 11% had clothing as a concern · 10% had transportation as a concern · 14% had trouble with enough diapers · 10% had employment difficulties · 4% had housing issues as a concern Objective B. In FY02 provide 1,200 Johnson County residents with clothing assistance. Results: · Provided clothing assistance to 1,535 individuals Objective C. In FY02 provide 1,300 households with emergency assistance in obtaining diapers, baby food, and infant formula. Results: · Provided 1,950 emergency diaper services Objective D. In FY02 provide local bus tickets to 1,200 individuals. Results: · Provided 1,214 individuals with local bus tickets 6. How do you plan to use the evaluation results to enhance/extend your services? We use them for fundraising information/marketing. If there is an unmet need, we use it to inform other organizations & fun&rs. We use narrative reports from client satisfaction services to enhance our training and examine our service delivery methods. For example, we used our suicide statistics to inform our decision about adopting the Ray of HopeTM suicide survivors support group at the request of the local group's founder. Also, the knowledge that there were so many children without health insurance prompted us to send two volunteers to be trained to do outreach for the Hawk-I health insurance program. 7. How do your programs/services impact the community? The Crisis Intervention program provides the community an outlet and place to have anonymous, free counseling support that is available all day, every day. The Food Bank and Emergency Assistance that we provide help keep people from going hungry and allow them to use their resources to meet other daily living needs/expenses. We provide a vehicle for a diverse group of jccoghs\fundingform.doc 9 Agency Name Crisis Center of Johnson County volunteers (both our average 150 trained volunteers and hundreds of untrained people) to help others in their community. We offer a place for area youth to fulfill service learning projects. We are a community service site for people involved with the corrections system to perform restitution. 8. How did the agency respond to the UWJC recommendations from last year? Our recommendation said to keep up the good work. We have tried to maintain representation from multiple communities on our board of directors. We have further implemented our Strategic Plan by hiring a volunteer coordinator that is fluent Spanish. We have worked hard to solidify our partnerships with area churches. jccoghs\fundingform.doc 10 Agency Name Crisis Center of Johnson County Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) (Roster is attached-committee assignments are in transition at the writing of this application). 2. How often does your board meet? They meet once every month on the third Wednesday. Some board committees meet outside of our regular board meeting schedule. 3. What is your average attendance at board meetings? Ten members present. 4. How is the board involved in strategic planning and governance of the agency? The board, staff, and volunteers met to develop our five-year strategic plan in the Fall of 2000. The board annually reviews progress on our strategic directions & movement towards our vision. The board is actively involved in fund raising planning & resource acquisition. The programming and planning committee recently revised our confidentiality policy with the assistance of staff. 5. What type of training/orientation do board members receive? New board members have an orientation meeting with the executive director. In addition, we have an annual retreat to discuss our strategic plan or some aspect of board member responsibilities. Board members are also provided information through our monthly information packets. Some board members also attend in-service training that our regular volunteers receive. Finally, a more experienced board member will check-in with newer members to see that their volunteer needs are being met. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Yes, we have a gift acceptance policy, an investment policy, and other procedures are reviewed annually by our auditor. The executive director is working on combining it all into one set of financial procedures. Gift acceptance policy was approved in 2000. Investment policy in 2001. 7. Have you filed the annual report with the Secretary of State? Yes If yes, date filed? Filed on 01/24/01 they are biennial reports now, so our next one is due in 2003. 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? Filed 12/2001 If no to questions 6, 7, or 8, give explanation. IRS 990will be filed again in December of 2002. 9. Does your agency have a yearly audit? Yes X No If yes, Who completed the audit? How much did the audit cost? Greenwood & Crim,P.C. completed our audit for $2,440. If material weaknesses are noted in the audit, what is your plan for addressing them? There were no material weaknesses found in the audit. jccoghs\fundingform.doc 11 Agency Name Crisis Center of Johnson County If you do not have an audit, what is in place to assure accountability in the agency's financial management? N/A 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X $1,000,000 b. employment practice liability X $1,000,000 General Liability X $1,000,000 Umbrella Liability Professional Liability X $1,000,000 Property or Renters X $510,000 Vehicle X $1,000,000 FYI, St. Paul Insurance will no longer be offering Professional Liability coverage after current policies expire. We have coverage until 10/10/02 and are shopping around for another provider now. jccoghs\fundingform.doc 12 Agency Name Crisis Center of Johnson Count~ Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Employed two years at the Crisis Center. MSW degree from the University of Iowa. Member of the Iowa Attorney General's Crisis Response Team. Former instructor at the University of Iowa School of Social Work. Former Trainer for the National Network for Youth. Co-founder of the Iowa Community Youth Development Training Institute. He was a former Crisis Center volunteer in the 1980's with both programs and served on the board of directors. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X X $39,472 - $53,268 1 1 1 Coordinator of Services X X X $28,000 - $38,300 1 1 1 Crisis Intervention Program X X X $26,000 - $32,000 1 1 1 Director Food Bank/Emergency X X X $26,000 - $32,000 1 1 1 Assistance Program Director Volunteer Coordinator X X X $21,000 - 26,500 0 1 1 Office Manager X x X $16,000 - $24,000 1 1 1 Office Assistants They make $7.50/hr 3 1 1 (work-study students) according to university policy, we pay $1.88/hr of that amount. TOTAL FTEs 8 7 7 jccoghs\fundingform.doc 13 Agency Name Crisis Center of Johnson County 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? N/A 4. How much was spent on staff development in the last fiscal year? $ 2,913 5. How much is budgeted for staff development in this fiscal year? $ 2,000 6. What training and support opportunities are offered to staff?. Staffare allowed to participate in the same in-service training offered to volunteers. Staffare encouraged to attend a Crisis Center Convening annual conference in Chicago, IL. In addition, they are encouraged to attend locally sponsored training offered through other agencies. Staff are also allowed to submit request for a partial book educational reimbursement for a class taken that will relate directly to their job duties. 7. Please attach current organizational chart as Appendix B. (attached) 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 4.75% Yes No If no, brief explanation 9. Does your agency X The last Full review was 6/21/00 have personnel policies? If yes, date board last reviewed? 10. Does your board X Input is collected from volunteers, staff, selected funding annually evaluate organizations, and board members. the director's performance? 11. Does your agency X The last description reviewed was the new volunteer have job coordinator position in June 2002. descriptions for every position? The last approval was in 2000. If yes, date of last board approval? 12. Is there an annual X performance review for every staff?. jccoghs\fundingform.doc 14 ...... Agency: Crisis Centerl of Johnsonl County Section 7: Financial Management A. Throe Year Historical Balance Sheet (As of your fiscal year-end) FY 00 FY 01 FY 02 Current Assets Cash $162,068 $175,887 $196,455 Investments $262,851 $271,154 $250,544 Receivables < 90 days $0 $0 $0 Other Total Current Assets $424,919 $447,041 $446,999 Other Assests Property $559,223 $568,253 $568,253 Equipment $80,444 $89,831 $95,978 less depreciation ($91,333) ($114,820) ($139,630) Receivables > 90 days $0 $0 $0 Other Total Non-current Assets $548,334 $543,264 $524,601 Total Assets $973,253 $990,305 $971,600 Crisis Center is on a CASH Basis FY 00 FY 01 FY 02 Current Liabilities Accounts Payable $0 $0 $0 Payroll Taxes Payable $0 $0 $0 Contracts Payable $0 $0 $0 Mortgage Payable-6 months $0 $0 $0 Total Current Liabilities $0 $0 $0 Other Liabilities Mortgage Payable-Balance $0 $0 $0 Other $0 $0 $0 Total Other Liabilities $0 $0 $0 Total Liabilities $0 $0 $0 Net Assets $973,253 $990,305 $971,600 Liabilities & Net Assets $973,253 $990,305 $971,600 FY02 is from a draft copy of our audit I Agency: Cdsis Center of Johnson County FY 02 FY 03 FY 04 B. Income & Expenses _ #lcome Local Funding Sources Iowa_._City $40,600 $40,600 $41,818 _ Coralv~lle $4,850 ! $5,335 $5,550 Johnson County $75,280 $67,752 $67,752 FY03 10% less. United Way - Allocation $94,152 $98,584 $103,514 [ - Designated Giving I $11,176 $10,225 $9,637 Grants-Federal, State, Foundation $13,318 $125,555 $15,000 FY_03 CDBG grant for building addition Net Sales of Sennce $0 ~ $0 $0 Net Sales of Materials $0 $0 $0 Contribution s/Fu nd raising I $203,879 $209,000 $211,000 Investment Income $0 $0 $0 FY03/04 hope to not suffer market losses Other $3,947; $4,000 $4,500 Total Income $447,202 $561,051 $458,771 Expenses Wag_es & Salaries $169,187 $196,236 $206,048 FY03 includes new position Benefits $28,099 $33,700 $38,418 FY03 includes new position Occupancy $3t,324 $147,360 $39,391 FY03 includes warehouse addition Non-occupancy _$186,846 $206,278 $208,000 F__Y03 hold down cost-help fund new staff Other (Fundraising) $10,106 $12,000 $14,000 $425,562 , $595,574 $505,857 FYO3,Food_donations significantly down C. Fund Balance Revenue $447,202 $561,051 $458,771 Carryover Balance fi'om previous year $175,887 $197,527 $163,004 Tot_al Operating Bu_d~q_et $623,089 $758,578 $621,775 Less Total Expenses $425,562 $595,574 $505,857 Ending Fund Balance $197,527 $163,004 $115,918 Less Restricted Balance (explain) $197,527 Carryover Fund Ba~nce $163,004 $115,918 I Agen :Cdsis Center__of Johnson County ~. BdlDo_noflFunder Resblcted Fund~ _ Designated for: FY 02 FY 03 ,,.~ _ .~dsis Center Board ~)n-cal[/AIl~reimburseme~t $3.022; $3,022 $3.022; )oard(endowmentaccorditl~odonorswishes) nterestincomeusedforoperations $239.875~__$239.875 $2~ =. Grant~ DeecrlpBonlPurpo~e FY 02 ~ 03 FY 04~ --- ~o¢nmu~ment Grant =ood Bank_Warehouse Add, ion $0 $1~12,510 $~$0~ Crisis Center Board of Directors 2002-2003 Christopher Eland (V) Jacqueline Smetak (V) Acting Chair Iowa City, IA Solon, IA Volunteer Job Coach (11/03) (5/03) Jane Anderson (C) David Rust (C) Vice-Chair Iowa City, IA Iowa City, IA Social Work Consultant Psychologist (3/04) (8/04) Jesse Bums (C) Kim McCoy (C) Treasurer Coralville, IA North Liberty, IA Banker Real Estate Developer (9/05) (7/04) Steve Ballard (C) Julia Davis (C) Iowa City, IA Iowa City, IA Attorney Retired Dean (1/03) (10/05) Derek Kruempel (V) Lucy David (V) Tiffin, IA Iowa City, IA UI Graduate Student (10/04) (3/03) Charles Scott (V) Michele Welter (V) Iowa City, IA Iowa City, IA Instructional Designer/Photographer Homemaker/Volunteer (11/03 ) (10/04) Doug Swailes (V) Iowa City, IA (C) -- Community Representative Machinist Serves: 3 yr. term (10/04) 2 consecutive terms (V) = Volunteer Representative Serves: 2 yr. term 2 consecutive terms ,~,,~ [J~.~ · Crisis Center Crisis Line (319) 351-0140 1121 Gilbert Court Business Line (319) 351-2726 Iowa City, Iowa 52240 Food Bank (319) 351-0128 · C~ ~Center~,~ Fax (319) 351-4671 ~ ~ ~ www. JohnsonCountyCrisisCenter. org E-mail: rwilburn@soli.inav, net 4~lP ~ Appendix B Table of Organization Board of Directors 15 members total (8 community members, 5 active volunteers, 1 President of the Corporation and 1 University of Iowa Studente Volunteer) Executive Director Coordinator of Services / Office Crisis Food Bank I Volunteer Manager Intervention Program Coordinator Program Director Director Office Assistant Trained Program Volunteers (~vork stt~') Community Service Volunteers Organized Volunteer Groups Sporadic Volunteers All trained volunteers in good standing have input into policy decisions through meetings of the Corporation & volunteer representatives on the Board of Directors Section 1: Background Agency Name: Dental Care for Kids of Johnson County Address: 201 Dental Science South, Iowa City, IA 52242 Phone: 319-335-7479 , Director Name: Dr. Cynthia Christensen Signature: Bd. Pres Name: Dr. Michael Kanellis Signature: Request Completed By: Dr. Christensen Date: 09/24/2002 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30~X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $0 $0 $1000 Does not include designated ~ecial Needs Grants FY 02 FY 03 FY 04 City of Iowa City Johnson County City of Coralville What were local funds used for this year: Dental treatment for children What will next year's local funds be used for? Dental treatment for children Agency Mission Statement: The mission of our agency is to provide dental services for indigent children of Johnson County who do not qualify for Title XIX, Hawk-I, or other third party coverage. Snmmarize your programs and services for which yon are requesting funding: Dental Care for Kids of Johnson County: List any accreditation and licensure your agency currently has. Explain. We are accredited by the Commission on Dental Accreditation through the ADA (American Dental Association). Agency Name Dental Care for Kids of Johnson County Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Dental Care for Kids of Johnson County (previously known as Dental Services for Indigent Children of Johnson County) has provided dental treatment for over a decade to those individuals less than 17 years of age who are not qualified for other forms of assistance and who could not otherwise afford dental care. Services are provided in the Department of Pediatric Dentistry at the College of Dentistry from 8:00 a.m. to 5:00 p.m. Monday through Friday and on an emergency basis at the Center for Disabilities and Development on evenings and weekends. State appropriations for indigent patients are not allocated for the College of Dentistry to provide dental services. This program was developed to respond to the need for treatment of dental disease which affects nearly all individuals at one time or another. Our activities have primarily involved the deliver of emergency, restorative and preventive dental services (orthodontic services are not covered by this agency). During the past year, we have continued working with the Iowa City School system, administrators of elementary schools in outlying Johnson County, the Iowa City Free Medical Clinic, the Visiting Nurses Association of Johnson County and the Johnson County Health Clinic, WIC Clinic, Head Start and the Campus Fair. These contacts have helped us in the past years and we will continue with them in the future. j ccoghs\funding form. doc 2 Agency Name Dental Care for Kids of Johnson County Section 2: Client Profile ~ FY01 FY02 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 18 15 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 14 14 3. How many Coralville residents did your agency serve?3 Unduplicated Count 0 1 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 5 Female: 7 This information is not available. 6-17 10 Male 8 18-29 30-61 62-75 >75 3. Briefly describe your service population. Our service population are indigent children of Johnson County who do not qualify for Title XIX, Hawk-I, or other third party coverage 4. How do you determine eligibility for services? We require a written application form to be completed and returned. To qualify for the program, applicants must meet the age, income and residence guidelines. 5. Are there fees for your services? Yes X No__ If yes, please describe your fee structure: We have a fiat fee for dental services which will be charged by the individual services provided to each patient based upon the guidelines established by the College of Dentistry for predoctoral dental students' fees and typically are approximately one-half of the fees charged by faculty or private practitioners in the county. 6. Do you provide services to areas outside of Johnson County? No. Area(s) served: NA Services Provided: NA Funding Sources: NA j ccoghsLfunding form. doc 3 Agency Name Dental Care for Kids of Johnson County Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client The College of Dentistry has a "Patient's Rights and Responsibilities" sheet attached to the patient registration form, (b) Community We have no formal mechanism. 2. Briefly summarize your findings: We have received no patient complaints regarding access or care provided to this point. 3. What changes have been made in response to these findings? NA 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred We receive referrals from the Johnson county We do not currently track referral sources. schools, Pheasant Ridge Neighborhood Center, Free Medical Center, Visiting Nurses Association of Johnson County, WIC clinic, Head Start and the Campus Fair. 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Only the Johnson County Child Health Center provides service in any way similar to ours. They will issue a voucher for a set dollar amount and only to patients how are seen at their clinic and referred for care. This covers only a small portion of our clientele. There is nothing that we are aware of for the rest of our clientele. Our purpose is to provide dental treatment to those individuals who are not qualified for other forms of assistance and who could not otherwise afford dental care. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. We are the only agency who provides dental treatment for children. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. IC Dental Health Clinic 1. They refer patients to us for dental treatment with a voucher for a limited dollar amount. We complete any necessary treatment in a cost-effective manner and supplement if the voucher does not cover the necessary treatment _plan. j ccoghs\funding form. doc 4 Agency Name Dental Care for Kids of Johnson County Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Challenge: Patients keeping scheduled 1. We can attempt to educate patients of the appointments, importance of keeping the appointment or giving cancellation notice. 2. Opportunity: The College of Dentistry 2. We can let our referral sources know that would like to add pediatric dentistry patients to we have increased capacity to treat childrens' the senior-year curriculum, dental needs at the same fee structure. 3. 3. 2. In what way will the needs of your service population change in the next five years? We have no way of knowing. The numbers of low income children in our clinic appears to be on the increase. 3. How do you plan to address these changes? The numbers of patients we treat under this program make up such a small part of our total clinic pool, we probably will not have to make substantial changes. 4. Describe the evaluation methods you use to measure the success of your services? Direct feedback from clientele. 5. What are the results of these evaluations (outcomes)? We have had only positive feedback for this program. 6. How do you plan to use the evaluation results to enhance/extend your services? We would like to continue with our program as in the past, with the addition of 4th-year practitioners. 7. How do your programs/services impact the community? We are one of the few practitioners in Johnson County who continue to provide dental care for indigent children. 8. How did the agency respond to the UWJC recommendations from last year? The directorship for the program has changed hands this year and I have not seen last year's recommendations. j ccoghs\funding form. doc 5 Agency Name Dental Care for Kids of Johnson County Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) NA 2. How often does your board meet? NA 3. What is your average attendance at board meetings? NA 4. How is the board involved in strategic planning and governance of the agency? NA 5. What type of training/orientation do board members receive? NA 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? NA 7. Have you filed the annual report with the Secretary of State? If yes, date filed? NA 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? NA If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? How much did the audit cost? This is part of the University of Iowa process. If material weaknesses are noted in the audit, what is your plan for addressing them? NA If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) State of Iowa Torte Act Insurance Check if agency has Amount Directors & Officers a. fiduciary liability b. employment practice liability General Liability Umbrella Liability Professional Liability Property or Renters Vehicle j ccoghs\funding form. doc 6 Agency Name Dental Care for Kids of Johnson County Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Dr. Christensen has been the Director of the program since being hired as Clinic Director for the Department of Pediatric Dentistry. She has a D.D.S. and a Master's degree in Pediatric Dentistry. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year NA TOTAL FTEs 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? NA 4. How much was spent on staff development in the last fiscal year? NA 5. How much is budgeted for staff development in this fiscal year? NA j ccoghs\funding form. doc 7 Agency Name Dental Care for Kids of Johnson County 6. What training and support oppommities are offered to staff?. Mandatory OSHA training sessions are conducted for all staff. In addition the College of Dentistry offers continuing education courses and the University of Iowa offers courses though the Staff Development and Training Department. They also oversee programs such as staff tuition grant and assistance program, internship program, CD-ROM instructional program, software training and videos, among others. The majority of courses are at no charge for employees. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? Departmentally, wages increased an average of 4%. Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board last reviewed? 10. Does your board X annually evaluate the director's performance? 11. Does your agency X have job descriptions for every position? If yes, date of last board approval? NA 12. Is there an annual X performance review for every staff?. j ccoghsXfundmg form. doc 8 _ __~ ]Agency:~Dental Care for Kids of Jo~hnso~n County~ Other (Carryover) $4,470 $7,814 $9,964 Total current Assets Othe~Assests ii ii ~ i~ ~Equipment- -- I~e~s depreciation _ ~__ ~ _ Receivables > 90 days Other -- ~ - ? - - TotalNon-currentASsets $0 -- $0-i SO- Current Liabilities -- ~ayroll Ta~es payable Con~c~ ~ay~bi~ ~ -- Mo~age P~able-~ month~_~L~' rom~ curre.~ Ua~es $3,6~9 ~ther Uabilities - Mo~gage Payable-Balance Other ~ ~ ~ TotalLiabilities ~ NetAssets ~ $7,814 $9,964: $9,00~ [iabilities & ~et ~s~ts Page 9 _ i Agency: Dental Care for Kids of Johnson County FY02 FY03 FY04 B. Income & Expenses . Income Loc~al Funding Sources _ _ $0 $0 ~ $0 . Iowa City $0 $0 $0 _ __ Coralville $0 $0 $0 John~0n County $0 $0 $0 i United Way - Allocation . $0 $750 $250 1 __ - Designated~Giving $1,629_ $1,729. $500 Gra~nts-Federal, State, Foundation $0 _ $0 _ $0 Net~Sales of Service _ $0 . $0 . $0 Net Sales of Materials $0 $0 $0 Contdbutions/Fundraising $0 $0 $0 Investment Income $0 ~ $0 $0 _ Other $0 $0 $0 Tectal Income $1,629 $2,479 $750 Wages & Salaries $0 $0 Ben~efits ~ $0 $0 $0 OccuPancy I $0 $0 $0 Non-occupancy _ $0 $0 $0 -- __ Other (Dental Treatment) $2,590 $6,000 $6,232 __ _ $2,590 $6,00~00 $6,232 1 Fund Balance Revenue $1,629 $2,479 $750 Car~ ~ver Ba!ance from previous year $9,964 $9,003 [ $5,482 Total Operating Budget $~11,593 i $11,48~2 ~ $6,232~_ Less Total Expenses _ $2,590 I $6,000 $6,232 Ending Fund Balance _ . $9,003 $5,482 ($01 _ Less Restricted Bala?ce (explain) ; , __ Carryover Fund Balance I $9,003 $5,482 ($0) Page10 Total Restricted Fu nd~s __ $0 $0 $0 E. In Kind Support: . Last Year This Year Next Year Se~ices/Volunteers . D!recter, re~tionLl~entsI Asst~ office $16,751 $18,415 $16,931 Materiel Goods Space, Utilities, et~ $6,460 $6,783 $7,122 0~: (Please footn~ ~Total In-kind Support __ $23,21 t ~25,198 $24,053 Total Grants $0 Page 11 Section 1: Background Agency Name: Domestic Violence Intervention Program Address: PO Box 3170 Iowa City, IA 52244 Phone: 319-354-7840 ext: 116 ~ ~ Director Name: Cris Kinkead Signature: ~ -,.~-J.~z~'7 [ Bd. Pres Name: Lois Cox & Kris Corlette Signat ~v~-~_' ~ Request Completed By: Cris Kinkead & Sheri Gilds Date: September 24, 2002 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Budget Amount received from UWJC 49960 49738 52260 9.35% Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City 54256 54256 56968 10.19% Johnson County 54065 54065 56768 10.16% City of Coralville 3000 3300 3480 .62% What were local funds used for this year: Operations, Salaries, Benefits What will next year's local funds are used for? Operations, Salaries, Benefits Agency Mission Statement: The Domestic Violence Intervention Program is founded on the belief that everyone has the right to live free of fear and harm. Our mission is to end domestic violence through support, advocacy, shelter and education. Summarize your programs and services for which you are requesting funding: DVIP's funding request is for the entire agency verses a particular program. DVIP offers the following services: Shelter and Community Support Services to adult women and male victims of domestic abuse, their children and loved ones. (Male victims do not have residential access, however, may seek all other DVIP services). Other services include: 24-hour crisis hotline, support groups, transportation, peer counseling, information and referral, emergency financial assistance, systems education, Domestic Abuse Response Team, Batterers Education Victim Contact, and Language Line. Youth Services: counseling, support groups, school advocacy, tutoring, summer program and community activities. Other activities include games, arts, and surprise Sunday's. Advocacy: all DVIP clients may receive advocacy in the following areas: Medical, criminal justice and judicial, emergency legal advocacy such as no contact orders, personal, social services and other human service agency advocacy. The DVIP also operates a community Furniture Project, accessible to homeless individuals in the Johnson County area. Education Services: DVIP's 1 Agency Name: Domestic Violence Intervention Program education services include: general public speaking, training professionals and educating all levels of public education sectors. Other educational services provided include: composing education packets for victims of domestic abuse in English and Spanish; development of agency brochures, handouts, and posters; and developing DVIP curriculum such as: clergy, health care professionals, and domestic violence in the work place. DVIP's goal in educating the public is two fold. One, it is our goal to educate the general community about the dynamics of domestic abuse so the community in turn will have the resource information for themselves should they become a victim; or be able to make a referral to someone they know is a victim of abuse. DVIP's second goal is to help train and set up protocols with area professionals so that DVIP can assist in intervention efforts for victims or their loved ones. DVIP also maintains a volunteer program and provides four trainings a year to the Johnson County community. Volunteers are integral to the work we do. DVIP utilizes volunteers to answer the 24-hour crisis line, work in the shelter with the women and children, office support and maintenance. List any accreditation and licensure your agency currently has. Explain. DVIP is not an accredited agency. Some funders require site visits of which specific contractual criteria are scored. Any employee working for an Iowa Coalition Against Domestic Violence member agency is required to be state certified as a Domestic Abuse Advocate at level I, II or III. The three certification levels specify the types of services that can be provided by employees working in domestic violence programs. Advocates must be certified on an annual basis. There is a specific process to follow for each level of certification and continuing education requirements to stay at the same level. jccoghs\fundingform.doc 2 Agency Name: Domestic Violence Intervention Program Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) The DVIP began as a grass root, volunteer run agency. The agency first began in 1976. In 1977, the University of Iowa's Women's Resource and Action Center (WRAC) received a one-year CETA grant from the government to explore the problem and incidence of domestic violence in our community. Responding to the needs from the study, volunteers quickly established a safe home network, referral service, and provided emergency housing in motels for battered women. By 1979, the Crisis Center established Aid and Alternatives to Victims of Spouse Abuse. The Domestic Violence Intervention Program became incorporated and opened the first domestic violence shelter in Johnson County in 1980. The DVIP was partially funded by the United Way, the city of Iowa City, Johnson County and the Community Block Grant. A first year budget of $29,000 provided battered women and their children emergency housing, counseling and a 24-hour crisis line. In 1986 a mandatory arrest domestic abuse law took effect, which entirely changed the community's perception of the prevalence of domestic violence. At this time, DVIP worked with other community based organizations to begin a men's program for perpetrators of domestic violence. As a result of this work, DVIP formed a unique coalition with the County Attorney's Office, law enforcement officials, and community agencies. This coalition served as a state model for comprehensive service delivery to battered women and their children. Today there is a state law mandating perpetrators to Batterer's Education Programs once convicted of domestic assault. In 1992, a lawsuit accusing the DVIP of harboring a father's children started. Accordingly there was an investigation and suit was settled out of court in 1995. During this time DVIP underwent a Capitol Campaign Drive, raising community funds to build a new shelter. The campaign was successful and the entire mortgage was paid by the year 2000. Twenty-three years later, DVIP has served more than 20,000 women, men and children and answered more than 175,000 crisis hotline calls. Many state laws have been passed since the first mandatory arrest law in 1986. These new laws have dramatically changed how we do our work. These laws include Iowa Criminal Code 236, confidentiality laws, pro-se protective orders, harassment and stalking laws, immigration laws for battered women, full faith and credit and dating violence. These laws make seeking services for victims in the Johnson County community easier and friendlier. The board of directors once helped run the agency in the grass root days, working shifts during the overnight hours and on weekends. Today, DVIP's board of directors work closely with the executive director to provide a long-range vision for the agency. jccoghs\fundingform.doc 3 Agency Name: Domestic Violence Intervention Program Section 2: Client Profile ooo oot 1. How many Johnson County residents (Including lC & 1 Unduplicated Count 10876 I I 190 Coralville) did your agency serve? crisis calls are all of Johnson County and not broken out. 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 658 924 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 138 71 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 82 Female: 1016 Caucasian 641 6-17 155 Male 174 African American 372 18-29 358 Unknown 10,000 Hispanic 53 30-61 371 10,000 crisis calls. DVIP does not Asian/Pacific lslander 24 62-75 5 calculate client profile (the Native American 12 >75 unknown 10,219 unknown figures) Unknown 10,088 3. Briefly describe your service population. DVIP serves adult women and men victims of domestic abuse, their children and loved ones. Johnson County residents receive support, advocacy shelter and education. DVIP serves a larger population other than victims of domestic abuse. It is our mission to educate the general population about domestic abuse issues so that the public can then seek for themselves or refer someone they know to be a victim to DVIP. 4. How do you determine eligibility for services? The primary eligibility determination is that potential clients identify themselves as having been affected by domestic violence. This can include a person who is a victim ora direct act of domestic abuse or someone who is a support person to a victim. Secondary victims are people who are close to the victim and are victimized as a result of the primary person being victimized, such as the victim's children. Other eligibility factors include danger level and capacity. The DVIP shelter and outreach programs are often at capacity. As a result, DVIP can only take in women who are in the most physical danger. Another determination for eligibility is location. DVIP serves primarily Johnson County residents. When we serve a resident from outside the area DVIP staffmust first speak to a referring agency and assess the woman's situation. Eligibility for DVIP's Youth Program is limited to children whose parent is receiving DVIP services. 5. Are there fees for your services? Yes No x 6. Do you provide services to areas outside of Johnson County? As of December of 2002 DVIP will not serve clients outside of the Johnson County area, with the exception of a support group in Washington County. Until Dec. 2002 we will serve, Cedar, Iowa, Jones and Washington County. There are not enough funds available from these counties to continue services beyond that date. Until December 2003 DVIP will serve these counties on an on call as needed basis. DVIP averages 3 calls per month from these other counties. Area(s) served: Washington County (See above jccoghs\fundingform.doc 4 Agency Name: Domestic Violence Intervention Program Services Provided: There will be a two-hour support group held in Washington County each week. Funding Sources: The Washington Coalition Against Domestic Violence has raised enough funds to operate a support group. This is a reimbursable claim. Section 3:Communi .ty Relations 1. How do you assess satisfaction with your services? a) Client: Every client leaving the shelter program is given an agency evaluation form to fill out before they depart. An envelope is provided and the filled out form is put in the program director's mailbox. Every six months information is compiled and shared with staff that assess the information and evaluates whether or not changes need to be made. b) Community: A community survey is sent every three years to DVIP donors, collaborating agencies and other interested persons. This information is also compiled. Once compiled the information is utilized at DVIP board strategic Planning sessions and DVIP staff retreats. The last survey to the public went out in 1999. Another survey will be developed and sent before the next fiscal year. 2. Briefly summarize your findings: a) Client: Two things were evident in the client evaluation this year. First, the lack of affordable housing is a concern. Single women, working a full-time minimum wage job find it extremely difficult to stay in the area. The second finding had to do with women wanting a longer follow-up program after they leave the DVIP shelter. b) Community: The most consistent feedback we received was about DVIP's public relations. Many felt that we were not in the media enough. 3. What changes have been made in response to these findings? a) Client: DVIP started a focus group with staff, the Iowa City Iowa Coalition Against Domestic Violence Public Policy staff and recent past residents to discuss options about housing and follow-up programs. This group is an on-going group, however, discussions have generated ideas about how DVIP can be of more help once a client leaves shelter, particularly if they are in a transitional housing program. One idea that the group set as a goal was for DVIP to make staff available, on-site, at the transitional housing programs in Iowa City. This option is currently being evaluated. b) Community: DVIP has made strong efforts in the last two years to be in the public eye. DVIP has had small ads in the advertiser, many radio spots and better advertising when fundraising events are hosted. A more recent endeavor has been a PR project to include the University coaches in four public services announcements to be aired after November 15th 2002. In addition, DVIP has planned for two radio spots in December and January. The DVIP Board Education Committee was formed in 2002 and is tasked with supporting the DVIP mission of educating the community about DVIP and domestic abuse issues. jccoghs\fundingform.doc 5 Agency Name: Domestic Violence Intervention Program 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. 60% Word of mouth: Past clients, relatives and friends of past clients 20% Other shelters: Primarily Emergency Housing Project 10% Local Police and Law Enforcement Agencies: Coralville, Sheriff, ICPD, Campus PD, 10% Department of Human Services, Mid Eastern Council on Chemical Abuse (MEECA), Mercy Hospital and The University of Iowa Hospitals. 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? DVIP offers an unduplicated service in the Johnson County Community. DVIP offers the only shelter and programs for adult/children victims of domestic abuse. The United Action for Youth agency provides domestic violence services to teenagers. DVIP also offers services for teenagers whose moms are receiving services at DVIP. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Since 1980 DVIP has offered the only shelter program to victims of domestic violence. It is our belief that DVIP is an unduplicated service in the Johnson County area. In past years, DVIP not only offered services to battered women and their children, the agency has been instrumental in being activists to change laws so that victims would be safe in the communities in which they lived. In recent years DVIP expanded from crisis intervention, adding a prevention component to women and youth. Crisis intervention services remain the primary services, allowing victims immediate safety by entering the shelter in a confidential setting (the address is not advertised) and assisting with Pro-se No Contact Orders. Prevention services are defined as educational programs such as groups addressing the dynamics of abusive relationships, the affects of domestic violence on children and safety planning. Much of the work we do is educationally based, from teaching parents alternatives to physical discipline to helping adults recognize the warning signs of controlling behaviors and characteristics of an abusive parmer. In an effort to assist women with the skills and knowledge of being independent, DVIP offers Personal Economic Program training so that women can be knowledgeable about budgeting for the long range, even with very little income. jccoghs\fundingform.doc 6 Agency Name: Domestic Violence Intervention Program 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Johnson County Coalition Against 1. Local organizations meet monthly. Focus Domestic Violence is educating and raising awareness to the community about domestic violence issues. 2. Department of Human Services 2. DVIP is asked to attend multidisciplinary meetings on a weekly basis, discussing joint DHS and domestic violence cases. 3. Domestic Abuse Investigation Team 3. Local Law Enforcement, Prosecuting Attorney, Batterers Education Program Coordinator, both hospitals and DVIP Advocate review court domestic abuse cases once a month to make sure cases are being acted upon from a community response model. Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1 .State Crime Victim Assistance Division funds 1. Agency restructure and trying to keep as have been eliminated from state budget many of our services as possible. DVIP is ($74,000) working with the Iowa Coalition Against Domestic Violence to lobby funds back into the state budget. 2. Fundraising 2. Board receiving two trainings specific to fundraising: "Board Fundraising" and "Direct Ask". The board is also evaluating the concept of"events" verses a Large fundraiser, verses direct asks. jccoghs\fundingform.doc 7 Agency Name: Domestic Violence Intervention Program 2. In what way will the needs of your service population change in the next five years. a) Crime prevention for younger youth will be an issues; down from age 11 to age 7. b) An increase in the number of people seeking shelter due to the decrease of 64 affordable housing units that will be available in Iowa City this year and more next year. c) National Insurance Companies are limiting coverage for counseling and mental health services. This will cause an increase of people seeking free or sliding fee scale counseling services. d) Limited community resources as well as limited DVIP services (due to state cuts) will keep women and children in dangerous situations. These limited resources include: limited shelter spaces, less individual counseling, less education about domestic violence issues, less affordable housing in the community, welfare reform reaching the 5th year meaning women will be kicked off the welfare system and will need more resources such as housing and day care, less available cash funds for rent deposits and the University Hospital losing 16 beds in the Psychiatric Ward will result in more calls for shelter from the mental health population. 3. How do you plan to address these changes? Obviously DVIP does not have the resources to address all of these issues. DVIP will be undergoing a restructuring plan that will have a positive impact on our service delivery. DVIP is restructuring how we provide overnight shelter coverage, putting most of our professional staff resources into day/evening positions. This will minimize the impact of state funding cuts on our services. At this time DVIP has every intention of providing the same shelter services as we have in the last year. We will decrease individual counseling services while increasing support group opportunities in an effort to reach as many people seeking services as possible. We will also have less face-to-face contact but have more phone contact. DVIP will continue all of its collaborations, working with area agencies to assist those in need. DVIP will continue its participation on the Juvenile Crime Justice Committee. 4. Describe the evaluation methods you use to measure the success of your services? The evaluation method that DVIP currently uses is an annual staff retreat in which goals and objectives are determined. During the year several follow-up session are set to determine what goals have been met, what goals will not be met and how we will meet unmet goals. DVIP also uses a client evaluation tool to determine our success with the population we serve as well as our annual statistics. These figures along with client feedback are used in staff meetings and the annual retreat to evaluate services and gaps in services. 5. What are the results of these evaluations (outcomes)? DVIP does not use a specific tool to measure outcomes, however, two staff trainings are set to start this very process. With the purchase of the United Way "Measuring Program Outcomes: A Practical Approach" DVIP will receive training on outcome measures. Another training set for this winter is specific to evaluating domestic violence programs. This training also incorporates outcome measures. DVIP does keep statistical information. Last year DVIP provided the following: DVIP served a total of 1,2 ! 4 People. Those individuals received a total of 22,017 DVIP services, averaging 18 types of services each. DVIP provided 6,762 nights of safety (shelter); the average length of stay for shelter residents was 33 nights. DVIP's volunteers spent 2,466 hours volunteering, and DVIP reached 3,540 people through speaking engagements. DVIP was on the radio, on TV, or in the newspapers 20 times this last year. DVIP also served 11,245 people on the 24-hour crisis hotline. 6. How do you plan to use the evaluation results to enhance/extend your services? We currently use the goals/objectives method, along with our client evaluation to assess services. The follow-up sessions and client evaluation focus groups are used as a time to discuss what is working and what is not working and to discuss necessary changes. j ccoghs\fundingform.doc 8 Agency Name: Domestic Violence Intervention Program 7. How do your programs/services impact the community? 1) Shelter, support, education, advocacy to over 1,200 people 2) Over 11,000 crisis calls (crisis line available 24 hrs. a day) 3) Children remain in school (DVIP has a 48 hour registration policy) 4) The Johnson County community is safer through DVIP's educational efforts. DVIP provides education and consultation to area hospitals and local law enforcement setting domestic violence protocol. We educate the public at large by offering speaking to civic groups, church groups, schools, local human service agencies, and colleges. 5) Community Advocacy has grown. As the Johnson County community becomes more aware of the dynamics of domestic violence and the services available to victims and perpetrators, they in turn become stronger advocates to oppose such behavior. 8. How did the agency respond to the UWJC recommendations from last year? 1) Last year the panel recommended making DVIP's goals and objectives clearer. DVIP completed this year Strategic Planning Session in August. Goals and objectives are being finalized. A list of goals and objectives will be sent to United Way. We recognize this is no longer asked as a requirement on the grant process, however, for the sake of accountability, DVIP will get them to United Way this year. 2) It was also suggested that DVIP develop a stronger program evaluation and measuring tool for services. This, as I mentioned above is in process. Two trainings have been set and Outcome Measures will be put into place this FY. jccoghs\fundingform.doc 9 Agency Name: Domestic Violence Intervention Program Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) See Attached 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? 3A of members meet consistently 4. How is the board involved in strategic planning and governance of the agency? The DVIP Board of Directors has a Strategic Planning Session on an annual basis. The last three years DVIP had hired a strategic planning facilitator. This years focus is the process of raising funds for the agency. The board was able to answer the following questions by the end of the session: a) what do we need the money for, b) How much is needed, c) what resources do we have, d) how can we raise the funds, e) what are the cost and risk of each option in d, and f) who should do what? 5. What type of training/orientation do board members receive? DVIP has a well-developed board orientation and training process. Once voted onto the board, new members meet with the Executive Director and Board Chairs. The orientations consist of the following components: tour of the facility, an introduction to employees, a brief history of the agency, a brief history of board involvement, staff and board role definition, and a thorough briefing of the board manual. DVIP's board is committed to on-going agency development. In the last year development activities have included: and training about fundraising, board involvement in fund, raising, and how board fundraising ties into the agencies budget; another training about "Direct Ask' fundraising is set for October 15TM. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Yes, DVIP does have a policy for investments, stocks and a check signature policy. These policies were approved in 1999 and reviewed every other year. 7. Have you filed the annual report with the Secretary of State? If yes, date filed? March 2001 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? November 2001, this year is in process. If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes If yes, Who completed the audit? Clifton and Gunderson LL P How much did the audit cost? $4375 jccoghs\fundingform.doc 10 Agency Name: Domestic Violence Intervention Program If material weaknesses are noted in the audit, what is your plan for addressing them? The only material weakness noted was segregation of duties. The auditors also noted that DVIP is a smaller agency and measures are taken to lesson liability. If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers YES 1 million a. fiduciary liability b. employment practice liability General Liability YES 1 million/ 2 million Umbrella Liability NO Professional Liability YES 1 million/ 2 million Property or Renters YES-Property 766600 bldg 57500 contents Vehicle YES 300,000 liab jccoghs\fundingform.doc 11 Agency Name Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Cris Kinkead has been employed as Executive Director ofDVIP for 10 years. She workedas the Director of another domestic violence program for 3 years prior to coming to DVIP. Cris has 18 years experience in the field of domestic violence. She has an AA Degree and she is a Certified Domestic Abuse Advocate II. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent -- Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Shelter Coordinator X X X $20,800 to $31,200 4.00 3.75 0 Shelter Coordinator PT X ~ X X $10.00 to $12.00 per hour 1.75 .90 0 Executive Director X X X $39,000 to $50,000 1.00 1.00 1.00 -- Director of Finance X X X $28,000 to $40,000 1.00 1.00 1.00 -- Director of Shelter X i X X $28,000 to $40,000 1.00 1.00 1.00 -- Services Director of Youth X X X $28,000 to $40,000 1.00 1.00 1.00 -- Services X Director of Advocacy X . X $28,000 to $40,000 .65 1.00 1.00 Services Director of Outreach X X X $28,000 to $40,000 .35 0 0 Services Director of Education X X X $28,000 to $40,000 .35 0 0 Counselor X X X $20,800 to $31,200 1.00 1.00 0 Youth Advocate X X X $20,800 to $31,200 1.65 1.65 1.65 Furniture Project X X X $20,800 to $31,200 1.00 1.00 1.00 Coordinator Furniture Project Asst $9.00 per hour .15 .20 .15 Outreach Advocacy X X X $22,880 to $31,200 0 0 3.20 House Manager X X X $5.25 per hour 0 0 2.00 Americorps X $9,000 to $9,600 1.75 2~50 .75 SUBS [ TOTALFTEs 16,75 16.00 13,75 Agency Name: Domestic Violence Intervention Program 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 16 FTE 4. How much was spent on staff development in the last fiscal year? 1175 5. How much is budgeted for staff development in this fiscal year? 2000 6. What training and support opportunities are offered to staff. DVIP staff in-service trainings: Diversity in Action; Boundaries; Hoops and Fences; Communication styles; Problem Solving Techniques; Time Management; Self-Care; Public Relations. Local Community Training: Rape Victim Advocacy; Substance Abuse; Community Mental Health; Housing Issues; Gay/Lesbian/Bi-sexual/Transgender domestic violence training; People with Disabilities; Adolescents with Mental Health and Leadership training. State Training: AmeriCorps; Victim Advocate Training; Certification-Expert Witness, Administrative and Level II. Other: Employee recognition, celebrate birthdays, free vacation day when giving to United Way. 7. Please attach current organizational chart as Appendix B. See Attached 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3% Yes No If no, brief explanation 9. Does your agency X DVIP's Personnel Policies are reviewed every other year have personnel and more if needed. policies? If yes, date board last reviewed? 7/02 10. Does your board X There is five parts to the Executive Director's Evaluation, annually evaluate they include: a review by the whole board; a review by the director's board committee chairs; an external review by community performance? and state agencies/members; a review from internal DVIP program directors and a self-review by the ED. 11. Does your agency X have job descriptions for every position? If yes, date of last board approval? Feb 2002 12. IS there an annual X The staff performance review was overhauled this year. performance Reviews are based on DVIP's mission, policies, ethical review for every guidelines, and job descriptions. Program Directors review staff? is similar to the ED's with a few modifications; it includes a staff review, a community review, a self-evaluation and an evaluation by the ED. There is not a board component. jccoghs\fundingform.doc 13 ~ I i IAgency: Domestic Violence Intervention Program / Section 7: Financial Management A. Three Year Historical Balance Sheet ~ ~ .......... ' (As of ),our fiscal ),ear-endI?[ i Current Assets ' Current Liabilities Cash _ _ ~568361 92965~. __ 1_3~_90C~ ........ A__c~_o__u.0_t_s Payable 494 4821 ] 4757 Accounts Receivable ~ 1698 C Compensated absences ...... ~8~39~8_~__ _1_4__9_241 . _ 12903 __ ~fan_ tR_~e~_~i~vabl~e ............. _~3_60~3_ ._ ~_5.6_8~ 2_8_7~_~ A~__ru_ed payroll 7162i 9805 8360 Pledges Receivable 8135 5260 2601 Deferred revenue~ .................. ~01 1260 0 Prepaid Expenses 5028 6854 5382 Other 8004 8004 8004 Total Current Assets $103,60,i $132,460 $176,60~ Total Current Liabilities $24,058 $38,814 $34,024 Other Assets Other Liabilifiss Land .... _85. 0_.0~- _~_ 8~ __5~__0_ _ ___8__500C _Mortgage Payable-Balance 35036 0 0 Building & Improvements 552762 552762 552762 Long Term Liabilit), 63972 55968 47964 Equipment 39387 58354~ 7682c~ Total Other Liabilities $99,008 $56,968 $47,964 Vehicles 22600 412031 43203 Total Liabilities $123,066 $94,782, $81,988 less accumulated depreciation ----- ~ - ~;1~1~--~'~-~6~ ...... ~Net Assets $546,392 $616,386 $666,786 Total Non-Current assets $684,856 $578,708 $672,174 Total Assets $668,458 $711,168 $746,774 Liabilities & Net Assets $668,458 $711,168 $746,774 Under Current Liabilities: 1. Compensated absences is accrued vacation as of end of fiscal year. ............................... 2_.."~Oth~e~' is current year amount of CDBG forgivable loan. Under Other Liabilities: Lon~l Term Liabilit~ is CDBG for~livable loan carried to FY09. Agen~cy: Domestic Violence Intervention Program B. Income & Expenses FY02 FY03 FY04 Income Local Funding Sources i I-(~w-~'~ity .... 5_4256i 54256_j~__ 56968 requ_e~_ting 5% increas_e_ Coralville 3000 3300 3480 requesting 5%.i~nc_re~ase Johnson County 54065 54065 56768 requesting 5% increase United Way-Allocation__ 49909 49738; 52224 requesti~. 5% increase ............ _-.~esignated Givin~ 14923~ 13660 13660 Grants-Federal, State, Foundation 399558' 374654 300000 CVAD funds eliminated Contributions/Fundraising ....... 99033 69500 75000 Investment Income 1053 1200 I' 900 rates decreasing ...... Other 2379 484T~- 0 ...... ,! ...... FY03 is YT--D~ Fy04 is Restricted Income 47323 9157 0 unknown at this time Total Income $725,499 $630,014 $559,000 Expenses FY02 FY03 FY04 _ ~Wages & Salaries 421808 425600_~_ 360000 staffing reductions Benefits 81103i 88000 75000 due to budg_et_cuts Occupanc~y_ ........ 51462 54751 54000 Non-Occupancy 81110 70217~ 70000 I FY03 is YTD, FY04 is Restricted .Ex~oenditures 4395_81 15000 0 unknown at this time Total Expenses $679,441 $653,668 $659,000 C. Fund Balance FY02 FY03 FY04 Revenue 725499 630014 559000 Carryover Balance from previous yr 59787 90224 59787 Total Operating Budget $785,286 $720,238 $618,787 Less Total Expenses 679441 653~T--559000 Ending Fund Balance $105,845 $66,670 $59,787 Less Restricted Bal (explain) 15621 68~ 10255 youth svcs, direct aid Carryover Fund Balance $90,224 $59,787 $49,632 ~.gency: Domestic Violence Intervention Program D. Bd/Donor/Funder Restricted Funds Designated for: FY02 FY03 FY04 Americor~_s Salades & benefits 9683 12907 360C CDBG/Landfill ~e_Pr~ect 43016 39000 3900(3 Crime Victim Assistance Division Salaries & benefits 82930 71632 Eme~ency Shelter Operations.__ ..... 17600 176-0_0_ _ 1760(3 Family Violence Prevention Salaries & benefits ~.~50151 472~2.5_ ... 5000(] FEMA Food, Household 4903 5126 520(3 .. Violence Against Women Jones County, DA_R_T_ 19398 2904 178_0_{ 145237 148354 145001 VOCA Salades & benefits i E. Central Iowa United Way Iowa & Cedar Counties --1-428 ..........0 0 Chase Manhattan Bank Youth staffing ..... 15000 2~00-0_ 2000(3 Johnson County Juvenile Cdme Prevention IYouth s~ffing 9257 ___~5_00 1000(3 Total Restricted Funds $398,603 $374,248 $308,200 E. In-Kind Support: FY02 FY03 FY04 Direct Svc, Clerical, Services/Volunteers Maint:_Hr~s (~$14.81 250000 250000 Food, Household, Material Goods Clothin ,~n~n~n~n~n~n~n~q~sc. 21500 2250(3 ! 22500 ~storage, utilities, office space, Utilities, etc. and mtg spa~ce I 7500~ 10000 1000_0. Other (Please Footnote/ Total In-Kind Support $279,0001 $282,500 $282,500 F. Matching Grants Description/Purpose FY02 FY03 FY04 Emergency Shelter Grant staff salaries 1760(31 ........ 17600 _1_7.6_00_ Family Violence Prevention volunteer hrs @ $14.81__ 50151 47225 50000 VOCA volunteer hrs ~ $14.81 145237 148354 145000 Total Grants $212,988 $213,179 $212,600 Domestic Violence Intervention Program] NAME ADDRESS COMMIT. BOARD Term Officers Apicella, Agnes Adjunct Faculty UI Solon Personnel Apr. 99-Apr. 03 Education Brown, Mary Prairie Restoration Iowa City Treasurer Finance Oct. 0J-Oct. 04 Corlette Kris Attorney Iowa City Co-Chair Education Jan. 01-Jan.04 Executive Cox, Lois Attorney Iowa City Co-Chair Personnel Dec. 00-Dec. 03 Executive Hollingsworth, Jeff Accountant North Liberty Finance Jul. 00-Jul 03 Kronlage, Paul Financial Consultant Epworth Finance Jun. 00-Jun. 03 Muzzin, Paulina Community Volunteer-- Attorney Coralville Events Oct. 01-Oct. 04 Spaight, Lynn Program Officer~,k~r Cedar Rapids Iowa City Recorder Events Mar. 00-Mar. 03 Foundation Executive Joan Tephly Retired Teacher Iowa City Education Apr. 01-Apr. 04 Zell, Philip Astronomer Iowa City Events Apr. 99-Apr. 03 DOMESTIC VIOLENCE INTERVENTION PROGRAM Organizational Chart DVIP Board of Directors Executive Director, FI Cds Kinkead Finance, FT Advocacy Services, FT Services, FT Services, FT Shed Gilds Kdstie For~mann Doser Sue Randall Delaney Dixon · Program ,, Community Advocacy * Mon-Fri. 9a-5p, FT · Youth Coordinator, Assistant Services Coordinator, (Angle Madsen) FT (Sue Sass, FT · Tues-Fd. 4:30-10:30p (Jaron Varner) Tara Leonard, Amedcorps (Open Position) · Youth Advocate, PT Work Study Niki Kanaby, Amedcorps (Sara Green-Otero) Volunteers Nicole Baldwin, Amedcorps) · Tues-Thurs, 9:30p- Americorps 9:30a, FT · Youth Advocate, Interns · BEP, 3 hours weekly (Mary Ann Pedde) Americorp (Tara Leonard) (Matt Rosberg) Men 10p~8a and Fri · Washington County 9:30p-8:30a Support Group Facilitator, (Marlene Clowers) 3 hours weekly Work Study (Chris Bergren and Saturday 8a-6p Volunteers Marlene Clowers) (Tara Leonard) Americorps · Furniture Project Sat 6p---Men 9:30a, Interns Coordinator, FT FT (Chris Bergren) (Atria Buresh) · Program Assistant, 13 hours weekly (Tara Leonard) York Study Volunteers Americerps Interns Work Study Volunteers Americorps Interns Section 1: Background Agency Name: Elder Services, Inc. Address: 2947 Sierra Ct. SW Phone: 319-338-0515 Iowa City, IA 52246 Director Name: Connie Benton Wolfe Signature: Bd. Pres Name: Joyce Carman Signature: (/ / / Request Completed By: Connie Benton Wolfe Date: SepteYnber 27~ 2002 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total 47,383 49,320 54,252 4.26% FY 02 FY 03 FY 04 62, 063 62, 063 65, 000 5. 11% 21, 850 19, 665 45, 000 3. 53% ~ of Coralville 2, 800 3, 080 5, 000 .39% What were local funds used for this year: Chore, Home Repair/Modification, Respite/Companion, Assessment & Intervention What will next year's local funds be used for? Nutrition, Chore, Home Repair/Modification, F~espite/Companion, Assessment &/ntervention Agency Mission Statement: The mission of Eider Services, lac. is to enhance the quality of life of o/der persons by providing affordable, high-quality home and community-based services in east-central Iowa. The agency will offer support to family caregivers to enable them to remain active participants in both arranging and providing care for their family members in need of assistance. E/der Services will invite community volunteers to invest in the care of vulnerable elders through supervised programs and will promote meaningful, reciprocal, community involvement by creating opportunities for o/der persons to contribute through intergenerational volunteer opportunities. Summarize your programs and services for which you are requesting funding: E/der Services,/nc. has grown to provide multiple services for seniors and their family caregivers in Johnson County. These services are grouped under five divisions within the agency and include: Agency Name Elder Services, Inc. · In-Home Support Services Nutrition (Congregate & Meals on Wheels) Chore Respite Home Repair/Modification · Geriatric Care Services Information & Benefits Analysis Geriatric Assessments Care Plan Development & Service Referral Care Consultation Long-term Care (Case) Management · Case Management Facilitation for Frail Elders Multi-County, Multi-disciplinary Case Management Facilitation for Frail Elders Resource Enhancements for Multi-County Case Managers Legal Case Management Specialist Memory Loss Education Specialist Family Caregiver Counseling Specialist · Family Caregiver Support Services Nation-wide referral and service linkage Family Caregiver Counseling · Productive Aging Services Retired Senior Volunteer Program Collaborative School Program Collaborative University Program Friendly Visiting Program Homeland Security Program List any accreditation and licensure your agency currently has. Explain. Elder Services, Inc,, as a direct provider of community services, does not fall under a category of specific accreditation and/or licensure. However, key positions within the agency do require professionals with licensing to ensure the highest quality standard in care for our aging clients. The Elder Services, Inc. Geriatric Care Team is under the direction of David Purdy, Licensed Social Worker. Our Case Management Facilitation Program for Frail Elders is under the direction of Chris Forcucci, Registered Nurse and Certified Geriatric Care Manager. Our Nutrition Program for eldera is under the direction of Diane Flemming, Licensed Dietitian. The Family Caregiver Support Program is under the direction of Steve Siglin, MSW. Our Memory Loss Education Specialist is Lavon Yeggy, Registered Nurse with Geriatric Specialization. j ccoghs~funding form.doc 2 Agency Name Elder Services, Inc. Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Elderly Services Agency was founded in duly of 1980 to serve people 60 and over in Johnson County. /ts original mission was to help older people remain safely in their homes as long as possible by coordinating, and delivering paid and volunteer services. ESA started with a director, a ha/f-time chore worker and a receptionist. In 1984, we trained 50 student volunteers to visit and call our frei/er o/der clients. A shared housing program began in 1985. In 1986, the Board of Supervisors contributed funding to the agency; we also started a sma//housing repair program with $1,000 from Iowa City. In 1988, Gannett Foundation awarded ESA $45,000 to start a case management program. After the grant period ended, the City, County, United Way and the Heritage Area Agency on Aging picked up the financial support for this program. In 1990, the state funded the Retired Senior Volunteer Program. In 1993, the year of the flood, ESA spent a tremendous amount of time and staff effort in the clean-up effort. Also in 1993, ESA and Ecumenical Towers sent a survey to 600 randomly selected elderly to determine unmet needs related to remaining in their homes. By the end of 1995, ESA computerized reporting/recording efforts. In 1996, RSVP began its association with the Iowa City School District, working with o/der volunteers to staff programs to help students learn and improve academically. Also in 1996, Heritage AAA provided a grant for assessment and intervention. Case management expanded to serve Iowa and Washington counties. In 1999, RSVP won an annually renewable Federal grant to support its efforts with the public schools. RSVP also won a Community Involvement in Education Award from the State of Iowa that year. In spring 2000, the Board of Directors acted to relocate the administrative and clinical staff to a new office in southwest Iowa City, opening the door for agency expansion. Also in 2000, the agency officially changed its name to E/der Services,/nc. (ES/) and adopted a new logo. Staff grew to include a full- time rural geriatric social worker, an additional part-time Iowa City/Coralville geriatric social worker, and a part-time systems administrator. In 2001, E/der Services, Inc. added Cedar County to our service area for Case Management. Both Case Management Facilitation and Assessment and Intervention experienced unprecedented growth in FY01. Also expanding in this year was the Retired Senior Volunteer Program, which won a new grant award to replicate its intergenerational programs to Iowa and Muscatine counties. In March of 2001, ESI added the Family Ceregiver Counseling Specialist to our staff end began to expand our support for family caregivers. In October FY02, a new full-time position to provide Legal Case Management services was permanently p/aced with ESI to serve Johnson, plus three other counties. This year... E/der Services expanded its service offerings by assuming the responsibility for operation of the Johnson County Senior Nutrition Program. This program includes congregate meals in Iowa City, Cora/vii/e, So/on, and Hills plus home-delivered meals (or Meals on Wheels) for the county. The agency has worked hard to integrate the nutrition program into the system of care established for elders and to expand the service options for clients to include second meals, nutritional supplements, and menu choices. Family Caregiver Assistance Services were expanded to include community seminars and the development of support groups for caregivers. In addition, we added to our service mix the support of a Memory Loss Education Specialist to work directly with seniors and their family caregivers to help them deal with issues related to dementia and Alzheimer's disease. The agency established the capacity to electronically bill for Medicaid Waiver reimbursement and upgraded its fund accounting capabilities to allow for unit cost billing to grant, entitlement, insurance and private pay sources. j ccoghskfunding form. doc 3 Agency Name Elder Services, Inc. Section 2: Client Profile ~ ~ FY01 FY02 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 1,892 1,662' Coralville) did your agency serve? 2. How many lawn City residents did your agency serve? 2 Unduplicated Count 1,419 1,377 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 203 180 *Please note, the FY02 client statistics represent the first generation of statistics utilizing our agency management information system. In the past, data has been collected by individual programs and consolidated. Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-59 86 Female: 1,213 African American 9 60-69 336 Male 449 Native American 3 70-79 575 Asian 7 80-89 532 Hispanics 5 >90 133 Non-Minority White 1,638 3. Briefly describe your service population. Tho population that ESI serves falls into two categories: seniors and thoir carogivors. Our senior population is very frail, 87% require assistance with two or more activities of daily living; over 68% of them are considered Iow-income; approximately 20% live in rural areas. Our caregiver population also falls into two categories: spousal caregivers and/or adult children caring for elderly parents. Spousal caregivers make up 45% of our caregiver clients and are generally over the age of 65 themselves. Adult children caring for elderly parents are generally 45 - 60 years of age and represent a wide range of income levels. 4. How do you determine eligibility for services? In general, anyone over the age of 60 can call upon Elder Services for assistance. Eligibility for specific subsidized services is established either by the funding source or in collaboration with the funding source. For example, some of our primary funding sources have the following criteria: Older Americans Act Program Funds - Clients must be over the age of 60 and funds must be targeted to Iow-income, minority, disabled, frail and rural seniors. Medicaid Waiver and Senior Living Trust Funds are only available to seniors meeting both income and level of care guidelines. Retired Senior & Volunteer Program - Open to serve volunteers over the age of 55+ willing to work to achieve community impact in five priority areas. Home Repair/Modification - Open to clients residing in Iowa City over the age of 60+ and meeting Iow-income guidelines. 5. Are there fees for your services? Yes. X No__ If yes, please describe your fee structure: Elder Services is in the process of refining a sliding scale system to establish both recommended voluntary contributions and/or shared fees for its services. We are working first on our In-Home Support Sen/ices to establish full unit costs and then 4 tiers of recommended donations/fees. * j ccoghs\fundingform, doc 4 Agency Name Elder Services, Inc. This change is bein~l explored in response to the projected increase in demand for aging/caregiver services and in part because of consumer requests for private-pay services. An example of the sfiding scale being tested for the Chore program is included below: Monthly Income/ Monthly Income Unit Cost Client Co-Pay or Household Size 1 Household Size 2 Recommended (No asset restriction) (No asset restriction) Donation ** $0 - $739 $0 - 995 $15.00 $2.00/unit $740 - $1,109 $996 - $1,493 $15.00 $5.00/unit $1,110 - $1,366 $1,494 - $1,841 $15.00 $10.00/unit $1,367 + $1,841 + $15.00 $15.00/unit * At the time of this application preparation, this scale has not been finalized by the Board of ESI. It does, however, demonstrate the type of structured approach we are attempting to put in place. **Client Co-Pay or recommended donation may be reduced by ESI case management staff ff medical or other unusual expenses are noted. 6. Do you provide services to areas outside of Johnson County? Yes (Area Served; Service Provided; Funding Source) SOlM.¢e Johnson Iowa Wash Cedar Linn Benton Jones Mused. Des Funding Co. Co. Co. Co. C~¢': tO: Co: Moines (.OutSide Of Co. JohnsonCO~) Nutrition x x Medicaid Waiver Chore X x Medicaid Waiver Ilome Repair/ x Modification Respite/ x x Private Pay Companion Heritage Agency Assessment & x Intervention Case X X X X l leritage Agency Management Facilitation Memory Loss ~?:~ x x x uI College of : ;~3~ Nursing- US Adm. Education on Aging Grant ; Heritage Agency Legal Case : x x x x Management Aging Services Family x x x x x x x Heritage Agency Caregiver Counseling Retired Senior X x x x National Service & Volunteer Corps Iowa Dept. Elder Program Affairs jccoghs\fundingform.doc 5 Agency Name Elder Services, Inc. Section 3: Communi ,W Relations 1. How do you assess satisfaction with your services? (a) Client - Each of our/n-Home Support Services offered by E/der Services has both an ongoing mechanism for collecting client feedback as services occur and an annual survey method for more formally evaluating the service. For example, the congregate meals program asks daily for feedback on the quality of food, appropriateness of menu, portion sizes, etc. This is done with feedback cards p/aced on the tab/es each noon. A more formal evaluation of congregate nutrition occurs with an annual survey of all participants responding to questions that will allow us to evaluate whether the service provides the comprehensive nutrition interventions necessary for clients at significant nutritional risk, meets the needs of clients with special dietary restrictions, offers the variety of food types of appeal to this population, etc. (b) Community- The community provides satisfaction feedback to E/der Services in a variety of ways. For each of our programs with citizen review panels making funding recommendations, we receive a c/ear message of the perceived value of our Community services with the a/location process. Our own annual campaign also provides us with information regarding the community's satisfaction with and perception of our work. We receive feedback from the aging community via the Heritage Agency Advisory Council on Aging, the Johnson County Task Force on Aging, and the Johnson County Coalition on Aging. 2. Briefly summarize your findings: Satisfaction with the services that ESI provides is high. Clients tend to find our direct and clinical services quite responsive to their individual situations and needs and our staff extremely professional in their approach. 3. What changes have been made in response to these findings? Several changes have been made recently in direct response to feedback from clients and the community. For example, our chore program has been re-designed partially due to the feedback from clients about concerns related to the seniors being the "employer of record" for independent contractors. With this in mind, we now are offering chore services through the use of ESI employees and relieving the o/der client of this burden. In our congregate meal satisfaction survey, we received comments concerning the staffing pattern we had established in our downtown meal site. We have now changed that staffing pattern to add a meal-site manager to ensure that each client attending the program feels welcomed and is informed about other services available to them in the community. An example of utilizing community feedback for change is apparent with our Home Repair/Modification program. Our citizen review pane/expressed a sense that we should be looking for additional revenues in a more aggressive/creative manner and that large home repairs should somehow be reimbursed to a funding pool. ES/is testing an entrepreneurial j ccoghs\funding form. doc 6 Agency Name Elder Services, Inc. approach to using our Construction Consultant to provide guidance to o/der citizens who do not financially qualify for the subsidized home repair program. In exchange for the professional expertise received, we receive a referral fee from contractors which then becomes part of the Home Repair/Modification program budget. We are also exploring the option of attaching a lien on property where modifications costing more than $3,500 are made to a dwelling. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Soume of Referral % of clients referred Other Human Service Agencies 35% Family/Neighbors/Friends 30% Department of Human Services 20% Hospital Discharge Planners/Physicians 10% Other (Churches; Police; etc.) 5% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Several organizations in Johnson County, who are members of our multi-disciplinary case management team, provide case management services for elders that may a/ready be their clients. Some of these organizations include: Visiting Nurse Association; Hospice; Mercy Home Healthcare; UI Home Care; and Pathways. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Elder Services, lac. specializes in service to elders and their caregivers. Our staff is professionally trained to deal with the complexities of reaching, reassuring, and working with this population. ESI is the access point for managing care under the Medicaid Waiver in Johnson County. Our clinical staff is trained to provide a comprehensive geriattfc assessment which establishes the level of care requirements for an individual We are generally considered the first place to call ff you are a senior or caregiver, and we consider it our responsibility to help guide the client into a full system of care, rather than meet only the presenting need. j ccoghs~funding form. doc 7 Agency Name Elder Services, Inc. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1.Family Caregiver Collaborations · The ESI Family Caregiver Counseling Specialist has worked with a group of Johnson County community agencies to develop and present a series of four very successful caregiver workshops in the spring of 2002. To accomplish this goal, we worked with Hospice, Mercy Hospital, UI Human Resources Department, Pathways Adult Day Health Center, and others. This group continues to work together to address caregiver needs in the community. 2. Case Management Facilitation for Frail · The model of case management Elders utilized in Johnson County is a unique multi-disciplinary collaboration. Over thirty health and human service providers (non-profit and for-profit) participate in twice monthly staffing sessions to provide peer review of case plans. The team also functions in the disbursement of Senior Living Trust Funds for Johnson County. 3. Memory Loss Education Specialist ° A collaboration with the University of Iowa College of Nursing lead to the development of a new pad-time position of Memory Loss Education Specialist. This nursing position provides training to case management staff and education for seniors and their caregivers suffering from the effects of dementia, Alzheimer's disease, and other memory loss. The work accomplished by this position is part of a greater study funded by the U.S. Administration on Aging to seek ways to improve services for Alzheimer's victims across the country. j ccoghs\funding form. doc 8 Agency Name Elder Services~ Inc. Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Expanding/Enhancing our Case ,~ Explore the potential for a partnership Management System for the Frail Elderly to with the University of Iowa to secure ensure care is available for seniors in the home modification assessments and least restrictive environment, assistive device consultations for Johnson County Case Management clients. · Seek funds to secure and expand to full-time the position of Memory Loss Education Specialist as a resource for Case Managers of Johnson County and their clients. · Work in partnership with the 2. Expanding services to assist family University of Iowa to seek applied caregivers and testing new interventions to research grants to advance evidence- support families in their decision making based practice in family caregiver role. interventions. · Develop aweb-presence to connect family caregivers for support and information. 3. Removing system barriers that prevent · Develop a network of Elder Services elders from accessing services and Benefits Checkup Stations for modifying our delivery models to promote Johnson County retirees. · implement a training program for all consumer choice and direction. Chore, Senior Companion and Respite workers. · Expand consumer choice options in our In-Home Support Programs. (i.e. nutrition and chore). jccoghs~undingform, doc 9 Agency Name Elder Services, Inc. 2. In what way will the needs of your service population change in the next five years? The population of seniors in Johnson County is projected to grow at twice the rate of other populations through the year 2020. The greatest growth wi//be among the population of 85+ seniors. Among those, it is estimated that over 50% will need some type of personal assistance with activities of daily living. Because our service population is o/der and frailer, their needs are for more comprehensive services. For example, a client who enters case management must meet a level of care criteria which would qualify them for nursing home care. In meeting this individual's needs while maintaining them in their homes, we must be able to provide a bund/ed package of nutrition, persona/assistance, home repair/modification, chore, and other services. We must find better ways to seamless/y integrate health care and human services to ensure that the senior can be sustained. In addition, the need to provide greater family caregiver support services will grow rapidly. And, because family caregivers continue to provide 80% of the care for persons over the age of 65 in this count/t, there is no better investment than to find ways to assist family caregivers to carry on. If we can extend the time a/ow-income senior is sustained at home with the help of a family caregiver by even one month, we can potentially save the state $3,500 in revenue to pay for nursing home care. 3. How do you plan to address these changes? /n preparation for the changes in the aging population, ESI is taking steps in the fo/lowing areas: · We are aggressively seeking new revenue streams to allow us to continue to expand the services available to seniors and their caregivers. These revenues include grants, contracts, entrepreneurial activities, and cost-recovery fees (when client income allows). · ES/is working hard to build in quality control and to enhance our interventions based on identified "Best Practices"in the aging network. · The Board and staff of ES/are committed to increasing opportunities for consumer choice and self-determination whenever possible and appropriate. This value is now formal/y stated by our Board in our agency Values Statement. Our Management Team is slated to begin a review of each of our services in 2003 to identify opportunities to build in consumer options and choices. 4. Describe the evaluation methods you use to measure the success of your services? A number of our key programs at ES/have developed or are in the process of refining outcome measures that allow us to track the effectiveness of our interventions. Some of the primary outcomes we are tracking include: · Case Management Outcomes - Database tracking of all case management clients for care indicators and length of client maintenance in program. · Family Caregiver Support Service Outcomes - Caregiver Support and Satisfaction Telephone Survey. This telephone survey contacts each of the family caregivers who have received services to determine their rankings of quality and effectiveness of caregiver services, impact of the interventions, and other satisfaction with other support services received. · Retired Senior VolunteerProgram Outcomes (forourschoolcollaborationprograms) Survey of involved teachers, survey of RSVP volunteers, value of services to school system. · Nutrition Program Outcomes (Planned for ?Y04) - Nutritional risk assessment of clients entering the Meals on Wheels program and after six months of nutritional intervention. j ccoghs~undingform, doc 10 Agency Name Elder Services, Inc. 5. What are the results of these evaluations (outcomes)? · Case Management Outcomes -In FY02, the average length of time that we sustained a client in their own homes after entering the case management program was 22.5 months. The value of this outcome to the state (assuming state payment of nursing home costs) was $78,750 average per client. · Family Caregiver Support Service Outcomes - In our telephone survey, 87% of caregivers served by our program felt that the services that they had received had enabled them to continue in their role of primary caregiver for a frail senior for a longer time than would have been possible without this intervention. · Retired Senior Volunteer Program Outcomes - Over 90% of classroom teachers involved indicated the program positively impacted their student's enjoyment of reading and thereby increased the student's potential for academic success. Volunteers contributed 4,920 hours of reading support to at-risk students. The value of this outcome to the school system is $49,200. 6. How do you plan to use the evaluation results to enhance/extend your services? ESI will continue to develop and refine its outcome data over this next year. We are better positioned to define and measure outcomes now because of our commitment to creating an agency-wide management information system. Outcome data will be shared regularly with Board and the ESI management team, We will use the impact of our services to help guide our plans to grow (through grant writing and/or fund raising, etc.) certain programs/interventions within the agency. 7. How do your programs/services impact the community? Our Case Management Program for Frail Eldedy provides the access point for Medicaid Waiver services. The value of those services in Johnson County in F¥02 was approximately $1.3 million. We have developed a model multi-disciplinary team approach to case management which has proven to be both effective for the client and expandable as case loads shift. In fact, we have one of the few case management programs for elders in the state of Iowa that does not have a waiting list. This is because of the collaborative model we have developed at Elder Services. In addition to Medicaid Waiver dollars, the Elder Services Case Management program piloted and refined utilizing the Case Management Team for the distribution of over $20,000 in direct service funds through the Senior Living Trust Purchase of Service Program. Johnson County's Retired Senior & Volunteer Program is considered a national model of intergenerational service. Our partnership with the schools has lead to the development of three models to assist students - Rock n Read; Speak Out; Partners in Reading. Each of these volunteer opportunities works to improve the skills of students at the same time that it blends generations for the common community good. The agency's In-Home Support Services often make the difference in whether an older person can remain at home or must look at alternative housing. Meals on Wheels and the Chore program are often the first service families seek for their elders and this provides an j ccoghs\fundingform, doc 11 Agency Name Elder Services, Inc. important entry point into a continuum of care that can help to maintain the senior in their preferred environment - their home - for as long as possible. 8. How did the agency respond to the UWJC recommendations from last year? ES/was very appreciative of the positive comments extended by the United Way of Johnson County last year. We continue to work very hard to expand, enhance and improve services for elders in our area. We are also committed to continuing on the path to development of outcomes and measuring impact of each of our services and interventions. This know/edge will allow us to better tailor our services for clients and their caregivers. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? The ES/Board of Directors meets month/y, with the exception of July and December. 3. What is your average attendance at board meetings? Our average attendance at Board meetings is 12. 4. How is the board involved in strategic planning and governance of the agency? The E/der Services, Inc. Board of Directors has demonstrated their understanding of their role in governance of the agency and their commitment to fulfilling that role as ESI has moved through a period of rapid growth and change. This past year the Board reviewed and revised the ES/mission statement and crafted both a Values Statement and Vision Statement to establish the guiding principles for our or- ganization. The Board regularly discusses our resource needs to carry out our mission and how we can enhance our capability to serve elders. Throughout the year, we schedule ali of our key management staff to report directly to the Board on opportunities, problems, shifting or special needs of clients, etc. for each of the agency's programs. This information is crucial to the Board in setting the broad agenda of the agency and staying in touch with the changing service environment of ESI. Key Board members have played a crucial role this past year in opening doors for some of our most important collaborative relationships. In particular, our relationships with several departments within the University of Iowa have expanded. The Board has been invaluable in working to introduce us to potential new donors, as well. The ES/Board of Directors is actively engaged in all aspects of planning for future needs of the senior and family caregiver population of Johnson County. We have a special Long- Range Planning Committee that takes the lead with administrative staff in developing and updating the agency's strategic plan. The Board of Director, in particular the Executive Committee, provides an important sounding board for the Executive Director of the agency. They are aware and respectful of appropriate j ccoghs\funding form. doc 12 Agency Name Elder Services, Inc. re/es for Board, staff leadership and staff. There is a high level of trust and respect and a true sense of '~teamwork' on behalf of the agency. 5. What type of training/orientation do board members receive? An annual orientation for new (and returning) Board members is scheduled within 30 days fo/lowing the annual meeting where new members are elected. Each Board member receives a notebook of written materials including our agency by-laws, policies, annual budget, and list of programs and staff. In addition, we include a list of basic responsibilities for non-profit Boards, an agency history, a Board roster, and a roster of agency funding sources. A Board Education Committee is part of the Board committee structure and it is their responsibility to ensure the ongoing education and involvement of Board members. There is a great deal of information shared with the Board at each meeting, including a complete review of agency financial and operational status. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Yes. These fiscal policies and procedures were approved on dune 26, 2001 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Mamh 18, 2001 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? November 15, 2001' If no to questions 6, 7, or 8, give explanation. * Our FY02 990 will be filed no later than November 15, 2002. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? How much did the audit cost? Dan Koskamp, CPA, C/iRon-Gunderson in Cedar Rapids, Iowa Cost $8,000 If material weaknesses are noted in the audit, what is your plan for addressing them? No material weaknesses were noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? NA 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X 100,000 b. employment practice liability X 1,000,000 General Liability × 1,000,000 Umbrella Liability .... Professional Liability × 1,000,000 Property or Renters X 68,000 Vehicle X '1,000,000 j ccoghs\funding form. doc 13 Agency Name Elder Services, Inc. Section 6: Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. The current Executive Director of ESI, Connie Benton Wolfe, was hired in March, 2000. Her educational qualifications include a BA in Social Work/Gerontology and a MA in Educational Leadership. She brings over 25 years of experience working in the field of aging, both at a local provider level and at the national level. She has provided training and consultation in the development of home/community services in over 20 states, Canada and Denmark. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X X 55,000 ~ 65,000 .80 .80 1.00 Operations Manager X X X 27,000 ~ 35,000 1.00 1.00 1.00 Fiscal Manager X X X 35,000 ~ 40,000 .50 1.00 1.00 Division Directors X X X 32,000 ~ 45,000 4.50 5.00 5.00 Clinical Staff: Social X X X 26,000 - 38,000 2.00 2.50 3.00 Workers & R.N. 's Program Coordinators X X X 22,000 - 32,000 2.75 3.50 4.00 Clerical Staff X X X 12,000 ~ 22,000 1.00 1.00 1.00 Nutrition/Kitchen Staff X X X 12,000 ~ 25,000 3.00 5.25 5.25 Chore/Respire Workers X X X 12,000 ~ 25,000 0.00 3.00 6.00 TOTAL FTEs 15.55 23.05 27.25 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? In FY02 (last year) 13.55 FTE's served Johnson County. 4. How much was spent on staff development in the last fiscal year? $2,816 5. How much is budgeted for staff development in this fiscal year? $4,500 6. What training and support opportunities are offered to staff?. ES/tries to encourage attendance at one national conference for its Executive Director and Division Directors. These may vary based on the position (i.e. National Family Caregivers Conference, National Conference of Geriatric Care Managers, American Society on Aging/NCOA Conference, etc. New information is then shared at the next scheduled agency staff meeting. j ccoghs\funding form. doc 14 Agency Name Elder Services, Inc. All Case Managers are required to complete a regional quarterly training at Kirkwood Community College. Various professionals working at the agency will participate in continuing professional education at the local or state levels, as appropriate. Ail of our In-Home Support staff are required to attend an annual training covering emergency responses, agency policies and procedures, and how to work with an aging population. Of course, all training opportunities are contingent on the budget. The Board and Executive Director of Eider Services are committed to making training and education available to staff. We encourage exposure to new ways of providing care and services and we constantly challenge our staff to pull new ideas into our agency from their educational experiences. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? The average wage increase was 3%. Yes No If no, brief explanation 9. Does your agency have personnel X policies? If yes, date board dune last reviewed? 2002 10. Does your board annually evaluate X the director's performance? 11. Does your agency have job × descriptions for every position? If yes, date of last board approval? 12. Is there an annual performance X review for every staff?. j ccoghskfunding form.doc 15 Agency: Elder Services, Inc. Section 7: Financial Management A. Three Year Historical Balance Sheet fas of )/our fiscal )/ear-end/ FY 00 FY 01 FY 02 Current Assets Cash $10,618 $12,489 $8,400 Investments $86,097 $40,285 $95,412 Receivables < 90 days $22,259 $44,787 $55,806 Other $887 $57,771 $13,729 Total Current Assets $119,861 $155,332 $173,347 Other Assests Property $0 $0 $0 Equipment $37,917 $65,193 $93,342 less depreciation ($28,172 ($29,073 ($38,528) Receivables > 90 days $0 $0 $0 Other $40,277 $42,862 $47,788 Total Non-current Assets $50,022 $78,982 $102,602 Total Assets $169,883 $234,314 $275,949 FY 00 FY 01 FY 02 Current Liabilities Accounts Payable $3,586 $16,303 $50,033 Payroll Taxes Payable $6,779 $0 $12,869 Contracts Payable $0 $0 $0 Mortgage Payable-6 months $0 $0 $0 Total Current Liabilities $10,365 $16,303 $62,902 Other Liabilities Mortgage Payable-Balance $0 $0 $0 Other $0 $0 $0 Total Other Liabilities $0 $0 $0 Total Liabilities $10,365 $16,303 $62,902 NetAssets $159,518 $218,011 $213,047 Liabilities & NetAssets $169,883 $234,314 $275,949 16 Agency: Elder Services, Inc. Last Year Current Year Next Year B. Income & Expenses FY02 FY03 FY04 Income Local Funding Sources ~owa City $62,063 $62,063 $65,000 Coralville $2,800 $3,080 $5,000 Johnson County $21,850 $19,665 $45,000 United Way - Allocation $49,320 $49,689 $50,553 - Designated Giving $7,907 $7,907 $7,907 Grants-Federal, State, Foundation $705,489 $863,519 $890,000 Net Sales of Service $33,731 $29,600 $50,000 Net Sales of Materials $18,232 $55,877 $66,776 Contributions/Fundraising $47,811 $81,944 $82,000 Investment Income ($1,830) $1,000 $1,000 Other $12,266 $20,140 $10,000 Total Income $959,639 $1,194,484 $1,273,236 Expenses Wages & Salaries $467,293 $597,855 $615,791 Benefits $104,329 $128,150 $153,948 Occupancy $57,773 $82,504 $84,979 Non-occupancy $114,959 $114,631 $118,000 Other- Program Expenses & Supplies $220,249 $277,344 $300,519 Total Expenses $964,603 $1,200,484 $1,273,236 C. Fund Balance Revenue $959,639 $1,194,484 $1,273,236 Carryover Balance from previous year $218,011 $213,047 $207,047 Total Operating Budget $1,177,650 $1,407,531 $1,480,283 Less Total Expenses $964,603 $1,200,484 $1,273,236 Ending Fund Balance $213,047 $207,047 $207,047 Less Restricted Balance (explain) $0 $0 $0 Carryover Fund Balance $213,047 $207,047 $207,047 17 A.qenc¥: Elder Services, Inc. D. Bd/Donor/Funder Restricted Funds Designated for: Last Year This Year Next Year Note - There are no restricted funds. Total Restricted Funds $0 $0 $0 E. In Kind Support: Last Year This Year Next Year ServicesNolunteers :Volunteer hours ~ $8.00 per hour$33,550 $67,200 $67,200 Material Goods $0 $0 $0 Space, Utilities, etc 3ffice Space & Senior Dining $29,496 $54,144 $54,144 Other: (Please footnote) Total In-kind Support $63,046 $121,344 $121,344 F. Grants Description/Purpose Last Year This Year Next Year Ecumenical Towers - HUD Grant Services Coordinator $40,778 $42,639 $45,000 CDBG - Small Housin`g Repair In Home Support $40,000 $40,000 $50,000 The Herita,ge Area Agenc¥ on Aging Assessment & Intervention $54,984 $53,334 $54,000 The Heritage Area ACjency on A~lin`g In Home Support $14,422 $13,989 $14,000 The Heritage Area Agency on Aging Count}, Facilitation $88,871 $86,205 $87,000 The Heritage Area Agency on Aging Family Care Giver $47,561 $46,133 $47,000 The Heritage Area Agency on Agin`g Purchases of Services $82,233 $74,133 $75,000 The Heritage Area Agency on Aging Alzheimer's Pro,gram $32,068 $22,200 $26,000 University of Iowa Memor~ Loss Specialist $0 $23,415 $25,000 The Herita`ge Area Aclency on A`gin`g Nutrition Pro`gram $221,960 $335,261 $340,000 Iowa Department of Elder Affairs RSVP $24,848 $29,542 $30,000 Corporation for National Service RSVP $57,764 $96,668 $97,000 Total Grants $705,489 $863,519 $890,000 18 """ ELDER SERVICES, INC. BOARD OF DIRECTORS 2002 President Joyce Carman 1997-2003 Keith Guillory 2001-2007 Iowa City Iowa City Retired Teacher Retired Professor Vice President Joan Parsons 1997-2003 Susan Boyd 1998-2004 North Liberty Iowa City Housewife Fiction Writer Treasurer Roberta Patrick 1996-2002 Iowa City Susan Saterfiel 2001-2007 Retired Iowa City Retired Director of Finance Don Saxton 2001-2007 Secretary Oxford Joan Buxton 1998-2004 Retired teacher Iowa City Chad Warren 2001-2007 Retired Nurse Iowa City Directors Attorney Kay Brown 2002-2008 Iowa City Barbara Womer 1996-2002 Retired Public Relations Specialist North Liberty Nurse Lynne Cannon 1999-2005 Iowa City Immediate Past President / Non-voting member Glenys Williams 1995 Chemistry Professor Coralville Tom Deprenger 2002-2008 Professor Emeritus (Geriatric Medicine) Iowa City UI Development Officer Appendix A Last updated: 9/27/02 Elder Services, Inc. COMMITTEE ROSTER 2002 EXECUTIVE COMMITTEE FINANCE COMMITTEE Joyce Carman, President Susan Satediel, Chair Susan Boyd, Vice-President Don Saxton Susan Saterflel, Treasurer Glenys Williams Joan Buxton, Secretary Glenys Williams, Immediate Past President (Ex Officio) EDUCATION COMMITTEE LONG RANGE PLANNING COMMITTEE Barbara Womer Roberta Patrick Joan Buxton, Chair Glenys Williams Lynn Cannon Keith Guillory (Chair to be determined) Don Saxton PERSONNEL COMMITTEE NOMINATING COMMITTEE Chad Warren, Chair Lynn Cannon Joan Parsons Barbara Womer Keith Guillory Joan Buxton (Chair to be determined) DEVELOPMENT COMMITTEE BY-LAWS REVISION COMMITTEE (AD-HOc) Tom Deprenger Susan Boyd Lynne Cannon, Chair Kay Brown Roberta Patrick Chad Warren Appendix A September 24, 2002 Elder Services, Inc. Appendix B Section 1: Background Agency Name: Emergency Housing Project, inc. Address: P O Box 3146, Iowa City, IA 52244 Phone:,338~- 5416 Director Name: Christina M. Canganelli Signature: Bd. Pre~ Name: Dorothy M. Persson Signature: Request Completed By: Christina M. Canganelli Date: September ~ 2002 Cheek Your Agency's Budget Year: 1/1-12/31 X 7/1-6/30 10/1-9/30 4/1/01- 411102- 411103- % 3/31/02 3/31/03 3/31/04 Total Needs Grants $32,100 $35,340 $51,550 13.54% FY 02 FY 03 FY 04 City of Iowa City $10,000 5; 14,000 $56,000 9.98% Johnson County $12,000 $11,400 $48,600 8.55% City of Coralville $1,300 $1,430 $2,500 .71% What were local funds used for this year: Local funds were used to pay for staff salaries and benefits not covered by grants, as well as some operational expenses. Local funds were utilized as matching dollars in order to leverage other grant dollars. What will next year's local funds be used for? Next year, local funds will be utilized to pay for salaries and benefits not covered by grants, as well as some operational expenses. Local funds will be utilized as matching dollars in order to leverage other grant dollars. In so much as the FY04 award amounts allow, local funds will be utilized to further stabilize the staff structure and increase access to the facility. Agency Mission Statement: The mission of The Emergency Housing Project is to meet the short-term needs of men, women, and children who are homeless in our community and to work in partnership with them to achieve maximum possible independence. Summarize your programs and services for which you are requesting funding: Emergency and TransitionalShelter: The Emergency Housing Project provides both emergency/transient and short-term transitional housing to men, women, and children, the disabled and elderly. In 2001, EHP provided shelter and supportive services to 725 individuals (610 persons unduplicated) for a total of 11,252 nights stayed. Women and children constitute about 30% of those sheltered. Veterans constitute about 15% of those served. The shelter component also consists of breakfast and a nightly meal, shower and laundry facilities, mailing address and message service for residents. There is one EHP counselor staffing the shelter per evening and overnight shift. This individual is required to oversee the Drop-In Center and evening meal, perform intakes with new clients, respond to both emergency and on-going needs of clients and others, answer the phone, coordinate volunteers, provide information and referral, and maintain a safe and orderly house. EHP remains open throughout the night~irectly assisting individuals in crisis throughout the night. This level of access has never been restricted to current residents of the shelter. EHP is requesting additional funding to provide for one part-time employee to cover weekend daytime hours (11:00 am 5:00 pm) during which the shelter is currently closed. Agency Name: Emergency Housing Project, inc. Drop-In Center: From 5:00pm - 10:00pm daily, EHP operates Johnson County's only evening drop-in center. The Drop-In Center is open to all in need--former clients, homeless persons not currently staying in the shelter, and other low and very low-income citizens of Iowa City, Coralville, and Johnson County. Men, women, and children utilize the EHP Drop-In Center Program for laundry and shower facilities, clothing and toiletry donations, an evening meal, a mailing address so as to receive mail, telephone use, messages, and most importantly access to EHP staff and outreach workers from community based mental health and substance abuse service providers. The VA Homeless Veterans Outreach Worker is also available on a consistent basis to address the needs of current clients who are veterans and of other veterans who may not currently be staying in the shelter but camping. In an average month, our services are utilized over 500 times by people not staying in the shelter--250 unduplicated persons in the year. EHP is requesting additional funding to provide for one additional full-time employee whose express charge would be to direct the operations of the Drop-ln Center, and assist patrons with needs. Currently this activity is absorbed as only one part of the shelter coordinators overall evening duties. The hours between 5:00pm - 10:00pm are extraordinarily hectic with more than 45 persons coming through the house for the Drop-In Center services, basic shelter services, and requests for new intakes each night. With the addition ora Drop-ln Center Coordinator, the Shelter Coordinator would be able to focus on the intake, assessment, and other housing counseling needs of clients. In-House Counseling: Anyone intending more than a transient stay is expected to participate in the In- House Counseling Program, a recently HUD certified Housing Counseling Program. EHP staff work with participants to design their own self-sufficiency goals and then agree in writing to pursue them. Roughly 90% of all EHP clients participate in the counseling program. Participants may stay for a maximum of 90 days in so much as they remain compliant with house policies and programmatic requirements. Staffwork with clients to access community resources addressing needs as basic as a pair of glasses or work boots, to a social security card, bus passes, any mainstream public assistance for which the client may qualify, child care, medical and dental care. Clients are expected to address substance abuse and mental health issues where relevant. Staffwork with clients and assist with finding and/or maintaining gainful employment and with housing searches. Staff work with clients to address budgeting, money management, and life skills. Clients are expected to save up to 75% of their earnings while staying at the shelter to be utilized towards the costs of setting up their own households. We regard our work with clients as a partnership--an interactive agreement between EHP staff and the individual--responsibility borne on both sides. John E. Thomas Security Deposit Assistance Program: One of the primary goals of EHP is to facilitate the transition of our clients into stable affordable housing. It is not uncommon for a family to face as much as $1,200 in upfront costs to obtain rental housing. In July of 2001, EHP was able to capitalize the Security Deposit Assistance Program with a public grant award of $5,000 and a private gift of $3,000. In the first year, a sum total of $5,500 was expended towards security deposits totaling over $17,500. Thirty-eight households were assisted and now have secure housing with an average of less than $150 in EHP assistance per household. Security deposit assistance is not restricted to current residents of the shelter. People are referred by DV1P, the Crisis Center, HACAP, among others. The program is designed to provide assistance to individuals and families in securing rental housing. EHP relies on client contribution, outside donations and financial assistance of other agencies and organizations to secure the full deposit amount. List any accreditation and licensure your agency currently has. Explain. On September 18, 2002, EHP received notification of approval as a U.S. Department of Housing and Urban Development Certified Housing Counseling Agency. This certification authorizes EHP to provide comprehensive houslng counseling services. EHP will be required to report to HUD regarding services rendered on an annual basis for the purposes of recertificiation. Current counseling components focus on: pre-occupancy (rental), pre-rental and rental scenarios, post-occupancy (rental), budgeting and money management, housing care and maintenance and referrals to community resources. These cmnponents have been identified as they are immediately relevant to critical housing needs and problems prevailing in the community (lack of affordable housing units, extremely low vacancy rates, and cost burdened renters). j ccoghs\fundingform.doc 2 Agency Name: Emergency Housing Project, inc. Agency History: The Emergency Housing Project (EHP) is a private, secular, not-for-profit organization founded in 1983 by local faith communities, the City of Iowa City, and human service agencies. EHP's original purpose was to provide temporary shelter to those in need. In I984, the City of Iowa City provided CDBG funds to purchase the shelter, a single-family home in the north side of Iowa City. Until 1993, EHP was operated by a half-time director and a largely volunteer staffthat provided shelter and a hot evening meal. In July of 1993, with the support of the United Way, EHP hired a full-time director. Shortly after, EHP introduced the In-House Counseling Program) through which participants develop and agree in writing to pursue individually specified goals. Today, participants receive counseling on budgeting, interpersonal and life skills, assistance with employment and housing searches, and information and referral to other needed social services. Over the past three years, EHP has focused on increasing accessibility to professional staff. Whereas the In- House Counseling Program was originally staffed at only part-time, over the past three years, we have gradually increased capacity. Two full-time employees now staff the program. Recently, EHP was approved as a HUD certified Housing Counseling Agency. This will provide a vehicle by which EHP staff may continue to professionalize and begin to work towards a comprehensive package of housing counseling services for our clients and this community. Over the past three years, EHP has sustained operations at 24 hours a day Monday through Friday. The shelter remains closed Saturdays and Sundays from 11:00M - 5:00pm due to lack of funding. This is a significant improvement from years prior when the shelter was not staffed at all during the day. Given the critical needs and emergent nature of our work, it is crucial to maintain accessibility to knowledgeable and qualified staff in a timely manner. Funcling permitting, EHP hopes to extend hours of service this year so as to remain open during weekend daytime hours. This will most especially assist families with small children. In the past year, the Executive Director and Board have worked to develop and refine job descriptions and a comprehensive employee manual. We are in the process of developing a staffprocess and procedures manual to better assist with overall continuity of operations and to yet further codify the programs of the organization. In 2001, the board of directors worked in partnership with the Iowa Non-Profit Resource Center to rewrite the by-laws of the organization and to strategically reconstruct the membership of the board so as to bring in much needed skills and resources. In 1997 and 1998, EHP coordinated the development and writing of a countywide grant proposal to HUD that would create a job training and placement program for chronically unemployed homeless people, including those with mental illness and chemical addictions. STAR (Supported Training and Access to Resources) is a collaborative venture involving a consortium of many agencies throughout the community (Goodwill, MECCA, Life Skills, among others) that provides job training, employment opportunities, and includes such corollary services as substance abuse and mental health counseling. STAR utilizes an intensive case management team approach tailored to meet the expressed goals of the individual. Clients have access to the program resources for up to two years. Case managers and outreach workers assist clients in attaining vocational goals while providing assistance with transportation, medical needs, child care, life skills, education, and rent and utility deposits. STAR is in its fourth year of operations and is currently managed and staffed by MECCA, due to an internal lack of capacity within the scope of EHP resources. From 1980 to 2000, the population of Johnson County increased by 35%. EHP staff refuse shelter to hundreds of men, women, and children each year due to a Iack of shelter space. There are serious health, safety, and welfare concerns presented dally due to the chronically over-crowded conditions in the current house. Overcrowding becomes even more of a concern given the needs of families with young children (an ever growing portion of the homeless population) and as the majority of our residents have special needs relating to mental illness, substance abuse, and/or medical disability. A permanent solution is required. In 2002, EHP received an anonymous contribution to fund a feasibility study for a new facility. The board is implementing the preliminary stages of the study and will be holding a series of focus groups before year's end. The results will be utilized to further develop our concept plan and vision and to galvanize support. Concurrently, we are researching other programs, funding sources and criteria. The board is proceeding on a six-month strategic plan that will result, if successfully executed, in the launching of a capital campaign next spring. jccoghs\fundingform.doc 3 Agency Name: Emergency Housing Project, inc. Section 2: Client Profile ~~ 2000 2001 1. How many Johnson County residents (Including IC & 1 Unduplicatecl Count Coralville) did 7our agency serve? 718 8 ! 0 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 707 800 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 11 15 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 63 Female: 252 White/Caucasian 576 6-17 72 Male 648 Asian/Pacific Islander 0 18-30 216 Total 900 Black/African American 234 31-61 531 Hispanic/Latino 72 American Indian/Alaskan Native 18 >62 18 Non Hispanic/Non Latino 828 Other 72 Total 900 Total 900 Total 900 3. Briefly describe your service population. EHP provides shelter and supportive services for men, women, and children, the disabled and elderly. Women and children constitute approximately 30% of those served. Veterans constitute about 15% of those served. All EHP clients are either low or very low income. Current residents of EHP are homeless. Roughly 55% of the homeless have no medical coverage, 26% suffer from acute infectious conditions and 46% suffer from chronic health conditions. Approximately one-third of EHP residents suffer from histories of drug and alcohol addiction and approximately one-third suffer from mental health problems. Many show evidence of a co- occurring disorder exhibiting symptoms of both a substance abuse and mental health problem. These problems are further exacerbated due to lack of access to mental health and substance abuse treatment centers and programs. EHP clients have profound skills and health deficits that severely and negatively impact their ability to compete in the open market. Because of this, they are often times unable to effectively compete in the market without supports. 4. How do you determine eligibility for services? Eligibility for shelter services is based on the criteria of homeless as defined by HUD. Eligibility for all other services is based on demonstrating need. 5. Are there fees for your services? Yes No X If yes, please describe your fee structure: 6. Do you provide services to areas outside of Johnson County? No. Area(s) served: Services Provided: Funding Sources: j ccoghs\fundingform.doc 4 Agency Name: Emergency Housing Project, inc. Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: Exit interviews are performed with all possible clients at the point of exit from the program. Clients are asked to respond to questions ranging from how they view their stay and success in the program to what could have made their stay more successful. Clients are also welcome to discuss any issues regarding services with staff at any point during their stay. As we work with our clients on a one-on-one basis, in private counseling sessions, this can and does happen frequently. (b) Community: EHP will hold a series of focus groups this Fall. Topics of discussion will range from the need for a new shelter facility, understandings or concerns regarding the current facility and programs, suggestions on new programs and community needs with respect to homelessness, overall impression of the organization as it exists today and suggestions for improvement. Our objective is to achieve participation from all stakeholders throughout the community. Representation from community based programs, public programs, local government, healthcare and education, faith communities and others will be solicited. Currently, assessment is maintained on an individual basis, during presentations to congregations and small group representation of local faith communities, local civic organizations, schools, and through dialogues with the City of Iowa City Community Development staff; the Housing and Community Development Commission and the Local Homeless Coordinating Board. Also in 2002, The Emergency Housing Project Board of Directors resurrected the Annual Meeting for Mission Partners and Friends of EHP. 2. Briefly summarize your findings: For years, EHP staff fielded complaints from clients that the staffand the facility were not readily accessible during the day. Staff from other community-based organizations echoed these concerns. Overall, most commentary is positive with respect to those services under the internal locus of EHP control. Negative commentary focuses on the facility itself. Clients consistently report on the over-crowded conditions. Families in particular are gravely concerned regarding the lack of accommodations for children and the fundamental lack of any sense of family space. These same concerns are echoed from the community at-large. Service providers ranging from community- based programs, DHS, the schools, the police and the hospitals have all voiced these concerns. There is growing concern regarding the lack of Drop-in Center facilities for daytime use. There is also growing concern regarding the shelter needs of the homeless who may be intoxicated. External to our current service base, client concerns largely fall into one of four categories: the difficulty and frustrations in locating affordable rental housing, difficulty in finding permanent jobs (many jobs clients are able to find are through temporary employment), temporal, spatial, and client specific gaps with respect to transportation needs and chronic, often overwhelming, healthcare issues compounded by a fundamental inability to pay for services. 3. What changes have been made in response to these findings? The shelter is now open and staffed twenty-four hours a day, Monday through Friday. EHP has worked to increase access to staff and has moved from one part-time housing counseling provider to two-full time employees whose express charge is to work with the clients on an individual basis during their stay. We continue to struggle with the issue of need for a new facility that effectively addresses the health, safety, and welfare concerns of all of our residents. We are in the preliminary stages of a feasibility study now and hope to be in a position to launch a campaign for a new facility next Spring. This will of course require much broader support and ownership from j ccoghs\fundingform.doc 5 Agency Name: Emergency Housing Project, inc. throughout the community. EHP cannot address daytime Drop-In Center needs of the homeless until such time as we have new space to offer and additional staff or committed volunteers. Given a new facility, there may be ways in which to address the temporary shelter needs of homeless persons who are intoxicated or unable to effectively participate in a program through overflow accommodations. With respect to external concerns, EHP is investigating new program directions with regard to landlord/tenant education; the housing counseling certification is a vehicle by which we may better assist with housing searches; we are already investigating innovative methods to address the transportation needs of clients, most especially as related to gaining and maintaining employment. The NOPV and mobile health clinic are recent and preliminary initiatives in responding to the health related concerns of clients. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Local Social Service Providers including but not limited to: Crisis Center, DVIP, Iowa City Public Housing Authority, DHS 40% Self-Referral 20% Hospitals (UIHC, VA, Mercy) 20% Faith Communities 10% IC & Coralville Police 10% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Emergency and Transitional Shelter: EHP is the only general-use homeless shelter in Johnson County providing shelter and transition services to men, women, children, the disabled, and elderly. Drop-In Center: EHP offers the only evening drop-in center in the county. Salvation Army does provide and evening meal. In-House Counseling Program: There is no other program offering services similar to those of the In-House Counseling Program to the same clientele without a payment source. John Thomas Security Deposit Assistance Program: GICHF and CMHC via the Path Program both offer modest security assistance. STAR: There is no other program offering services similar to those of STAR to the same clientele without a payment source. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Emergency and Transitional Shelter: DVIP provides shelter services to victims of domestic violence only. EHP does take referrals from DVIP, space permitting. EHP provides shelter for the general homeless population. Drop-In Center: The dinner served at EHP is later than the one served at the Salvation Army so as to accommodate varied work schedules. Additionally, the two organizations are located a significant distance from one another--a serious consideration for persons who are either on foot or reliant on public transportation. John Thomas SecuriO~ Deposit Assistance Program: The GICHF Security Deposit Program has rigorous qualifying criteria. Many if not most of our clients do not qualify for the program. In order to qualify for security deposit assistance through the Path Program, individuals must have a diagnosed mental illness and have received services fi'om the Community Mental Health Center. j ccoghs\fundingform.doc 6 Agency Name: Emergency Housing Project, inc. 7. Outside of referrals list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1 .STAR (Supported 1 .EHP coordinated the development and writing ora countywide grant Training and Access to proposal to HUD that would create a job training and placement program Resources) for chronically unemployed homeless people, including those with mental illness and chemical addictions. STAR involves a consortium of many agencies throughout the community (EHP, Goodwill, MECCA, Life Skills, among others) that provides job training, employment opportunities, and includes such corollary services as substance abuse and mental health counseling. STAR utilizes an intensive case management team approach tailored to meet the expressed goals of the individual. Clients have access to the program resources for up to two years. Case managers and outreach workers assist clients in attaining vocational goals while providing assistance with transportation, medical needs, child care, life skills, education, and rent and utility I deposits. STAR is in its fourth year of operations and is currently managed and staffed by MECCA, due to an internal lack of capacity within the scope of EHP resources. 2.NOPV (Nursing 2.In Spring of 2001, EHP and the College of Nursing partnered to Outreach Program for implement a nurse case management program for the homeless of our Vulnerable community. EHP clients receive: blood pressure and blood glucose Populations) screening, dietary and lifestyle counseling on ways to manage hypertension and diabetes, foot clinics to prevent and manage minor foot ailments, smoking cessation counseling, dental health and general health education, parenting coaching, and assistance in accessing the local health care system. Services almost immediately expanded to be offered at the Free Lunch Program. Furthermore, this health initiative has led to a monthly health clinic held by medical students and faculty and the recent implementation of a mobile health clinic unit. 3.Johnson County 3.The coalition was formed to enhance communication and encourage Tuberculosis joint work on tuberculosis among community health providers, Elimination Coalition community groups, and the Department of Public Health in Johnson County. Support is provided by funds from the Iowa Department of Public Health and pooled support from the coalition agencies and organizations (including EHP, Free Medical Clinic, Temp-Employment Companies, UIHC, Student Health, Family Health and College of Nursing). Specifically, the coalition aims to work on targeted testing, patient follow-up, disease reporting, patient and provider education, and outbreak management for high risk and underserved residents of Johnson County. jccoghs\fundingform.doc 7 Agency Name: Emergency Housing Project, inc. Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1 .New/Improved Shelter Facility 1 .EHP received an anonymous contribution of $25,000 to fund a feasibility study for new facility. EHP will hold a series of focus groups this Fail. Topics of discussion will range from the need for a new shelter facility, understandings or concerns regarding the current facility and programs, suggestions on new programs and community needs with respect to homelessness, overall impression of the organization as it exists today and suggestions for improvement. Our objective is to achieve participation from all stakeholders throughout the community. Representation from community based programs, public programs, local government, healthcare and education, faith communities and others will be solicited. The results will be utilized to further develop our concept plan and vision and to galvanize support. Concurrently, we are researching other programs, funding sources and criteria. The board is proceeding on a six-month strategic plan that will result, if successfully executed, in the launching of a capital campaign next spring. 2.Further stabilize Staff Structure 2.EHP hopes to realize increased ownership and investment from the community. We continue to stabilize the staff structure and operations of the existing organization and in preparation of our future vision. To that end, we are increasing the fundraising activities and opportunities sponsored by the board, investigating new grant opportunities, and significantly increasing opportunity of ownership by the local funding sources. 3.Strengthen Transition Services 3.EHP hopes to utilize the housing counseling certification as one vehicle through which existing services can be strengthened and new programs and initiatives developed. The certification does allow the organization to apply for unique funding streams available to certified agencies only. 2. In what way will the needs of your service population change in the next five years? Children eighteen and under make up the fastest growing segment of the homeless population-- accounting for approximately 40% of all people who are homeless nationally. Iowa has one of the highest per capita incidents of childhood homelessness in the nation. This trend is only expected to continue and the conditions deteriorate given national policy, state budget cuts, and economic downturns. More and more families will experience homelessness. Requests for shelter in general, yet most critically from families, will not only continue but will escalate. Additionally, there is an ever-increasing number of clients with multiple barriers to sustained economic independence. These barriers are inherently systemic in nature--chronic substance j ccoghs\fundingform.doc 8 Agency Name: Emergency Housing Project, inc. abuse, erratic work histories and habits, mental and physical health needs. Often times these characteristics are co-occurring. Multi-needs clients take longer to complete the program, require more intensive involvement by staff, and require resources well beyond the scope of resources internal to EHP. 3. How do you plan to address these changes? EHP is in the preliminary stages of a feasibility study for a new facility. The need for increased shelter beds is recognized not only by EHP but by other partnering organizations, the police, hospitals, and the schools. The planning committee recognizes the need to give special attention to the needs of families when considering the design and layout of the facility. There are programmatic initiatives that must be considered as well with respect to providing increased educational and vocational opportunities for children and their parents, parenting counseling and health care. Some of these partnerships are already underway (NOPV for example). Ultimately the needs of persons with multiple barriers are not substantively addressed through a shorter-term program as provided by EHP currently. Thus prompting the executive director and board to investigate more permanent solutions such as permanent supportive housing, single-room occupancy, and transitional housing needs for different household structures. These concepts and their viability will be explored fully throughout the course of the feasibility study. 4. Describe the evaluation methods you use to measure the success of your services? EHP relies on several measures as indicative of success. Most readily is the incidence of recidivism with in the year---or individuals returning to the shelter for an additional stay during the course of the same twelve-month period. Client exit interviews are used as an evaluative measure of services as is the strategic plan as set forth by the board of directors. In the past, staff have maintained individual records on each client indicating destination at the point of exit from the program but this information has not been managed collectively. And whereas information regarding a clients qualifying status for SSI, SSDI, Medicaid, Medicare, foodstamps, etc.., is noted at the point of assessment there was no process for revisiting this same information or revisions at the point of exit. New data that occurred during an individual's participation in the program was not managed and was reported anecdotally only. Throughout this year, staff have entered and maintained client records in a data management system that disclose not only demographic information but more outcome based information that will speak to program efficacy such as changes in income and sources of income, qualification for mainstream resources, and details regarding housing placement and destinations of clients upon exit from the program. 5. What are the results of these evaluations (outcomes)? With respect to the recidivism rate, we have found that this rests between 13% and 15% each year. The rate remains relatively static largely due to the inherent limitations of our program with respect to addressing the systemic and complex nature of the barriers to economic independence presented by many EHP clients. Results from client exit interviews have been previously addressed, as was the utility of the strategic plan. EHP staff have been entering client data into a web-based data management system for more than one year now. However, the system was not fully operational until August of 2002. As such, we are not able to generate reports at this time that would reflect outcome-based information such as those identified above. Such reporting will be prepared for the next fiscal yea~a sampling of which will be presented during the presentation to the panel. At j ccoghs\fundingform.doc 9 Agency Name: Emergency Housing Project, inc. this time we can only speak of trends. There is a noticeable positive impact with respect to increased income, employment participation and secure housing placements at the point of exit from the program, however, we do not have specific percentages at this time. 6. How do you plan to use the evaluation results to enhance/extend your services? EHP plans to incorporate the results to further increase access to housing counseling type resources, to assist us in identifying how best to target EHP resources and staff time, to better articulate needs of our clients at the grassroots level, and to take into consideration when investigating new program concepts and opportunities. We anticipate that evaluative measures and results will ultimately assist our focus in developing future partnerships and initiatives and will provide a easily comprehensible vehicle through which to articulate and advocate for the need and benefits of such partnerships and initiatives. 7. How do your programs/services impact the community? The Emergency Housing Project positively impacts the community in many ways and on many different levels. As we provide shelter space for the homeless of our community there are less homeless men, women, and children out on the street--sleeping and existing in very public and exposed situations that ultimately lead to the deterioration of both their physical and mental health. EHP clients are required to maintain sobriety if they are going to continue to access the shelter and Drop-In Center services. As such, there is an implicit motivation to remain sober and achieve extended stays of sobriety. This allows for increased opportunities of behavior modification and positive reinforcement of the sustained sobriety. The community realizes significant benefits from this in principle with regard to the health, safety, and welfare of its citizens and concretely with respect to outlays of city dollars. Persons left to the streets are accountable only to themselves and have no external motivation to attempt sobriety. Often times, their condition rapidly deteriorates, leading to increased charges of public intoxication at a minimum and possible other criminal charges at significant expense of time and cost to our police department and city; there are increased incidents of incarceration and increased pressures on the jail; and finally, escalated need for medical intervention and emergent care. This same scenario can be extended to the homeless who suffer from severe mental health problems. While at the shelter, EHP clients are required to address mental health problems and are expected to maintain med-compliancy. Again this allows for increased opportunities for behavior modification and positive reinforcement. Persons on the street do not have this motivation and may turn to self-medicating through the use of street drugs and alcohol. Again leading to the same spiral of deterioration and cost to the community. Many of the homeless suffer from chronic health issues. Through access to the EHP facility, support staff and community health initiatives previously discussed, people can gain timely access to community health services before situations escalate to a point where emergent care may be the only alternative. Clients are motivated to maintain personal hygiene and better health through access to laundry and shower facilities, clothing and toiletry donations. The Emergency Housing Project improves the health, safety, and welfare of community at-large. In working with EHP staff, clients can better target their resources and stay focused. Staff assist clients in achieving goals and objectives that will ultimately lead to their increased economic independence. Through the In-House Counseling Program, clients are able to gain assistance with referrals and contact information for community resources, assistance with employment and housing searches, bus tickets for transportation to work, and much more. In so much as clients are successful in addressing these issues, we are ultimately successful in shortening the duration of j ccoghs\fundingform.doc 10 Agency Name: Emergency Housing Project, inc. homelessness. Extended stays of homelessness bring with it negative impacts and lead to deteriorated conditions that multiply and become chronic. One of our primary objectives is to facilitate the transition of our clients from homelessness to stable, affbrdable housing. In so much as our clients are successful in achieving this there is a real benefit to this community. As stays of homelessness are reduced, as people are able to find employment and able to find housing they are once again able to resume more normalized lives and once again participate actively in the fabric of the community. There is a generational component to this also, as there is much research showing negative and often permanent health and education impacts for children experiencing extended stays of homelessness. 8. How did the agency respond to the UWJC recommendations from last year? The EHP Board, Executive Director, and staff are grateful for the support and positive feedback made by the UWJC last year. Furthermore, we appreciate the acknowledgement that our clientele is representative of a difficult and vulnerable population. EHP continues to pursue the UWJC recommendation to diversify and strengthen the board as evidenced by the current membership of the board (please see Appendix A). We continue to document requests for shelter that have been denied due to lack of space and document feedback from clients regarding service needs through client exit interviews. We are moving forward with the effort to galvanize support for a new facility as indicated previously in this application. As a recipient of state funding for homeless services, EHP is mandated to utilize a statewide, web-based data collection system. We are tracking information that we intend to utilize to better document program outcomes. EHP staff have been entering client data into the system for more than one year now. However, the system was not fully operational until August of 2002. As such, we are not able to generate reports at this time that would reflect outcome based information such as changes in income from point of entry to time of exit from the program, efficacy in accessing mainstream resources such as Medicaid, SSI, or SSDI, housing situation at the point of exit from the program. Such reporting will be prepared for the next fiscal year. jccoghs\fundingform.doc 11 Agency Name: Emergency Housing Project, inc. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? The full board meets monthly. Subcommittees meet at least monthly if not more frequently. 3. What is your average attendance at board meetings? Board attendance ranges from 85% to 100% regularly. 4. How is the board involved in strategic planning and governance of the agency? The board is responsible for establishing EHP's mission and its vision for the future. To that end, the board approves and periodically updates the strategic plan, including but not limited to long- range goals, operating objectives that will lead toward accomplishing those goals, and protocols for evaluating the organization's progress in relation to them. The board formulates and periodically updates EHP's policies. The board appoints the executive director and establishes expectations, standards of performance, and fair, objective protocols for evaluating him/her in relation to them on an annual basis. The board sets standards for the quality of services and their delivery, and monitors the organization's performance in relation to them. The board approves EHP's annual operating and capital budget, monitors the operating performance in relation to them and ensures the organization's financial viability. The board ensures its own efficiency and effectiveness by establishing priorities for improving the boards structure and performance and routinely evaluating the board's actual performance in relation to these priorities. Internal review of performance occurs on an annual basis. Furthermore, the board develops, approves and maintains its own Annual Calendar of Events. 5. What type of training/orientation do board members receive? All incoming board members are taken on a walk through of the shelter, typically during Drop-In Center hours prior to a formal orientation meeting. Board orientation begins by thoroughly reviewing the organization's by-laws with the newly elected board member(s), the current board chair, and the executive director. The by-laws are a working document containing comprehensive descriptions of board member duties and responsibilities and the unique charges of each board sub- committee. Pursuant to this is an overview of the history of the organization and a summary of current programs. Newly elected board members are then led through the current budget, historical budget information and the various financial reporting documents used at the regular board meetings and for quarterly reporting purposes. The discussion naturally progresses at this point to focus on the current strategic plan, progress on the plan, and future vision for the organization which then brings the orientation full circle to a closing discussion regarding the board members expected role in achieving the goals and objectives of the strategic plan--achieving the vision. Internal board training activities include: videos and performance evaluations for the board and board sub-committees. Outside training opportunities are planned on an annual basis. Last year for example, a training session on Board Development was held for the EHP Board of Directors in j ccoghs\fundingform.doc 12 Agency Name: Emergency Housing Project, inc. partnership with the Iowa Nonprofit Resource Center and faculty from the University of Iowa College of Public Health. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Bookkeeping and financial management activities are currently contracted out to an independent firm. The EHP Board and Executive Director is in the process, however, of developing a written record of internal procedures. 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Yes. The report was last filed on January 24, 200I. Per recent changes in statutes (1999), the reporting to the Secretary of State is to be done biennially. 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? The most recent IRS form 990 filed was for 2000. The 2001 IRS form 990 is underway and will be completed prior to the November 15th deadline. If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? Greenwood and Crim How much did the audit cost? $2,300 If material weaknesses are noted in the audit, what is your plan for addressing them? The audit notes that the organization has an inadequate segregation of certain duties due to limited number of employees. Management feels that corrective action is not practical under current circumstances. This condition has been present consistently in the past and will continue to persist until such time as the organization can afford adequate administrative support staff. Management will continue to stabilize the direct services of the organization and work to identify additional funding that would allow for an increase in administrative staff5 If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers X $1,000,000 a. fiduciary liability b. employment practice liability X $1,000,000 General Liability X $1,000,000 Umbrella Liability X $1,000,000 Professional Liability X $1,000,000 Property or Renters X $225,000 Vehicle X $1,000,000 j ccoghs\fundingform.doc 13 Agency Name: Emergency Housing Project, inc. Section 6:Personnel and Staff Development I. State the length of employment of the Executive Director and his/her qualifications. The Executive Director has been employed by The Emergency Housing Project for four years. The Executive Director has a Master of Arts from the University of Iowa in Urban and Regional Plarming with an emphasis of study in Housing and Community Development and a Bachelor of Arts in Economics. She is a board member and Chair of the Local FEMA Board and an active member of the Local Homeless Coordinating Board and the Iowa Coalition for Housing and the Homeless. In the past, she has served on the Board of Directors of The Emergency Housing Project and Table to Table and has served as a representative to the Greater Iowa City Housing Fellowship. 2. Staff Salaries & Benefits: Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X X $42,500 IFTE IFTE IFTE Program Manager X X X $35,000 1FTE 1FTE 1FTE Services Coordinator X X X $30,000 1FTE 1FTE IFTE Shelter Coordinator X X X $9.00 - $10.30 per hour 3FTE 3FTE 3FTE Shelter Coordinator $9.50 per hour .5fie .5rte .5fie Maintenance/Transport X X X $8.50 per hour 1FTE 1FTE I FTE Drop-In Center Coordinator X X X $8.50 - $9.00 per hour 1FTE Weekend Daytime Coordinator $8.50 - $9.00 per hour .51~e TOTAL FTEs 7.Sfte 7.$fte 9fte j ccoghs\fundingform.doc 14 Agency Name: Emergency Housing Project, inc. 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? Not Applicable 4. [Iow much was spent on staff development in the last fiscal year? $145 was expended in 2001 5. How much is budgeted for staff development in this fiscal year? $1,250 is budgeted for 2002 with $1,105 expended to date (September, 2002). 6. What training and support opportunities are offered to staff?. Staff are required to maintain current First Aid, CPR (infant/child and adult), Mandatory Reporting of Child Abuse, and Working with Blood Borne Pathogens in the Workplace certifications. Additionally, staff are encouraged, and this year were required, to participate in the U of I Continuing Education Workshops focusing on developing counseling skills. Staff are also encouraged to attend other miscellaneous workshops and conferences held through out the state in so much as funds are available. The Executive Director and staff would appreciate the opportunity to participate in regional and national conferences, however, the current budget does not allow for this. Internally, the Board of Directors has developed as a crucial support and resource for the staff and the Exeuctive Director most especially in areas of management and supervision. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 4% Yes No If no, brief explanation 9. Does your agency have personnel X policies? lfyes, date board June last reviewed? 2002 10. Does your board annually evaluate the director's X performance? 11. Does your agency have j ob X descriptions for every position? If yes, date of last May board approval? 2002 12. Is there an annual performance X There is a semi-annual performance review for all staff. review for every staff?. jccoghs\fundingform.doc 15 Agency: Emergency Housing Project Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) FY 99 FY 00 FY 01 Current Assets Cash $33,915 $27,458 $21,430 Investments Receivables < 90 days Other Total Current Assets $33,915 $27,458 $21,430 Other Assests Property $228,938 $228,938 $228,938 Equipment $36,754 $39,869 $41,169 less depreciation $204,842 $219,206 $230,229 Receivables > 90 days Other TotaINon-currentAssets $60,850 $49,601 $39,878 Total Assets $94,765 $77,059 $61,308 FY 99 FY 00 FY 01 Current Liabilities Accounts Payable Payroll Taxes Payable $1,155 $3,715 $5,128 Contracts Payable Mortgage Payable-6 months Total Current Liabilities $1,155 $3,715 $5,128 Other Liabilities Mortgage Payable-Balance Other Total Other Liabilities $0 $0 $0 TotalLiabilities $1,155 $3,715 $5,128 NetAssets $93,610 $73,344 $56,180 Liabilities & Net Assets $94,765 $77,059 $61,308 Agency: Emergency Housing Project B. Income & Expenses Last Yr Cur Yr ~ 1 Next~xt Yr Local Funding Sources lowa City $8,375 $12,000 $35,000 Coralville $1,300 $1,430 $2,500 Johnson County $11,375 $11,700 $30,000 United Way - Allocation $34,570 $34,530 $47,500 - Designated Giving $1,640 $3,340 $3,500 ~rants-Feder~!, State, Foundation ~ $89,381 $92,421 $102,500 Net Sales of Service: Homeless Verifications! $4,50~) $10,000 Net Sales of Materials Contributions/Fundraising $77,573 $87,425 $94,000 Faith Communities $21,486 $25,500 $25,500 Other $140 $45 $300 Total Income $245,840 $272,891 $350,800 Expenses Wages & Salaries $166,196 $199,250 $233,981 Benefits $20,251 $31,550 $33,357 Occupancy $37,424 $37,750 $41,250 Non-occupancy $18,334 $19,200 $24,400 Security Deposit Assistance $2,104 $5,000 $7,500 I Other: Client Transportation Assistance $1,608 $1,250 $1,500 Total Expenses $245,917 $294,000 $341,988 C. Fund Balance Revenue $245,840 $272,891 $350,800 Carryover Balance from previous year $20,377 $20,300 ($809)/ Total Operating Budget __ $266,217 $293,191 $349,991 Less Total Expenses $245,917 $294,000 [ $341,988 Ending Fund Balance ~ $20,3~0~ ($8~9)! -$8'003 Less Restricted Balance (explain) Can3~over Fund Balance ~ $20,300 I ($809) $8,003 I Agency: Emergency Housing Project D. Restricted Funds Designated for: Last Year This Yea Next Year Anonymous Contribution Feasibility Study: New Shelter Facility ~25,000 ~ Total Restricted Funds , $0 , $25,000 $0 E. In Kind Support: Last Year This Year Next Year Services/Volunteers estimated at $10.00 per hour of service $24,500 $26,500 $32,500 Material Goods $4(~,000 $4~2,500 . $45,000 Space, Utilities, etc Other: (Please footnote) Total In-kind Support $64,500 $69,000 $77,500 F. Grants Description/Purpose Last Year This Year Next Year Community Foundation & Misc. Operations Support $2,500 $2,500 $2,500 CDBG Staff/Client Security Deposit/Sm. Rehab $I 3,406 $25,000 $30,000 FEMA Mass Shelter Operations Support $5,319 $9,321 $10,000 Joint State ESGP/HSOGP Mass Shelter Operations Support $45,600 $28,100 $32,500 HUD Administration and Outreach: STAR $22,556 $27,500 $27,500 Total Grants $89,381 $92,421 $102,500 Appendix A: Emergency Housing Project Board Roster Name Office Town Occupation Term End Date Committee Assignment Black, Barbara Iowa City Library Coordinator, ICPL 3 yrs March, 2005 Budget & Finance & Fundraising Dobberstein, Dwight Iowa City Architect 3 yrs March, 2005 Building & Grounds & New Shelter Development Dreusicke, Deborah Coralville Director of Development, 3yrs March, 2005 Fundraising University of Iowa Libraries Dungy, Clai Iowa City U of I Physician 3 yrs March, 2003 New Shelter Development Eimas, Joan Iowa City Retired High School Media Specialist 6 yrs March, 2003 Personnel, Nominating, & Fundraising Goodale, Chris freasures Iowa City Development Officer University of 3 yrs March, 2004 Executive, Fundraising, & Iowa Foundation Budget & Finance Hethcote, Herb Iowa City Professor, University of Iowa 3 yrs March, 2003 Executive & Fundraising MacDonald, Heather Iowa City Associate Professor/Chair of Graduate 3 yrs March, 2004 New Shelter Development Program Urban and Regional Planning Merchant, James Iowa City Professor and Dean of the U of I 3 yrs March, 2004 New Shelter Development College of Public Health Norbeck, Betty Secretary Iowa City Retired 3 yrs March, 2003 Executive & Budget & Finance Persson, Dottle President Iowa City Head Librarian, U of I 3 yrs March, 2004 Executive, Personnel, & Psychology Library Nominating Revier, David Coralville Retail Manager 3 yrs March, 2005 Personnel Werderitsch, Tom Iowa City President/CEO Seizer Werderitsch 3 yrs March, 2005 Building & Grounds, Budget & Finance, & Associates (General Contractors) New Shelter Development Woodburn, Bob Vice President Iowa City Retired 4 yrs March, 2003 Executive, Nominating, Building & Grounds, & !New Shelter Development Appendix B: Emergency Housing Project Organizational Flow Chart EHP Board of Directors Crissy Canganelli Executive Director Karl Dixon Leon DeBoer Services Coordinator Program Manager Volunteers Duncan Anderson/Abby Burgess & Willie Conner/Melissa Copeland Outreach Workers Shelter/Program Coordinators James Quarles Operations Support/Maintenance Section 1: Background Agency Name: Evert Conner Center for Independent Living Address: 730 S. Dubuque Street Phone: (319) 338~-3870 Voice - 338-4785 TTY Director Name: Chris O'Hanlon Signature:~LsaL ~ 't~ Bd. Pres Name: Kevin Burt Timothy Clancy Co-Chairs Signature: Request Completed By: Ethel Madison Date: 09/20/02 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 10/1-9/30 X 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated giving or Special Needs Grants 100,00 100.00 1000.00 >1% FY 02 FY 03 FY 04 City of Iowa City Johnson County City of Coralville What were local funds used for this year: United Wa', funds were used last year to purchase postage to mail our quarterly newsletter. We mail to approximately 250 people with disabilities, organizations and businesses per quarter. At least 432 residents are mailed to in a one year period from Johnson County (108 per mailing) What will next year's local funds be used for? We are proposing that seek funding from United Way to fund a mral outreach position to assist us to reach more consumers in the n~ral area of Johnson County. Agency Mission Statement: Our mission is to assist individuals with disabilities to maintain control over day-to-day activities and to advocate for themselves in order to achieve greater independence and full participation in an integrated society. Agency Name Evert Conner Center for Independent Living Summarize your programs and services for which you are requesting funding: We are requesting funding assistance for informing the Johnson county public of our deaf services. We want to do this through advertising. Our goal is to reach out and inform both the deaf and hearing communities about people's rights and responsibilities. We will do this by letting people know where to call for our deaf services and their interpreting needs. We offer a deaf services program, which is designed to provide outreach, advocacy, education and support to individuals who are deaf and to those who are hard of hearing. Interpreter services are also included in the deaf services program to assist staff and board members to effectively communicate with staff and consumers who are deaf; Interpreter services and education on deaf culture are also provided to the general community. Other services are provided at the request of consumers. All services and programs are designed and implemented by peers to assist consumers to acquire knowledge, and locate resources in the community. Education about civil rights legislation is provided so that consumers will know their rights and will use self-advocacy skills to assist them to live and participate in the community in the same way as others who live without disabilities. Education and technical assistance are provided to others in the community to assist with better access. It is our mission to ensure that people who live with disabilities will have information and support to empower themselves to make choices concerning their day to day activities including their right to live and participate fully in the community. List any accreditation and licensure your agency currently has. Explain. This Center does not have any accreditation or license in the sense that is meant in this document due to the nature ora Center for Independent Living. (CILs) are defined and established within the Rehabilitation Act. The Rehab Act sets criteria that must be maintained, and is evaluated by the federal government. This evaluation includes an annual written report and site visits are made periodically to ensure that that criterion is adhered to. The concept that CILs are based on is that the individual who has the disability is the expert about their needs and how they xvant their needs to be met. The acknowledgement of this concept is why CILs are tmique and set themselves apart tSom traditional service providers. This idea has expanded to all states in the US and to at least 5 other countries. Services are designed and provided through peer role modeling. Individuals who live with disabilities continue to advocate for increased funding to expand the peer role-modeling concept because it has been proven, that it is the most effective way to design and provide services for individuals who live with disabilities and for family members of people who live with disabilities. j c coghsLr~ndingfonn, doc Agency Name Evert Conner Center for Independent Living Agency History (Using one page only, please surarnarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Independent Living, Inc,/dba Evert Conner Center for Independent Living was established and Incorporated In August of 1979. The Mental Health/Mental Retardatiom and Developmental Disabilities Unit of the Depananent of Human Services of Johnson County pmvided funding to establish support and advocacy groups. The initial purpose of the agen%, was to establish peer counseling and advocacy support groups for persons living with mental illness, mental retardation and developmental disabilities residing in Jolmson County. The funding was to allow services such as: resource information, social and recreational opportunities, and education concerning facilitating a method to address their needs. Business meetings were initiated to offer discussions for disseminating information conceming legislative issues relating to disabilities. The meetings also served, as a forum for discussions regarding housing needs, household managemenl, job oppt?mmifies and self-advocacy. The consumers established a speaker's bureau. Its purpose was to inform the community of disability rights and issues, address concerns of those to become advocates and promote the deinsfitutionalization and mat~ueammg of consumers into the community. In 1982, the organxzalion became a member of United Way of Johnson County. With additional funding, the agency Increased staff and provided edueationni classes in the areas of communication skills, self-esteen~ sex~uality, community resources, prevocational skills and vocalional skills training. We also taught classes in asse~dvenessJdecision making, consumer economics, safety, hygiene, relaxation and copIng with stress. Through a purchase of service contract with the local human services department, we offered additional services including job coaching. All services were provided p~narily to the support groups. In 199Z IL, Inc decided to develop an independent living Center because of exhibited need. It seemed that all guidelines were being followed to allow us the affiliation with the exception of federal recognition. We apphed for federal funding to establish a Center for Independent Living (CIL) fitting the federal definition and guidelines. We were approved for funding. This funding is adininistered through the department of Rehabilitation Services Administrafior~ and is on going unless there is a change in the Rehabilitation Act as amended in 1992. In 1995, we changed our name fi.om Independent Li'~g, Inc to the current name because of Even Conner's strong conviction to advocate for his right to live in the community instead of in an institution. In 1999, the board of directors made a decision to change our fiscal year to coincide with the federal fiscal year. In January 2000, we hired an interpreter to develop an Interpreter referral service. In September 2001, we hired an individual to develop a deaf services program. We moved to a mom visible and accessible space in the winter of 2001. We will continue to build relationships within the 7 counties served by the Center and will continue to maintain a majority of individuals who live with disabilities on our board and slaff to ensure strong peer role modeling in all services provided by the CIL. jccoghsLCundingfom~.doc 3 Agency Name Evert Conner Center for Independent Living Section 2: Client Profile ~~ 2~'~ 2002 1. How many Johnson County residents (Including lC & 1 Unduplicated Count 110 161 Coralville) did your agency serve? 2. How many lowa City residents did your agency serve? 2 Unduplicated Count 106 103 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 4 58 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 I Female: 77 Asian 3 6-17 I Male 82 African American 8 18-29 59 Caucasian 143 30-61 92 Native American 5 62-75 6 >75 3. Briefly describe your service population. Our service population includes any individuals who have limitations, which prohibit or substantially affect their ability to work, live in the community and care for themselves without assistance. The individuals may experience limitations because of mobility, sensory, cognitive, or health related issues. Individuals may receive services regardless of age, disability type, culture, ethnicity, religion or sexual preference. 4. How do you determine eligibility for services? Eligibility is determined by a consumer's funding status, work history or history with other services designed for persons who live with disabilities in this and other communities or by observation or by self-disclosure. Community organizations that provide a service to the general community is eligible to receive accessibility auditing or technical assistance concerning disability law and disability related issues to assist with the integration of people with disabilities into the community. 5. Are there fees for your services? Yes X__ No If yes, please describe your fee structure: Fees may be charged for accessibility audits and consultation to businesses and organizations concerning accessibility for which we charge a flat rate. In addition we charge for other services provided to a consumer on a purchase of service agreement and for interpreting services. 6. Do you provide services to areas outside of Johnson County? Yes, we serve seven counties: Benton, Cedar, Iowa, Jones Johnson, Linn and Washington. Services Provided: Advocacy, Information and Referral, Life skills training, and Peer Counseling. Other services are provided upon request from a consumer. Funding Sources: Department ofEducation/P, ehabilitation Services Administration, Department for the Blind, other small grants which may include United Way of Linn County, private donations and contributions., and through our interpreter program. j ccoghsL,~ndingform.doc Agency Name Evert Conner Center for Independent Living Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client - Evaluation forms is given to all consumers receiving individual services on an annual basis. Evaluations are also handed out to participants who attend training sessions. (b) As the new Director I will be personally calling consumers. (c) Community: Periodically surveys are sent out to the general public. The last community survey was mailed to more than 50 organizations and service providers in 2000. 2. Briefly summarize your findings: We determined that consumers needed us to provide more services, especially in the rural area and work harder to become more visible in the community. We received hardly any responses back from the community. We have provided disability awareness training to law enforcement officers in Johnson County and in Linn County. They have expressed through evaluations that the information presented was of a particular value to them in their efforts to serve the whole community. 3. What changes have been made in response to these findings? We make changes according to the requests made by the respondents when possible. It is difficult to offer additional services until our funding is increased. We continue to work on better public relations and marketing strategies. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Self referrals/referrals by other consumers and case managers 95 percent Iowa Protection & Advocacy 1 percent MR/MH/DD Unit 1 percent Division of Vocational Rehabilitation Services 3 percent 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? No other provider of services covers the full range of services that we provide. Life Skills; Department of Vocational Rehabilitation Services; Iowa Department of the Blind; Any of the counties case management providers; CHADD of Iowa City; Senior Peer Counseling program; Each one of these providers offers some of the same services that we do but not the full range of services that we do. No other provider is providing the deaf services that we are. j ccoghs~fundingform.doc Agency Name Evert Conner Center for Independent Living 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. We are consumer mn and directed. Our board and staff continue to be unique because they are comprised ora majority of individuals who live with disabilities. Cross disability is maintained in all aspects of the centers policies and services. Disabilities represented on our board include: Vision, hearing, mobility, Cognitive, and mental healdi. These are also areas maintained on our staff or tltrough contract. The purpose of this mixture of disability types will ensure that die appropriate approach to outreach and services are provided, and that there are adequate role models to ensure effective outcomes for the individuals who live with those and other .types disabilities. We provide services that are designed to empower consumers to become self-sufficient and to live independently in the community. Services are provided from a peer perspective, which means that peers who have been successful in living on their own and locating appropriate resources will work with others to become self-empowered through knowledge of decision making, locating needed resources, learning to locate, hire, train and fire personal assistants, learning what their rights are, learning to use self-advocacy skills so they can better live in the community. We encourage consumers to make decisions about their day-to-day activities and to make choices that best suit their needs. We provide training in areas of civii rights law, which encourages self-advocacy. In addition, we provide advocacy when necessary so that consumers will have the same opportunities as everyone else in the community and in the workplace. Further we are unique because the people who make plans for our consumers are individuals who also have disabilities which means that they know first hand what the barriers are which prohibit individuals from becoming as independent as possible. We provide education and advocacy on behalf of consumers living in institutions to ensure their release if they choose to live in the community and if that community has programs and resources to meet their needs 7. Outside of referrals list up to 3 primary collaborations. Briefly describe the nature of each. Collaborations Briefly describe 1. Funding. 1. Four other CILs and Conner CIL pooled our resources to offer a state match to draw down $164,000 to be distributed among the 5 CILs. 2. We have developed a network with 2. Collaboration with Heritage Area Agency on Heritage to work with legislators to make aging, better future plans for elderly and people who live with disabilities. 3. We continue to work with representatives 3. Americans with Disabilities Act (ADA) from other agencies to assist with the annual Celebration Julu 26 th ADA Celebration: This year the participants included: Emma Goldman, The Arc, Center for Disability and Development (CDD), Johnson County Coalition, Johnson County SEATS and Mayor's Youth to provide a successful ADA Celebration. jccoghs~'undingform.doc Agency Name Evert Conner Center for Independent Living Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Funding 1. The board is in the process of developing fundraising strategies. 2. Staffing 2. Additional funding will allow us to increase staff. 3. Service deliver Funding affects staffing and service delivery. 3. Additional staffwill increase outreach to rural counties. 2. In what way will the needs of your service population change in the next five years? Considering recent and ongoing legislation to serve individuals in the least restricted environment, and with the passage of the MICAS SA, we anticipate an increase in the need for the type of services we provide. Under the circumstances there will be a greater demand to serve people who live with disabilities and those who are elderly in the community instead of in an institutional setting. More peer counseling and peer support will be needed to fill that need. 3. How do you plan to address these changes? There are currently proposed changes at the federal level which will allow increased funding for Centers for Independent Living, we will continue to apply for funding locally, and implement fundraising strategies. This will increase our funding which will allow us to increase staff and services, and will allow us to continue to advocate for systems change. 4. Describe the evaluation methods you use to measure the success of your services? We compare outcomes to proposed objectives to determine if we completed our stated activities, and by providing evaluation forms to consumers who have participated in the programs and services in the reporting year to access their satisfaction, concerns, input and suggestions for the future. The programs are further evaluated by a comprehensive compliance report made available annually to the federal government (RSA). In addition RSA makes site visits periodically to the CIL for further detailed information concerning services, policies, consumer service records (CSRs), accessibility, etc. 5. What are the results of these evaluations (outcomes)? IfRSA or consumers suggests changes, we develop a plan to implement the change. jccoghs~fundingform.doc Agency Name Evert Conner Center for Independent Living 6~ How do you plan to use the evaluation results to enhance/extend your services? The evaluation results are included in our discussion at an annual retreat and they help to shape our objectives or goals for the upcoming year. If larger than one year, we set a longer-range plan to be implemented on an annual basis. 7. How do your programs/services impact the community? Our services impact the community, by providing education to organizations, businesses and consumers to enhance access into services provided by the general community. We provide accessibility auditing to assist businesses and organizations to become accessible. We provide education concerning disability and on deaf culture so that the community will know how to work with individuals who are deaf. We encourage accessibility when there is new construction. We consult managers, homeowners, builders, and developers concerning Universal Design and the need for it, and why it is a smart way to build for the future. 8. How did the agency respond to the UWJC recommendations from last year? The only recommendation made by United Way was to address agency direction, services provided and outcomes of our programs and services in future presentations. Our upcoming presentation will focus on those issues. Section 5: Board Governance I. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly and they will schedule necessary meetings when it is warranted to take care of business that takes longer than their regular monthly meeting. 3. What is your average attendance at board meetings? A majority of the members are in attendance or have called to state reason for non-attendance, with the exception of two meetings in 12 months. 4. How is the board involved in strategic planning and governance of the agency? The board writes policy, approve budget and budget spending, sign checks according to policy and procedures. A board committee has been instrumental in meeting with staff to plan for the future of the Center. 5. What type of training/orientation do board members receive? Board members receive orientation from Center start} usually the director to offer an overview of the philosophy and types of services provided by the Center. And a board training concerning board duties and responsibilities is provided by an outside source. Or by other board members who have jccoghs~fundingfo nn.doc Agency Name Evert Conner Center for Independent Living received professional board training. Funding is available for a board member to attend the National Council on Independent Living Conference annually. 6. Does your agency have written policies and procedures for financial management? Yes. If yes, date of last board approval? FY 2000 7. Have you filed the annual report with the Secretary of State? If yes, date filed? March 28, 2001. Filed change of address May 30, 2002. 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? April 30, 2002 If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes__ No X In the past fiscal year, we had a financial review. The board has an audit completed every two years. This year ending 9/30/02 there will be an audit. Greemwood and Crim have provided our auditing and review services in the past with the exception of two years, (1999 and 2000). In those years Latta Harris Hanon & Penningroth provided the service, If yes, Who completed the audit? How much did the audit cost? Fiscal year we 2001, we completed a Financial Review. The cost was $2,700.0. We will have a compliance audit this year ending September 30, 2002 by Greenwood and Crim The cost will be $3,700 including filing of the 990. If material weaknesses are noted in the audit, what is your plan for addressing them? There were no material weaknesses. If you do not have an audit, what is in place to assure accountability in the agency's financial management? Alternate years we have a financial review because that is all that is required if your income is less than $300,000 in federal funds. 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X $1,000,000. b. employment practice liability X General Liability X $1,000,000. Umbrella Liability Professional Liability Property or Renters We are researching Vehicle Section 6:Personnel and Staff Development j ccoghsLfimdingform doc Agency Name Evert Conner Center for Independent Living l. State the length of employment of the Executive Director and his/her qualifications. Cluis O'Hanlun is our new Executive Director and was appointed October 1~t, 2002. He has a Masters Degree from the University of Iowa Counselor Education program. He has been with the Evert Conner Center Since1994. He has served on our board of directors and as an Independent living skills counselor. Ctuis has proven over many years of dedicated work to be a strong advocate for the civil rights of Persons with disabilities. He was twice elected chair of the Iowa State Association for Independent Living (ISAIL) He is currently serving a three-year term on the Iowa State wide Independent Living Council, (SILC), This is a governor appointment. He has been twice elected by other S1LC, members to be on the executive conUmttee. He also has served many years on the University of Iowa's Rehabilitation Counselor Education Advisory Board. He proudly identifies himself as a person with a disability and is thankful for how that fact has help to shape into the person he is today 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X $30,000 - 45,000 1 I 1 Peer Serdces Coordinator X X 16,000 - 21,000 80.0 80.0 .80.0 Administrative Assistant X X X 18,000 - 25,000 1 I 1 Consumer Services Coordinator X 18,000 - 26,000 0.7 0.7/1 1 Deaf Services Coordinator X 18,000 - 26,000 0.5 0.5 Interpreter Referral Services Coordinator X X 18,000 - 28,000 1 0.5 0.5 Career Skills Advisor X X 18,000 - 23,000 I 1 Personal & Teclmical Asst. Hourly (8.00 - 13.00) 0.2 0.3 0.3 Clerical Hourly (8.00 - 10.00) 0.2 0.2 0.2 TOTAL FTEs 5.9 6.0 5.3 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 2.05 FTE's are provided in Johnson County 4. How much was spent on staffdevelopment in the last fiscal year? $3,000 5. How much is budgeted for staff development in this fiscal year? $3,000 6. What training and support opportunities are offered to staff? jccoghs~fi~ndingform.doc 10 Agency Name Evert Conner Center for Independent Living Our staff attends trainings designed to support the independent living history and movement. At least two staff members or one staff and one board member attend the national conference on Independent Living held in Washington DC each year. They come back and provide information to the other staff and board members. We also attend any local seminars and workshops that will benefit our service delivery and consumers. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? In the past two years there were increases in wages by changing hours some from full- time to part-time with the salary remaining the same for one individual. Another staffperson was promoted from skills advisor to administrative assistant and raised from 21,000of23,000. In the current year one individual was switched from part-time to full time with an increase in salary from $13,000 to $21,000. The board has approved a 2 percent increase to be used to allow small raises on a merit basis. Yes No If no, brief explanation 9. Does your agency Yes have personnel policies? 2000 If yes, date board last reviewed? 10. Does your board annually evaluate the director' s performance? Yes 11. Does your agency have job descriptions for Yes every position? If yes, date of last 1999 board approval? 2001 12. Is there an annual performance review for every Yes staff? jccoghs\fundingform doc 11 Evert Conner Center Agency:i Section 7: Financial Management ' A. Three Year Historical Balance Sheet (As of your fiscal year-end) unaudited FY 00 FY 01 FY 02 Current Assets Cash $40,782 $33,614 $8,422 Investments $24,513 Receivables < 90 days $26,139 $37,239 $19,566 Other $308 $283 Total Current Assets $67,229 $71,136 $52,501 Other Assests Property Equipment $37,256 $37,256 $44,484 less depreciation ($30,587 ($33,529) ($33,592 Receivables > 90 days Other Total Non-current Assets $6,669 $3,727 $10,892 Total Assets $73,899 $74,863 $63,393 FY O0 FY 01 FY 02 Current Liabilities 1 ' Accounts Payable $29,949 $11, 70: $1,068 Payroll Taxes Payable $3,997 $3,200l $5,400 Contracts Payable Mortgage Payable-6 months I Total Current Liabilities $33,946 $14,370 i' $6,468 Other Liabilities I Mortgage Payable-Balance Other Total Other Liabilities $0 $0 i $0 TotalLiabilities $33,946 $14,370i $6,468 NetAssets $39,953 $60,493 $56,925 Liabilities & Net Assets $73,899 $74,863 $63,393 Less Total Expenses $229,588 $194,474 $220,487 Ending Fund Balance $ 31,293 $ 1~3,409 $ 16~491 Less Restricted Balance Carryover Fund Balance 31,293 13,409 16,491 Evert Conner Center Last Cur Next Yrl0/0'l- Yrl0/02- Yr10/03- 10/02 10/03 1004 B. Income & Expenses Income Local Funding Sources Iowa City Coralville Johnson County United Way - Allocation $100 $100 $1,000 - Designated Givfng 1,810.81 $1,408 $1,200 Grants-Federal, State, Foundation $207,373 $200,429 $205,801 Net Sales of Service $42,324 $15,175 $12,761 Net SaKes of Materials Contributions/Fundraising $5,487 $3,843 $12,216 Investment Incom, Othe Total Income $257,995 $220,955 $232,976 Expenses Wages&Salaries $143,233 $146,513, $138,938 Benefits $22,851 $26,713 $27,362 Occupancy $21,816 $20,464 $22,200 Non-occupancy $7'85 $1,560 Othc $41,688 $30,427 Total Expences' $229,588 $194,474 $220,487 C. Fund Balanc, Revenu( $257,995 $220,955 $232,978 Carryover Balance from previous year $2,886 ($13,07; Total Operating Budget $260,881 $207,882 $232,978 Evert Conner Center D. Bd/Donor/Funder I Designated Last Year This Year Next Year Restricted FundsI for: Iowa Department of PAS Training $27,850 $28,132 820,000 the B nd Total Restricted $27,850 $28,132 S20,000 Funds E. In Kind Support: I Last Year This Year Next Year Services/Volunteersi 600.0 @ $15 $8,500 $10,860 S11,000 per hour; ~ 724:733 Material GoodsI Motorized $12,000 wheelchair Space, Utilities, etc l I month rent $1.850i S01 Other: (Please '~ ADA $200 $220 8235 footnote? Celebration Total In-kind i $8,700 $24,930 S11.235 Supportl F. Grants Description/ Last Year This Year Next Year Purpose RehabilitationServices Services to promote $162,184 $165,428 S173.801 Administration choice & independence for people who live with disabilities. ' S20,000 Iowa Department forI Career $27,850 $28,138 the Blind Development/ To enhance employment for persons with disabilities through individualized counseling and ~education. $190,034 Total Grants $193,566 $193,801 Evert Conner Center Appendix A Our Board does not have a term limit. We are under a federal mandate that we must have $1% of our board be people with disabilities. They also must be representative of cross disabilities and multicultural. Board Chair Timothy Clancy Iowa City, Ia $5240 Board member 9 years Target Employee Coe Chair Kevin Burr Coralvillc, Ia Board member 2 years Musician/radio DJ Treasurer David Dietzel Solon, Ia Board member 1 year Rockwell Collins office Cathy Hardy Coralville, Ia Board member 1 year Teacher Joe Howell Washington Ia, Board member 3 years A Retired Person with a disability Richard Twohy Iowa City, Ia Board member lyear Person with a disability Jean Martinolich Iowa City, Ia Board member 2 years Teacher Mike Phenicie Washington la New Board member Person with a disability City of Washington employ Agency Name Evert Conner Center for Independent Living Evert Conner Center Appendix B. The Board of Directors The Executive Director reports to the Board. The Staff report to the Executive Director. Section 1: Background Agency Name: 4Cs Community Coordinated Child Care Address: 1500 Sycamore Street Phone: (319) 338-7684 Request Completed By: Michelle Hankes Date: September 24, 2002 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated $21,193 $17,566 $20,000 ~ 3% giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City $0 $0 $6,000 1% Johnson County $0 $0 $0 0% City of Coralville $0 $0 $0 0% What were local funds used for this year: Program staffing and new server. What will next year's local funds be used for? Program staffing and building improvements. Agency Mission Statement: 4Cs' primary purpose is to promote the well-being of children and their families by assisting parents, child care providers, employers, and others with their child-related needs. This encompasses addressing challenges to the community's child care system; documenting needs and trends in the child care delivery system and serving as a resource for the planning and development of new programs. Summarize your programs and services for which you are requesting funding: 4Cs' programs serve Johnson County families through child care referrals, parent education, and family resources such as our toy lending library and emergency child care facility. Child care providers are also served by 4Cs through education programs, our resource library, and suppod systems that include the food program, infant specialist home visits, networking oppodunities, and counseling. List any accreditation and licensure your agency currently has. Explain. · Home Ties program is licensed through the State of Iowa as a child care center every year. Agency Name: 4Cs Community Coordinated Child Care · 4Cs is annually accredited as the Food Program Sponsor of Johnson County through the Department of Education, and Bureau of Food and Nutrition. director/u nitedway/fy04jointfu ndingform .doc 2 Agency Name: 4Cs Community Coordinated Child Care Agency History 4Cs Community Coordinated Child Care was created in 1972 in response to community child care needs. This means 4Cs is an agency that addresses the demands of consumers and consumer needs in a multi-faceted childcare delivery system. The following is a brief outline of how 4Cs addresses the needs in Johnson County: Resource and Referral is operated as a member of the Iowa Child Care and Early Education Network. Allocations from the Child Care and Development Block Grant and the University of Iowa fund the many components of this program. Our referral system provides computerized, comprehensive, information on the location of available childcare slots in Johnson County. Last year, the referral component of the program served over 1200 children, of which over 80% received our services at no cost. 4Cs distributed childcare center directories and consumer education materials to over 5000 individuals. Technical assistance is available to providers and parents through telephone counseling, individual appointments and group meetings. Our agency has been instrumental in developing and implementing the infant care program Best Beginnings under the state initiative of the Johnson County Empowerment. By having certified instructors in "Resources for Infant Educators" and "Program for Infant and Toddler Cargivers" on staff, 4Cs is able to meet the community's demand for excellence in infant care education. The 4Cs Education and Training program offers individual consultations, group presentations, and resources on child development, health and safety, parenting skills, and business practices. Each month, classes are held for First Aid, CPR, Mandatory Reporting of Child Abuse, Universal Precautions, and new home-based providers. Additionally, regular training classes are held for the Child Care Food Program and Best Beginnings. Each November and April, the 4Cs Conference reaches over 300 participants with information from basic care to enhancement programs. Currently, over 300 families and child care centers are members of our Toy Library and Resource Center, representing 1500 children who benefit from the toys and books. Multi cultural, anti-bias, educational toys and activities are the focal point of the self-circulating system. These resources were expanded in FY02 due to a grant from Empowerment. Our newest program began in October of last year due to more Empowerment funding. The In-Home Provider Mentor program supports caregivers who provide child care out of their homes through home visits, telephone consultations, networking events, and incentives. In its first nine months, the program has reached 24 child care providers and has established cooperative programs with the Hawkeye Area Child Care Providers' Network and Grant Wood AEA. Home Ties is a child care center for homeless or near-homeless families of Johnson County, one of only two in the state of Iowa. This program is a vital connection for families striving to attain self-sufficiency. Originally, the center capacity was for 11 children, but due to demand, the license was raised to accommodate 22 children in 1999. In 2002, the demand for infant care required that Home Ties change its license to double the openings for infants. Some of the families who have transitioned out of Home Ties have been able to use child care assistance funding to remain in care until a permanent arrangement was found. Through a gracious gift of the Mennonite Church, Home Ties operates at 405 Myrtle Avenue, Monday through Friday with expanded hours from 7 a.m. to 6 p.m. Upon admission, families are given information about health care options and other supports in the community. Additionally, families are asked to identify barriers so that an individualized plan can be developed for them to become more self-sufficient. director/u nitedway/fyO4jointfu ndingform .doc 3 Agency Name: 4Cs Community Coordinated Child Care The Child Care Food Program is a federally funded program whose emphasis is on educating children and home-based caregivers on the importance of good nutrition. In exchange for submitting menus, each month, registered family providers receive partial reimbursement for the food they serve. Benefits from the food program reach an estimated 800 children. Section 2: Client Profile . ' · ' -. ~ FY01 FY02 1. How many Johnson County res/dents (Including lC & 1 Unduplicated Count 6,828 8,112 Coralville) did your a~lency serve? * 2. How many/owa C/ty res/dents did your agency 2 Unduplicated Count 3,414 4,056 serve? 3. How many Cora/v///e res/dents did your agency 3 Unduplicated Count 1,457 1,778 serve? * These counts do NOT include: general information contacts, indirect services, or community education. Age (use agency's Gender Ethnicity * breakdown if needed) (use agency's breakdown) 0-5 28% Female: 68% American Indian / Alaska 2% Native 6-17 1% Male: 29% Asian 2% 18-29 30% Unknown: 3% Black or African American 7% 30-61 40% Native Hawaiian or Pacific 2% Islander 62-75 1% White 80% >75 0% Hispanic or Latino 7% * Ethnicit,' is tracked only for the Home Ties Child Care Center program. 3. Briefly describe your service population. · Families with children (birth to 12 years of age); · Homeless/near homeless families with children; · Child care providers; · Emergency foster children 4. How do you determine eligibility for services? · Most of 4Cs' services are available to all residents of Johnson County. Eligibility for 4Cs Home Ties Child Care Center program services is determined by family income and situation (homeless, jobless, participation in other agency services,) 5. Are there fees for your services? Yes X No If yes, please describe your fee structure: · Referral Fees: These fees are on a sliding scale determined by size of family and annual income and range from no charge to $30. director/u nitedway/fy04jointfu riding form .doc 4 Agency Name: 4Cs Community Coordinated Child Care · Toy Library Membership: A one time damage deposit of $10 is assessed to all members. A sliding scale determined by family annual income is used for membership fees. The fees can range from no charge to $25. · Classes and workshops: While most classes are free, some have a standing fee (such as CPR, First Aid, etc.) Fees range from $5 to $25. 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Washington County Services Provided: Child Care Referral for parents, Education and Training for child care providers Funding Sources: Child Care Block Grant (East Central Iowa TRAIN) Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client - Surveys are regularly done with parents who have used our referral services, each class and workshop has an evaluation at its end for participants, and exit-surveys are completed with families who have finished using the Home Ties program. (b) Community- A questionnaire has recently been developed by a marketing group from the University of Iowa to assess community opinion of 4Cs Community Coordinated Child Care. Last year was the first year this survey was used and will be our year for comparison. 2. Briefly summarize your findings: · 98% of client responses were favorable toward the services received from 4Cs. · 99% would recommend 4Cs' services to friends. · The biggest complaint is the lack of knowledge about 4Cs. · The community questionnaire also noted that 4Cs was not well-advertised in the community. · The other concerns included: lack of infant care availability, lack of second shift availability, and the lack of sick child care. 3. What changes have been made in response to these findings? · 4Cs continues to tackle the infant care shortage with the Best Beginnings program. · In response to advertising concerns, the 4Cs website has undergone a complete make- over, and the board and executive director are creating marketing plans. Budget shortages are requiring that marketing will need to be done through innovative methods. · 4Cs discontinued the Comfort & Care sick child program two years ago due to loss of funding through the University of Iowa, and will not be able reinstate the sick child care program unless funding is reinstated through the University of Iowa or a new source is found. director/u nitedway/fy04jointfundingform .doc 5 Agency Name: 4Cs Community Coordinated Child Care 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of Clients Referred · Department of Human Services · 10% · University of Iowa · 15% · Emergency Housing Project · 3% · Crisis Center · 1% · DVIP · 1% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? · HACAP provides Head Start programs for preschool children of disadvantaged families. · The American Red Cross and other health/education agencies offer workshops in First Aid, CPR and Universal Precautions. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. · 4Cs' child care program, Home Ties, provides programs for preschool children, but it also provides care for infants and toddlers. Home Ties is also unique in that participants use the services temporarily while the parents find work, housing, or go back to school. · 4Cs not only offers First Aid, CPR, and Universal Precautions classes, but also is the only agency in Johnson County certified to offer Mandatory Reporting of Child Abuse, Program for Infant and Toddler Caregiving Trainings, and several other classes specifically related to child issues. · 4Cs is the only agency in Johnson County who sponsors the Food Program and provides child care referrals. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly Describe 1. University of Iowa, HACAP, 4Cs 1. Training three providers who work as ECCHOE Grant "early head start" caregivers for children of Pell Grant recipients in a subsidy program. 2.4Cs Toy Library, Grant Wood AEA, The Arc of Johnson County 2. Sharing resources available at the Toy Library for special needs children and their families. 3.4Cs, Hawkeye Area Child Care Providers' Network, Grant Wood AEA 3. "Ages and Stages" workshop and directodu nitedway/fy04jointfu ndingform .doc 6 Agency Name: 4Cs Community Coordinated Child Care resource program to bring assessment tools to child care providers. Grant is pending. Section 4: Strate.qic Plannin.q and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Funding Losses 1.4Cs is establishing an annual fundraising event and doubling its grant writing efforts. 2. Board Recruitment - 4Cs is looking for individuals to increase the diversity of its 2. 4Cs will be taking advantage of the board. United Way board bank program. 3. Technological Advances - The costs of upgrades and staff skills. 3. Staff will be sent for training workshops. A rotating schedule for replacing outdated machines/software is being planned. 2. In what way will the needs of your service population change in the next five years? · New state legislation passed in FY02 will take affect in FY03 and will transition in over the course of the next five years. This legislation affects family child care providers who work out of their homes through new guidelines for registration with the state. Providers who did not have to be registered must now go through the registration process, and currently registered providers will have new rules they must follow. 3. How do you plan to address these changes? · 4Cs will support all child care providers in the registration process through education and training. Provider support programs such as the Home Mentor program, Best Beginnings, Play Together; Learn Together, and the Food Program will continue to stress the need to be registered and offer home visits by child care professionals to assist with the process. 4. Describe the evaluation methods you use to measure the success of your services? · Quantitative Measures ~- # of child care referrals made [' # of providers listed with 4Cs and/or registered with the state ~- # of infant care slots created ~-# of founded child abuse cases in family child care settings directodunitedway/fy04jointfundingform.doc ? Agency Name: 4Cs Community Coordinated Child Care ~- # of children and families transitioned out of Home Ties ~- Toy library usage and membership · Qualitative Measures ~- Home visit evaluations of providers' homes/sites ~- Provider evaluations of courses and workshops ~- Parent evaluations of 4Cs' services ~- Internal audit of food program menus 5. What are the results of these evaluations (outcomes)? · Rural needs for services remain unmet for child care providers. · Educational workshops that specifically target infant care and business practices have the greatest impact on child care providers. · Child care providers need more courses in nutrition. · The average professional life of a family child care provider increases significantly when involved in support programs such as Best Beginnings and Home Mentor Program. · The numbers of referrals and Home Ties transitions have remained steady in recent years. 6. How do you plan to use the evaluation results to enhance/extend your services? · The Home Mentor Program is expanding its outreach in rural areas by combining resources with other 4Cs' rural programs in order to reach more child care providers. · More workshops and courses in Programs for Infant and Toddler Caregiving, Child Net, and Resources for Infant Education are being offered this year. · Four classes in nutrition have been added to the upcoming training calendar. 7. How do your programs/services impact the community? · 4Cs Community Coordinated Child Care's services improve the quality of child care available to Johnson County families through education, program resources, and one-on- one counseling. · 4Cs also increases the quantity of child care through our recruitment and support of new providers. · The Resource and Referral program makes child care providers accessible to parents. 8. How did the agency respond to the UWJC recommendations from last year? The 4Cs Board of Directors was asked to strengthen its overseeing capabilities. The following measures were taken in response to this request: · A new process of screening grant and program proposals and funding sources to determine 4Cs capability in meeting program responsibilities has been created through a board program committee. · The Executive Director is creating a manual for any successor that should smooth any challenges for future transitions. · The board and director have created an e-mail network to deal with questions that arise in emergency situations. · The board has created task forces for specific programs and situations. directodu nitedway/fy04jointfundingform .doc 8 Agency Name: 4Cs Community Coordinated Child Care · Major program decisions will now require board consultations. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly (Every 4th Tuesday.) 3. What is your average attendance at board meetings? 2/3 of the Board 4. How is the board involved in strategic planning and governance of the agency? · The Board of Directors determines the goals for each year's plan of work and ranks priorities for the agency. · The board determines all written policies. · The board determines the appropriateness of new programs and the ability of 4Cs to carry out those programs. 5. What type of training/orientation do board members receive? · New board members receive a pre-orientation with information about 4Cs from the person recruiting them prior to applying. · After being accepted by the Board of Directors, new members receive a one-on-one orientation/training with the Executive Director. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? April 2002 7. Have you filed the annual report with the Secretary of State? If yes, date filed? 2001 8. Have you filed the IRS form 990 for the most recent year?. If yes, date filed? January 2002 If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X No If yes, Who completed the audit? Greenwood & Crim How much did the audit cost? $2,500 If material weaknesses are noted in the audit, what is your plan for addressing them? · None were noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) director/u nitedway/fy04jointfu ndingform .doc 9 Agency Name: 4Cs Community Coordinated Child Care Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X 1,000,000 b. employment practice liability General Liability X 2,000,000 Umbrella Liability Professional Liability Property or Renters X 201,000 Vehicle X 500,000 director/u nitedway/fyO4jointfu ndingform .doc ]0 Agency Name: 4Cs Community Coordinated Child Care Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. · Length of Employment: 19 months at 4Cs · Education: MA in Science Education/Museum Studies, BA in Political Science/History, BA in Music Performance · Career History : 3 years Program Manager/Assistant Director Wild Rose Program Center 2 years manager of Iowa City Area Science Center exhibits 4 years Program Development Manager for Girl Scouts of the Mississippi Valley, Inc. 2. Staff Salaries & Benefits Check if Applicable Full-Time Equivalent Retire- (FTEs) Paid Health ment Current Salary Range Last This Next Position Leave Ins. Plan Per Position Year Year Yea r Executive Director X X $35,000 - $40,000 yearly 1.0 1.0 1.0 Asst. Executive Director I X X $28,000 - $33,000 yearly 1.0 1.0 1.0 Resource & Referral X X $20,000 - $25,000 yearly 1.0 1.0 1.0 Coordinator Home Mentor X X $25,000 - $29,000 yearly 1.0 1.0 1.0 CACFP Coordinator X X $23,000 - $28,000 yearly 1.0 1.0 1.0 CACFP Assistant $8.00 - $10.00 per hour 0.5 0.5 1.0 Receptionist $5.15 - $8.00 per hour .75 1.0 1.0 Home Ties Coordinator X X $24,000 - $28,000 yearly 1.0 1.0 1.0 Home Ties Lead X X $20,000 - $23,000 yearly 2.0 2.0 2.0 Teachers Home Ties Assistants $6.50 per hour 4.0 4.0 4.0 Toy Librarian* $6.50 - $7.50 per hour 0.5 .26 0.0 TOTAL FTEs 13.75 13.75 14.0 * Toy Librarian position is transitioning to a full time volunteer position. 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? · Last Year: 13.75; This Year: 15.75, Next Year: 14.0 4. How much was spent on staff development in the last fiscal year? $3,932 5. How much is budgeted for staff development in this fiscal year? $3,930 director/unitedway/fy04jointfundingform.doc ! t Agency Name: 4Cs Community Coordinated Child Care 6. What training and support opportunities are offered to staff? · Annual conferences that offer the latest information on child care resources, education, and program assessment. · Certification in CPR, First Aid and Universal Precautions for child care assistants · Appropriate skill trainings (computer skills, grant writing, etc.) 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 4% Yes No If no, brief explanation 9. Does your agency have personnel X policies? If yes, date board last reviewed? April 2002 10. Does your board annually evaluate the X director's performance? 11. Does your agency have job descriptions X for every position? If yes, date of last board approval? December 2001 12. Is there an annual performance review X for every staff? director/u nitedway/fy04jointfu ndingform .doc 12 Agency: 4Cs Community Coordinated Child Care Section 7: Financial Management A. Three Year Historical Balance Sheet F~Oi ~ FY02 (As of your fiscal year-end) FY 00 Current Assets Cash $64,038 $53,123 $26,470 Investments $0 $0 $0 Receivables < 90 days $0 $0 $0 Other $0 $0 $0 Total Current Assets $64,038~ $53,123_ $26,470 Other Assests Property ' $82,725i $84,488i $84,488 Equipment $60,132 / $601132I $74,056 less depreciation ($38~951~ ($54,76§)I ($70,067 Receivables > 90 days $0. $0 ~ $0 Other Total Non-current Assets $103,906 $89,852 ~ $88,47~ Total Assets $167,944 $i42,975 / ~14194~ FY 00 · curren{ Liabiiiiies Accounts Payable $0 $0 $0 payroll Taxes Payable $1,637 _ $2,478 $2,687 Contracts P~yable $0 $0 $0 Mortgage Payable-6 months $0 $0 $0 Total Current Liabilities $1,637 $2,478 $2,687 Other Liabilities Mortgage Payable'Balance $66,517 ± $42,155 $331§89 Other Total Other Liabilities . $66,517 $42,155 $33,889 TotalLiabifities $68,154 $44,633 $36,576 NetAssets $99,790 $98,342 $78,371 Liabilities & Net Assets $167,944 $142,975 $114,947 11 Agency: 4Cs Community Coordinated Child Care FY02 FY03 FY04 B. Income & Expenses Income Local Funding Sources ~ Iowa City i $0 _ $0 ~ $6,000 Coralville $0 . $0 $0 Johnson County $0 . $0 $0 United Way - Allocation $20,293 _ $17,566 _ $20,000 - Designated Giving $3,381 $3,850 $3,500 Grants-Federal, State, Foundation $320,109 $314,660 $320,420 Net Sales of Service $35,077 $31,000 $33,000 Net Sales of Materials $0 $0 $0 Contributions/Fundraising ~ $16,961 ~ $29,300 ~ $25,000 Investment Income $1,191 $1,320 $1,400 Food Program Reimbursement $206,606 $215,000 $225,000 Rental Income $12,172 $11,30~ $11,300 Total Income $614,790 $623,996 $645,620 Expenses ~ ~ ~ Wages & Salaries $274,646 _ $267,470 $280,843 Benefits $19,505 $18,800 $18,600 Occupancy: Mortgage, rent, utilities, insurance $44,804 $48,680 $51,114 Non-occupancy: Program materials, supplies, etc. $110,688 $74,062 $77,765 Food Program Reimbursements . $197,966 $205,000 $215,000 Total Expenses . $647,609_ $614,012~ $643,522 ~.." Fund Balance Revenue _ $614,790 , $623,996 $645,620 Carryover Balance from previous year _ $31,609 i ($1,210) $8,774 Total Operating Budget $646,399 $622,786 $654,394 Less Total Expenses $647,609: $614,012 $643,522 Ending Fund Balance ($1,210) $8,774 $10,872 Less Restricted Balance (explain) Carryover Fund Balance ($1,210)~ $8,774 $10,872 12 Agency: 4Cs Community Coordinated Child Care 1 D. Bd/Donor/Funder Restricted Funds Designated for FY02 FY03 FY04 Toy Library Donatior Toy Library Rent $6.000 $6,000~ $6,000 Total Restricted Funds $6.000 $6,000 - $6,000 / E. r~ Kind Suppor~ FY02 FY03 ~ FY04 ServicesNolunteers (6,50 per hour)* Toy Library, Home Ties __ $6,760 I $8,500 [ $10,000 Material Goods Toy Library, Home Ties T I$10'000 $10,000 ~ $10,000 Other: (Please footnote) ~ Total In-kind Support $85,760~ $90,500 / $95,000 . Fotal lind . ;85,; Volunteer Hours Breakdown: FY02=1040 hours, FY03=1307 hours, FY04=1538 hour F. Grants , Description/Purpose FY02 FY03 FY04 Child Development Block Grant .Training, Resource and Referral $46,840 $49,740 ! $50,000 Universit~v of Iowa Resource and Referral, Best Beginnings ~ $51,000 $41,500 $41,500 Empowerment of Johnson County Provider Support, Home Ties (FY03, 04) $84,706 $145,920 $145,920 DECAT Pro'eject Home Ties (FY02) $73,082 $0 $0 Food Pro~ram Food Program $62,481 $67,500 $70,000 Other Grants Program Support $2,000 $10,000 $13,000 Total Grants $320,109 I $314~660 ' $320,420 13 4Cs Community Coordinated Child Care Board of Directors President Judith Crossett Iowa City, IA Geriatric Psychiatrist, University of Iowa Hospitals and clinics Term ends: 6/30/03 Committees: Executive, Fiscal, Fundraising Vice President Joan Tephly Iowa City, IA Early Education, University of Iowa Term ends: 6/30/05 Committees: Executive, Fundraising, Personnel Treasurer James Pusack Iowa City, IA German Professor, University of Iowa Term ends: 6/30/05 Committees: Executive, Fiscal Secretary Kay Prediger Iowa City, IA Retired (Preschool Education) Term ends: 6/30/03 Committees: Executive, Grievance Alice Atkinson Iowa City, IA Early Education Professor, University of Iowa Term ends: 6/30/05 Committees: Personnel, Grievance Dave Merrick Iowa City, IA Insurance Broker, A.W. Welt Ambrisco Term ends: 6/30/04 Committees: Fundraising, Grievance Julie Home North Liberty, IA 52317 Private consultant/In-Home Child Care provider Term ends: 6/30/03 Committees: Personnel John Hartley Iowa City, IA Elementary Teacher Term ends: 6/30/04 Committees: Fundraising Pending Term 7/1/02 - 6/30/04 Committees: Pending 4Cs Community Coordinated Child Care Organizational Chart Section 1: Background Agency Name: Free Lunch Program Address: 120 North Dubuque Street Phone: 351-7574 Director Name: Deloris Tvedte Signature- Bd. Pres Name: David Schuidt SignatureI Request Completed By: Deloris Tvedte Date: September 27, 2002 Check Your Agency's Budget Year: 1/1-12/31 x 7/1-6/30 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $6090,00 $5608.00 $7000.00 27.5% Does not include designated giving or Special Needs Grams FY 02 FY 03 FY 04 City of Iowa City Johnson County __ City of Coralville What were local funds used for this year: To help provide an average of 100 noon meals 6 days/week. What will next year's local funds be used for? To help provide an average of 100 noon meals 6 days/week. Agency Mission Statement: The Free Lunch Program's mission is to provide a free nutritious meal with milk and juice to everyone who comes to our table. Our slogan is "an open door, a full plate, no questions asked." Summarize your programs and services for which you are requesting funding: Funds requested will be used to help provide a nutritious noon meal six days a week to approximately 100 persons in need. The dining area opens daily at 9:00am for coffee, light breakfast and socializing. List any accreditation and lieensure your agency currently has. Explain. The Free Lunch Program has successfully passed the annual inspection by HACAP of cooking, dining, and storage areas. Agency Name _Free Lunch Program Agency History (Using one page o~y, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) The Free Lunch program has been in operation for 20 years. In 1983, St. Mary's Lenten Bible Study group responded to a suggestion fi.om therapists Ronnye Wieland and Carol Lear fi.om the Community Mental Heakh Center to offer a flee community meal. Free Lunch began serving on Tuesday noon at the Knights of Columbus building. The other three Iowa City Catholic churches soon became involved and each took one Tuesday a month. The program expanded to Tuesday and Thursday with 10 churches supplying food and volunteer teams in the summer of 1983. Free Lunch moved to its present location in the Wesley Foundation at 120 North Dubuque Street in September 1983. Since 1989, meals have been served Monday through Saturday. We currently have 37 different volunteer groups preparing and serving meals on a regular basis. Most teams serve once a month. Volunteers prepare and serYe a balanced meal each day using food donated by the team. This is supplemented by food delivered by Table to Table, or surplus government food purchased fi'om HACAP in Hiawatha. Five gallons of milk are purchased by Free Lunch and delivered each day by John's Grocery. Food that remains atter serving all guests fi.om noon to 1:00 p.m. is shared with other agencies such as Emergency Housing as~d the Salvation A~my. We have an annual volunteer appreciation meeting. All volunteers are invited to attend. Dessert and coffee are served. Figy persons attended the event in 2001. There is a time for sharing information and working on any issues or concerns. jccogh s\ funding form.doc 2 Agency Name Free Lunch Program Section 2: Client Profile ~ ~ ~ _2000 2001 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 29,200 30,381 Coralville) did your agency serve? Duplicated 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 3. How many Coralville residents did your agency serve? 3 Unduplicated Count Age (use agency's Gender Ethnicity (use agency's breakdown) * breakdown if needed) * 0-5 Female: 20% 6-17 Male 77% 18-29 Children 3% 30-61 62-75 >75 · The Free Lunch Program ~s a volunteer run group and doesn't have the resources to gather client profile information on a regular basis. An intern from JCCOG has attended the FLP over five times (March to September) to do a head count and provided the percentages listed above. 3. Briefly describe your service population. About half of the Free Lunch population has been homeless or on the edge of homelessness. Some are transients passing through on 1-80. Many regular guests suffer from medical and economic problems. Some struggle with mental illness. Others have physical disabilities. Some have substance abuse problems. Some of the long-term guests receive continuing medical treatment at the VA or other local hospitals. Most of those employed are in unskilled, low paying work. A few are artists, musicians, or students struggling to make ends meet. 4. How do you determine eligibility for services? All persons who come are welcomed and are served. 5. Are there fees for your services? Yes__ No x If yes, please describe your fee structure: 6. DO you provide services to areas outside of Johnson County? Area(s) served: Services Provided: Funding Sources: Serving Teams come from churches in Shueyville, Solon, Hills, Amana, Wellman, Sharon Center, Coralville, and Iowa City. j ccoghs\funding form. doc 3 Agency Name _Free Lunch Program Section 3:Community Relations 1. How do you assess satisfaction w~th your services? (a) Client - The guests often express appreciation for the quality of the meal. (b) Commun/ty - Thirty-se~en teams cook and serve lunch. Referrals are made regularly to the Free Lunch Program by community agencies. 2. Briefly summarize your findings: There continue to be very positive responses to the program. 3. What changes have been made in response to these findings? NONE 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Churches, Crisis Center, Emergency Housing, word of mouth 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? The Salvation Army serves an evening meal each day. The Agape Cafe at Old Brick serves Wednesday breakfast during the school year. 6. Describe what distinguishes your agency and/or its services t~om other agencies that provide similar services in Johnson County. The Free Lunch Program is the only flee noon meal served to people in need. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Table to Table 1. Recycled food is delivered daily for use by the Free Lunch cooks. 2. Community Mental Health Center 2. Two staffare present several days a week as part of the PATH program. 3. College of Nursing/VNA 3. Flu shots, health screening, nutrition education are provided. jccoghs\fimd/ngform.doc 4 Agency Name _Free Lunch Program Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staff'mg, finances, service delivery) Challenges/Opportunities Strmegies 1. Increasing and uneven numbers of guests. 1. Keep food that can be fixed quickly in the Meals served vary from 80 to 150 daily, storage area. 2. The dishwasher keeps breaking down. It is 2. Soften the water supply or de-lime the only one year old. dishwasher two or three times per week. 3. Restroom remodeling needed. 3. A grant has been secured by the Wesley Foundation from CDBG funds in the amount of $39,000 to remodel the restrooms. This will benefit the Free Lunch guests and the Free Medical Clinic patients. 2. In what way will the needs of your service population change in the next five years? The numbers of persons in need will probably increase. 3. How do you plan to address these changes? Inform the serving teams to prepare for more persons. Provide more purchased food to supplement the food brought by the serving teams. 4. Describe the evaluation methods you use to measure the success of your services? We visit with our guests and receive their comments. 5. What are the results of these evaluations (outcomes)? The guests are generally pleased with their meals. 6. How do you plan to use the evaluation results to enhance/extend your sen,ices? We do not plan to extend our services to a seventh day each week. 7. How do your programs/services impact the community? Feeding hungry people is meeting a basic human need. 8. How did the agency respond to the UWJC recommendations fi'om last year? The low numbers of women and children continues to be an issue. The population we serve is predominantly male so we expect the numbers of males to be larger than the numbers of females. There has been a more accurate survey of the number and demographics of the lunch guests by an intern from Linda Severson's office. An important aspect of the Free Lunch philosophy is to serve hungry people without regard to their situations and not to intrude on their privacy. This makes it difficult to gather demographic data. Our volunteers cook and serve wonderful meals to all the guests who come. jccogh s\ ftm ding form.doc 5 Agency Name _Free Lunch Program Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) See attached 2. How often does your board meet? Two or three times a year with called meetings as needed. 3. What is yoar average attendance at board meetings? 11 of 14 members 4. How is the board involved in strategic planning and governance of the agency? The board deals with current issues and anticipates future needs and problems. 5. What type of training/orientation do board members receive? Most board members have been or are currently volunteers on serving teams. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? NO__ 7. Have you filed the annual report with the Secretary of State? If yes, date filed? NO 8. Have you filed the IRS form 990 for the most recent year? If yes. date filed? NO If no to questions 6, 7, or 8, give explanation. The Free Lunch program is not incorporated. We have operated since the beginning of the agency as a program of the Wesley Foundation. The Foundation has the proper status and files the proper reports. 9. Does your agency have a yearly audit? Yes No X__ If yes, Who completed the audit? How much did the audit cost? If ma~:erial weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, what is in place to assure accountability in the agency's financial management? We have an annual financial review conducted by someone with bookkeeping experience who is not a member of the board. 10. Insurance Coverage: (check what coverage your agency has) I Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X $1,000,000 b. employment practice liability General Liability X $1.000,000 Umbrella Liability Professional Liability Property or Renters Vehicle *Volunteer Workers X $1,000,000 jccoghs\fundingtbrm.doc 6 Agency Name _Free Lunch Program Section 6:Personnel and Staff Development 1. State the length ofempioyment of the Executive Director and his/her qualifications. Six years. She was a professional cook and a serving team leader for her cb~ch. 2. Sta~Salaries &Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (Fl'Es) Position Leave Ins. Plan Per Position Last This Next Ymr Year Year Director $3,000 annual 1/3 1/3 1/3 TOTAL l~'l'Es 1/3 1/3 1/3 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 4. How much was spent on staff development in the last fiscal year? __0 __ 5. How much is budgeted for staffdevelopment in this fiscal year?__0__ 6. What training and support opportunities are offered to staff?. The board assists the director by volunteering for tasks she delegates. jccoghs\fundingform.doc 7 Agency Name _Free Lunch Program 7. Please attach current organizational chart as Appendix B. see attached 8. Comparing the last complete fiscal year to current fiscal year, what was the average °A wage increase? 8% Yes No If no. brief explanation 9. Does your agency The director is very part-time. have personnel policies? If yes, date board No last reviewed? 10. Does your board This is done informally throughout the year by observing annually evaluate her performance the director's performance? X 11. Does your agency September 23, 2002 have job descriptions for every position? X If yes, date of last board approval? 12. Is there an annual The only paid staff is the director. performance review for every staff? X jccoghs\ funding form.doc 8 IAgency: !Free Lunch Program Last Yr Cur ~ Next Yr El. Income & Expenses Local Funding Sources Iowa City Coralville Johnson County United Way - Allocation $5,868 $5,728 $7,000 - Designated Giving $4,163 I $3,642 . $3,800 Grants-Federal, State, Foundation $2,019 $2,626 $2,626 Net Sales of Service Net Sales of Materials Contributions/Fundraising $11,693 $10,300 $12,000 Investment Income Other $22,296 $25,426 Expenses Wages & Salaries $2,400 3,600 Benefits $13,150 $13,665 Occupancy $11,161 Non-occupancy $5,534 $6,770 $8,100 Other , $19,095 $22,920 $25,365 Fund Balance Revenue $23,742 $22,296 $25,426 Carryover Balance from previous year Total Operating Budget $37,699 $40,899 $43,405 Less Total Expenses $19,095 i $22,920 $25,365 Ending Fund Balance $18,603 i $17,979 $18,040 Less Restricted Balance (explain) Carryover Fund Balance $18,603 Agency: Free Lunch Program D. Bd/Donor/Funder Restricted Funds Designated for: Last Year This Year Next Year Total Restricted Funds $0 $0 $0 E. In Kind Support: Last Year This Year Next Year Services/Volunteers 12,480 hrs ~ $6.00 ($8.00 in 2003) $74,880 . $74,880 $99,840 312 days x 8 people x 5 hfs Material Goods 100 est. daily 6.days Per week- $31,200 $31,200 ~ $46,800 food and supplies ($150 daily 2003) Space, Utilities, e~q Other: (Please footnote) Total In-kind Support $106,080 $106,080 $146,640 F. Grants Description/Purpose Last Year This Year Next Year EFSP~mergency food and She!ter) purchase food $2,019 . $2,626 $2,626 Total Grants $2,019 $2,626 $2,626 FREE LUNCH PROGRAM APPENDIX A FREE LUNCH PROGRAM BOARD NAME RESPONSIBILITY ADDRESS OCCUPATION Clark, Bruce & Iowa City Sue: retired teacher Sue Bruce: retired, U of I Speech & Hearing Dee, Pat Secretary Coralville Flatgard, Steve Solon Steve: accountant & Sandy Sandy: moving company Griffin, Amy ~ Food Coordinator Iowa City Homemaker Jensen, Richard Treasurer Coralville Retired U of I engineering tech automation systems Palmberg, Mary Volunteer Iowa City Retired U of I Provost Coordinator Office Schuldt, David Board Chair Coralville Retired Director, Wesley Foundation Shepherd, Tom Wesley Board Iowa City Retired University Health Liaison Protection Office Shultz, Paul Wesley Director Iowa City Director, Wesley Foundation Tvedte, Deloris Director Iowa City Free Lunch Program Director Zastrow, Sherri Iowa City Operations Director, Community Mental Health Center Keller, Jeannette: Legal Consultant West Liberty Attorney FREE LUNCH PROGRAM APPENDIX B I Free Lunch Board I Treasurer -~ [ Director [Volunteer Coordinator (Volunteer) I I Food Coordinator (Volunteer)[ 137 Serving Teams with leader(s)[ Section 1: Background Agency Name: Iowa City Free Medical Clinic Address: 120 North Dubuque Phone: 337-4459 Co-Director Name: Sandy Pickup Signature: Bd. Pres Name: Bill Wirth Signature: Request Completed By: Sandy Pickup Date: ~- Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated 98,548 101,140 104,174 34% ~cial Needs Grants FY 02 FY 03 FY 04 City of Iowa City 6,284 6,584 6,913 2% Johnson County 93,600 92,297 96,911 32% City of Coralville 1,500 1,650 2,000 1% What were local funds used for this year: Health care delivery and medication assistance were provided with local funding. This includes salaries, benefits, equipment, office supplies, liability insurance and medications. For what will next year's local funds be used? FMC will use local funds to provide over 5,000 patient visits, including lab, prescription medications and follow-up treatment for our clients. Agency Mission Statement: The Iowa City Free Medical Clinic is a private nonprofit corporation, providing quality health care to the underserved of Johnson County. Our organizing principles of practice are: · To eliminate barriers to health care by offering services without cost · To offer services in a non-hierarchical environment that is non-judgmental, confidential and informal · To encourage the participation of patients in their own care · To serve as an advocate for the underserved in the community Summarize your programs and services for which you are requesting funding: Services provided by FMC are general out-patient care, including eye exams, medications, in clinic laboratory testing, testing sent to outside labs, case management for clients with chronic illness and application to pharmaceuticals companies for chronic medications. Voucher programs assist residents of Johnson County not able to afford medications and medical supplies. List any accreditation and licensure your agency currently has. Explain. Iowa City Free Medical Clinic has been accepted in the "Volunteer Health Care Provider Program" with the Sate of Iowa. (IAC 10/7/98 Chapter 88) Agency Name Iowa City Free Medical Clinic Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) The Free Medical Clinic (FMC) began seeing patients in March of 1971. Since opening 31 years ago, thousands of people have been seen with a variety of medical concerns. In the first year of operation FMC had 2,481 clinic visits. The primary diagnosis was "normal exam," followed by "upper respiratory infection". In FY 02, FMC had 5460 clinic visits. The primary reasons for patient visits were for hypertension, followed by diabetes. In the late 80's FMC staff was beginning to see the increase in patients with chronic medical problems. In May of 1990 our first paid physician was hired. The person in this position was to provide continuity to patients with chronic medical concerns and provide supervision for staff follow-up of these patients as well. Our patients continue to be the uninsured, "very low income" people who do not qualify for other assistance programs. Patients are seen here for job physicals, colds and flu, hypertension, diabetes and other acute and chronic conditions. Other services offered include dental care, eye exams, Mercy Night, dermatology, physical therapy, TB testing, gynecology, HIV testing and counseling, pediatric well child exams and immunizations and podiatry. While we have added paid medical staff, one of the primary reasons we have been able to maintain our original commitment to free health care for all, is the dedicated participation of a large volunteer staff. Physicians, lab technicians, pharmacists, physician assistants, nurses, medical students, patient advocates, receptionists and interpreters come together with staff to create an environment of caring and support for one another and our patients. In December we will be losing professional liability coverage under The St. Paul, the major writer of malpractice insurance in the state, because they are discontinuing this service. The costs of new malpractice coverage are exorbitant. We have registered Iowa City Free Medical Clinic with the State of Iowa's "Volunteer Provider Program" which will indemnify physicians volunteering in free clinics. Each physician must apply, and after acceptance FMC staff must maintain documents and report quarterly to the program. An additional cost factor that is hurting FMC is the tail we must purchase to cover any past claims that may occur after the termination of The St. Paul policy. All new coverage for the FMC is also more costly. *see breakdown in financial pages Quality assurance is an ongoing part of FMC commitment to providing quality health care to our clients. Random chart reviews and client satisfaction surveys are done throughout the year to assure a high quality of care. Our Patient-In-Need Program continues to be invaluable in keeping patients with chronic medication needs supplied with the proper medications. Over 300 hundred patients are currently enrolled in this program. In October Terry, Lockridge and Dunn (TLD) are donating a free organizational review of FMC. This may tell FMC Board and staffways in which we might work more efficiently as a medical facility and as a non-profit. The results will also be used in long range planning. jccoghs\fundingform.doc 2 Agency Name Iowa City Free Medical Clinic Section 2: Client Profile 1. How many Johnson County residents (Including lC & 1 Unduplicated Count:g Coralville) did ?/our agency serve? 2. How many lowa City residents did your agency serve? Count$ 3. How many Coralville residents did your agency serve? Count ~g Appendix C Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-12 275 Female: 3053 Asian 192 13-19 254 Male 2407 Black 1014 20-29 1321 Caucasian 2554 30-39 889 Hispanic 947 40-49 I 162 Mixed 22 50-59 963 Native American 36 > 60 596 No answer/other 695 3. Briefly describe your service population. FMC provides health care to the uninsured and underinsured in Johnson County and surrounding areas. 4. How do you determine eligibility for services? We have no eligibility requirements other than we ask that the clients have no other resources or option for health care. 5. Are there fees for your services? Yes No__X__ If yes, please describe your fee structure: We ask that patients leave at least a five dollar donation if they can afford that. 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: We do not have clinics in the following counties, however, people from Benton, Cedar, Iowa, Keokuk, Jefferson, Lima, Muscatine and Washington counties, non US citizens and out of state people use our services at 120 N. Dubuque. Services Provided: General out patient care, HIV counseling and testing, dental services and financial assistance with medications, eyeglasses and hearing aids Funding Sources: Patient donations offset some costs for out of county clients. 13% of clinic visits in FY 02 were non Johnson County residents. j ccoghs\fundingform.doc 3 Agency Name Iowa City Free Medical Clinic Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: We conduct a yearly satisfaction survey at the end of every calendar year. One hundred patients complete this survey. We also conduct an abbreviated form of this survey on a bi-monthly basis. (b) Community: We conduct a United Way Directors questionnaire every 3 years in September, gathering information on how the Free Medical Clinic's services are utilized and understood by agencies' clients and staff. 2. Briefly summarize your findings: All surveys conducted over the past five years have been positive. Overall, patients are very satisfied and appreciative of the care received at Free Medical Clinic. Staff from other agencies are glad to have the clinic as a referral site for their clientele. Suggestions from clients and staff of other agencies have been helpful and have been responded to. 3. What changes have been made in response to these findings? We have mailed out brochures to agencies unsure of our services. We have expanded services when possible to meet the needs requested by our patients (e.g., dental services, in-kind procedures at Mercy Hospital, medication requests). We have expanded our numbers of available interpreters and have purchased or translated materials as needed. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred University of Iowa Hospital We do not currently keep statistics in these Mercy on Call categories. MECCA Emergency Housing Project Community Mental Health Center Estimated 1% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Some private doctors see patients free of charge, UIHC sees some indigent patients, and Mercy Hospital will see some patients without charge. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. We have no financial guidelines or restrictions. We never bill the patient. j ccoghs\fundingform.doc 4 Agency Name Iowa City Free Medical Clinic 7. Outsideofreferrals, list up to 3 primary collaborations. Bfiefly describe the nature ofeach collaboration. Collaborations Briefly describe 1 .UI Family Practice 1 .FMC is receiving funds from a grant to follow-up on patients seen by YP residents at FMC for depression. 2.Johnson County Public Health, EHP 2.FMC provides TB testing for EHP clients and does follow-up 3.UI College of Nursing 3.FMC is a practicum site for nursing students jccoghs\fundingform.doc 5 Agency Name Iowa City Free Medical Clinic Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1 .Termination of Malpractice insurance 1. We have enrolled all eligible volunteers on the state indemnification program. Exhaustive search to find the least expensive coverage. 2.Too many new patients 2. We are attempting to manage the weekly addition of clients with chronic illness. Hiring case manager, open one more afternoon a week and streamlining other clinic hours 3.Co-Director/volunteer coordinator is leaving 3. We are taking this opportunity to work out after 12 years at FMC a job description for a new position that would better suit the needs of our growing clinic, increase the hours of a 3A time position to full time and stay within our budget. 2. In what way will the needs of your service population change in the next five years? We believe the cases of patients with chronic illness will continue to rise. Uninsured populations will grow as well. 3. How do you plan to address these changes? Without increased funding we will be unable to address these needs. We can be open more hours and hire more staff if we have more funding. Grants will not fill the void. 4. Describe the evaluation methods you use to measure the success of your services? Quality assurance is used to make sure we are providing quality care. Chart review is the main component of this program. Patient satisfaction surveys are done throughout the year, asking patients about their visit and treatment as well as surveys asking patients about insurance and income. jccoghs\fundingform.doc 6 Agency Name Iowa City Free Medical Clinic 5. What are the results of these evaluations (outcomes)? Patient Satisfaction Survey Results May 2002/50 patients excellent good fair poor Courtesy and respect of staff: 36 14 Amount of time examiner spent with you: 29 21 Examiner's attention to your medical history and questions: 35 15 Clear explanation of labs run and/or medications dispensed: 36 14 Overall care: 38 12 Comments: "Really appreciate your service" "We appreciate your service and great attitudes more than you know" "I would like to commend the staff and volunteers for the way they have impacted many lives. Their commitment in bringing free health care to poor people in society is highly commendable and appreciated" "We are grateful for this" "Wouldn't know what to do without this Clinic" "Every one of you is a major blessing!" "I appreciate the care given to me at the clinic very much" "Don't change anything - thank you" Patient Satisfaction Survey Results July 2002/50 patients excellent good fair poor Courtesy and respect of staff: 42 8 Amount of time examiner spent with you: 38 12 Examiner's attention to your medical history and questions: 40 9 1 Clear explanation of labs run and/or medications dispensed: 40 8 2 Overall care: 45 5 Comments: You provide a greatly needed service in this area. Need more people with kindness, as I see here. jccoghs\fundingform.doc 7 Agency Name Iowa City Free Medical Clinic This is a great place; everyone is friendly and wonderful. The staff made me feel very comfortable. I'm very grateful that you offer the services you do. And the service was terrific. I'm very impressed and appreciative. Free Medical Clinic Survey Results Conducted April/May 2002 200 Clients Do you have health insurance? Where would you go if Free Medical Clinic didn't exist? Insurance: 4* No Insurance: 196 * one of the four with insurance explained that their insurance covers catastrophic care only; one of the four with insurance was here for dental visit and their insurance did not cover dental care No Insurance/Emergency Room: 96 No Insurance/Nowhere: 86 No Insurance/Private Physician: 14 Insurance/Emergency Room: 1 Insurance/Nowhere: 2 Insurance/Private Physician: 1 Comments: "1 woutd probably go to a private doctor for as long as they would continue billing me; I have a high debt now that I am gradually paying off" "Without Free Clinic I would have to suffer the consequence for not being able to have health care" "1'11 never forget your kind support" "Thanks for being here" "1 owe hospital $800+" "1 hope Clinic stays - people are great here" "1 appreciate and thank Free Clinic staff for every service and for being so nice" "1 wish Free Medical Clinic to exist and grow bigger and bigger so as to serve the so many people like me, thank you so much" "1 am sole family support. I am also sending help to parents who were wiped out in Fayette flood" "You have done a lot for me. Thank you so much" '~1 am very glad the Free Clinic is here" "Always the best of treatment! What would I do without you?" j ccoghs\fundingform.doc 8 Agency Name Iowa City Free Medical Clinic Free Medical Clinic Survey Results Conducted August 2002 1 SO Clients Do you have health insurance? Where would you go if Free Medical Clinic didn't exist? Insurance: 3* No Insurance: 147 * one of the three with insurance was here for dental visit and their insurance did not cover dental care; one of the three with insurance had a $5,000 deductible he could not afford No Insurance/Emergency Room: 78 No Insurance/Nowhere: 66 No Insurance/Private Physician: 3 Insurance/Emergency Room: 1 Insurance/Nowhere: 0 Insurance/Private Physician: 2 Comments: "We need you" "i've tried to keep insurance but I only can afford my children. I try hard not to get sick" "FMC has been a tremendous help for our family" "1 don't know where I would go" "This place is truly a lifesaver" "i'm so luck to have you" "Wait too long" 6. How do you plan to use the evaluation results to enhance/extend your services? Nothing stands out as a major concern at this time. We feel our mission of providing free healthcare to the uninsured is the most important service we have to offer. 7. How do your programs/services impact the community? We keep sick people out of emergency rooms, provide employment physicals so people can become employed, and help to keep our community healthy. 8. How did the agency respond to the UWJC recommendations from last year? The United Way Citizen Review Panel appreciates the valuable services provided by the Free Medical Clinic to a vulnerable population in our community. The Panel applauds the agency's creative efforts to access professional volunteers and to adapt services to meet the changing needs of its clients. The Panel also appreciates the clinic's active support of UWJC. The agency is encouraged to share the results of its client satisfaction surveys and program evaluations with the Panel. The Survey results were made available to the committee. jccoghs\fundingform.doc 9 Agency Name Iowa City Free Medical Clinic Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? Four new members were added in July and August. Prior to that attendance was 6-8 members. 4. How is the board involved in strategic planning and governance of the agency? We have an annual retreat where our 5 year plan is discussed. The last retreat was in September 2001. A retreat will be scheduled to review the results of the organizational audit and set 5 year goals accordingly. 5. What type of training/orientation do board members receive? New board members receive a manual with clinic and board information. Each new member is also required to come to the clinic one evening to see how the operation works and to visit with staff. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? No 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Yes 1/15/02 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? Pending- due 11-15-02 If no to questions 6, 7, or 8, give explanation. #6- policies and procedures will be a result of the TLD audit 9. Does your agency have a yearly audit? Yes No X__ If yes, Who completed the audit? FY 00 audit was completed by Bradshaw and Gurrity. How much did the audit cost? $2,200 If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, what is in place to assure accountability in the agency's financial management? There will be an audit of FY 02 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers X $1,000,000 a. fiduciary liability b. employment practice liability General Liability X 1,000,000 Umbrella Liability jccoghs\fundingform.doc 10 Agency Name Iowa City Free Medical Clinic Professional Liability X 1,000,000 Property or Renters X 96,800 Vehicle Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Sandy Pickup has worked at FMC for 16 years. Mary Dole-Ritter 12 years and Barbara Vinograde l0 years. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Co-Director X X X 36,791 to 37,841 3 2.6 2 Case Manager X X X 29,120 to 30,894 1 1 1 Office Manager X X X 15,172 to 22,069 .75 .87 1 Physician X 32,582 to 41,707 .4 .4 .4 Dental Assistant 2,040 .12 .12 .12 Clinic Facilitator X X X 2,1840 to 23,400 0 .34 .75 Physician Assistant X 4,300 to 5,200 .15 .15 .15 TOTAL FTEs 5.42 5.48 5.42 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 4. How much was spent on staff development in the last fiscal year? $915.00 5. How much is budgeted for staff development in this fiscal year? $2,000.00 j ccoghs\funding form.doc 11 Agency Name Iowa City Free Medical Clinic 6. What training and support opportunities are offered to staff?. Staffare allowed time offto attend workshops and conferences that pertain to the work we do at FMC. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3% Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board last reviewed? 11/98 10. Does your board X annually evaluate the director's performance? 11. Does your agency X New job descriptions may be written as a result of the have job 1999 organizational audit done by TLD. descriptions for every position? If yes, date of last board approval? 12. Is there an annual X performance review for every staff?. j ccoghs\fundingform.doc 12 .l_A~qency: Iowa City Free Medical Clinic Section 7: Financial Management A. Three Year Historical Balance Sheet (A§ of you? fiscal year-end) FY 00 FY 01 FY 02 Current Assets ~Cash $33,037 ~ $40,251 $20,968 Investments $107,899t $113,871 $1!6,366 Receivables < 90 days Ot~r Total Current Assets . $~140,936 $154,122 $137,333 Other Assests Property Equipment $17,116 $17,456 ~ less depreciation ~ ($1,757)~ ~eceivables > 90 days Other Total Non-current Assets $0 ! $17,116 $15,699 Total Assets $140,936 $171,238 $153,032 FY 00 FY 01 FY 02 Current Liabilities . Accounts Payable $50 ~ $22 $240 Payroll Taxes Payable $4,290 $4,522 $4,366 Contracts Payable Mortgage Payable-6 months , Total Current Liabilities $4,340 $4,544 $4,606 )ther Liabilities Mortgage Payable-Balance Other Total Other Liabilities Total Liabilities $4,340 $4,544 $4,6 NetAssets $136,596 $166,694 $1~6 Liabilities & Net Assets $140,936 $171,238 ~ $153,032 13 ~ncy: Iow~ City Fre~e Medical Clinic . FY 02 ~ FY 03 FY 04 B. Income & Expenses Income Local Funding Sources Iowa City $6,284 $6,584 $6,913 ,500 ~ $1,650 $2,000 Coralville $1 Johnson County $93,599 I $92,297 i $96,911 UnitedWay-Allecation __ $99,196i $101,140[ $103,162 - Designated Giving $10,831 ~ $9,830 $9,000 Grants-Federal, State, Foundation $5,017~, $33,000 i $1,500 ' Net Sales of Service Net Sales of Materials __ Contributions/Fundraising $82,429 $73,525 $81,200 , Investment Income $3,053 $2'500 I $2,500 Other ,,o i~ Total Income $301,9uo $320,526 $303, Expenses Wages & Salaries $196,330 $205,600 $207,614 Benefits $43,001 $45,457 $46,955 Occupancy $19,298 $20,358 $21,290 Non-occupancy $39,681 $37,707 $42,120 Other-pharmaceuticals $12,146 i $9,000 $9,450 Malpractice insurance ~ $9,741 Total Expense $320,176 $342,570 $338,429 C. Fund Balance Revenue ~ $301,908 $320,526 $303,185 Carryover Balance from previous year $154,122 $135,854 $113,810 Total Operating Budget ~ $456,030 $456,380 $416,996 Less Total Expenses 320,176 $342,570 $338,429 Ending Fund Balance ~135,854 $113,810 $78,567 Les? Restricted Balance (explain) . Carryover Fund Balance $135,854 $113,810 $78,567 14 ~g~ncy: Iowa City Free Medical C!in!~ D. BdlDoeor/Funder Restricted Funds Designated for: / FY 02 ! FY 03 I FY 04 Donor Scholarship $500 $500 $500 Donors Client Financial Assistance [ $3,000 t $3,000 r $3,000 Soard___ 3 month operatin~ funds $80,044 ~ ;8i,( ii~ $85,643It $84,607 Total Restricted Funds $83,544 $89,143 $88,107 E. In ~!~d Support: FY 02 I FY 03 FY 04 ServicesNolunteers 4,000 medical and non-medical hours Material Goods donated medications _ $237,855 J $268,776 $303,717 Space, Utilities, etc Other: (Please footnote) Donated lab tests and medical supplies $102,000 ~ $112,200 $t23,420 Total In-kind Support__ $339,855 ! $380,976 $427,137 F. Grants Description/Purpose FY 02 FY 03 FY 04 ~tate of Iowa HIV counseling and Testing $887 $1, $1,500 ;tare of Iowa __ Smoking cessatian $3,316 $5,500 ~ $0 Empowe~ent__ i Tir~p ~utreach pediat~ric clinic $289 $0 $0 Ganette Foundation $0 $0 ~ Spanish classes for staff ~ $525~ DBG __ Ease Management $0 ! $18,000 I $0 DePression Case Management for people with depres~ $0 $8,000 $0 Total Grants $5,017 $33,000 $1,500 Notes '~nd Comments: volunteer MD ~ $80, Clerical @ $11, Lab Tach ~ $14, Pharmacist @ $34, Nurse ~ $21, Podiatrist ~ $48, ~urse P[actitioner ~ $30, Opto_metrist @ $30, P~hysical Therapist ~ $26, Dietician @ $18, physician Assistant ~ $32, Dentist ~ $47 and Patient Advocate ~ $11 (per hour) FY 02 Sample mediceti~ons and prescriptions from pharmaceutical company patient assistance programs ~ $50 average cos~i 5,000 prescriptions filled in FY 02, less $12,145 from FMC pharmacY expense line.) Approx. 13% annual cost iqcrease 4015 lab tests sent out at $25 average cost and medical supplies donated by individuals and, medical practi~es __ o Trends indicate a 10Yo annual cost increase in these items I 15 Appendix A Free Medical Clinic Board of Directors FY 03 Name Office & Occupation Hm# Wk# e-mail Term/exp Committee Assignment Acord, Marsha Personnel Associate Director of Wesley Center/Campus 895-6678 338-1179 ~vmarsh~aol.com 7/02-7/05 12014. Dubuque Minister (1~t Term) IowaCity, IA 52245 Barber, Gloria Finance Radiology admin 472-3878 339-3278 Gloria barber5a)merc¥ic~ 8/02-8/05 -- 414 West 5th Street Mercy Hospital (1° Term) Vinton, IA 52349 Iowa City Bergus, George Past chair ~ FaculW, Family Medicine 338-9733 384-7566 george-bergus~uiowa.edu 7/99-7/02 418 Wa~es St. Board Development U ofl (I~ Tern0 iowa City, IA 52245 Boyd, Robert Fundraising Business owner & operator 337-5152 338-7561 FAX 338-8620 3/01-3/04 City Electric Space Needs (1~ Term) Box 1516 Iowa City, IA 52244-1516 Dameron, Graham Treasurer Public Healt[t Consultant 337-9270 335-9640 ~rabam~ina~ net 8/01-8/04 -- 48 Penfro Personnel (la Term) Iowa City, lA 52246 Finance gdameron(a)mail public-health.ui~w_ a.edu France, Nona Board Development BSN, MSN, ARNP at University of Iowa Health 337-5920 353-6165 nona-france(~uiowa,¢du 8/99-8/02 620 Oakland Ave. Care (1~ Term) Iowa City, IA 52240 Lembke, Vol Fundraising Professor of Accounting U ofi, Retired 351-2902 V alden-le mb ke~,uiowa.edu 7/01-7/04 -- 114 Post Rd Finance (1 ~ Term) Iowa City, lA 52245 Rice, Gretchen Fundraising Nurse Practitioner and FMC volunteer 351-4359 rice~soli.inav.n¢[ 9/98-3/04 3711 Forest Gate Dr. NE Board Development (2nd Term) Iowa City, IA 52240 Walsh, Shannon Fundsaising Attorney 3374420 Shannon Walsh J D~aol. corn 8/02-8/05 2261 Davis Street Board Development Private Practice (1~ Term) Iowa City, lA 52240 Weyer, Sally Secretary Attorney 351-5193 sawever,rt~aol ¢~!! 6/00-6/03 PO Box 3188 Personnel Private Practice (1st Term) Iowa City, IA 52244 Wirth, Bill Chair Business owner and operator 337-2420 351-1250 bill.wi,~ch ~a)st at e fa~ .wn. corn 1/97-3/03 4655 Running Dee~ Woods NE Fund~aising ! FMC ¥olunteer (2nd Term) Iowa City, IA 52240 Personnel Finance Wilmoth, Ralph Board Development Director Johnson Couniy Public Health 356-6040 rwihnoth~co.johnson ia us JCPH 1105 Gilbert Ct Ext 104 Liaison Iowa City, IA 52240 __ 09/27/02 Appendix B Free Medical Clinic Organizational Chart BOD P~tie~al S ~rxicc~ Medical Director Admil:listr:~,rive l)~rec~ ~Z; Manager ~n Clinic Facilitator office assistants ::: Physician Assist~t Physician Assis~t The Board of directors is at the "top" of the org chart The Iowa City Free Medical Clinic is directed by 3 co-director, (Clinical, Medical and Administrative directors) these directors are supervised by the BOD and are responsible to each other. Physician assistants are responsible to the medical director Medical Volunteers are supervised by the Clinic facilitator Administrative volunteers are supervised by the Office Manager. 9/27/2002 Appendix C Iowa City Free Medical Clinic Section 2 1. 5460 total clinic visits 85% of these visits were from Johnson County residents (IC, CV, JC, HL, UI) 2491 unduplicated count 85% of 2491 = 2117 Non-residents 122 HIV Johnson County total: 367 Vouchers: 328 TOTAL 2934 (this # does not include over 1600 "walk-ins" during clinic office hours (OTC meds, bp checks, preg. tests, referrals) 2 5460 total clinic visits 60 % of these visits were from Iowa City residents 2491 unduplicated count 60% of 2491 = 1495 Homeless (5% of 2491) 125 Vouchers 328 U of I 26 TOTAL 1974 (this # does not include over 1600 walks-ins or clients having HIV counseling and testing) 3. 14% of clinic visits were from Coralville residents 14% of 2491 = 349 A "unit of service" or "clinic visit" at FMC consists of any and/or all of the following: Dr. visit Lab work Pharmacy Referrals Counseling Section 1: Background Agency Name: Girl Scouts of the Mississippi Valley, Inc. Address: 240 Classic Car Ct. SW Suite A Phn~. (31~// Cedar Rapids, IA 52404 277' Director Name: Diane T. Nelson Signature: ~_ ~/~/~d~/ Bd. Pres Name: Deborah J. Hughes Signature: f/~~~.~vvv ~.~ ~/ / Request Completed By: Carla Jesse Date:: Septem~ 15,20~2 Check Your Agency's Budget Year: 1/1-12/3I 7/1-6/30 10/1-9/30 9/1-8/31 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $0 $0 $21,760 .08% Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of lowa City $0 $0 $0 $0 Johnson County $0 $0 $0 $0 City of Coralville $0 $0 I $0 $0 What were local funds used for this year: What will next year's local funds be used for? Funding of $21,760 will be used to supplement program opportunities for girls, support volunteers, and assure that we can offer Girl Scout program to every girl in Johnson County. Agency Mission Statement: The purpose of the Girl Scout movement is to inspire girls with the highest ideals of character, conduct, patriotism, and service that they may become competent and resourceful citizens. We help girls grow strong. Summarize your programs and services for which you are requesting funding: Girl Scouting is an informal education and leadership program designed to help girls put into practice fundamental principals and values found in the Girl Scout Promise and Law. It is carried out in groups of girls partnering with adult leadership and offers a wide range of activities developed around the interests and needs of girls. Girls ages 5-17 for groups by program age levels. (Daisy, Brownie, Junior, Cadette, Senior) A wide variety of age appropriate activities are made available at each program age level. Whether a girl experiments with kitchen science, learns self-defense, demonstrates internet safety, hones her soccer skills, or coordinates a diaper drive for another agency, all Girl Scout program activities are designed to fulfill one or more of the Four Program Goals. · Develop Self-Potential · Relate to Others · Develop Values · Contribute to Society Agency Name: Girl Scouts of the Mississippi Valley, Inc. List any accreditation and licensure your agency currently has. Explain. 1) Girl Scouts of the Mississippi Valley, Inc. is chartered through Girl Scouts of the U.S.A. every four years at the recommendation of the National Board of Directors. Prior to charter renewal, the council conducts an assessmant of its performance. This assessment determines whether the council is meeting its obligations to girls, volunteers, and its communities. 2) Girl Scouts of the Mississippi Valley, Inc. maintains an American Camping Association accredited camp. Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Girl Scouting is for every girl everywhere. In fiscal year 2001, the Girl Scouts of the Mississippi Valley (GSMV) is serving 11,306 girls, ages 5-17, with the help of 3,220 adult volunteers throughout ten counties in Iowa and five in Illinois. In Johnson County, 1,303 girls are served by 371 trained volunteers. Our final FY2002 membership data indicates that one in every 10 Girl Scouts is from diverse racial and ethnic background - reflective of the diversity found in the council area. Membership applications in this council indicate that 15 Girl Scouts are mentally disabled, 14 have hearing impairments or are deaf, 83 have severe learning disabilities, 32 have physical disabilities, 66 are blind or visually impaired, and 13 list other disabilities. Girl Scouts made its way to Iowa in 1917 when troops formed ~ in Iowa City. The first incorporated council to serve Johnson ~i ~o~.~ County was Cardinal Council, organized in 1952. In 1975, Cardinal Council joined with other areas to form Girl Scouts of the Mississippi Valley, Inc., serving ten counties in Iowa and five in Illinois. Throughout its history, the Girl Scout organization has strived to reach out to every girl regardless of ethnicity, ability, or economic circumstances. In the past 90 years, Girl Scouting has shown girls how to reach their goals and meet challenges head- on. Girls involved in Girl Scouting learn how to take responsibility, how to lead, how to set goals, and how to reach them. This experience helps girls become leaders in business, government, and in their homes and communities. The values we promote--and live by--are timeless. With an emphasis on service to the community, the Girl Scout Promise and Law are just as important today as they were in 1912. Girl Scouting is not standing still. Our program is diverse, with activities and projects that are geared for meeting the demands of the 21st century and targeted to what girls, ages 5 through 17 want and deserve today. Girl Scouting is proud of its history. It expects to be even more proud of its future. jccoghs\fundingform.doc 2 Agency Name: Girl Scouts of the Mississippi Valley, Inc. Section 2: Client Profile 200 200 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 1381 * 1303' Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 815 746 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 236 220 · All membership data above indicates registered girl members. Adult volunteers included only in age breakdo~vn. Age (use agency's Gender Ethnicity (use agency's # also with breakdown if needed) breakdown) Hispanic Decent 0-5 123 Female: 1,303 Am. Indian/Alaskan 9 2 6-17 1,180 Male 0 Asian 32 2 Adults 18+ 371 Black 35 0 Caucasian 1,075 19 Other 18 3 Unreported 108 3. Briefly describe your service population. Girl Scouting is for every girl, everywhere. Girl Scouts of the Mississippi Valley, Inc. serves girls representing every population group, regardless of ethnicity, disability, religion, or any other criteria. Girl Scouting exists only to serve girls. Many years of experience show that girls have unique needs and interests that are best met in a program designed especially for them, delivered in an all- girl setting. 4. How do you determine eligibility for services? Girl Scouting is for every girl, everywhere. Membership is granted to any girl, 5 to 17 years of age, who makes the Girl Scout promise and accepts the Girl Scout Law, and has paid annual membership fees to Girl Scouts of the U.S.A. Financial aid is available through Girl Scouts of the Mississippi Valley, Inc. to those who cannot afford the seven-dollar membership fee. 5. Are there fees for your services? Yes ,/ No If yes, please describe your fee structure: A seven-dollar fee is charged by our national organization, Girl Scouts of the USA. Girl Scouts of the Mississippi Valley offers financial assistance to families in need of support in order to participate. Some volunteer troop leaders also ask for troop dues or activities fees ranging from zero to $40 per year. Fundraising activities, including the Troop Opportunity Sale and the Girl Scout Cookie Program, offer troops the opportunity to be completely self-supporting. Girl Scouts of the Mississippi Valley, Inc. offers financial assistance to families in need of support in order to participate. jccoghs\fundingform, doc 3 Agency Name: Girl Scouts of the Mississippi Valley, Inc. 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Girl Scouts of the Mississippi Valley, Inc. serves girls in 15 counties. In Iowa, we serve Johnson, Washington, Iowa, Linn, Jones, Cedar, Muscatine, Jackson, Clinton, and Scott counties. In Illinois, we serve Rock Island, Henry, Mercer, Warren, and Knox counties. Services Provided: Girl Scouting outside Johnson County is almost identical to the services offered in Johnson County. Girl Scouting is an informal education program designed to help girls put into practice fundamental principals and values found in the Girl Scout Promise and Law. It is carried out in groups of girls partnering with adult leadership and offers a wide range of activities developed around the interests and needs of girls. Whether a girl experiments with kitchen science, learns self-defense, demonstrates intemet safety, hones her soccer skills, or coordinates a diaper drive for another agency, ail program activities are designed to fulfill one or more of the Four Program Goals. · Develop Self-Potential · Relate to Others · Develop Values · Contribute to Society Funding Sources: [] Product Sales (64%) The FY2003 budget anticipates [] Program Fees (15%) revenue of $2,703,045 from these [] Interest (1%) sources: · $1,716,000 (64%) from Product []UnlteaWays(?%) Sales - The Cookie Program Sale ($1,607,000) and the Troop · Miscellaneous (4%) Opportunity Sale ($109,000) still [] Contributions (9%) accounts for most of our revenue to fund services to girls and volunteers. · $402,490 (13%) from Program Fees - These are fees paid to attend camp, council-sponsored events, and a few specialized volunteer trainings. · $28,000 (2%) from Interest on Investments · $188,000 (7%) from United Way and Community Chest allocations and donor-designated gifts - We receive allocations from seven United Way or Community Chest organizations and donor-designated gifts from two additional United Ways in our 15-county jurisdiction. · $119,200 (4%) from Miscellaneous Income - This category includes income from the sales through our retail stores and trading posts ($95,000) and other miscellaneous income. · $249,200 (9%) from Contributions - Contributions include annual appeal ($85,000), grants ($82,791), gifts-in-kind ($31,564), and special events ($50,000). j ccoghs\funding form. doc 4 Agency Name: Girl Scouts of the Mississippi Valley, Inc. Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client 1) Program Evaluations - Most events for girls have an evaluation survey. Girls are asked how they liked various activities and what other types of events would interest them. Adult volunteers are also asked how events can be improved and what additional program options they would like to see. 2) Retention Rates - If coming back for more is an indicator of client satisfaction, Girl Scouts is meeting the needs o£girls. Girl Scouts of the Mississippi Valley, Inc. carefully analyzes data showing what percentage of girls choose to return to Girl Scouts year after year. In Johnson County, 75% of girls choose to come back to Girl Scouts. 3) Leader Feedback - Girl Scouts of the Mississippi Valley, Inc. policies are influenced by volunteers known as delegates. Delegates are elected by volunteer leaders. They represent their area to elect board members and influence Girl Scout Council policy. (b) Community 1) Collaborations are one way that we receive feedback from the community. When agencies are eager to work with Girl Scouts, we know that we are perceived in a positive way and are adding to the community in a positive way. 2) Community support to Girl Scouts is evident through the success of the Girl Scout Cookie Program. 2. Briefly summarize your findings: Though Girl Scouts is not without its challenges, it is a program that is embraced by the community and enjoyed by girls. 3. What changes have been made in response to these findings? As a result of feedback Girl Scouts is constantly honing program opportunities for girls. In response to overwhelming attendance at the Girl Scout Day with the Women's Hawkeye Basketball, Girl Scouts now collaborates with four sports teams at the University to offer clinics and events for girls. In response to retention rate analysis Girl Scouts of the Mississippi Valley, Inc. is planning aggressive action. The new Initiative, "]New Directions" will offer older girls (ages 12-17) a wider menu of program activities and participation options. These are examples of many ways that Girl Scouts of the Mississippi Valley, Inc. is responsive to the feedback we receive from girls, parents, volunteers, and the community. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Because of an aggressive effort to offer the unique opportunities of Girl Scouting to Every Girl, Everywhere, referrals are not a significant source of new clients. Source of Referral % of clients referred j ccoghs\funding form. doc 5 Agency Name: Girl Scouts of the Mississippi Valley, Inc. 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? No other agency or organization offers program like Girl Scouts of the Mississippi Valley, Inc. Girl Scouts is a values based informal education program designed to meet the unique needs of girls in a single-sex environment. It offers girls a unique long-term partnership with dedicated volunteer adult role models. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Though many organizations offer program for youth, Girl Scouts is unique in many ways. Girls-Only Environment A girls-only environment is important to offer to girls in many developmental stages. Thorough research by the American Association of University Women shows that girls can still be short changed by bias in the classroom and in many areas of their lives. Girl Scouts offers learning situations and leadership opportunities to counter balance those effects. Long Term Program The Girl Scout program is offered long term. A girl can participate in Girl Scout from the time she enters Kindergarten to the day she tums 18. This lasting bond with a caring adult role model can become a pivotal relationship for many young women. Wide Program Scope From travel opportunities to computer technology; from science experiments to financial literacy; from stress reduction to leadership opportunities. Girl Scouts offers a vast array of program for girls to which they may otherwise not have access. Values Based The foundation of the Girl Scout movement is the values found in the promise and law. The Girl Scout Law We all have a better future when one girl promises to do I will do my best to be her best, serve her country, help people, and live by a honest and fair, code of ethics, friendly and helpful, considerate and caring, courageous and strong, and responsible for what I say and do, and to respect myself and others, respect authority, use resources wisely, make the world a better place, and be a sister to every Girl Scout. j ccoghs\funding form.doc 6 Agency Name: Girl Scouts of the Mississippi Valley, Inc. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. The Iowa Children's' Museum 1. Offers special programs and events based on Girl Scout badge requirements and program guidelines. 2. Goodwill Industries 2. Girl Scouts completed local drive for donations to Goodwill. Last year 1,399 bushels of merchandise were collected. 3.University of Iowa Athletics and student 3. Offer sports clinics and workshops based groups on Girl Scout program guidelines. Last year 2,149 Girl Scouts attended an athletic event or clinic and 700 girls were involved in other student led activities. Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Finding funding to better support volunteers 1. Better utilizing press and P.R. opportunities and offer more specialized program to share the Girl Scout message. opportunities for girls. 2. Offering program to every girl in Iowa City, 2. Better utilizing press and P.R. opportunities because we are no longer allowed to distribute to share the Girl Scout message. information through public schools. Retaining New program opportunities for older girls girls as they enter middle school and beyond as based on research ever more school, religious, and social activities become available. 3. Finding adult volunteers has become 3. Increased emphasis on recruiting non- increasingly difficult and more time consuming ~arent volunteers. Offering more flexibility as more girls live in single parent homes or in job sharing, training options, and meeting homes where both parents work. times. 2. In what way will the needs of your service population change in the next five years? j ccoghs\funding form. doc 7 Agency Name: Girl Scouts of the Mississippi Valle,/, Inc. Girl Scout service population includes all families with girls. Looking at census data, we anticipate that the population in Johnson County will continue to grow and become more diverse. Language barriers may also become an issue. 3. How do you plan to address these changes? · Girl Scouts will continue to implement aggressive recruitment strategies to reach Every Girl, Everywhere. · Girl Scouts will continue to promote pluralism and offer a variety of program opportunities that appeal to a wide variety of individuals. · Girl Scouts will increase efforts to offer materials in more than one language. 4. Describe the evaluation methods you use to measure the success of your services? The council surveys both members and non-members to determine how well the council is meeting its mission, goals, and objectives. The board of directors appoints a council performance assessment task force that is charged with conducting the council performance assessment. This assessment is based on criteria and standards set by Girl Scouts of the USA. Documentation is gathered and reviewed in order to determine the success of each criteria. After the task force has completed their work, a team from national comes in to review the documentation and preliminary report. This report indicates both strengths and weaknesses, as well as opportunities for growth. The final report is written and presented to the board of directors for acceptance. 5. What are the results of these evaluations (outcomes)? The evaluation identified the following strengths and weaknesses in Girl Scouts of the Mississippi Valley, Inc. Strengths: · The council is serving 1 in 7 girls. · The council has a volunteer management system, which includes screening methods, training, development, evaluation, and recognition. · The council provides financial assistance and makes it available to all those who need it. · The council is to be commended for its excellent risk management plan that thoroughly outlines procedures for all situations in the council. · The council has successful collaborations with many organizations · There is evidence of a strong girl/adult partnership · Hiring and training a qualified staff. · The staff reflects the racial and ethnic composition of the council population's base. Areas of growth: · The council needs to develop a long-range (3-5 year) membership plan. · The council must continue to develop strategies to serve the growing racial/ethnic populations within its jurisdiction. · A long-range fund development plan (3-5 years) which should include an endowment fund, planned giving, and annual giving to reduce the dependence on girl generated income. jccoghs\fundingform.doc 8 Agency Name: Girl Scouts of the Mississippi Valley, Inc. 6. How do you plan to use the evaluation results to enhance/extend your services? The final report from the evaluation becomes the basis for the council's long range strategic plan, and yearly goals and objectives. A yearly evaluation on the progress of the council's tactical plan is conducted by the board to assure the council is on target with meeting the needs of the members of the organizations and fulfilling our mission. 7. How do your programs/services impact the community? Service to Others Girl Scout troops typically work on at least one Community Service Project every year. For example, last year over 300 Girl Scouts collected 1399 bushels of merchandise for Goodwill. The highest awards in Girl Scouting require over 100 hours of service. Stronger Youth Girl Scouts is Where Girls Grow Strong. Gift Scouts helps cultivate values, social conscience, and self-esteem in young girls, while also teaching them critical life skills that will enable them to succeed as adults. We all have a better future when one girl promises to do her best, serve her country, help people, and live by a code of ethics. 8. How did the agency respond to the UWJC recommendations from last year? N/A Section 5: Board Governance l. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Five times per year 3. What is your average attendance at board meetings? 13 - 16 board members and 7 employed staff 4. How is the board involved in strategic planning and governance of the agency? The board is responsible for the development and implementation of the council's long range strategic plan. The board also monitors the progress made on the council's yearly goals and objectives. 5. What type of training/orientation do board members receive? All new board members receive an in depth orientation on the Girl Scout organization and a training on board member responsibilities. A training/orientation is offered once a year for all new and returning board members. 6. Does your agency have written policies and procedures for financial management? Yes If yes, date of last board approval? October 1999 7. Have you filed the annual report with the Secretary of State? If yes, date filed? January 9, 2002 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? January 9, 2002 If no to questions 6, 7, or 8, give explanation. j ccoghs\funding form. doc 9 Agency Name: Girl Scouts of the Mississippi Valley, Inc. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? McGladrey & Pullen How much did the audit cost? $7,800 If material weaknesses are noted in the audit, what is your plan for addressing them? N/A If you do not have an audit, what is in place to assure accountability in the agency's financial management? N/A 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X 2,500,000 b. employment practice liability General Liability X 1,000,000 per occur 2,000,000 aggregate Umbrella Liability X 6,000,000 Professional Liability Property or Renters X 2,014,000 Vehicle X 1,000,000 per accident j cc oghs\ funding form. doc 10 Agency Name: Girl Scouts of the Mississippi Valley, Inc. Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. The current executive director Diane Nelson, has been employed with the council since January 2, 2002. Diane brings with her knowledge of not for profit management, fund development, marketing and communications, personnel management, and a proven track record with recruitment and retention. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X X 60,000 - 90,000 1 1 1 Associate Executive Dir. X X X 47,000 - 71,000 1 1 1 Finance Director X X X 42,000 - 62,000 1 1 1 Fund DevelopmentjMkt Dir X X X 37,000 - 57,000 1 1 1 Information Systems Mgr. X X X 26,000 - 41,000 1 1 1 Administrative Services Dir X X X 37,000 - 57,000 1 1 1 Regional Team Director X X X 37,000 - 57,000 3 3 3 Adult Development Mgr. X X X 26,000 - 41,000 1 1 1 Program Development Mgr. X X X 26,000 - 41,000 3 3 3 Community Develop Mgr. X X X 26,000 - 41,000 3 3 3 Membership Develop Mgr. X X X 26,000 - 41,000 8 8 8 Sales/Customer Serv Mgr. X X X 26,000 - 41,000 1 I 1 Equestrian Program Mgr. X X X 26,000 - 41,000 1 1 1 Equestrian Program Asst. X X X 18,000 - 25,000 1 1 1 Activity Center Coordinator X X X 18,000 - 25,000 1 1 1 Office Support Staff X X X l 6,000 - 25,000 8 8 8 TOTAL FTEs 35 35 35 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 3.7 4. How much was spent on staff development in the last fiscal year? $11,479 j cc oghs\funding form.doc 11 Agency Name: Girl Scouts of the Mississippi Valley, Inc. 5. How much is budgeted for staff development in this fiscal year? $19,710 6. What training and support opportunities are offered to staff?. An orientation schedule for new staff includes a training session with every staff member at the director level, as well as one-on-one training with the direct supervisor. Supplemental training is made available to staff as appropriate opportunities arise. Staff have been sent to classes organized through community agencies, at local community collages, and to specialized trainings at the Edith Macy Training Center operated by Girl Scouts of the U.S.A. in New York. Scholarships for professional development are sometimes provided by Girl Scouts of the U.S.A. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 2.7% Yes No If no, brief explanation 9. Does your agency have personnel X policies? If yes, date board last reviewed? 9/1/90 10. Does your board annually X evaluate the director's performance? 11. Does your agency have job X The board does not approve the position descriptions for every position? descriptions. If yes, date of last board approval? 12. Is there an annual performance X review for every staff?. j ccoghs\fundingform, doc 12 ]Agency: Girl Scouts of the Mississippi Valley Section 7: Financial Management A. lhreo Year Histodcal Balance Shoot (As of your fiscal year-end) FY O0 {01'~199 to F~ 0~ {~/~/00 to FY02 {~l~lO~ to 8/~/00} 81~lO~} Current Asse~ Cash $172.667 $59,143 $8,331 Investments 1.329.378 1.356.445 982.772 Receivables < 90 days 3,860 8,804 8.924 Other 159.443 17C 210 167 309 Total Current Assets $1.665.348 $1.594.602 $1.167 336 Other Assests Prope~y $1,751,629 $1.787,112 $1.957.242 Equipment 780.514 833 479 921.532 ess depreciation ~1,648,292) (1,749,557)~ {1,899,557) Receivables > 90 days - 1 Other _ Total Non-current Assets $883.851 $871 034 $979.217 Total Assets $2,549,199 $2,465,636 $2,146,553 FY 00 FY 0'1 FY 02 Current Liabilities Accounts Payable $59.434 $34.597 $41.278 Payroll Taxes Payable 16,150 17.192 16,999. ContractsPayable . MortgagePayable-6 months 2,316 2.234 . Total Current Liabilities $77.900 $54.023 $58.277 Other Liabilities Mortgage Payable-Balance 103.444 100,832 Other 2.186,511 2,155,926 2.029.999 Total Other Liabilities $2.289,955 $2.256.758 $2.029.999 Total Liabilities $2.367.855 $2.310,781 $2,088,276 NetAssets $181.344 $154,855 $58,277 Liabilities & Net Assets $2.549.199 $2.465.636 $2.146.553 Agenc~ Girl Scouts OfFythe01 MississippiFY02Valle FY 03 (911/00 to (911101 to (9101102- 8/3110t) 8131102) 8/3tl03) Income & Expenses Income Local Funding Sources $221.861 $210,041 $249,031 Iowa City Coralville Johnson County United Wa~ - Allocation $21,760 - Designated Giving $2 302 $5,076 $0 Grants-Federal. State. Foundation $57.237 $22,713 $0 Net Sales of Service* $149,707 $299,175 $403,690 Net Sales of Materials $96,623 $112,072 $107~000 Contributions/Fundraising $1,739,690 $1.751.037 $1,882~564 Investment Inc. ~ncl unreal~zea lOSS on ~nves~menls $14.324 ($3,905 $28,000 Other $17.400 $10,288 $11,000 Totallncome $2.299.644 $2.406.497 , $2,703,045 Expenses Wages & Salaries -- $1.116.785 $1,241,903 --$1,329,780 Benefits $239.699 $250,356 $256,650 Occupancy $106.914 $152,626 $108,270 Non-occupancy $858 785 $949,973 $1,008,345 Other Total Expenses $2,322,183 $2,594,858 $2,703,045 7_,. Fund Balance Revenue $2,299,644 $2,406,497 $2,703,045 Carryover Balance from previous year Total Operatin~qBudget $2,299,644 $2,406,497 $2,703,045 Less Total Expenses $2,322,183 $2,594,858 $2,703,045 Endin9 Fund Balance $22,539 $188,361 $0 Less Restricted Balance (explain) Carryover Fund Balance ($22.539) ($188,361)j $0 Net Sales of Service includes fees for camp and other program offerings. This appears to '~ave increased in FY02 because full resident camp was not offered in FY01, As new 3rogram offerin[s are developed we anticipate growth in this area. '* Wages appear to have increased in FY02 because full resident camp was not offered in FY01, and seasonal staff were not hired. Agency: Girl Scouts of th[Mississippil Valley~ D..d/Donor/Funder Restricted Fun~s Designated for: Last Year ~ This Year INextYear Maquoketa Trust Fund__(interest only) _ ~Camp scholarships $76 $80 i _ $84 r Capital Fund (interest only) ~Camp capital improvements ~ $5,362 $4,500 $4,000 Total Restricted Funds $5,438 $4,580 $4,084 E. in Kind Support: .... Last Year This Year Next Year ServicesNolunteers GSMV does not track or monitor volunteer time Material Goods !Computer/Software/Program supplies(more) ] $18,254 ! $28,364 ! $30,000 Space~ Utilities, etc Meeting spac~e _ . _ $0 $3,200 $3,500 Other: (Please footnot~e) __ __ _ $0 $0 $0 Total In-kind Support __ $18,254 $31,564 $33,500 Addl Material Goods !n kind __ Tractor/mower I~ease/capital improvements F. Grants Description/Purpose Last Year This Year 'Next Year Name of Organization Date of Application in FY2002 Variety Club of Iowa (PSF) Construction~materia!s for cam~ ; $4,000 Rock Island Community Foundation (MRs) Scholorship~support $2,000 __ Community Foundation of the Great River Diversity Trai~ning for Girls $2,500 _ $1,500 __ Litton Life Support Diversity Training for Girls $119 Litton Life Support for Davenport Summer Summer outreach project in Davenport $230 RiverBoat Development Authority Camp Marketing Study $17,700 Zonta Club of the Quad Cities_ Women in Labor day i - $525' Crescent-Janko Masonic Foundation ~Cedar Rapids Activity Cneter Support $1.356[ International Paper Teaming for Tomorrow program ~ $1,3~6~ _ Doris & Victor Day Foundation Quad Cities Outreach $2,500 Rouch Family Foundation i RI Summer Program $2,000 - Pillsbury Company Teaming for Tomorrow program $3,000 Melvin McCay Trust Diversity Training for Girls $500 Greater Cedar Rapids Community Founds Outreach in Cedar Rap~ids __ $5,000~ _ Maquoketa Area Foundation Scholorsh_ip s_upport $800! $800 Mary Ira Gittens Knouse Chadtable Trust Scholorship support Riverboat Development Authority i for handic~gped accessible ten! uni[ (BL.~ $20,000 $9,000; -rhe Moline Foundation i Horses in the City Program . $2,000 _ C.D. Wiman Memorial Trust ?rogram Opportunities in Moline $1,000 Weaver Witwer Trust Fund I Cedar Rapids Activity Center $2,064 Total $57,237 $22,713 Girl Scouts of the Mississippi Valley, Inc. BOARD OF DIRECTORS A~endix A PRESIDENT - 1 s'~ VICE PRESIDENT - 2N~ VICE PRESIDENT - SECRETARY - 2003 TREASURER - 2003 2003 2003 Loft Harms 2003 Deborah Hughes Gerry Floyd Judy Nauseef Davenport, Iowa Kelly Woitel Cedar Rapids, Iowa Iowa City, Iowa Iowa City, Iowa ALCOA Geneseo, Illinois Attorney Self Employed Bettendorf, Iowa Kelly Financial Services 2002 (Girl Member) 2002 2002 2002 2002 Sara Adams Kathryn Griffith Pam Hirshberg Mary Lagerblade Bill Leaver Taylor Ridge, Rock Island, Illinois Galesburg, Illinois Rock Island, Illinois Lynn Center, Illinois University of Illinois/ Work Fitness Center Mel Foster Company, Inc. Illinois DSCC Trinity Regional Health System 2002 (Girl Member) 2002 2002 2002 (Girl Member) 2002 Jacqui Liljequist Mark Lohman Gary Orr Deanna Ralston Donna Reilley Davenport, Iowa Geneseo, Illinois Port Byron, Illinois Clinton, 'Iowa Coal Valley, Illinois Lohman Brothers Insurance Washington Elementary Metlife 2002 2003 2003 2003 2003 Novella Sconyers Bret Robinson Cathy Stiles Rich Garrett Dr. Erica Goldstone Colona, Illinois Davenport, Iowa 52807 Silvis, Illinois Moline, Illinois Moline, Illinois Scott Community Farmer's State Bank Wells Fargo Bank AXA Advisors J.B. Young College Intermediate School 2003 Dennis Pauley The year indicates Rock Island, Illinois when each term Ameritech/SBC expires. Y:\FundDeveloprnent~BoantUst2OO2.doc Section 1: Background Agency Name: Goodwill Industries of Southeast Iowa Address: 1410 S. First Ave., Iowa City, IA 52240 Phone: 319-~3~3.~-4158 President's Name: John Watson Signature. ~~ d~ Bd. ChairName: KatieOberbroeckling Signatu~~~l~0/~i~,fl/~,/ Request Completed By: Mike Townsend, Tammi Erb Date: September 27, 2002 Check Your Agency's Budget Year: I/1-12/31 X 7/1-6/30 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $72,670 $73,257 $80,000 .68% Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City Johnson County City of Coralville What were local funds used for this year: Employment Services and ACCESS What will next year's local funds be used for? Employment Services and ACCESS Agency Mission Statement: The mission of Goodwill Industries of Southeast Iowa is to advance the well being of persons who experience barriers to independence. To achieve this purpose, Goodwill provides a variety of training, employment, and support services. Summarize your programs and services for which you are requesting funding: Employment Services is the collective name of all of our community based employment and training services. The goal of this service is to increase the level of vocational independence, decrease hospitalization/ institutionalization and increase opportunities for successful living for persons with disabilities and other barriers to independence by providing community-based training and employment services. Services offered include career development, job seeking skills training, job development, employer education, follow-up and long-term job coaching. ACCESS is our assistive technology service. The goal of this service is to increase the level of vocational independence and increase opportunities for successful living for persons with disabilities by providing evaluation and training in the use of assistive technology. Assistive technology is any device that helps people lead more independent lives. Services offered include assistive technology evaluation and training. List any accreditation and licensure your agency currently has. Explain. All of our services are accredited by CARF. CARF is a North American standards setting and accrediting body; its mission is to assess the quality of services and outcomes attained and assist with quality improvement efforts. Goodwill Industries of Southeast Iowa Agency History Goodwill Industries of Southeast Iowa was established in Iowa City in 1965 to provide rehabilitation, training and employment services to persons with disabilities and other disadvantaged persons who may experience barriers to competitive employment. The Goodwill program is designed to encourage and enhance dignity, self- respect and social and economic independence. The need for an organization like Goodwill Industries was recognized in the early 1960's by the local Association for Retarded Citizens and area professionals. In thc spring of 1965, the Iowa City Kiwanis Club began early organizational efforts, and Goodwill Industries was incorporated on November 24, 1965. Goodwill first opened its doors in early 1966 in the former Montgomery Ward building in downtown Iowa City. In 1968, Goodwill moved to a new 32,000-sq. ft. facility on First Avenue. A retail store in Cedar Rapids was opened in 1967 and training programs began there in 1973. The Iowa City Goodwill Industries was one of the first organizations in Iowa to be fully accredited by the Commission on Accreditation of Rehabilitation Facilities in 1977. It has maintained the highest level of accreditation by CARF ever since. Goodwill has ranked high in the state in job placements the past several years. Goodwill Industries began providing community-based training and employment services for persons with brain injuries in late 1989. The program was funded by a grant from the Division of Vocational Rehabilitation Services and was developed under the auspices of the East Central Iowa Brain Injury Task Force. A services coordination component for these individuals and their families was added during 1992. During 1998, Goodwill began offering supported community living services for persons with disabilities. During 1995, Goodwill began thc ACCESS Program. This program is designed to provide evaluation of the need for and training in the use of assistive technology to aid persons with disabilities to build on their strengths and overcome barriers to independence. Goodwill received major contributions for renovation and equipment to implement the ACCESS Program from the Roy J. Carver Charitable Trust, The City of Iowa City Community Development Block Grant program and the Iowa Division of Vocational Rehabilitation Services. Recently, Goodwill Industries has expanded services to provide job development and support services for persons who are involved in the correctional system. In addition, Goodwill began serving homeless individuals as a part of a three-year Dept. of Housing and Urban Development (HUD) grant program named STAR. In 2001, Goodwill initiated a Wheels to Work program to provide donated cars for individuals on public assistance to enable them to drive to work. We are also partners in a HUD grant with the City of Iowa City, providing vocational services for residents of public housing. Goodwill benefits its clients by encouraging and assisting them in their own desire to help themselves. It enables economic and social advancement of people by providing jobs, training for jobs and placement into jobs. Both nationally and locally, it is the largest private sector employer of persons with disabilities -- helping tax "users" become taxpayers. Goodwill is a leader in seeking to create job opportunities in other sectors. It provides valuable labor contracting services to area business and industry. Goodwill also benefits its communities by recycling a tremendous quantity of donated materials. As indicated in our strategic plan, we intend to continue the long-term trend by expanding our services in terms of the number of people served and the types of populations served. We also intend to expand the geographic area served within our Goodwill assigned territory. It is also our plan to continue to enhance the quality of the services we provide by increasing the number of successful outcomes attained. In addition, we plan to continue strengthening our financial position. It is our intention to enhance our position as a leading resource for the citizens of Johnson County. j ccoghs\funding form. doc 2 Goodwill Industries of Southeast Iowa Section 2: Client Profile : ~ ~ 2000 - 2001 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 260 305 , Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count N/A N/A 3. How many Coralville residents did your agency serve? i 3 Unduplicated Count N/A N/A [Mi[u IIl Ji'~qJ Jl ~1 L'TTi I~ m mv~] ~i~ t[liTlvv~ ~ Inl I I1 kWll KI J~ M k I I [I] 14 k~l Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 0 Female: 154 African American 27 6-17 21 Male 151 Native American 0 18-29 130 Asian 5 30-61 134 Hispanic 22 62-75 20 Caucasian 251 >75 3. Briefly describe your service population. We serve adults and secondary school students who have barriers to independence. Thc people we serve may have a disability or other conditions that create barriers; we serve individuals who arc homeless, offenders, welfare recipients and residents of public housing. 4. How do you determine eligibility for services? Goodwill entrance criteria: 16 years of age or older (any age for Case Management services). · Documentation of a disability or a disadvantaging condition. · Availability of services and supports that match thc individual's preferences, strengths and needs. · Not harmful to self or others. · Capable of, or can arrange transportation. · Capable of, or can arrange, physical care (provided at Iowa City Center). · Third party funding or self-sponsorship (no fee for Case Management services). 5. Are there fees for your services? Yes X__ No If yes, please describe your fee structure: We charge a fee per unit of service or per outcome for most of our services. 99% of these fees are paid by third parties. There is no charge for some of our grant funded services. 6. Do you provide services to areas outside of Johnson County? Area(s) served: Linn County Services Provided: Employment and training; case management for persons with a brain injury Funding Sources: Iowa DVRS, United Way of East Central Iowa and 22 counties j ccoghs\funding form. doc 3 Goodwill Industries of Southeast Iowa Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client. We survey each client twice a year as a part of the staffing meeting. (b) Community. We survey our funders on an annual basis. The board surveys key community leaders every few years. 2. Briefly summarize your findings: Our Services Management Report indicates high levels of satisfaction. 3. What changes have been made in response to these findings? Numerous changes to individual's program plans arc made in response to clients' input. We have focused staff training on areas for improvement as identified by our funders, such as job development and individual program plan authoring. 4. What are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Iowa Division of Vocational Rehabilitation Services 55% Johnson County MH/DD 35% STAR 5% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Employment Systems, Employment Plus, The Arc of Johnson County, Rural Employment Opportunities, MYEP. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. 1. We serve all disability groups and also people with other barriers to employment; the other providers tend to specialize. 2. As a business ourselves, we have a reputation among employers as an organization that acts in a very businesslike manner. 3. We are by far the largest of the providers of like services. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1.STAR (a collaborative project with MECCA and 1. Goodwill provides employment services for the Emergency Housing Project) homeless individuals. We were a primary fome in procuring this grant and continue to advise this multi-year HUD project. 2. Grant Wood Area Education Agency / local 2. Goodwill provides transition Services for high community school districts school students with disabilities. We also jointly administer two federal grants: High School-High Tech Program and Super Seniors 3. Iowa Workforce Development 3. Goodwill is an active participant - planning and implementing Workforce Development services in the area. Our President serves on the State Workforce Development Advisory Board. j ccoghs\funding form.doc 4 Goodwill Industries of Southeast Iowa Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Expand our mission-related services. This growth 1. Complete a growth planning process. Establish strategy will enable Goodwill to better meet the growth strategy guidelines. Pursue opporttmities needs of customers: persons who experience barriers that are consistent with the mission growth plan to independence, employers, funders, and and meet established criteria for growth. community members. 2. Achieve financial strength. Financial strength 2. Achieve and maintain cash working capital at and stability will be the foundation for Goodwill's 40 to 60 days. Build a mission reserve. Build and mission growth and success, maintain an "endowment" fund. Execute a capital campaign. Develop a plan and decision criteria for physical assets and investments. Achieve and maintain financial goals and benchmarks for each cost and profit center. 3. Develop staff and board competencies. 3. Recruit and select employees and board members with skills and values that match Goodwill's needs. Offer relevant and timely staff training at all levels. Provide competitive compensation for all employees. Promote a climate that encourages and rewards innovation, excellence, and customer focus. Implement succession planning. 2. In what way will the needs of your service population change in the next five years? A. The population we serve will be aging. Many of these individuals are long-term clients. Retirement is in their near future. B. The people we serve will have more significant barriers to independence. Among these barriers are a lack of basic work habits and skills. Iowa DVRS (our primary funding source) has a waiting list and will bc serving only those individuals with a significant disability. 3. How do you plan to address these changes? A. We are investigating "exemplary practices" regarding aging services. We are also looking for appropriate funding. g. We have added a Work Activity service which features a higher staff to client ratio. We also are providing more training focusing on the needs of persons with more significant barriers. 4. Describe the evaluation methods you use to measure the success of your services? We use an outcomes measurement system based on the program evaluation system developed by Walker & Associates. We use thc aggregate data as a management tool to make recommendations for quality improvement. 5. What are the results of these evaluations (outcomes)? Select results: · 49% ofterminees obtained competitive employment; (target: 40%). j ccoghs~unding form. doc 5 Goodwill Industries of Southeast Iowa · 90% of clients available for supported employment obtained a job; (target: 90%). · 118 clients maintained employment; (target: 120). · Average ACCESS client satisfaction score: 3.8; (target: 3.5). 1 4 scale, 4 is higher. · Average cost per ACCESS participant: $1,138; (target: 1,250). 6. How do you plan to use the evaluation results to enhance/extend your services? We analyze our outcome measures and use them as a part o£our strategic plarming process, our budgeting process and our quality improvement efforts. 7. How do your programs/services impact the community? We are a source of labor for community employers. Our services have resulted in hundreds of' Johnson County residents gaining employment. Local business and industry have benefited by outsourcing work to Goodwill; our Contracts Department completes this work to the quality specifications of the business. We have also recycled millions of donations through our Retail Stores. 8. How did the agency respond to the UWJC recommendations from last year? We had no recommendations. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (See attached) 2. How often does your board meet? 6 - 8 times per year. 3. What is your average attendance at board meetings? 75% 4. How is the board involved in strategic planning and governance of the agency? Our Board assumes ownership of the strategic plan. The current plan was developed as a product of a planning retreat. On Nov. 16, we will have another retreat to begin the process of updating the plan. The Board also actively governs by approving the budget and monitoring financial performance, approving the purchase and sale of physical assets and by creating and/or approving major policies. 5. What type of training/orientation do board members receive? New Board members receive an orientation that involves our mission, vision and values, our financial picture and our services, operations and outcomes. Periodic training is offered by various staff at Board meetings. Board members also attend Goodwill Industries International events. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? There are written policies and procedures that have been reviewed by the Finance Committee and/or the Board. Polices have been approved at various times. 7. Have you filed the annual report with the Secretary of State? If yes, date filed? May 8, 2002 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? May 7, 2002 j ccoghs\funding form.doc 6 Goodwill Industries of Southeast Iowa 9. Does your agency have a yearly audit? Yes X__ No If yes, Who completed thc audit7 Honkamp, ICmcger & Co, PC How much did the audit cost7 $4,$$0 If material weaknesses arc noted in the audit, what is your plan for addressing them7 Current segregation of duties was found to be a material weakness. However, wc have not identified a cost effective remedy for this weakness. If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X b. employment practice liability X 1,000,000 General Liability X 3,000,000 Umbrella Liability X 2,000,000 Professional Liability X 3,000,000 Property or Renters X 5,859,200 Vehicle X 1,000,000 Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. 24 years tenure; M.B.A.; 27 years experience in the field 2. StaffSalaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year President & CEO X X X This position does not have a 1.00 1.00 1.00 salary range. Current salary is $97,645. Senior Vice President X X X 51,000-71,400 1.00 1.00 1.00 Chief Financial Officer X X X 48,540-67,830 1.00 1.00 1.00 Human Resources X X X 45,900-64,260 2.00 : 2.00 2.00 Retail Communications & X X X 40,800-57,120 1.00 1.00 1.00 Marketing Production Manager X X X 35,525-49.907 5.00 5.00 5.00 Program Manager j c coghs\funding form.doc 7 Goodwill Industries of Southeast Iowa Program Director, WFD X X X 32,791-45,907 1.00 1.00 1.00 Assistant Program Director X X X 30,059-42,083 5.00 6.00 6.00 Retail Manager StaffTraining Specialist X X X 27,326-38,256 10.00 10.00 11.00 Store Manager Payroll Specialist X X X 13.50-18.90/hour 2.00 2.00 2.00 Accountant Employment Specialist X X X 12.86-18.00/hour 25.00 29.75 27.50 Case Manager Communications Specialist X X X 12.25-17.15/hour 1.00 1.00 1.00 Semi Driver X X X 11.87-16.62/hour 5.00 4.50 4.00 Vocational Evaluator Account Specialist X X X 11.31-15.83/hour 2.00 2.00 2.00 Follow Along Specialist X X X 10.77-15.08/hour 6.00 6.00 6.00 Support Service Manager Administrative Assistant Assistant Store Manager X X X 8.86-13.66Paour 50.25 47.30 52.25 Job Trainer Job Coach Instructor/Supervisor Store Clerk X X X 8.04~11.83/hour 65.75 80.85 84.85 Warehouse Clerk Production Worker X X X 7.28-10.71/hour 19.25 22.10 22.80 Material Handler TOTAL FTEs 209.25 222.50 231.40 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 75 4. How much was spent on staff development in the last fiscal year? $62,904 5. How much is budgeted for staff development in this fiscal year? $68,000 6. What training and support opportunities are offered to staff?. An extensive orientation called "Building Pride" is offered for new employees. A variety of"in service" trainings are offered on a weekly basis. Staff are encouraged to attend local, regional and national conferences and seminars. Tuition assistance is offered for relevant courses. 7. Please attach current organizational chart as Appendix B. (See attached) 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? The average increase for staff employees from fiscal year 2000 to 2001 averaged 7%. The increase was comprised of: a 2% increase to all staff July 16, 2000; a 3% increase to all staff January 1, 2001; a 2% anniversary increase to staff that had not reached the top of the pay scale for that position range. jccoghs\fundingform.doc 8 Goodwill Industries of Southeast Iowa Yes No If no, brief explanation 9. Does your agency have personnel policies? X If yes, date board last reviewed? 12/01 10. Does your board annually evaluate the director's X performance? 11. Does your agency Comment: Our Board does not review staffjob have job descriptions - only the President's. The review of staffjob descriptions for descriptions is a staff function. every position? X If yes, date of last board approval? 12. Is there an annual performance review for every staff?. X jccoghsSfunding form. doc 9 ~ Agency: Goodwill Industries of SE Iowa _ J Section 7: Financial Mana¢ ement A. Three Year Historical Balance Sheet (As of your fiscal year-end) _ FY 99 FY 00 FY 01 Current Assets Cash . 377,061 379,724 1,165,794 Investments 374,957 403,4~5 . Receivables < 90 days 257,446 281,409 327,052 Other 66,999 161,571 130,249 Total Current Assets $701.506 $1,197,661 $2,026,580 Other Assets Properb~/ 3,122, 193 2,862,898 4,050,938 Equipment 1,571,485 1,705.028 1,967,950 less depreciation (3,203,736) (3,165,024 (3,430,964 Receivables > 90 days Other 81,942 Total Non-current Assets $1,469,942 $1,402,902 $2,669,866 Total Assets $2,191 448 $2,600,563 $4,696,446 FY 99 FY 00 FY 01 Current Liabilities Accounts Payable 40.016 74,268 $ 269,763 Payroll Taxes Payable 476 382 466,720 590,814 Contracts Payable Mortgage Payable-6 months 69.743 80,831 108,245 Total Current Liabilities $586 141 $621,819 $968,822 Other Liabilities Mortgage Payable-Balance 576,951 423,010 1,980,136 Other Total Other Liabilities $576 951 $423,010 $1,980,136 Total Liabilities $1,163,092 $1.044.829 $2,948,958 NetAssets $1,555,734 $1,747,488. Liabilities & NetAssets $2,191,448~ $2,600'563 ~ $4,696,446' 10 IAgency: Goodwill Industries of SE FY 2001 FY 2002 FY 2003 B.ir~comelnCome&Expenses Local Funding Sources Iowa City Coralville Johnson County United Way- East Central Iowa 89,100~ 68,900 93,700 United Way - Allocation- Johnson County 71,900 73,100 78,300 - Designated Giving 3,600 3,000 4,000 Grants-Federal, State, Foundation 225,272 458,200 328,300 ' Net Sales of Service . 2,025,035 ~ 2,045,700. 2,076,400 ~ See below 1.) Net Sales of Materials 7,244,147 8,327,200 9,071,500 Contributions/Fundraising 122,225 73,400 75,000 Investment Income 78,284 81,900 97,000 Other Total Income 9,859,563 11,151,400 11,824,200 Expenses Wages & Salaries i 5, 63,696 6,773,300 7,416,800 See below 2.) Benefits 1,295,158 1,347,300 1,446,300, Occupancy . 1,776,555 1,766,000 ! 1,821,600 Non-occupancy _ 832,400. 877,700 907,100 Other Total Expenses 9,667,809 10,764,300 11,591,800 C. Fund Balance Revenue 9,859,563 11,151,400 11,824,200 Carryover Balance from previous year 1,555,734 1,747,488 2,134,588 Total Operating Budget 11,415,297 12,898,888 13,958,788 LessTotal Expenses 9,667,809 10,764,300 11,591,800~ Ending Fund Balance , 1,747,488 2,134,588 2 366 988 Less Restricted Balance (explain) 73,135 65,300. 57,400 See below 3.) Carryover Fund Balance . 1,674,353. 2,069,288 2,309,588 1.) Fees received from local, state & federal government for services to clients 2.) 15 FTEs aCded from 2001 to 2003, position upgrades spanning from 5%-15%, across the board increases average 4% annually 3.)Temporarily restricted funds, see page 13, section D I 11 I Agency: Goodwill Industries of SE iowa [ Designated for: Last Year This Year Next Year BdlDonor/Funder Restricted Funds CiD' Development BIock Grant I lmprovedacce~sib!lily&safetytotheddve $8,650 $0 _ $0 I(temperadlyrestricted) (Temperadly Restricted Funds) Total Restricted Funds i $8,650 E. In Kind Support: I Last Year This Year Next Year Services/Volunteers Matedal Goods Space, Utilities. etc Other: (Please footnote, Total In-kind Support $0 $0 $0 F. Grants Description/Pprpose Last Year . This Year Next Year Census: Job placement for Welfare recipients Census Grant/Johnson Co DHS :Johnson Co: Payroll software & hardware t $9,479; $72,700 I $0 Linn Co Procurement Grant Contract initiative w/Options of Linn Co ~ $40,541 $5,000 $0 Iowa Paths Grant Education & vocational services for ex-offenders; $5,144 $45,300 $47,000 Employment services for special education S_uper Seniors Grant students $27,209 $148,900 $198,000 High School Hi Tach Grant Intsmships for high school students $81,857 $98,700 $83,300 Hud Grant ;Job placement for individuals in public housing $24,082 $47,200 $48,000 CiD' of Iowa Cib/;CDBG I $8,650 $0 $0 Wheels to Work Grant Vehicles for persons on Welfare to get to work $19,660 $40,400 $0 Total Grants $216,622 $458,200 $328,300 I I - IAgency: i Goodwill Industries of SE Iowa Iowa City I Coralville Johnson County United Way - East Central Iowa 44,573 48,300 49,400 United Way - Allocation- Johnson County 52,885 54,800 58,700 - Designated Giving Grants-Federal, State, Foundation 12,748 148,900 198,000 Super Seniors Grant Net Sales of Service ~ 750,535 701 ,g00 715,900 Net Sales of Materials Contributions/Fundraising Investment Income Other ' Total Income 860,741 ~ 953,900~1,022,000~ Expenses Wages & Salaries 615,890 705,400 744,500 Benefits 143,484 153,300 171,200 Occupancy ~ 75,919 86,600 91,000 Non-occupancy . 40,731 43,600 44,700 Other 3,822 3,900 4,000 Total Expenses 879,846 992,800 1,055,400 C. Fund Balance Revenue 860,741 953,900 i 1,022,000 Carryover Balance from previous year Total Operating Budget 860,741 953,900. 1,022,000 Less Total Expenses 879,846 992,800 1,055,400 Ending Fund Balance 13 · Agency: Goodwill Industries of SE Iowa ACCESS CENTER FY 2001 FY 2002 , FY 2003 · Income & Expenses ~ Coralville Johnson County United Way - East Central Iowa United Way- Allocation- Johnson County 19,015~ 18,300 . 19,600-- - Designated Giving _ 3,600 1,500 Grants-Federal, State, Foundation Net Sales of Service 43,335 22,900 12,000 Net Sales of Materials Cgntributions/Fundraising 350 Investment Income Other Total Income 66,300 42,700 31,600 Expenses Wages & Salaries 38,571 30,800 24,900 Benefits 8,894 8,500 6,800 Occupancy 4,884 3,900 3,500 Non-occupancy 908 1,100 1,000 Other 34 100 100 Total Expenses 53,291 44,400 i 36,300 C. Fund Balance Revenue 66,300 42,700 31,600 Carryover Balance from previous year Total Operating Budget 66,300 42,700 31,600 Less Total Expenses 53,291 44,400 36,300 Ending Fund Balance Less Restricted Balance (explain) 14 Goodwill Industries of Southeast Iowa Board Member Roster Director Occupation City Term Expires John-Paul Besong Vice President, Rockwell Collins Cedar Rapids 2003 Sheila Boyd Vice President, Group 5 Hospitality Iowa City 2003 Alan Campbell Retired Hospital Administrator Cedar Rapids N.A. Brenda Daufeldt Banking Officer, Hills Bank & Trust Iowa City 2004 Claiboume Dungy, Pediatrician, UIHC Iowa City 2003 MD/MPH Kym Gaylo (Secretary) Systems Manager, Procter & Gamble Iowa City 2005 Lelia Helms, Ph.D./J.D. Professor, College of Education, U. of I. Iowa City 2003 Betsy Hradek R.N., UIHC Iowa City 2003 Dean Moore CEO, Quality Care, The Nature Company Coralville 2004 Dennis Moore Dean, Cornell College Mt. Vernon 2003 Katie Oberbroeckling, Partner, McGladrey & Pullen, LLP Cedar Rapids 2004 CPA (Chairperson) Phil Peterson Vice President, Mercy Medical Center Cedar Rapids 2005 Dick Schwab Retired VP/General Manager, NCS Cedar Rapids 2005 Dale Simon, Ph.D./CPA Dean, Kirkwood Community College Iowa City 2004 (Treasurer) Terry Smith (Vice Chair) Manager, MidAmerica Energy Corp. Iowa City 2005 Doug Wenzel Vice President, Robert W. Baird & Co. Cedar Rapids 2004 John Watson (Ex President, Goodwill Industries Iowa City N.A. Officio) GOODWILL INDUSTRIES OF SOUTHEAST IOWA Committee Roster 2002 - 2003 F~xeentlve P. lamliag Katie Oberbroeckling - Chair Mell Taets - Chair Dale Smith Jean-Paul Besong Kym Gaylo Kym Gaylo Terry Smith Dennis Moore Dick Schwab Staff': John Walson Mell Taets Doug Wenzel Rudder & Finance Dale Simon - Chair Staff: John Watson Brenda Daufeldt Dean Moore Pro~ram~ Jim Schreiber Betsy Hradek - Chair Mell Taets Sheila Boyd Doug Wenzel Brenda Daufeldt Lelia Helms Staff.' Tmnmi Erb Dennis Moore Dick Schwab ~ Terry Smith Sheila Boyd - Chair Alan Campbell Staff': Mike Townsend Doug Wenzel Lelia Helms Katie Oberbroeckling Ad H~e Facilitie~ Kym Gaylo Chair Staff: John Watson Sheila Boyd Dean Moore Terry Smith Terry Smith - Chair Jean-Paul Besong Kym Gaylo Betsy Hradek Dean Moore Dale Simon Jim Schreiber Staff: Mike Townsend / Pat Airy / Greg Kriegermeier Goodwill Industries of Southeast Iowa October, 2002 JQhn Watson President Mike Townsend Tamm~ Erb Kc~ri Senior Vice Vi t of Vice President Vi of President and Chief Reta Operatons Financial Officer ~ ~ .____[ TQm Cavanaoh Wendv Ma Colleen Crew I~ra Mallicoat Carmen Heck Production Regional Communication Program Director Accountant Manager Specialist Manager __[ Deb Sherard VickiSherman ! Lora Moroan [ Andrea KaDlan Janette Frev Regional Administrative ~ Dunham ---[ Staff Training Payroll & Benefits Manager Assistant Program Director Specialist Specialist Pat ~edlacel<- ] __~ ~[ Tom Bostwick Barb Bevan Et~<3ers Carol O'Brien Staff Training Account Administrative Program Director Specialist Specialist AJP Assistant ____[ ,__~ ~[ John Stokes .__~ Charlotte Cozine Cameron Davis Nancy Overstreet Support Services Account Shopgoodwill Program Director Clerk Manager Specialist NR ~[ Shirl~vAnderson ~ Sc°tt Rh°de .__[Trisha wOIvertOn Production Administrative · ~, Shipper Packer Manager Assistant Section 1: Background Agency Name: Greater Iowa City Housing Fellowship Phone: 358-9212 Address: 1700 South First Avenue, Suite 25B Iowa City~ IA 52240 Director Name: Mar~ann Dennis Slgnatur~~' ~t_4.~c~ Bd. Pres Name: Charles Eastham Signature: Request Completed By: Maryann Dennis Date: September 16~ 2002 Check Your Agency's Budget Year: 1/1-12/31 ~' 7/1-6/30 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Budget $7,000 $7,500 $10,000 1.3 % FY 02 FY 03 FY 04 0 0 0 __ 0 0 0 0 0 0 __ What were local funds used for last year: Operation of the Securit~t~posit Loan Program What will this year's local funds be used for? Operation of the Security Deposit Loan Program Agency Mission: To increase the access to and availability of affordable housing for low-income people in Johnson County~ Summarize your programs and services: r~ Affordable Housing Program: The Housing Fellowship develops, owns, and manages affordable rental housing at scattered sites throughout Iowa City and Coralville. The Housing Fellowship offers affordable homeownershin opporttmities for low-income Iowa City households. Newly constructed houses are sold to first time, mortgage qualified buyers, as leasehold estates (Community Land Trust), in which the Housing Fellowship retains ownership of the land. Newly constructed houses are sold in Lone Tree with $5,000 down payment assistm~c¢ and a local property tax credit to mortgage qualified households with incomes at or below 110% of the Area Median Income. rn Security Deposit Loan Program (SDLP): Sponsored by US Bank, the SDLP offers low-income Johnson County households a one year, interest free, consumer loan of up to $400 to pay for a rental security deposit. A limited number of grants are available to pay for the $80 renter household City of Iowa City utility deposit. List any accreditation and licensure your agency currently has. Explain· Community Housing Development Organization (CHDO) - The Housing Fellowship meets all HUD requirements as a non-profit community housing developer. This qualifies the Housing Fellowship to apply for federal funds set-aside for CHDOs for the development of affordable housing. Agency History (Using this page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Greater Iowa City Housing Fellowship was incorporated as a non-profit in 1990. A community based housing organization; the Housing Fellowship began as a response to the severe shortage of affordable housing in our community by representatives from area religious congregations. The Housing Fellowship currently has fifteen congregations and four Human Services Agencies as permanent members. (Permanent members serve a supportive community role, not as Trustees.) The mission of The Housing Fellowship is to increase access to and availability of affordable housing for low-income people in Johnson County. The Board of Trustees serves as the policy making body. Well over one third of the Board of Trustees represents the low-income community. The Housing Fellowship employs four people and contracts accounting services. The Housing Fellowship is currently the only non-profit organization devoted solely to providing permanent, safe, decent affordable housing in Johnson County. The Housing Fellowship works closely with local providers of services. HACAP and the Neighborhood Centers are permanent members of the Housing Fellowship and have representatives of their agencies as Trustees. EHP and Four Oaks/Youth Homes are also permanent members of the Housing Fellowship. The Housing Fellowship has adopted innovative approaches for meeting the housing needs for low- income households in Iowa City. By placing scattered site, affordable rental units in service, GICHF avoids the concentration of low-income households in a neighborhood. Additionally, this method increases ~rfixed-income neighborhoods with the addition of affordable units in market rate neighborhoods. The rehabilitation of the houses helps to irc/prove and preserve neighborhoods. Since 1990, the Housing Fellowship has received more than $9.65 million in grants and loans from several sources to develop affordable housing. At the time of this writing, the Housing Fellowship owns and manages 95 rental units, all of which are occupied by very low-income households. The Housing Fellowship plans to increase its rental property portfolio by an additional 16 units by the end of 2002. The financing is in place to construct 16 affordable rental units in the Peninsula Neighborhood in Iowa City. The Housing Fellowship's rental housing has significandy impacted Ioxva City. As of this writing, the Housing Fellowship is housing 290 people. The rents on several of the Housing Fellowship units are well under the local Fair Market Rent. GICHF operates under a policy to increase the stock of affordable housing: Under this policy, after debt retirement of the Housing Fellowship's rental units, rents are set at operating and replacement reserve costs further reducing tenants' costs. The Housing Fellowship constructs single-family houses to sell to low-income homebuyers. In Iowa City, GICHF maintains ownership of the land and the homebuyer enters into a long-term land lease. This structure reduces the cost of the house by eliminating the cost of the land. Removing the land from the speculative market ensures affordability over time. Houses are sold at target prices well below the average sales price in our area. GICHF has sold eight homes and will construct three in 2003. In Lone Tree, IA newly constructed three bedroom homes and land are sold to income qualified buyers. A State grant buys down the cost of the lot by $5,000 and a $5,000, ten year; forgivable second mortgage is given to the buyer. Homebuyers in Lone Tree also receive a 10-year property tax credit. The Housing Fellowship has sold one house in Lone Tree and will construct two more. These financing strategies reduce the cost of the houses while not compromising design/constmcfion. Through a partnerstfip with the City of Iowa City, the Home Builders, the Iowa City School District and local lenders, local high school students construct a house for GICHF's Affordable Homeownership Program each school year. This partnership has been very xvell received, locally and nationally. It was featured on the HUD website. Sponsored by US Bank, the Security Deposit Loan Program arranges one year, no interest loans of up to $400 for a security' deposit for low-income households. It is an award-winning program that has loaned over $110,000 to over 355 households. Grants pay for City of Iowa City utility deposits. Loans and grants are made based on the availability of funds. Agency Name _ Greater Iowa City Housing Fellowship Section 2: Client Profile lffi 2oo02oo 1. How many Johnson County residents (incinding IC & 1 Unduplicated Count Hsg. 271 Hsg. 294 Coralville) did your agency serve? Loans 24 Loans 69 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count Hsg. 271 Hsg. 285 Loans 21 Loans 54 3. How many Coralville residents did your agency serve? 3 Unduplicated Count Hsg. 0 Hsg. 9 Loans 3 Loans 15 Housing statistics are for number of people. Loan statistics are for number of households. Age - SDLP heads of Gender SDLP Ethnicity (use agency's household (use agency's **Heads of Households breakdown)***Heads of Households breakdown if needed) * Rental Units 0-5 Female: 50 Caucasian 41% 6-17 4 Male 19 African-American 49% 18-29 37 Hispanic 4.5% 30-61 25 American Indian 4.5% 62-75 3 Multi-Racial 1% >75 · Age statistics are for the heads of households receiving security deposit loans. Tenant ages are not tracked from year to year. 1, Briefly describe your service population. Low-income, Johnson County households. The majority of our service population consists of single moms. 2. How do you determine eligibility for services? Income verification. Renter households must meet our tenant selection criteria - 3 years favorable landlord references, 3 years of no serious criminal convictions. Loan applicants must have 6 months continuous income and 2 years of favorable landlord references. Loan applicants also must demonstrate the ability to repay the loan. 3. Are there fees for your services? Yes ~' No__ If yes, please describe your fee structure: ~' A $15 application fee is charged for Security Deposit Loan applicants. ~' Rents are charged for rental housing units. Rents are strictly controlled. The majority of tenants pay no more than 30% of their income for rent. GICHF rental units are available to HUD Section 8 voucher recipients. HUD Section 8 pays a portion of the rent for eligible households. ;~ A $20 monthly land lease fee is charged to homeowners in the Community Land Trust Program. 4. Do you provide services to areas outside of Johnson County? NO Area(s) served: N/A Services Provided: N/A Funding Sources: N/A j c coghs~fundingform, doc 3 Agency Name __Greater Iowa City Housing Fellowship Section 3:Community Relations 1. How do you assess satisfaction with your services? (a.) Client - Security Deposit Loan Program - requests for loans and applications received. Repayment rate of loans. Monthly statistical reports. Affordable Housing - increase in the number of affordable rental housing units placed in service. Number of houses sold and length of time on market. Lease renewals. Vacancy rates. (b.) Community - Donations, continued funding awards, "word of mouth" network, and phone calls. 2. Briefly summarize your findings: A client satisfaction survey will be completed in Fall 2002. 3. What changes have been made as a response to these findings? N/A 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. [ Source of Referral % of clients referred Iowa City Housing Authority ~ 75% HACAP ~ 10% IEHP ~ 3% Crisis Center ~ 2% Client or Self Referrals ~ 10% 5. Describe what makes your agency and/or its services unique to Johnson County. The SDLP is the only revolving pool of funds available to low-income renter households in Johnson County for security deposits. The program contributes to the self-sufficiency of a household by establishing a banking relationship and helping with no credit or poor credit history. The Housing Fellowship is the only Community Housing Development Organization in Johnson County that provides permanent, affordable, family rental housing. The Housing Fellowship administers the only Community Land Trust in Johnson County. 6. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? ~ Emergency Housing - provides grants for Security Deposit Assistance. ~ Iowa City Housing Authority- provides publicly owned affordable rental housing to low- income households. Administers an affordable homeownership program to low-income buyers. ~'HACAP - provides transitional housing (time-limited) to low-income families ~ Successful Living - provides Single Room Occupancy affordable rental housing to low- income individuals. ~Burns and Burns Architects - for-profit developer of affordable rental housing. All persons/households served by the aforementioned are eligible to apply for the Security l)eposit Loan Program. j ccoghs~undingform, doc 4 7. Outsideofreferrals, list up to 3 primary collaborations. Briefly describe the nature ofeach collaboration. Collaborations Briefly describe relationship 1. Funders - Iowa City Dept. of Community 1. Provide funding. Define underwriting Development, Iowa Dept. of Economic criteria for Housing Fellowship projects. Development, US Bank Monitors projects. US Bank capitalizes the Security Deposit Loan Program 2. Student Built House - Partners include the 2. All parmers contribute to construct a house City of Iowa City, Homebuilders Assn., Iowa for the Housing Fellowship's homeownership City School District, local lenders, program. 3. Local Homeless Coordinating Board 3. Members collaborate on the array of service needs for housing and the homeless in Johnson County. Section 4: Strategic Planning and Agency Effectiveness 1. Describe no more than 3 challenges your agency is currently facing and how your agency is addressing these challenges? (i.e., staffing, finances, etc... ) Challenge Strategy for addressing challenge 1. Financing: Types of housing projects to 1. Examine the benefits and downfalls of pursue - scattered site rental housing limits the scattered site vs. multi-family housing. available funding sources. Addressed in June 2002 Strategic Planning Session. 2. Rental housing property tax status - Iowa 2. Examine a change in State law. City and Coralville 3.NIMBYism: Community resistance to 3. Continue to develop reputation as a good affordable housing for low-income households, property manager. Educate the Community to dispel stereotypes of low-income people. 1. In what way will the needs of your service population change in the next five years? It is anticipated that the need for affordable housing for low-income households in Iowa City and surrounding Johnson County will increase and will remain critical. The lack of affordable housing is one of the six health and human service issues identified as being the most seriously needed in the Johnson County Capacity Assessment, 1999-2000 completed by the United Way and JCCOG. The top two priorities of the City of Iowa City's five year City STEPS Consolidated Plan for Housing, Jobs and Services are: · the acquisition of land and/or construction of rental units · rehabilitation of existing housing stock. Agency Name __Greater Iowa City Housing Fellowship )~ The need for rental units that are conducive to family living will also increase. Many rental units constructed in this area are configured for non-related student households. That is, units tend to have many bathrooms and bedrooms, small kitchens and limited common areas. )~ The cost of moving and other barriers to accessing safe, decent housing will increase. All landlords, including owners renting to assisted households may charge up to two months rent for a deposit. The City of Iowa City utility deposit for renter households is a major barrier. )~ The local vacancy rate for rental units will stabilize, and more rental units will be available, increasing the demand for Security Deposit Loans. 3. How do you plan to address these changes? )~ To continue to develop affordable housing ~' to pursue additional public-private partnerships to address the critical need for affordable housing ~' to facilitate access to affordable housing for low-income households 4. Describe the evaluation methods you use to measure the success of your services? ~ Number of successful loan applications )~ Repayment rate of loan recipients ~ Rental housing vacancy rates ~ Rental housing lease renewals 5. What are the results of these evaluations? )~ 83% of applicants receive security deposit loans ~ average 89% repayment rate )~ 2001 rental housing vacancy rate of 2.45% )~ Stable neighborhoods due to long standing tenants 6. How do you plan to use the evaluation results to improve your services? } Continue the pre-screening of potential loan applicants )~ Continue monthly contacts with loan recipients regarding repayment status } Continue to process rental housing applications and maintain approved applicant pool )~ Continue to repair and maintain rental property to retain tenants 7. How do your programs/services impact the community? Security Deposit Loan Program has loaned over $110,000 to over 355 very low-income households who otherwise do not have the resources to pay a security deposit. )~ GICHF's rental housing has significantly impacted Johnson County. As of this writing, GICHF is housing 290 people. The rents on several GICI-~ units are well under the local Fair Market Rent, making the units affordable for households with incomes below 40% of the Area Median Income without rental subsidies. ~ Eight low-income Johnson County households are first time home buyers. 8. How did the agency respond to the UWJC recommendations from last year? )~ No recommendations were offered by UWJC. j ccoghs'tfimdingform, doc 6 Agency Name Greater Iowa City Housing Fellowship Section 5: Board Governance 1. Please provide a board roster with names, addresses, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) > See attached Appendix A 2. How often does your board meet? Monthly except for August 3. What is your average attendance at board meetings? 60% 4. How is the board involved in strategic planning and governance of the agency? The Board of Trustees held a strategic planning session in June of 2002 and developed a five year plan. The Board actively governs the Corporation through review of policies and procedures, planning and design of affordable housing projects and review of the monthly Consent Calendar mailed prior to each meeting. A Consent Calendar includes minutes from the last meeting, a financial report (balance sheet and income and expenses compared to budget), tenant occupancy report, and SDLP program statistics. Board Committees are active. For example, the Executive Committee monitors the written annual budget and the Human Resources Committee evaluates the Executive Director annually. 5. What type of training/orientation do board members receive? The Trustee Recruitment and Orientation Committee identifies potential Trustees. Trustees have a written position description and committee responsibilities and receive a packet of information including bylaws of the Corporation, the most current audit and financial report, a listing of members of the Board, program statistics etc. Potential Trustees also have an orientation meeting with the Executive Director prior to election. Yes No Comments Does your agency have X Adopted - 4/12/93 written policies and Amended - 7/12/93 Amended - 3/14/94 procedures for financial Amended - 7/10195 management? Amended - 4-9-01 If yes, date of last board approval? 4-09-01 Have you filed the X Secretary of State Report is now required every other year. annual report with the Secretary of State? If yes, date filed? 3-23-01 Have you filed the IRS X form 990 for the most recent year? If yes, date filed? ~-13-02 6. Does your agency have a yearly audit? Yes__ ~' No If yes, Who completed the audit? Greenwood and Crim, P.C. How much did the audit cost? $4,200.00 If material weaknesses are noted in the audit, what is your plan for addressing them? No material weaknesses noted. If no, What is in place to assure accountability in the agency's financial management? N/A jccoghs~undingform.doc 7 Agency Name __Greater Iowa City Housing Fellowship Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Ten years - started January 1993. Executive Director has a Master of Social Work in Administration and Social Development and is Certified as a Housing Development Finance Professional through the National Development Council. 2. Staff Salaries Check if Applicable Retire- Full-Time Equivalent Paid Health merit Current Salary Range*** (FTEs) Position* Leave Ins. Plan Per Position Last This Next Year Year Year x:ulive Director X X X $35,000 annual base salary 1 1 1 Compliance Manager X X * * $25,000 annual base salary 1 I 1 inter~ance and Repair X X X $24,960 annual base salaxy 1 I 1 -ninistmtive Assistant X X X $17,680 am~ual base salary 1 I 1 TOTAL FTEs 4 4 4 · GICHF contracts accounting services with Blue Moon Accounting. · *Employee elected not to participate in Simple IRA program. · ** GICHF does not have salary ranges for staff GICHF has base salaries. 3. If serving multiple counties, how may FTE's serve Johnson County (include administrative and direct service staff)? N/A 4. How much was spent on staff development in the last fiscal year? $489___ Staff development budget expenditures exceeded the budget the previous year because GICHF's Attorney attended the National Community Land Trust Conference in New Mexico. 5. How much is budgeted for staffdevelopment in this fiscal year?__~l,500 6. What training and support opportunities are offered to staff? Workshops and conferences offered by: IA Dept. of Economic Development, IA Finance Authority, IA Coalition for Housing and the Homeless, HUD, Landlords of IA, City of Iowa City. Staffattends an occasional nationalconference. The Executive Director attended the National Low-Income Housing Coalition annual conference in April 2002. 7. Please attach current organizational chart as Appendix B. 8. Was the agency able to provide raises? Yes 9. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 5~75% All positions received a 4% raise. The Administrative Assistant received an 11% raise due to increased responsibilities. jccoghs~undingform.doc 8 Agency Name Greater Iowa City Housing Fellowship Yes No Comments Does your agency X Adopted 4-12-93 have personnel I Amended 11-8-93 policies? Amended 6-10-02 If yes, date board last reviewed? 6-10-02 Does your board X The Performance Appraisal is completed by the Human annually evaluate Resources Committee of the Board of Trustees and is revi, the director's by the Board each year. performance? Does your agency X Executive Director 5-22-95 have job Compliance Manager 5-22-95 descriptions for Maintenance and Repair 5-10-99 every position? Administrative Assistant 5-10-99 If yes, date of last board approval? SeeComments~_. Is there an annual X The Executive Director reviews the performance of the performance Compliance Manager and the Administrative Assistant. The review for every Compliance Manager reviews the performance of the staff? Maintenance and Repair Employee. j c coghsLfundingform, doc 9 Agency: Greater Iowa City Housing Fellowship Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) 1999 2000 2001 Current Assets Cash 34,658 26,723 37,040 Investments (12,798) (30,258) (36,968) Receivables < 90 days 34,081 15,234 1,704 * Other 192,598 876 46,246 Total Current Assets 248,539 12,575 48,022 Other Assests Property 4,573,205 5,368,946 6,126,953 Equipment less depreciation (214,233 (405,716) (523,548 Receivables > 90 days 62,258 62,258 62,258 Other 3,243 3,900 3,900 Total Non-current Assets 4,424,473 5,029,388 5,669,562 Total Assets 4,673,012 5,041,963 5,717,584 1,999 2,000 2,001 Current Liabilities Accounts Payable 25,521 6,774 10,300 Payroll Taxes Payable 3,033 3,434 Contracts Payable Mortgage Payable-6 months 496,795 678,206 496,622 Total Current Liabilities 522,316 688,013 510,356 Other Liabilities Mortgage Payable-Balance 3,235,604 3,494,672 4,328,215 **Other 53,136 53,880 68,408 Total Other Liabilities 3,288,740 3,548,552 4,396,623 Total Liabilities 3,811,056 4,236,565 4,906,979 Net Assets 861,956 805,398 810,605 Liabilities & Net Assets 4,673,012 5,041,963 5,717,584 *Other 1999 2000 2001 Prepaid Insurance $17,047 $46 $1,317 Office Rent Deposit $830 $830 $830 Deposits on Real Estate Acquisitions $600 $0 $1,500 Construction in Progress $174,121 $0 $42,599 TOTAL *OTHER $192,598 $876 $46,246 **Other: 1999 2000 2001 Interest $16,603 $16,026 $23,647 Property Taxes Payable $20,580 $19,203 $17,510 Damage Deposits $15,953 $18,651 $27,251 TOTAL **OTHER $531136 $53,880 $68,408 !O __ AGENCY Greater Iowa City Housing Fellowship 2001 2002 2003 B. Income & Expense Lo__cai Funding Sources iowa City Johnson County United Wa)' -_Allocation $ 7,126 $ 7,375 $ 9,261 - Designated Giving $ 437 $ 1,308 $ 500 Grants-Federal_,State, Foundation $ 69,415 $ 165.147 $ 87,270 NetSalesofService(RENTALINCOME) $ 483,627 $ 564,112 $ 685,622 ~)Net Sales of Materials (HOUSE SALES) $ 2,732 $ 45,500 $ 5,000 (2)Contributions_lFundraising $ 24,345 $ 9,265 $ 9,450 Investment Income $ 942 $ 1,449 $ 1,478 (3)Other $ 11,046 $ 9,500 $ 9,018 Total Revenue $ 599,670 $ 793,656 $_ 807,600 Expense ~Wages&Salaries I$ 120,493 $ 126.362 $ 130,153 BenefitsI$ 28,942 $ 25,552 $ 26,319 Occupancy $ 18,884 $ 19,397 $ 19,979 (4)Non-occupancy iS 440,701 $ 611,018 3_ 568,806 OtherI$ 15,443 $ 4,500 $ 4,635 ~TotalExpense $ 624.463 $ 786.829 $ 749,891 C. Fund Balance Revenue $ 599,670 $ 793,656 $ 807,600 Car~over Balance from previous year $ (56,558) $ (101,351 $ (99,524'~ TotalOperatingBudget $ 543,112 $ 692,305 $ 708,075 Less Total Expenses $ 624,463 $ 786,829 $ 749,891 Ending Fund Balance $ (81,351) $ (94,524) $ (41,81( (5)Less Restricted Balance (explain) $ 20,000 $ 5,000 $ 5,000 __ CarE/over Fund Balance $ (101,351) $ (99,524) $ (46,816~ NOTESI GICHF sold a house to HACAP in 2002. -- (1)Net Sale of Materials (House Sales) (2)ContribufionslFundraising GICHF received a bequest in 2001. (3)Otherincludes: $ 2,00t $ 2,002 $ 2,003 Other Program Revenue $ 14,259 $ 11,557 $ 11,788 __ (Loss) Gain on Long-Term Investments $ (6,7101 $ (8,388) $ (9,226'~ Other Revenue and Reimbursements $ 3,497 $ 6,330 $ 6,457 TOTAL $ 11,046 $ 9,600 $ 9,018 -- (4)Non Occupancy Includes: 2001 2002 2003 Depreciation $ t17~833 $ 126,312 $ '147,785 (5)Less Restricted Balance (explain'~ Funds restricted by State of IA for land acq. and down payment assistance. I AGENCY Greater iowa City Housin9 Fellowship D. Bd/Donor/Funder Restricted Funds Designated for: 2001 2002 2003 State of Iowa LHAP Land Acquisition & Down Payment Assistance 20,000 5,000 _5,000 Total Restricted Funds 20,000 _5,000 5,000 -=. In Kind Support: 2001 2002 2003 ~ervices/volunteers LJS Bank Loan Processing 3,300 3,300 3,300 Trustees 4,560 5,900 5,900~ Legal 3,000 3,000 _ 3,000 Labor 1,050 1,210 1,210 TOTAL Services/Volunteers 10,860 12,200 1_2,200 Vlaterial Goods ~,ppliances, Light Fixtures, Trees 1,400 1,700 1,700 Space, Utilities, etc ~ther: (Please footnote) Reduced Land Costs, Donated Realtor Commission 22,341 58,952 20,415 Total In-kind Support 34,601 72,852 34,315 ;. Grants Description/Purpose 2001 2002 2003 State of Iowa LHAP Land Acc{u/sit/on & Down Payment Assistance 20,000 5,000 5,000 6SGP SDLP Defaults & Utility Deposits 4,480 9,520 7,000 State of Iowa HOME Developer Fee 25,490 48,~627 40,270 ;ity HOME/CDBG Land Acquisition 19,445 102,000 3_5,000 Total Grants 69,416 165,147 87,270 APPENDIX A Greater Iowa City Housing Fellowship opening the doors of Iowa City 1700 South First Avenue Suite 25B Iowa City, IA 52240 (319) 358-9212 Board of Trustees 2002 *The Fund Raising Committee was combined with the Planning Committee last year. Glorine Berry 02-03 Jerry Dallam 02-03 Charles Eastham, Pres. 02-04 4670 Sioux Avenue 18 Valley View Knoll NE 1152 E. Court St. Iowa City, IA 52240 Iowa City, IA 52240 Iowa City, IA 52240 'Retired (Rep. of Our Redeemer Lutheran) Registrar, U of I (1st Pres.) U of I College of Medicine Planning & Recruitment & Orientation Plamfing & Comm. Relations Planning Florence Ejiwale 02-03 Kevin Hanick 02-04 Richard Klausner, Vice Pres. 02-05 2559 Clearwater Ct. Lepic-Kroeger Realtors 725 South Clinton Iowa City, IA 52246 2346 Morman Trek Blvd. Iowa City, IA 52240 Therapist, Life Skills, Inc (GICHF Iowa City, IA 52246 Public Defender (Rep. of Low-Income Tenant) Realtor Residents) Housing Advisory Planning & Community Relations Recruitment and Orientation Renee Lauck, 02-04 Brian Lormg 02-03 Mary McCue, Secretary 02-05 1206 Diana Street Neighborhood Ctrs. of JC 447 S. Summit Iowa City, IA 52240 P O Box 2491 Iowa City, IA 52240 CPA, McGladrey & Pullen (GICHF Iowa City, IA 52244-2491 Rep of HACAP- Low-Income Assn. Tenant) Rep of Low-Income Assn. Community Relations Human Resources Rick Oehler, Treasurer 02-03 Patti Santangelo 02-04 Glenn Siders 02-05 Firstar Bank 3035 Stanford Ave. Southgate Development P. O. Box 1880 Iowa City, IA 52245 P.O. Box I907 Iowa City, IA 52244 Computer Consultant (Rep. of l~t Iowa City, IA 52244-1907 Branch Manager Christian Church) Construction Mgr./Developer Recruitment & Orientation Human Resources Community Relations Danelle Thompson 02-03 Don Robinson 02-03 Christy Wolfe 02-05 2401 Whispering Meadows Ave. 511 E. Washington St. 1830 High Street Iowa City, IA 52240 Iowa City, IA 52240 Iowa City, IA 52240 Accountant (Rep of Victory Temple and Homebuilders Assn. CLT Home Owner Public Housing Resident) Human Resources Agency Name Greater Iowa City Housing FellowshiE APPENDIX B Greater Iowa City Housing Fellowship opening the doors of Iowa City 1700 South First Avenue Suite 25B Iowa City, IA 52240 (319) 358-9212 TABLE OF ORGANIZATION BOARD OF TRUSTEES OFFICERS COMMITTEES President Planning Vice-President Recruitment and Orientation Treasurer Community Relations Secretary Human Resources Fund Raising Housing Advisory EXECUTIVE DIRECTOR ~DMINISTRAT1VE ASSISTAN~ ICOMPLIANCE MANAGEI~ ~CCOUNTAN~ ~IAINTENANCE AND REPAIR EMPLOYEEI j c coghsWlmdingform, doc I1~ Section 1: Background Agency Name: Hawkeye Area Community Action Program Phone: 319-393-7811 Address: P.O. Box 490 Hiawatha, Iowa 52233 Director Name: Don Maniccia Signature: Bd. Pres Name: Marty Cutter /~C~ ~Zz~--&~ Signature: Request Cmnpleted By: Allan Axeen Date: 9-27-02 Jane Drapeaux Check Your Agency's Budget Year: 1/1-12/3 l x 7/1-6/30 10/1-9/30 4/I/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Budeet $15,675 $1 O, 675 $1 O, 675 . 061 FY 02 FY 03 FY 04 $8,635 $8,635 $8,635 .0049 Johnson County [ $25,000 $22,500 $22,500 .013 City of Coralville $2,750 $3,025 $3,025 .0017 What were local funds used for last year: Local funds were used to support wrap around costs l'or Head Start pre-school attendees at all three Family Resource Centers in Johnson County and the Toddler programs at the Waterfront Family Resource Center and the Coral Ridge Family Resource Center. What will this year's local funds be used for? Funding will be used for the same programs this year. Agency Mission: The Mission of the Hawkeye Area Community Action Program is to promote economic and emotional strength towards a goal of self-sufficiency for low-income people in our communities. Summarize your programs and services: Hawkeye Area Community Action Program (HACAP) manages or operates about 50 programs funded by Federal agencies and grants, State of Iowa agencies and grants, and local revenue sources. HACAP's $19.6 million budget encompasses services such as Weatherization programs, Head Start and Early Head Start services, HUD Counseling and HUD Supportive Agency Name HACAP Housing Transitional Housing, Local Transitional Housing Programs, WIC services, Child Care Resource and Referral Services, Crisis Child Care, Food Reservoir and Second Harvest programs, Residential Rehabilitation services, and Lead Testing and Radon Testing Programs. List any accreditation and licensure your agency currently has. Explain. HACAP has three Family Resource Centers in Johnson County. They are: Waterfront Family Resource Center located at 2007 Waterfront Drive in Iowa City, Coral Ridge Family Resource Center located at 2441 10th Street in Coralville, and the Iowa City Family Resource Center located at 318 Bloomington in Iowa City. All three Family Resource Centers operate daycare services. Each site has Head Start Classrooms. The sites are licensed by the Department of Human Services according to their requirements for daycare operations. The Coral Ridge and Waterfront sites received renewals of their previous licenses and the Iowa City site was first licensed last year after its opening September 2001. The Waterfront and the Coral Ridge operations have also received their National Association for Education of the Young Child (NAEYC) accreditation. The NAEYC accreditation is done every three years. Sites must receive this accreditation to be able to receive federal education funding passed through the State of Iowa Department of Education. The process for accreditation is an eight month process of self evaluation which includes parent surveys and site visits from NAEYC evaluators. The Waterfront and Coral Ridge sites successfully completed their renewals during the last school year. The Iowa City site is eligible to apply for accreditation from the NAEYC this school year. Agency History (Using this page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) HACAP was incorporated in 1965 under provisions of the Economic Opportunity Act of 1964 as a private non-profit agency with the mission to help low-income families achieve and maintain self-sufficiency. HACAP's original incorporation was to serve only Johnson County. Subsequently under reorganization HACAP merged with the agency in Linn County. At that time the counties of Benton, Iowa, and Jones were also incorporated into the reorganized HACAP. Later the Washington County service area was added when they split themselves from the agency located in Burlington Iowa. The six counties are now the basic service area for most of HACAP programming. Some programs operated by HACAP over the years have been statewide in scope and also covering larger areas of eastern Iowa than the six county service area mentioned above. HACAP has developed and spun off into self-supporting agencies programs that began ~vith HACAP. The Metro Area Housing Partnership (MAHP) in Cedar Rapids and the Marion Senior Housing Program are two recent examples. In Johnson County HACAP operates three Family Resource Centers (FRC). Clients can access any program provided by HACAP at these sites. Basic intake services and applications for any service are provided even if that service may be delivered by a different site or regionally from the corporate offices in Hiawatha. The Coral Ridge FRC was built using a national competitive demonstration grant through Head Start and the Health and Human Service (HHS) Agency. This site has served as the model for the development of the Waterfront FRC (1995) and the Iowa City FRC (2001). Each site has three or four Head Start classrooms and the Waterfront and the Coral Ridge sites also operate toddler classrooms. HACAP has 160 Head Start slots and 24 toddler slots available in the FRC's. HACAP also contracts with Neighborhood Centers of Johnson County (NCJC) to operate two classrooms of 16 slots each at their Broadway and j ccoghs\fundingformdoc 2 Agency Name HACAP Pheasant Ridge facilities, and to provide comprehensive Head Start services to those eligible preschool children. In Johnson County HACAP is a Community Housing Development Organization (CHDO) eligible to receive HOME funds to develop low income housing through the City of Iowa City. HACAP operates 18 HUD sponsored Transitional Housing units. HACAP also operates under a Local Housing program 18 units of Transitional Housing units in a complex purchased from the City of Iowa City. The Transitional Housing program is designed to provide a family a 24 month stay in a program to develop the skills to be a successful housing consumer. Family Support Counselors work with the families on a weekly basis doing life skills training, budgeting, and job skill development to help families reach their full potential. HACAP maintains and finances a Case Management system to review and assess families receiving HACAP services to make sure that the best community efforts are used to assist families and eliminate duplication and overlaps in services. This Case Management system is part of the HHS / Head Start demonstration grant that originally financed the Coral Ridge FRC. HACAP is in the process of developing a training center at the Waterfront FRC. This training site will be using satellite technology to receive Head Start training programs. This training site will serve Johnson County, Washington County, and Iowa County. It will allow training without the time and expense of traveling to Hiawatha for HACAP and NCJC employees. It will also facilitate training for all programs on a regional basis. The site could also be used by other organizations in need of a training site when it is completed. Section 2: Client Profile ~ 2000 ;001 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 3508 5493 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 2503 3852 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 514 830 Age (use agency's Gender E~rhnicity (use agency's breakdown) breakdown if needed) 0-5 962 Female: 2400 Black/not Hispanic 1319 6-17 1545 Male 3093 Caucasian/not Hispanic 3215 18-29 (18-34) 1490 Hispanic 33 I 30-61 (35-54) 1081 Native American/Alaskan 58 62-75 (55-79) 247 Asian 178 >75 (70 +) 168 Other 204 Not Reported 188 3. Briefly describe your service population. HACAP's service population is comprised of families whose income levels fall under 150 % of the Federal Poverty guidelines, with programs having diftYrent eligibility guidelines. Head jccoghs\fundingform.doc 3 Agency Name HACAP Slart income guidelines are at 100 % of the Federal Poverty guidelines, Low Income Home l';ncrgy Assistance Program (LIHEAP) and Weatherization programs are capped at 150 % of the Federal Poverty guidelines. I IACAP's Housing Urban Development (HUD) Transitional Housing serves families below 125 % of thc guidelines upon eutry into the program. HACAP's Target Family Program concentratcs its efforts on serving homeless families who havc young children. We have found this groap to be our most challenging in Johnson County as families have nrultiple barriers to achieving self-sufl~cicncy. HACAP serves a growing number of elderly clients through its LIIIEAP and Crisis Utility Intervention Programs. Seniors are served by the Title V Employmeut Program. 4. llow do you determine eligibility for services? l'he basic determinant is inconre. Applications are assigned a numerical score using pointing criteria determiued and approved by funding agencies and HACAP's governance groups. In tfcad Start and thc Toddler Child (7are Program, points arc awarded for child cndangermeut, age, diagnoscd disabilities, teen parcnt, single parent, sibling enrolhnent, and English as a second language. 5. Are there fees fbr your services? Yes X No If yes, please describe your fee structure: The Toddler Child Care Program has a sliding fee scale structure that sets reduced child care rates fur l'amilics whose income falls at or under 50 % of the Federal Poverty guidelines to 125 % of the guidclines. Families whose incomes are above 125 % of the Federal Poverty guideliucs pay the fi.~ll fees lbr child care services. 6. Do you provide services to areas outside of Johnson County'? Area(s) served: loxxa, Benton. Jones, Washiugton. and I,inn Counties. Services Providcd: Itead Start, Early Head Start, and Toddler Child Care Funding Sources: I)epartment of Health and Human Services, Iowa Department oflluman Services, iowa Depm'tment of Education. Johnson County Empowerment, l,ocal and State Governments, Llnited Way of Johnson County, United Way of East Central Iowa, Linn County l£mpoxxcrment. Jones County Empox~ermcnt, Benton County Empowermeut, amt parent fees. jccoghs',J'u nd in g form.d oc 4 Agency Name HACA? Section 3: Communi ,ty Relations 1. How do you assess satisfaction with your services? (a) Client All levels of Boards, Commissions, and Councils for HACAP must have client representation equaling one third of the total membership. This allows participation and input in the formation of policy and the review of programs. On Head Start Policy Councils parents must make up at least 51% of the council. All sites have a Parent Committee that allows direct input in the operations for the site. Head Start parents also complete a Satisfaction Survey. (b) Community Case Management activities allow for a continual review of "best practices" as it relates to supportive services for clients. Community members make up one third of the membership on all HACAP Boards, Commissions, and Councils. This allows an independent input and expertise for governing bodies. 2. Briefly summarize your findings: The Parent Satisfaction Surveys were generally very positive. Problems of transportation and sick children were raised. Parents wanted more suggestions for activities they can be doing with their children. Parents wanted more information about their child's eating, sleeping, and toileting while they were in HACAP's child care program. 3. What changes have been made as a response to these findings? Teachers and Assistant Teachers were instructed to take more time to talk to parents at the beginning and the end of the days and talk more about non-educational matters if it was of interest to the parents. Make sure that these items are discussed at home visits. Discussions were held about team starting some classrooms to allow earlier arrivals or later dismissals times if the need arises. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Utility Companies 20% of LIHEAP and Utility Shutoffs Department of Human Services 30% of LIHEAP Crisis Intervention City of Iowa City Housing Services 25% of Homeless Families Emergency Housing Program 10% of Homeless Families DVIP 5% of Homeless Families Furnace Contractors 10% Emergency Furnace Replacements Department of Human Services 10% Child care needs 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Not very many duplicate the services we offer because we are mandated to serve the hardest to serve and the neediest population groups. The services that are possibly the most susceptible to duplication are the support counseling that are reviewed in case management to preclude duplication of services. The Federal Government has authorized HACAP to be the "Head Start" grantee in Johnson County. HACAP has chosen to contract with NCJC to provide Head Start services to 32 eligible children in Johnson County. jccoghs\funding form.doc 5 Agency Name HACAP 6. Describe what makes your agency and/or its services unique to Johnson County. Community Action Agencies are operated to provide programs that lead families to attain their highest level of success. Not by providing "hand outs" but a "hand up" to have the opportunity to succeed. Targeted Families have the opportunity for housing, Head Start and child care services, food supplements to meet nutritional needs, Family Support counseling, Consumer Education meetings, and an incentive based HACAP Store. Families are encouraged to participate in the system that they are a part of. Self-sufficiency is attained by raising self esteem and proficiencies. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe relationship 1.Grant Wood Area Education Agency 1. Grant Wood assesses all incoming Head Start participants. These assessments help the teachers coordinate an education program individualized for the child. If further evaluation is needed, a meeting with GWAEA, the family, and the teaching staff is arranged to develop a plan for success that encompasses both school and home. GWAEA does three classroom observations a year and individual observations as needed for mental health problems. GWAEA does training for classroom staff on behavioral and mental health topics. 2.Neighborhood Centers of Johnson County 2. Contract with NCJC to provide comprehensive Head Start services to 32 eligible preschool children. Provide support to their employees with on going training. 3.HACAP Case Management 3. Eighteen agencies are involved to add input for HACAP clients and to participate in the enrollment process for services. jccoghs\funding form.doc 6 Agency Name _HACAP_ Section 4: Strategic Planning and Agency Effectiveness 1~ Describe no more than 3 challenges your agency is currently t;acing and how yonr agency is addressing these challenges? (e.g.. staffing, finances, service delivery) Challenge Strategy for addressing challenge 1. More families reaching the end of their 1. Further develop the Target Families public benefits, program. Provide case management tbr entry into the program to make sure that it is a community based decision on the best use of resouI'CeS. 2. Minimal or no funding increases. 2. Search for efficient practices in programs. Provide access to technology for teachers. nurses, and family support workers to alleviate entry backlogs. Cluster services at FRC's to insure economies of scale. 3. Maintain a stable workforce. 3. Provide more training opportunities to existing employees so that they can meet qualifications for better jobs. Enconrage upward mobility. 2. In what way will lhe needs of>our service population change in thc next fivc years? With cuts in funding xxe will sec more families stay in a crisis mode for a longer period of time. More crisis means more domestic violence, more children in crisis, and longer periods ueedcd tbr stabilization. 3. How do you plan to address these changes? Targel Families with preschool children and in need of transitional housing need to be simultaneously enrolled to maximize the immediate affect of assistance. Other Target Family services need to be applied along with decisions of the Case Management Team to focus aid to these fmnilies. 4. Describe the evaluation methods you use to measure the success ofyonr services'? 1 ) Thc '1 argct Family initiative has developed an assessment tool that rates the Family Wcll- Being Indicators on a scale of 1-10. Thc indicators ~re: l lousiug, lqnploymcnt, Adult 15ducation. 'I ransportation, Nntrition, I lcalth. Income. Family Relations, Comnaunity lnvolvcmcnl, and Child I)cvclopment. These indicators are recorded on a monthly basis and are tabulated Ibr quarterly reports. jccoghs fundingl'orm doc ? Agency Name IIACAP 2) Head Start has developed a report to measure the outcomes fi'om October of the school year to May of the school year. Thc results are categorized iuto thc 8 Ilead Start Domain or Content Areas of the I lead Start Child Outcomes Framework required by the Head Start Bureau. These Domains are: Language Development. Literacy, Mathematics. Science, Creative Arts, Social and Emotional Development, Approaches to Learning, and Physical Health and Development. Within each of these Domains are thc Domain Elements comprising thc Head Start Objectives. Each child is assessed within these skills/objectives as to the Developmental Step thcy have achieved in working toward mastery of cach objectix e. Forerunner (below typical level) Step 1 (typical level fnr a child beginning preschool Step 2 Step 3 (mastery) 5. What are the results of these exaluations? 'Flae Target Family outcomes reflcct at least a 10% increase in all categories. The indicators tbr Housing, Employment and lncome show the greatest need. In all Domains, at least 20% more children were assessed at Step 3 in May as were assessed at Step 3 in October. In all Domains, at least 14% fewer children wcre assessed at the Forerunner Step in May as were assessed at the Forerunner Step in October. Domain Elements broken oat within each Domain show similar progress. 6. I Iow do you plan to nse the evaluation results to enhance/extend your service? The resuhs not only tell ! IACAP what is working they also point out areas that need attention. This may be more training IBr staff or more emphasis on skill building to improvc our client's movement toward self' snfficiency. 7. Flow do your programs/services impact thc commuuity? HACAP has a positive impact on Johnson County. Ahnost $800,000 LIHEAP and Emergency utility services are paid to Johnson County residents. HACAP's Lead Testing, Radon Testing, and Itousing Rehabilitation scrvices work to improve thc environment and safety for t'amilies in Johnson County. In our fransitional tlousing and our Head Start fi~ll day services parents must be working or going to school to receive services. Consequently even though they are receiving services they are also taxpa,xcrs. 8. How did the agency respond to the UWJC rccommcndations Ii-om last year? HACAP paid very close attention to the concerns that were shared fi-om the Citizen Review Panel last year. Staffturnover at HACAP has leveled oil} partly due to levcIs of benefits? salaries, and training opportunities available at IfA( AP. Management systems that were in place were assessed, and as attrition occurred_ the role of the local supervisors was strengthened in managing local operations. iccoghs flmding form.doc 8 Agency Name HACAP Section 5: Board Governance 1. Please provide a board roster with names, addresses, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) See Appendix A.5 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? At least 75% of the seated membership. 4. How is the board involved in strategic planning and governance of the agency? An annual Board of Directors Retreat is held to set strategic priorities for the Agency. HACAP's Board of Directors set major policy and monitors for compliance. 5. What type of training/orientation do board members receive? Annual orientation - "Welcome to HACAP's Board of Directors!" At each monthly board meeting, HACAP's regionally managed programs provide a program orientation. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Yes. _8/29/02__ 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Yes. _January 2001 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? Yes. __January 1, 2002 Comments: 9. Does your agency have a yearly audit? Yes__X No If yes, Who completed the audit? Meriwether, Wilson and Company, P.L.C. How much did the audit cost? $31,000 If material weaknesses are noted in the audit, what is your plan for addressing them? If a material weakness were identified, there would be immediate interventions implemented to correct the deficiency. If you do not have an audih What is in place to assure accountability in the agency's financial management? See Appendix A for Membership Roster jccoghs\fundingform.doc 9 Agency Name HACAP Section 6: Personnel and Staff Development 1. State the length of employment of thc Executive Director and his/her qualifications. Don Maniccia has been HACAP's Executive Director for 21 years. Don has a Bachelor's of Science Degree in Education and has 26 years of Community Action Agency Administration. 2. Staff Salaries Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position per hour Last This Next Year Year Year Site Services X I X X $15.00 - $24.00 3 3 3 Supervisor - 3 Receptionist/Service X X X $8.98 - $9.29 3 4 4 Worker Classroom Services x X x $14.00 - $14.61 2 2 2 Supervisor Teacher x X x $11.29 - $13.19 10 9.25 9.25 Assistant Teacher x X x $8.72 - $10.18 6 6.75 6.75 Teacher Associate x X x $8.21 - $8.70 9 8.5 8.5 Lead Toddler Worker x X x $9.23 - $10.00 3 2 2 Housekeeper x X x $7.70 - $7.88 3 3 3 Family Support x X x $12.31 - $13.30 5 3 3 Worker/ Home Visitor Housing/Life Skills x X x $13.34 - $14.81 1 1 1 Coordinator Teacher/Child Care x X x $14.00 - $14.42 Services Supervisor TOTAL FTEs 46 43.5 43.5 3. If serving multiple counties, how may FTE's serve Johnson County (include administrative and direct service staff)? 43.5 FTE's. 4. How much was spent on staff development in the last fiscal year? $19,320 5. How much is budgeted for staff development in this fiscal year? __21,270 jccoghs\fundingform.doc 10 Agency Name HACAP 6. What training and support opportunities are offered to staff? Training and staff development are ongoing activities in our child development and child care programs. Staff members receive training in first aide/CPR, blood borne pathogens, mandatory child abuse reporting, computer training, and literacy. Specialized training topics are determined through a staff training needs assessment process. Non-degreed early childhood classroom staff participates in child development training programs such as a Child Development Associate (a competency based training program) or a training track to complete an associate of arts degree in early childhood education. Family Support Worker/Home visitors participate in the Family Development Certification Program and the Child Development Associate Home Based Credentialing program. 7. Please attach current organizational chart as Appendix B. See Appendix B6 8. Was the agency able to provide raises? Yes. 9. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3% Yes No Comments Does your agency X This process is ongoing. have personnel policies? If yes, date board last reviewed? Does your board X annually evaluate the director's performance? Does your agency X The Head Start Policy Council approves job descriptions for all have job positions in Head Start/Early Head Start and Child Care descriptions for operations as they are updated and/or revised. This is an every position? ongoing process. If yes, date of last board approval? Is there an annual X There is an annual performance review for all staff members performance who work in the Head Start/Early Head Start and Child Care review for every Programs. staff?. 6 See Appendix B for Organizational Chart jccoghs\fundingform.doc 11 Agency: HACAP Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) FY 00 FY 01 FY 02 Current Assets $95,397.00 $70,018.00 $169,482.00 Cash Investments Receivables < 90 days $1,231 Other $9,725 $520 $1,374 Total Current Assets $105,122 $71,769 $170,856 Other Assests Property Equipment $152,951 $175,173 $169,058 less depreciation ($152,951) ($175,173) ($169,058 Receivables > 90 days Other Total Non-current Assets $0 $0 $0 Total Assets $105,122 $71,769 $170,856 FY 00 FY 01 FY 02 ;urrent Liabilities Accounts Payable $153,644 $54,313 $143,095 Payroll Taxes Payable Contracts Payable Mortgage Payable-6 months Total Current Liabilities $153,644 $54,313 $143,095 Other Liabilities Mortgage Payable-Balance Other $17,671 $17,456 $33,160 Total Other Liabilities $17,671 $17,456 $33,160 TotalLiabilities $171,315 $71,769 $176,255 NetAssets ($66,193) $0 ($5,399; _labilities & Net Assets $105,122 $71,769 $170,856 Agency: HACAP Last Yr Cur Yr Next Yr 2001 2002 2003 B. Income and Expenses Income Loca Funding Sources Iowa City $8.63~ $8.635 $8.635 Coralv e $2,750 $3,025 $3025 Johnson County $25,000 $22.500 $22 500 United Wa3, - Allocation $15,675 $10,675 $10,675 - Des~gna[eo Giving $1.056 $2.275 '> *Current Year is a Projecuon Grants-Federal State Foundation $1.755.466 $1.631 515 $1.631 515 Net Sales of Service $45.000 $80.000 $80.000 Parent Fees/DHS Child Care Cer[ificate Net Sales of Materials $0 $0 $0 Contribubons/Fu ndraising $0 $0 $0 ~nves~ment Income $0 $0 $0 Other Total Income $1,853,582 $1,758,625 $',756 350 Expenses Wages & Salaries $1.105.522 $1.005.805 $1.005.805 *In current year we reaucea manage- Benefits $298,490 $291,683 $291,683 men[ aersonne~ and ~eve~s of faro ~ Occupancy $0 $0 $0 support to De able to resoona to consum- Non-occuoancy $162 135 $189,570 $187,295 er demand for furl 2ay, full year cmlo care Other flndirect Charge $287.435 $271.567 $271 567 Total Expenses $1.853.582 $1,758,625 $1,756,350 Fund Balance Revenue $1,853.582 L $1,758.625 $1.756.350 Carryover Balance from previous year Total Ooeraung Budget $1.853.582 $1.758.625 $1 756.350 Less Total Expenses $1.853.582 $1,758,625 $1.756.350 Endmg Fund Balance $0 $0 $0 Less Restricted Balance lexela~n Car~over Fund Balance $0 $0 $0 IAgenc¥ HACAP 9. BdlDonorlFunder Restricted Funds Designated for: Last Year This Year Next Year 2001 2002 2003 Total Restricted Funds ~, In Kind Support Last Year This Year Next Year Profess ona Fees/Wraparound Services al ervlces/Volunteers Oartnersh o Site/Volunteer Se~ices $212 236 $215000 $215.000 ater al Goods $8.000 $1600( $16000 ~ace. Uti itles, etc $10.600 $0 $0 3ther Please footnote Total In-kind SUDDor~ $231 036 $231 000 $231.000 Grants Descrlpl eh/Purpose Last Year This Year Next Year ~ej3artment of Health/Human Services ~ead Stad Funds {Prescnoo $1 427 040 $1 308 918 $1 308918 owa Department of Educat]or~ Shared Visions Funds Preschooll $112664 $112.664 $112664 owa De~ar[ment of Human Services Child Care Bock Grant Funds 3reschoo $60.000 $100.000 $100 000 Johnson County Empowermenl Wraparound Child Care Funds 'Preschoo $9.240 $9 240 $9.240 ;ommun ty Services Block Grant Toddler Child Care Funds $146.522 $100 693 $100.693 Total Grants $1r755466 $1,631,515 $1631~515 Appendix A HACAP Board of Directors Officers and Johnson County Membership Roster Work Home Name Address Phone Phone FAX E-Mail County R_~presentative Term Limit Marry Cutter 400 Coltins Rd. NE Mail Vice President Station 124-323 Rockwell Cedar Rapids IA 52404 295-2216 378-1324 295-7910 mfcutter@rockwellcollins.com Linn Private 2005 Lyle Hanson Treasurer Finance City Hall 50 2nd Ave, Bridge Commissioner Cedar Rapids IA 52401 286-5002 286-5073 I ie~.cedar-rapids org Linn Public Appointed Tammy Wetjen- Kesterson Secretary 744 Clinton Ave Advocate Marengo, IA 52301 642-1233 ~ kesterson(~,yahoo.com Iowa Private 2004 913 S. Dubuque St. Suite 201 Terrence Neuzil Iowa City iA 52240 356-6000 356-4213 tneuzilC, co, iohnson.ia.us Johnson Public Appointed 1253 Dolan Place Mary Larew Iowa City IA 52246 338-1212 337-2264 338-2009 Johnson Private 2003 1625 Red Oak Dr Henry Herwig Coralville, IA 52241 .Johnson Public Appointed 813 Fairview Drive John Lee Coralville, IA 52241 688-5266 Johnson Consumer 2006 447 S, Summit St Mary McCue Iowa City, IA 52246 338-6134 mccue~zues.ia.net Johnson Private 2007 Appendix B HACAP'S Head StartJEarly Head Start Supervisory Structure Director of Field Operations Head Start/Early Head Start Head Start/Early Head Start Volunteer Specialist 1 Operations Supervisor ~ --ICACFP/Nutrition Coordinator IStaff Development Super~'s°r, ] ' IOffice Operations Supervis°r I [Child Development Specialist Child Development Associate L [Target Families Manager ] Coord Mentor Teacher / Site Services Supervisor Site Services Supervisor Site Services Supervisor Receptionist/Service Worker Receptionist/Service Worker Receptionist/Service Worker (2) Housekeeper Housekeeper Family Suppport Worker / Home Visitor (3) CJessroom Services Supervrsor Teacher/Childcare Services Supervisor Housekeeper ~ Early Childhood Teacher Early Childhood Teacher Classroom Services Supervisor -- Assist Teacher Assist Teacher Early Childhood Teacher -- Teacher Associate Teacher Associate -- Assist, Teacher -- Early Childhood Teacher Early Childhood Teacher Teacher Associate ~ Assist, Teacher Assist Teacher Assist Teacher -- Teacher Associate Teacher Associate Early Childhood Teacher Early Childhood Teacher Teacher Associate Teacher Associate Assist Teacher Early Childhood Teacher ~ Teacher Associate Teacher Associate Eady Childhood Teacher Early Childhood Teacher -- Lead Toddler Lead Toddler Worker Section 1: Background Agency Name: Handicare, Inc. Address: 2220 Ninth Street Phone: 319/354-7641 Coralville, IA 52241 Director Name: Ann Riley Signature: Bd. Pres Name: Wade Smith Request Completed By: Dawn M. Morgan Date: September 25, 2002 Check Your Agency's Budget Year: 1/1-12/31 x 7/1-6/30 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC 26364 23364 48960 4% Does not include designated ~ecial Needs Grants FY02 FY03 FY04 City of lowa City Johnson Count~ City of Coralville 1000 2500 5000 .4% What were local funds used for this year: To assist with the cost of specialized daycare for six children with special needs that were not eligible for or were on the waiting list for a waiver or county or state funding assistance.. What will next year's local funds be used for? To assist with the cost of specialized daycare for 3-6 (4 FTE) newly identified children with special needs that are not eligible for or are on the waiting list for a waiver or county or state funding assistance. This also included children with mental health needs. Agency Mission Statement: -To be supportive of the family unit with flexible schedules and service coordination. -To provide developmentally appropriate activities that help the children achieve school readiness and socialization skills. Summarize your programs and services for which you are requesting funding: To provide therapeutic and educational daycare and school complement services for children with developmental disabilities and special health care needs. List any accreditation and licensure your agency currently has. Explain. State of Iowa licensed childcare facility with daily preschool services. In the process of receiving NAEYC (National Association for the Education of Young Children) anticipating our final site visit to be completed between October and December 2002. Agency Name Handicare Inc. Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Handicare has been a leader in Iowa in the field of early intervention, inclusive childcare and preschool programs since October 1981. Over the years, we have grown fi.om a small licensed center of fifteen children to one that currently provides services to one hundred and fifty children daily in fifteen different classrooms. Our mission is to be supportive of the family unit by offering flexible schedules and service coordination. We provide adaptations to help all children successfully participate in developmentally appropriate activities, thus enabling the children to achieve school readiness and socialization skills. We employ thirty-five full time equivalent direct care staff, five full time administrative staff and eight program support staff. Our hours of operation include day and evening shifts Monday - Friday year round. At this time Handicare's enrollment includes sixty-four full time equivalent spots for infants and toddlers and sixty full time equivalent spots for preschool children. In addition, our school complement program serves thirty-two children between the ages of six and twelve years daily. Unfortunately we still have a waiting list of over one hundred children. Handicare enrolls children with needs that are higher than many childcare providers are trained to address. Twenty-seven of our children with diagnosed disabilities are under the age of six, and twenty- two are school age. Both groups include children that have medical needs such as trach care, apnea monitoring, oxygen, g-tube feedings, asthma treatments, intermittent catheterizations, higher level first aid care for blood clotting disorders and/or administration of prescription medications including injections and inhalants. For the children eligible for funding we have interagency contracts to provide family supports such as service coordination and respite care. The children receive individualized medical monitoring and treatments, educational supports and personal care adaptations. Handicare also enrolls children with behavior issues such as oppositional defiant disorder; conduct disorder, and attachment disorder. We have ten children living in "at risk" home environments and seven families that have children with mental health issues and/or social and emotional problems. Many of our children that need individual adaptations do not receive any funding assistance. Due to federal, state and local budget crisis's some children are on waiting lists that are over one year long. Other children are not eligible for funding assistance because they do not show developmental delays in two or more areas. For some, private insurance coverage is not available because the condition is considered chronic and does not keep the child restricted to a home setting. Handicare's strategic plan includes researching opportunities to expand our family support service through a variety of grants and community partnerships. The funding fi.om these grants and partnerships will provide training and support services for parents and their children to address mental health needs including how to promote social and emotional skills, conflict resolution, and problem solving skills. j ccoghs\ fundingform.doc 2 Agency Name Handicare Inc. Section 2: Client Profile 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 243 207 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 93 54 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 139 129 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-2 82 Female: 91 BLACK 23 3-5 81 Male 123 ASIAN 14 School age 51 H1SPANIC 6 MIDDLE EASTERN 5 WHITE 166 3. Briefly describe your service population. Handicare serves families with young children six weeks to twelve years of age ~om many backgrounds in the Johnson County area. A majority of the families have two parents working while the children attend but many of the children are from single parent families or one or both parents are taking classes. One fourth of the children have a developmental disability or specialized medical need. 4. How do you determine eligibility for services? Handicare's enrollment is based on the availability of space in each age group. Enrollment is prioritized for children with special needs and families already involved in the program. Individual attention is placed on the need for critical or specialized care along with the comfort level and training of the staff in that child's age group. 5. Are there fees for your service? Yes X No __ If yes, please describe your fee structure: A. See attached parents' private pay billing sheet B. State subsidized rate (per ½ day - 5 hr unit) special needs care regular care Infant $48.00 $12.45 2 -5 28.13 10.50 School age 28.04 9.00 C. Home and Community Based Waiver: Respite and Intermittent Monitoring and Medical Treatment (IMMT) $12.24 per hour Supported Community Living (SCL) $24.00 per hour 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: We provide services for children with residency in Linn, Cedar, Scott, Iowa, Benton, Washington, and Muscatine counties that have parents or foster parents who live or work in Johnson County. jccoghs\fundingform.doc 3 Agency Name Handicare Inc. Services: Early intervention daycare and school complement program; Contracted services for family service coordination; Least Restrictive Environment (LRE) classroom setting; respite, IMMT and SCL. Funding Sources: Private Parents; DHS, The ARC, Mayor's Youth, AEA contracts, Un/ted Way, service club grants, private donations and small fundraising projects. Section 3:Commnni~ Relations 1. How do you assess satisfaction with your service? (a) Client - NAYEC parent satisfaction surveys (b) Community - Comments from annual inspections by departments of Health, Human Service and Fire Safety; student and professor reports on the quality of student practicum experiences and United Way Citizen Review and Allocation Committee feedback. 2. Briefly summarize your findings: Handicare is a quality early childhood setting with administrative practices that support the direct care staff and keep our policies current. Our clientele are fi:om many different cultures and backgrounds. 3. What changes have been made in response to these findings? This past year we increased the cultural diversity of our education activities and written materials. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Parent Recommendations 65% DHS 18% 4C's Brochure 11% Center for Disability and Development 4% Area Education Agencies 2% 5.What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? The ARC provides respite and SCL services; there are many daycare centers in this area. 6.Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Our progran~ is unduplicated for those children with medical technical needs, multiple disabilities and toddlers or preschoolers with severe behavior issues. We accept children infant to twelve years develop-mentally no matter what the disability plus provide individualized adaptations for children that need intense intervention or medical services. We also provide evening childcare services, in house medical assistance, interagency and service coordination, and help families find appropriate funding sources. jccogh s\ funding form.doc 4 Agency Name Handicare Inc. 7.Outside of referrals list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. AEA - LRE, Early Access and Therapeutic 1 .a. Interagency service coordination Interventions b. Therapists who provide on site evaluations & weekly interventions while child attends Handicare 2. Mayors Youth/ARC 2. a. Contracts for interagency Supported Community Living and Respite services b. Co develop transition services for job training for adolescents 13-18 years that have disabilities 3. U ofI Depts. Of Early Childhood, 3.Provide students with practicum & volunteer Education, Nursing, Social Work, and opportunities or exposure to career opportunities Physical, Recreational and Music while increasing our staffto child ratio in therapies. Handicare classrooms. Section 4: Strategic Planning and Agene.y Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1 .It is a challenge to strive to increase 1.Continue increasing the number of inter-agency wages to professional levels when the contracts that reimburse us for our professional level majority of our income is dependent on services that are incorporated into our program. parent wages that do not increase rapidly. 2. Balancing our budget is challenging 2. a. Reduce the number of families utilizing state when subsidized rates are below actual funding until the rates improve. costs and we have continued funding b. Continue seeking corporate support for their reductions, employees' childcare costs and private contributions or grants to assist low income and at risk families. c. Increase United Way Allocations to help subsidize the costs of services for children with special needs that are without funding assistance. 3. National and State organizations have 3.Provide leadership in our community to identify recognized that children's mental health partnerships and apply for grants that will fund the issues have reached a crisis level. This start up costs for Early Childhood and Family provides an opportunity to create and Education Services to families from all social implement an early intervention and economic levels in Johnson County. These include prevention curriculum to guide families evening classes for parents and children to attend and children that promote healthy social together, facilitated discussions and curricultun pack- and emotional development, ets to implement at home for the parent and child. j ccoghs\ funding form.doc 5 Agency Name Handicare Inc. 2. In what way will the needs of your service population change in the next five years? We are seeing an increase in rotating schedules and job sharing plus more parents seem to have jobs that require evening hours or twelve hour shifts. We have also seen an increase in the number of requests for a service coordinator that is familiar with the child or family. 3. How do you plan to address these changes? We plan to keep adding staffto work our evening hours and increase the number of children we can accommodate each night. We are working on training more staff to provide the support services that are available through our program. 4. Describe the evaluation methods you use to measure the success of your services? The size of our constantly growing waiting list that is the result of parents and professionals promoting our program. Feedback fi.om public school teachers and administrators concerning children's school readiness skills or maintenance of their skills during summer months when the children have attended our program. Parent satisfaction levels documented by NAEYC surveys. Continued requests from community agencies to collaborate and form partnerships to meet a local need. The number of University of Iowa departments that request students be placed for practicum hours within our agency. 5. What are the results of these evaluations (outcomes)? All results have been very positive. The only complaint we hear is that many want us to expand our program to serve even more children. We offer several scheduling opportunities to match the needs of as many families as possible but we do not feel it is fmancially feasible to expand our program space or staff at this time. 6. How do you plan to use the evaluation results to enhance/extend your services? Continue looking for support funding for low-income families or children waiting for waivers or on waiting lists for services. Look for opportunities to adjust the utilization of the program space within our building to see if we can expand our current sixty-four infant and toddler spots. Continue to explore the development of family support services. 7. How do your programs/services impact the community? Forty-nine children enrolled at Handicare receive home and community support services so they can stay in their natural home setting and avoid out of home placement. One hundred twenty-four children daily receive quality early care and education services, and thirty-two children receive school complement services so over three hundred parents can be effective workers or attend classes for advanced education and training. Parents that have children with special needs are able to work full or part time because of our flexible hours of operation. All parents using our program have the availability to complete job tasks during day or evening shifts. 8. How did the agency respond to the UWJC recommendations fi:om last year? jccogh s\fundingform .doc 6 Agency Name Handicare Inc. We have continued to research and expand our contracted services to provide appropriate coverage for our programs costs. We have become an authorized provider for children under the Brain Injury Waiver. We are contracting with Mayor's Youth for SCL and are providing Rehabilitative Treatment and Support Services (RTSS) through DHS and increased the number of families receiving service coordination fi.om early access. Staffretention has improved to an average of two years minimum for part time staffwith a core of full time staff staying between five and ten years. This summer many part-time college students stayed for the summer and a higher percentage returned this fall due to the wage increase. We are using NAEYC outcome evaluations to monitor the success of our program. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attached as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? 8 - 10 members 4. How is the board involved in strategic planning and governance of the agency? Six of the board members are in the building daily to provide support and guidance to the administrative team. 5. What type of training/orientation do board members receive? Persons interested in becoming board members are given our Articles, Bylaws and strategic plan. They are invited to visit a monthly meeting to observe with the opportunity to be voted in at the second meeting they attend. We review each member's background and job responsibilities to assure we have diversity in representing our ages of clientele, business and human services practices. Training opportunities and workshops are shared at each board meeting as they arise but many often conflict with our members work requirements or they have attended similar activities in the past. 6. Does your agency have written policies and procedures for financial management? lfyes, date of last board approval? May 16, 2002 7. Have you filed the annual report with the Secretary of State? If yes, date filed? November 2001 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? May 13, 2002 9. Does your agency have a yearly audit? Yes If yes, who completed the audit? Gary Nielsen CPA How much did the audit cost? $1700 If material weaknesses are noted in the audit, what is your plan for addressing them? None noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? jccoghs\fundingform.doc 7 Agency Name Handicare Inc. 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers YES 1,000,000 a. fiduciary liability b. employment practice liability General Liability YES 1,000.000 Umbrella Liability YES 1,000,000 Professional Liability YES 1,000,000 Property or Renters NO Vehicle YES 500,000 jccoghs\fun ding form.doc 8 Agency Name Handicare Inc. Section &Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Ann Riley has been with Handicare since it's conception in October 1981. Ann is a Registered Nurse with a Masters Degree in Community Health Administration. She also has served on numerous national, state and local councils and committees and has been a member of the Johnson County business community since 1976. Her vita is available upon request. 2. Staff Salaries &Benefits Check if Applicable ] Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Exec Director/Reg. Norse X X 51,280' I I 1 Program Director X X 20,800 - 26,372 1 1 1 Special needs Coordinator Medications Manager/Health Aid X X 20,800 - 24,731 1 1 [-Finance Coordinator/ lntake X X 32065* I 1 1 Admissions Education Coordinator/Lead X X 20,800 - 26,885 1 1 1 Teacher Director Care Manager/Lead X X 20,072 - 20,169 3 2 2 Teacher Lead Teacher X X 7.00 - 10.40 hourly 8 9 9 Assistant Lead Teachers X X 6.69 - 8.47 hourly 12 12 12 Full Time Teacher Aides X X 6.50 - 8.75 hourly 8 8 8 Part Time Teacher Aides I 6.00 - 8.00 hourly 2.8 3. 3.3 Administrative Assistant X X 18720 -21840 1 I 1 Facility Coordinator/ X X 31426' I 1 1 Transportation Coordinator Food Service Manager X X 18,720 23,836 I I 1 ~Mainteaance and Kitchan X X 6.34 - 9.76 hourly 3 3.5 3.5 Assistants Bookkeeping Assistant 6.00- 7.00 0 .3 2.2---- Respite care giver $9.00 hourly .3 1.4 .4 TOTAL FrEs 45.1 47.2 48.4 *These positions are multi-tasked and have only been held by one person since the start oftbe organization. 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? All jccoghs\fundingform.doc 9 Agency Name Handicare Inc. 4. How much was spent on staff development in the last fiscal year? $2839 5. How much is budgeted for staff development in this fiscal year? $2950 6. What training and support opportunities are offered to malT?. CPR, Ist Aid and universal precautions, monthly onsite professional growth meetings, AEA and 4Cs childcare training workshops; Child Development Certification; related college course tuition reimbursement. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 7% Yes No If no, brief explanation 9. Does your agency have personnel X policies? If yes, date board last reviewed? April 2002 10. Does your board annually evaluate the X director's performance? 11. Does your agency have job X descriptions for every position? If yes, date of last board approval? _March 2002 12. Is there an annual performance review X for every staff. jccoghs\fundingform.doc 10 Section 7: Financial Management Three Year Historical Balance Sheet iAs of your fiscal year-end) ~ 1999 '2000 j 2oot 1999 2000 :urrent Assets . Current Liabilities Cash $62,978 $58,756 $43,705 Accounts Payable $11,560 $11,353 $12,826 investments Payroll Taxes Payable $1,584 $1,549 $1,769 Receivables < 90 days $76,387 i $73,014 $76,092 Contracts $52,935 $53,1 $50,590 Other $2,527 $3,851 $3,390 Mortgage payable-6 month~ $37,666 $37,666 $30,869 Total Current Assets $141,892 $135,621 $123,187 Total Current Liabili#es $103,745 $103,681 $96,054 Other Assests Other Liabilities Property $758,439 $758,439 $759,184 Mortg_a~]e Payable-Balance $515,789 ~ $489,507 $518,840 Equipment $183,571 $195,343 $279,832 Other $1,911 . $3,868 $1,066 less depreciation $277,776 $318,119 $357,245 TotalOIherLiabitities $517,700 $493,375 $519,906 Receivables · 90 days Total Liabilities I $621,445 i $597,056 $615,960 Other , NetAssets $740,233 $810,466 $903,488 Total Non-currentAssets $1,219,78651,271,901 i$1,305,261 i _ _ __ ~Age~cy: Handicare 2001 2002 200~3 / B. Income & Expenses _ _ _ Local Funding Sources Iowa City Coralville _ ~ _,0 $2,500 ~ $5,000 Johnson ~County United Way - Allocation ~ $25,416 $24,114 $42,561 - Designated Giving _ $4,958 $4,717 $5,500 Grants-Federal, State, Foundation $33,166 $34,798 $54,900 Net Sales~of Service __ Net Sales of Materials__ Contributions/Fund[aising ~ $10,359 $15,451 $15,800 Investment Income _ __ $2,244 $1,781 __$2,000 ~ Other NUTRITION REIMBURSEMENT $27,066 $39,619 Total Income $999,549 $1,122,321 /51,196,642 Wages &~alaries . ~ $696,575 ~ $012,520 [ $837,652 Benefits t $88,239 $104,578 $114,001 Occupa~ ~ $135,38~ $141,942 $146,831 Non-occupancy $24,278 $19,240 $20,200 Other child~ren's program expenses $66,786 $78,368 $77,00-I $1,011,262 $1,156,657 $1,195,6 Fund Balance , Revenue _ / $999,549 $1,122,321 $1,196,642 Carryover Balance from previous year| $50,263 $38,550 $4,214 TotalOperatinSLBudget. __ . $1,049,812 $1,160,871 $1,200,856 Less Total Ex__cerises $1,011,2~62 $1,156,657 $1,195 684 EndingFund Balance $4,214 $5,17; Less Restricted Balance (explain~ Carryover Fund Balance $38,550I $4,214 I $5'172 Agency: Handicare D. Bd/DonorlFunder Restricted Funds Designated for: Last Year This Year Next Year E~oard of Directors Compensated Absences $20,785 i $23,062 $22,705 E~oard of Directors Future Fund $5,372 $6,972 $7,386 8oard of Directors :Equ!pment repair i $7,204 i $7,204 $7,204 Total Restricted Funds $33,361 $37,238 $37,295 in Kind Support: Last Year This Year Next Year .~rvices/Volunteers Direct Care with children $98,220 $98,551 $99,247 ~laterial Goods Classroom Supplies $12~848 $11,783 $13,743 ~ace, Utilities, etc I 3ther: (Please footnote) Total In.kind Support $111,068 $110,334 $112,990 F. Grants Description/Purpose Last Year This Year Next Year Cadety Club Bhcks and Mortar $16~000 $10,201 + $13,670 Johnson Cqunty Empowerment wraparound funds for Iow income families ; $9,798 $10,415 i $11,030 Trinity Episcopa! educational toy~ $200 $200 ~ $200 :_lfun playground tiles $5,000 3roctor and Gamble playground t es $2,000 ]ohson Coun~ Foundation _ $15,000 Samsa Grant ~ i $15,000 Total Grants I $32,998 $20,816 ~ $54,900 HANDICARE'S BOARD OF DIRECTORS Executive Board Wade Smith, President/Personnel Committee Coralville Information Systgms 03/00 - 02/04 Roman Terrill, Vice President/Finance Committee Iowa City Attorney 12/97 - 11/03 Hallsie Reno, Secretary/Executive Committee Iowa City Univ of Iowa- Physics 05/99 - 04/03 Jack Zimmerman, Treasurer/Executive Committee Coralville Credit Manager 06/01 - 05/03 Votina Members: Eric Bauer Iowa City Environmental Healb~ & Safety, Cedar Rapids, Inc. 08/00 - 07/04 Robin Paterson Coralville Univ. of Iowa Physics & Astronomy Dept 03/00 - 02/04 Brenda Kurtz, Fundraising & PR Committee Coralville ACT ProducL Line at NCS 08/00 - 07/04 Steve Sueppel, Finance Committee Iowa City CPA at Hills Sank 09/Ol - lO/O3 Lorri Hodgden, Fundraising & PR Committee Oxford Nurse at UIHC Ol/O2 - 02/04 Brad Houser, Building & Grounds Committee North Liberty Real Estate Agent ~ 08/02 - 09/04 Non - Votinq Members Ann Riley Coralville Executive Director, Handicare 3oined 10/81 Dawn Morgan Lisbon Finance/Admissions Coordinator, Handicare 3oined 12/85 Heather Kanz Coralville Education Coordinator, Handicare 3oined 08/99 Annie Brownsberger North Liberty Program Director, Special Needs Coord, Handicare 3oined 08/99 Amy Bowman Solon Roos Lead Teacher, Direct Care Manager/Curriculum .loined 04/01 3ill VanDee Iowa City Tiggers Lead Teacher, Direct Care Manager/Fundraising & Public Relations 3oined 05/01 Board of birectors Handicore Assistant Finance & Admissions Facility Coordinator Coordinator Accounting [ ~ /~anagers Assistan, ,, ~Food Service" -- Manager I[ Lead and Co Lead Teachers & Aid Assis,ont Lead Teachers Janitor I Teachers Assistant Assis,onts I~¢vised July 2002 Volunteers ~ Billing Update On May 15th, 2002, Handicare's Board of Directors voted to implement the following rate increase effective September 1,2002. When your child changes age brackets, the rate will go down the month after their birthday. 24 Month and 2 year Olds 3 - 5 Year Olds School Age Younger Full time Monthly $725 $624 $572 $420 Full time Weekly $230 $189 $172 $129 Rotating/Flex 112 time Monthly $542 $469 $429 $314 Rotating/Flex 112 time Weekly $163 $141 $128 $95 Half Time Monthly $483 $410 $372 $275 Half Time Weekly $144 $126 $119 $90 Daily Rate $53 $46 $43 $32 Extended Hour Rate $26 $21 $19 $15 Extended Hour Rates will be charged whenever your child has utilized their daily maximum hours for your billing contract. Extended hour rates will only be charged in 4 hour blocks. Example: A full time monthly contract entitles you to 50 hours of daycare per week, according to your normal scheduled hours. If your child attends more than 50 hours or stays later than their scheduled time, you will be charged for one four hour block of extended hour rate. There is also a one time non-refundable registration fee of $50 per child. The readmittance fee after 6 months absence is $10. Please detach and check the option you prefer. You may change your billing option only once per calendar year [] Full Time Monthly Parent Name [] Full Time Weekly Child/Childrens Name [] Rotating/Flex 1/2 time Monthly Child's Birthday U Rotating/Flex 1/2 time Weekly Date Signed F; Half Time Monthly Date to Begin [] Half Time Weekly [] Daily Section 1: Background Agency Name: Hillcrest Family Services Address: 2005 Asbury Road, DBQ IA 52004 Phone: 563-583-7357 Director Name: Gary Gansemer Signature: Bd. Pres Name: Julie Johnson Signature: ~ '/~ Request Completed By: Michael Luedtke/Stacy Gray Date: 9-25-02 Check Yonr Agency's Budget Year: 1/1-12/31 7/1-6/30 10/1-9/30 11/1-10/31 X 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC 9,711 9,372 12,000 4% Does not include designated ~ecial Needs Grants FY 02 FY 03 FY 04 City of lowa City Johnson County City of Coralville What were local funds used for this year: To offset revenue received from the Boarding House rent, due to the lower than market rent rates charged to our clients and to assist with salaries. What will next year's local funds be used for? To offset revenue received from the Boarding House rent, due to the lower than market rent rates and to assist with increasing staff training and development and with staff salaries. Agency Mission Statement: Hillcrest Family Services seeks to strengthen individual and family life. We are committed to instilling hope in those we serve. At Hillcrest we teach skills and provide information and resoumes that people need to make choices and gain control of their lives. As a caring ministry of the United Methodist Church and the Presbyterian Church (USA), Hillcrest is an advocate of children, youth, and adults in need. We work in partnership with the church and community to provide a full range of services that give people the opportunity to live life to the fullest. Summarize your programs and services for which you are requesting funding: Hillcrest Supported Living (HSL) provides a team of Visiting Counselors who specialize in assisting individuals diagnosed with a mental illness live successfully in the community. Services are provided in the individuals home or in the community. The role of the counselor is to enable the individual to develop supports and learn skills that will allow them to live, learn, work, and socialize in the community. The counselors teach skills related to basic daily living, develop resources, give support, and provide social, vocational, and housing assistance as necessary. Along with individual services, group activities are offered in the community in order to provide the client Agency Name Hillcrest Family Services with natural settings in which to learn, use and/or practice their skills. The program provides a 24- hour crisis intervention service to clients in the program, which is available by telephone as well as in person, as needed. Counselors meet individually with the client as often as is deemed necessary by the treatment team, but usually no less than one time per week. The adults we serve are typically diagnosed with Schizophrenia, Bipolar Disorder, Major Depressive Disorder, Anxiety Disorders, or Personality Disorders, and usually have secondary diagnoses as well as physical/medical concerns. The program also offers a Boarding House with occupancy for 10 individuals. This offers a lightly structured residence for individuals to live and develop their skills prior to moving into independent living in the community. Program goals focus on preventing unnecessary hospitalizations, goal attainment, consumer education, empowerment, and increasing the quality of life for those we serve. List any accreditation and licensure your agency currently has. Explain. Hillcrcst is accredited by thc Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and is granted deemed status through the Iowa Department of Human Services Mental Health and Developmental Disabilities Commission. A JCAHO survey was completed in August 2002 and thc agency is curremly waiting for thc official surveyor report. Preliminary reports indicate the agency will be granted another three-year accreditation and this will allow us to again apply for deemed status with the Iowa Department of Human Services. j ccoghs\funding form.doc 2 Agency Name Hillcrest Family Services Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually,) Agency Overall Hillcrest Family Services had its beginning in1896 when the first woman doctor to practice medicine in Dubuque, Nancy M. Hill M.D., became concerned about unmarried mothers and their babies who were not receiving proper care and opened a home for them naming it the Industrial Training School. This evolved into the Hillcrest Baby Fold which provided institutional care for pre-school children, placed children in foster and adoptive homes, and provided counseling for unmarried mothers. In 1963, the agency name was changed to Hillcrest Children's Services and institutional care for children was discontinued. Children needing temporary care were placed in foster family homes and infants released for adoption began to be place directly with adoptive parents upon discharge from the hospital. In 1964, an adoptions office was opened in Cedar Rapids. Currently, Hillcrest has many programs throughout southeastern Iowa. Services include Residential Treatment for Adolescents, Adult Residential Homes, Adoption Services, Outpatient Counseling, Health and Family Planning Clinic, WIC, In-Home Supervision, Supported Living Services, Family Centered Services, Hillcrest School, Vocational Training for Adults, Intensive Psychiatric Rehabilitation, Family Empowerment Program, Big Brothers/Big Sisters, Maternal Health Johnson County Hillcrest Family services began serving Johnson County in September of 1976 with the opening of the Iowa City Residence for women at 313 N. Dubuque Street, a seven-bed residential care facility for chronically mentally ill adult women. The purpose of this program was to help the women learn the skills to live independently in the community. In 1983, Hillcrest expanded the Iowa City Residence to fourteen beds for both men and women and changed the name to Hillcrest Residence. It was located at 214 E. Church Street. This program was closed in July 1999 due to low census. In July 1985, Hillcrest received a grant from the Iowa Division of MH/MR/DD to develop a Supervised Apartment Living program for persons with mental illness in Johnson County. This program worked with individuals with mental illness to learn the skills to be successful living in the community. The program remains today as the Hillcrest Supported Living (HSL) program. In February 1988, Hillcrest received a grant from the Gannett Foundation in order to buy and remodel a Boarding House for 9 persons with mental illness. This Boarding House, located at 728 Bowery St. in Iowa City is lightly structured in order to provide the skills teaching necessary to assist individuals to move independently into the community. In 2001, the third floor apartment was opened up in order to expand this to a ten-bed Boarding House. In the summer of 1996 Hillcrest opened Birch House, a five-bed waiver home in Iowa City for individuals with multiple psychiatric needs. This program is staffed 24 hours a day. In May 1997 the Hillcrest Recreation program was started in Johnson County. This offers recreational/socialization opportunities to adults with mental illness. In October 1997 Hillcrest began to provide individual and group therapy services to adults with mental illness. In July of 1998, Hillcrest began serving adults with mental illness in our Intensive Psychiatric Rehabilitation program. This program has a focus on a specific area of a person's life in which they want a change. This may be in their living, leaming, working, or social environment. Future plans for Hillcrest in the Johnson county area includes a program designed to serve families that have a parent diagnosed with a mental illness. This program will serve the entire family and will provide skills teaching, support services, crisis intervention, and family education regarding how to cope with the effects of mental illness. j ccoghs\funding form.doc 3 Agency Name Hillcrest Family Services Section 2: Client Profile ~ ~ 2001 002 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 82 72* Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 66 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 5 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 0 Female: 41 Caucasian 66 6-17 0 Male 31 African-American 4 18-29 11 Asian 2 30-61 56 Native American 0 62-75 5 >75 0 3. Briefly describe your service population. The Hillcrest Supported Living program serves adults, age 18 and older, who are diagnosed with a chronic mental illness. The majority of our consumers live in their own apartments in the Johnson County area, however, we also serve clients who may be living with family members, who are transitioning from a residential care facility or are living in our Boarding House. 4. How do you determine eligibility for services? The client must be 18 years of age or older, must have a diagnosed mental illness, must have potential for independent living and not require institutional or custodial care, and with assistance, support, and skill development should be able to function within the framework of the community. 5. Are there fees for your services? Yes X__ No__ If yes, please describe your fee structure: Hillcrest Supported Living has an hourly fee for direct services and for group services. Our direct service hourly rate is $46.69/hr. (county) and $48.58/hr. (ARO). Our group hourly rate is $14.15. We have a contract with Johnson and various counties, Consultec, and MBC of Iowa to provide services. The HSL Boarding House also has Room and Board charges, which are usually paid by the clients and/or their county. 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Hillcrest Family Services serves eastern and southeastern Iowa with a large variety of children, adult and family services. The Hillcrest administration offices are in Dubuque, Iowa. Locally, we limit our Hillcrest Supported Living services to Johnson County. Services Provided: See the Agency History section of this application to refer to the various programs provided by the agency throughout eastern and southeastern Iowa. The services provided j ccoghs\funding form.doc 4 Agency Name Hillcrest Family Services in Johnson County are Supported Community Living (the program of focus for this application), a Residential Care Facility (Bimh House), and Intensive Psychiatric Rehabilitation. Funding Sources: County contracts, MBC of Iowa, Consultec, and private pay. j ccoghs\ funding form,doc 5 Agency Name Hillcrest Family Services Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client - Satisfaction surveys are sent to clients every six months and at the time of discharge from our program. These allow the client the oppommity to give input about the program and how it may be improved. HSL also offers a monthly Consumer Advisory Group. This group allows clients to offer feedback about the services we provide and how we may improve or change aspects of the program. The Boarding House offers a monthly meeting in which the residents give feedback about the program and how it may be improved or changed. Several programmatic changes have taken place from input from our consumers. (b) Community - Satisfaction surveys are sent to case managers and significant others/family members on an annual basis and at the time of discharge of the client. These allow us to look at our strengths and deficits and make appropriate changes as necessary. We always encourage caseworkers, families and other service providers to give us feedback on our services and how we may improve our services. 2. Briefly summarize your findings: · Biannual Satisfaction surveys: Total # of responses - 19 Total # sent - 51 Percentage returned - 37% Average score 4.27 out of 5 · Discharge Satisfaction Surveys: Total # of discharges - 15 Total # of returned caseworker surveys - 8 Total # of returned client surveys - 3 Average score for caseworker survey 4.29 out of 5 Average score for client survey - 4.42 out of 5 · The Consumer Advisory Group and the monthly Boarding House meeting have provided an excellent avenue for consumers to be involved in their programming and give feedback on their satisfaction of the program. 3. What changes have been made in response to these findings? · Based on the information gathered from the biannual satisfaction surveys given to the clients, we have identified a need to better communicate with our clients regarding their anticipated discharge plan. This planning is to be done at the beginning of services and will be addressed more thoroughly in the Intake evaluation. Another concern for our clients and the caseworkers who are involved in the client's treatment is the high turnover of direct care staff. The plan to address this issue can be found in Section 4 of this application. · Based on the information gathered from the discharge satisfaction surveys, it has been identified that we need to improve staff training in the area of communication with caseworkers and other service providers. There has been an increase in staff training regarding the importance of working with the team of providers involved in the care of the client. Reducing staff turnover will also impact this issue as it has been observed that communication is more effective with consistent and stable provider relationships. · The Consumer Advisory group has given direction on how to structure our group services in order to meet the needs of our clients. One member of the group has also j ccoghs\funding form.doc 6 Agency Name Hillcrest Family Services been involved in the staff hiring process. The tenants at the Boarding House have provided direction in increasing their satisfaction by helping rewrite some of the policies and procedures established by Hillcrest to better meet their current needs. 4. Who are your referral sources to your agency? Please list the main soumes and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Johnson Co. Dept. of MH/DD 50% University of Iowa Hospitals & Clinics 15% Various County MH/DD departments 10% Chatham Oakes 10% Self referrals 5% Other (VAMC, Mecca, Mercy Hospital, etc.) 10% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Johnson County agencies that also provide Supported Community Living include Lifeskills, Inc., Goodwill, the Community Mental Health Center, and Successful Living. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Hillcrest Supported Living provides group activities that promote socialization and relationship building and decreases the chance of isolation. We also offer a 10-bed Boarding House specifically for people with mental illness to prepare to transition into community living. The primary focus of Hillcrest Supported Living is to work with people with psychiatric disabilities. All of the staff training and program development is specifically designed for work with this population. 7. Outsideofreferrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Mental Illness Awareness Week Committee 1. A group of local providers, one being Hillcrest, planning informational and educational activities for increased community awareness of mental illness. 2.Iowa City Public Library 2. Hillcrest uses their space to hold monthly Consumer Advisory Groups. This is an easily accessible resource for our consumers. 3.Johnson Co. Dept. of MH/DD 3. Our agencies share information and recommendations regarding rehabilitation goals for individuals using the service. j cc oghs\funding form.doc 7 Agency Name Hillcrest Family Services Section 4: Strateeic Plannine and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1 .Staff Retention 1. We continue to look for ways to increase staff salaries despite no service rate increases from the county. We MI1 continue to scrutinize and improve our internal and external training opportunities offered to staff. We will continue to offer morale building activities and "perks" in order to keep Hillcrest an enjoyable place to work. 2. Finances 2. Hillcrest will strive to continue to seek diverse revenue opportunities as they may become available. We intend to take advantage of grant writing opportunities that may become available. We intend to implement strategies to retain staff. 3. Maintain boarding house facility 3. Hillcrest will continue to seek various grants to help with the cost of renovation and basic physical upkeep of the older home. We will strive to update the furnishings and some of the older carpet in the home. We will continue to scrutinize the focus of programming at the boarding house and will strive to make it a rehabilitative environment. 2. In what way will the needs of your service population change in the next five years? As the population that we serve increases in age, we anticipate a higher degree of physical/medical needs that must be addressed. We continue to see a demand to serve clients coming from correctional institutions as well as clients with substance abuse problems. 3. How do you plan to address these changes? Hillcrest welcomes the opportunity to serve people with psychiatric disabilities who will be dealing with the above-mentioned issues. We will offer training to our staff in order to be well skilled and knowledgeable in these areas. We will collaborate with local agencies that have knowledge in these areas in order to increase our awareness of the needs for these populations and coordinate treatment interventions. j ccoghs\funding form.doc 8 Agency Name Hillcrest Family Services 4. Describe the evaluation methods you use to measure the success of your services? Hillcrest Supported Living recently began using the IAPSRS Toolkit, which tracks client progress over time in various areas (housing, employment, legal, hospitalization, education). This tool is completed upon admission to the program and every six months thereafter. Another evaluation tool we use is the consumer's service plan. We review the consumer's service plan on a quarterly basis to identify progress made on consumer goals. This enables us to identify the success of the chosen treatment interventions on an individual basis. Quality Indicators are completed on a monthly and quarterly basis that measure client and agency outcomes. These indicators were developed as a result of the identification of risk factors, processes critical to the success of treatment, safety, and internal agency outcomes. 5. What are the results of these evaluations (outcomes)? Overall, the quality indicators show us how many hospitalizations and client suicide attempts happen on a monthly basis, as well as results from discharge satisfaction surveys. We are currently in the process ofrestrncturing the quality indicators in order for them to provide more information than they do at this time. We have no information at this time regarding the data collected from the Toolkit since we only recently implemented the evaluation tool. 6. How do you plan to use the evaluation results to enhance/extend your services? As we monitor the quality indicators we will be able to identify clients who are frequently using the hospital or attempting suicide so we may increase interventions with that individual. Once we gather information from the Toolkit, it is our hope that it will provide us with data that will allow us to build on the strengths of our program and/or make changes in our program in order to be more helpful in certain areas to those we serve. The review of the consumers service plan on a quarterly basis allows us to identify interventions that may not be working and allows us to redesign the plan to meet the consumer's needs. 7. How do your programs/services impact the community? Hillcrest supported Living provides support, assistance, and skills teaching to help people with mental illness live independently in the community. This assistance allows these individuals to contribute to the community through employment, by attending school, and by participating in community activities. Our goal is to try to help these individuals stay within these community roles despite having a mental illness. Our program also meets an identified community need to provide affordable housing to people with disabilities. Community education regarding mental illness is an important part of the role of the Supported Living Program. Hillcrest staff are involved in committees designed to provide education to the community regarding mental illness and what resources are available for persons with mental illness. 8. How did the agency respond to the UWJC recommendations from last year? Hillcrest strives to continue to try to diversify our sources of revenue. However, payment for our services is largely dictated by the needs and resources of the consumers we serve. In 2001, Hillcrest opted to become a provider of Adult Rehabilitation Option (ARO) services, a separate funding strean~ through Medicaid. This funding option was developed jointly by the State and the counties in order to provide alternative funding and services to persons with mental illness. The Hillcrest Supported Living program continues to provide more and more services through the Adult Rehabilitation Option (ARO). j ccoghs\ funding form.doc 9 Agency Name Hillcrest Family Services We expanded services in Ottumwa, Iowa when we were awarded a two-year contract with the Heartland Board to operate Highland Place RCF and RCF/PMI program. By taking on this contract, with a unique risk sharing agreement, Hillcrest was able to provide a quality new service using existing agency support services. This assisted all Hillcrest programs as administrative costs were reduced in other programs from the previous fiscal year. The RCF/PMI program was a totally new program and funding source for Hillcrest. Hillcrest Family Services has entered into a contract, effective November 1, 2002, to become the Community Mental Health Center for Washington County. The new funding streams associated with the Community Mental Health Center status will further diversify Hillcrest's funding streams. This new program will also further reduce administrative overhead for other Hillcrest programs. Hillcrest strives to increase collaboration with other providers. Over the past year, the Director of Clinical Services has reached out to other service providers to coordinate training opportunities. Hillcrest also continues to strive to collaborate on a regular basis with other providers involved in the care of our clients. The Visiting Counselors are trained upon hire and during weekly team meetings about the importance of collaborating with the client's treatment team. The Hillcrest staff are encouraged to contact those on the team not only when there are issues of mutual concern but also when the client is doing well. As stated earlier in this application, Hillcrest staff also collaborates with other service providers through a committee process in order to identify community education needs regarding persons with mental illness. j ccoghs\funding form.doc 10 Agency Name Hillcrest Family Services Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? The full board meets every other month and the committees meet every other month or as needed. 3. What is your average attendance at board meetings? 16 4. How is the board involved in strategic planning and governance of the agency? The Board of trustees was involved throughout the planning for the present three-year Strategic Plan when it was developed in 2000. The entire Board discussed Strengths, Needs, Opportunities, and Threats. Several Board members participated in the staff discussions on the same topics. The Social Services Committee and then the entire Board approved the Strategic Plan in September. Each year since then the Social Services Committee and the entire Board review the progress on the annual operating objectives and approve new annual operating objectives. 5. What type of training/orientation do board members receive? New board members attend a one-day orientation session. This session is an overview of the agency and a tour of the Dubuque programs. Several Program Directors and Administrative staff are involved in the orientation by providing information about their programs. In order to continue to orient Board members, each Board meeting also includes a presentation from a Hillcrest staff person about their program. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Yes, 5-9-02 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Yes, 9-16-01(done biannually) 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? Yes, 3-11-02 If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X__ No__ If yes, Who completed the audit? How much did the audit cost? O'Connor, Brooks, & Co., P.C. $8,646 (for agency) $507 (HSL Program) If material weaknesses are noted in the audit, what is your plan for addressing them? N/A If you do not have an audit, what is in place to assure accountability in the agency's financial management? N/A 10. Insurance Coverage: (check what coverage your agency has) j ccoghs\funding form.doc 11 Agency Name Hillcrest Family Services Insurance Check if agency has Amount Directors & Officers X SIM a. fiduciary liability b. employment practice liability General Liability X $1M/$3M Umbrella Liability X $7M Professional Liability X $1M/$3M Property or Renters X $7,413,149 (blanket) Vehicle X $1M (liability per accident) $5,00O (medical coverage per accident) SIM (uninsured and under- insured) j ccoghs\funding form.doc 12 Agency Name Hillcrest Family Services Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Gary Gansemer was the Assistant Executive Director at Hillcrest Family Services from April 1988 to August 1996, and has been the Executive Director/CEO from February 1998 to now. He has a B.A. in Psychology from St. Ambrose University and a Masters in Social Work from St. Louis University. He is currently a Licensed Independent Social Worker (LISW) in the state of Iowa. 2. StaffSalaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Utilization & Review X X X 21,200 - 30,226 0.03 0.02 0.02 Director of Human X X X 30,000 - 48,000 0.02 0.02 0.02 Resources HR Assistant X X X 8.10 - 11.55 per hour 0.03 0.02 0.02 Assistant Executive X X X 40,000 - 60,000 0.04 0.03 0.02 Director Executive Director X X X No salary range 0.03 0.02 0.02 Director of Finance X X X 40,000 - 60,000 0.03 0.02 0.02 Director of Adult Services X X X 30,000 - 48,000 0.00 0.10 0.05 Assistant of Finance X X X 22,500 - 32,080 0.04 0.03 0.03 MIS Coordinator X X X 34,000 - 48,500 0.04 0.03 0.03 Payroll X X X 9.00 - 12.83 per hour 0.03 0.02 0.02 Acct. Receivable Clerk X X X 8.10 - 11.55 per hour 0.04 0.03 0.03 Acct. Payable X X X 8.10 - 11.55 per hour 0.03 0.02 0.02 Acct. Bookkeeper X X X 8.10- 11.55 per hour 0.04 0.02 0.02 Program Coordinator X X X 23,000 - 36,000 0.40 0.40 0.30 Asst. Program Coordinator X X X 20,000 - 28,515 0.50 0.50 0.40 Visiting Cotmselor X X X 18,360 - 21,922 6.50 5.50 4.50 Secretary X X X 7.25 - 10.34 per hour 0.00 0.00 1.00 Executive Secretary X X X 19,000 27,089 0.02 0.01 0.0I Maintenance Supervisor X X X 24,000 - 34,218 0.00 0.00 0.03 Maintenance X X X 8.10- 11.55 per hour 0.10 0.15 0.04 Cleaning 6.80 9.70 per hour 0.01 0.04 0.05 7.93 6.98 6.65 TOTAL FTEs j cc oghs\funding form.doc 13 Agency Name Hillcrest Family Services 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 6.98 4. How much was spent on staff development in the last fiscal year? $1,085 5. How much is budgeted for staff development in this fiscal year? $1,400 6. What training and support opportunities are offered to staff?. Internal training is offered on a monthly basis to our staff. The Director of Clinical Services conducts and/or coordinates trainings on mental health and related issues each month in the Iowa City office and is able to offer CEU's to the staff who need them for licensure. A clinical training calendar is developed each year with input from agency staff and supervisors. External training opportunities are offered in the form of conferences and workshops in which staff may choose to participate. Relevant books and periodicals are purchased in order to assist staff in keeping abreast of current clinical issues. Hillcrest offers a couple of programs that allow employees to be nominated by their supervisors, coworkers, or outside customers that recognize them as outstanding employees. These programs award the recipient with $50 or a Target girl card. We also have a committee, called the Morale Corral, charged with the task of designing morale-building activities for employees throughout the year. Examples of these activities include staff picnics, on-site neck and shoulder massages, one free yoga session, movie passes, a paid "Play Day", etc. These activities are designed to support staff morale and increase staff retention. Further, the Commnnity Supported Living programs offer their staff an incentive program. This program allows them to receive extra compensation for increased productivity on a two- month average. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3%* Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board last reviewed? 4-1-01 10. Does your board X annually evaluate the director's performance? 11. Does your agency X The job descriptions are signed and approved by the have job Director of Human Resources. descriptions for every position? If yes, date of last board approval? j ccoghs\funding form.doc 14 Agency Name Hillcrest Family Services 12. Is there an annual X performance review for every staff?. *A Merit increase is also given to staff who have met certain criteria on their annual performance evaluation. This Merit increase is given over-and-above the annual salary/wage increase. The amount of this increase is approved by the Board. Staff may also be eligible for a Merit Bonus. This is a one time, one lump sum given to those who have met certain criteria on their annual performance evaluation and are nominated by their supervisor. Nominations are intended to be received for those employees who have gone above and beyond their job duties. j ccoghs\funding form.doc 15 Agency: Hillcrest Family Services Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) FY 99 FY 00 FY 01 Current Assets Cash $1,024,900 $1,272,379 $1,470,623 Investments $893,442 $717,699 $752,790 Receivables < 90 days $512,439 $611,711 $783,642 Other: $85,989 $98,178 $102,927 '1 Total Current Assets $2,516,770 $2,699,967 $3,109,982 Other Assests Property Equipment $3,333,124 $3,686,610 $3,547,670 *2 less depreciation Receivables > 90 days Other Total Non-current Assets $3,333,124 $3,686,610 $3,547,670 Total Assets $5,849,894 $6,386,577 $6,657,652 FY 99 FY 00 FY 01 Current Liabilities Accounts Payable $66,443 $71,351 $140,956 Payroll Taxes Payable $108,508 $99,630 $83,443 Contracts Payable $22,156 $21,474 $5,703 Mortgage Payable-6 months Total Current Liabilities $197,107 $192,455 $230,102 Other Liabilities Mortgage Payable-Balance $1,086,235 $1,281,791 $973,850 Other: $1,326,075 $1,316,757 $1,616,689 *3 Total Other Liabilities $2,412,310 $2,598,548 $2,590,539 Total Liabilities $2,609,417 $2,791,003 $2,820,641 Net Assets $3,240,477 $3,595,574 $3,837,011 Liabilities & Net Assets $5,849,894 $6,386,577 $6,657,652 '1 Includes: Interest receivable, Unconditional promises to Dubuque Co. United Way and Pledges,and Prepaid expenses. *2 Hillcrest Family Service audit report list "Land, building and land" as a net amount. *3 Includes: Bank overdraft, Due to Development Fund (FY01), and accrued vacation. 16 I Agency: ; Hillcrest Family Services Last Yr Cur Yr , Next Yr B. Income & Expenses FY01 FY02 FY03 Income Local Funding Sources Iowa City Coralville Johnson County $9,500 United Way - Allocation $9,501 $9,488 - Designated Giving $1,142 $900 $477 Grants-Federal, State, Foundation $12,202 $8,167 $18,116 Net Sales of Service $251,693 $192,746 $189,216 Net Sales of Materials $35,907 $41,928 $33,609 Contributions/Fundraising Investment Income Other $1,900 $3,400 $1,000 Total Income $312,345 $256,629 $251,918 Expenses Wages & Salaries $172,818 $157,795 $152,533 Benefits $44,573 $40,756 $35,638 Occupancy $41,753 $37,493 $27,370 Non-occupancy $51,719 I $45,521 $29,150 Other $0 I $0 $0 $310,863 $281,565 $244,691 C. Fund Balance Revenue $312,345 $256,629 $251,918 Carryover Balance from previous year $312,345 *2 Total Operating Budget $256,629 $251,918 Less Total Expenses $310,863 i $281,565 $244,691 Ending Fund Balance $1,482 I ($24,936), $7,227 1'3 Less Restricted Balance (explain) I Carryover Fund Balance $1,482 ($24,936) $7,227 Occupancy cost in FY01 included $12,202, FY02 included $ 8,167, FY03 $ 0 expenses pay by CDBC county grant. '2 Hillcrest Family Services operates on the accrual basis accounting system, accrual basis accounting does not account for "Carryover Balance from previous year". *3 Large net loss FY02 is due to drecreased referrals, high staff turnover, and staff shortage cause by the Program Coordinatator FLMA leave. I II I IAgency: I Hillcrest Family Services D. BdlDonorlFunder Restricted Funds Desi(Inated for: ~ Last Year This Year ~Next Year For client Client Emergency Needs Funds For client $4,824 $4,000 $4,500 I Women's Clothes Closet Fund ~ $300 $300 I $300 Women's Medical Fund ~ For client $500 $500 $500 Total Restricted Funds $5,624 $4,800 $5,300 Services/VolunteersE' In Kind Support: Last Year This Year Next Year Material Goods Space, Utilities, etc i Other: (Please footnote) $0 Total In-kind Support $0 , $0 Description/Purpose I F. Grants Last Year This Year Next Year CDBG Grant from Johnson Co Improvements to Boarding House $12,202 $8,167 CQ1 Grant from Johnson Co HSL services provide to Families $10,000 CQ1 Grant from Johnson Co. Staff incent yes $8,116 Total Grants $12,202 $8,167 = $18,116 HILLCREST FAMILY SERVICES Board of Trustees 27 + 3 ex officio members OFFICERS President: Julie Johnson 1762 Dover Court Dubuque Iowa 52003 Phone: (563) 588-9325 Vice President: Steve Bonnet 2nd Vice President: Stephanie Savage Treasurer: Keith Cook Secretary: Steve Horman JOHNSON COUNTY TRUSTEES Joyce Patton, Iowa City, Development Committee Term: 2000 - 2003 Homemaker Steve Yoder, Iowa City, Social Services and Nominating Committees Term: 2001 - 2004 Manufacturing Manager, Rockwell Collins, CR Roger Stutsman, Riverside, Social Services Committee Term: 2002 - 2005 Agribusinessman Rev. Douglas Williams, Coralville, Personnel Committee Term: 2002 - 2005 Pastor Rev. Harry Althoff, Iowa City Ex officio General Presbyter 9/10/02 HILLCREST FAMILY SERVICES Table of Organization May, 2002 Beard of Trustees Executive Director/CEO I Assistant [ Director of E~eculJve Director of Executive Director/COO D t Finance/CFO Human Secretary Resources I Coordinator Sisters Director of Resource Clerical Staff Coordinator Coordinator Finance Assistant I Mental Health Case Facilitation Research MIS Coordinator Services Associate Health Services Maintenance Director Director Director of Children and IPRS Family Services Coordinator nr15102 HILLCREST FAMILY SERVICES Table of Organization Adult Services March 2002 Executive Director/CEO Assistant Executive Director/COO Director of Adutt Mental Health Coordinator ICARE Section 1: Background Agency Name: Iowa Center far AIDS Resources & Education (ICARE) Address: 321 East First Street, Iowa City, Iowa 52240 Phone: 319-338-2135.~) Director Name: David G. Packard Signature: ~c'. ~--~ /~'~~ Bd. PresName: Dr. Todd Simpson Signature: (~ ?'~Jd/.~.,/1/~ Request Completed By: David G. Packard and Ruth Beyerhelm Date: 9/24/02 Check Your Agency's Budget Year: 1 / 1-12/31 __ 7/1-6/30~X 10/1-9/30 4/I/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated $16,500 $17,162 $21,870 ! 0% ivin or S ecial Needs Grants FY 02 FY 03 FY 04 City of Iowa City $11,000 $9,350 $10,935 5% Johnson County $20,000 0 0 0% City of C oralville $ 1,000 $1 ~ 100 $2,187 1% What were local funds used for this year: Direct Services, Prevention Education, Teen Peer Education and Awareness Program What will next year's local funds be used for? Direct Services, Prevention Education and Youth Programs Agency Mission Statement: To enrich the quality of life for persons living with and affected by HIV/AIDS. Through the distribution of information and services; we aim to foster the self- empowerment necessary to live productively and positively in the face of HIV/AIDS. Summarize your programs and services for which you are requesting funding: Direct Services: We are requesting funding to support our Case Management program. As a member of the Southeast Iowa C.A.R.E. Consortia, "case management" includes intake and psychosocial assessment, care plarming, advocacy, applications for Ryan White C.A.R.E. Act assistance and the AIDS Drag Assistance program, crisis intervention, counseling, emotional support, information and referral, financial services and client monitoring. The Consortia compensates ICARE $60 per month, per client, regardless of the number of hours we spend with that client. This covers but a fraction of the real cost of providing these services. Further, ICARE defines case management more broadly than the Consortia. In addition to the above, we provide housing and general financial assistance, transportation, social support, respite care, chores, support groups and comprehensive benefits counseling. The number of people served also expands under our definition. We provide services to people affected by HIV/AIDS (family, friends, parmers) and incarcerated persons, for which we receive no Consortia compensation. Lastly, our clients and "concerned others" tend to be poor, multiply diagnosed and have little, if any, social support, heightening their need for direct services. Agency Name ICARE Prevention Education: We are requesting funding to support our prevention education program that ICARE provides to the community free of charge. This includes: · Regular workshops as part of the volunteer training at the Johnson County Crisis Center to educate volunteers about psychosocial issues surrounding HIV infection · Workshops with the Iowa City Family Planning Clinic to raise awareness about cultural sensitivity when working with men who have sex with men (MSM) · Outreach training for University of Iowa students · Panel discussions with Lesbian, Bisexual, Gay and Transgender youth groups · Structured HIV prevention groups for at risk youth, using Centers for Disease Control and Prevention (CDC) endorsed "Programs that Work" at; Youth Homes, Inc., Mid Eastern Council on Chemical Abuse (MECCA), and Johnson County Alternative High Schools · Peer education youth group, HEAT (HIV Education Action Team) dedicated to stopping the spread of HIV among young people List any accreditation and Hcensure your agency currently has. Explain. Training in HIV testing/counseling and prevention case management provided by the Iowa State Department of Public Health. CDC endorsed "Programs that Work" for youth provided by the Iowa Department of Education and/or Iowa State Department of Public Health; · Power Moves · Becoming a Responsible Teen (BART) · Be Proud, Be Responsible Making a Difference Making Proud Choices Prevention programs provided through the Iowa State Department of Public Health; · Top Safe · Survive Outside · Popular Opinion Leader · Prevention Case Management (PCM) Agency Name ICARE Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) ICARE is a non-profit AIDS service organization with a two-fold purpose: to provide care for people affected by HIV/A1DS and to provide prevention education for those at risk for the vires. The program began in 1986 when Kerry Grippe and Rick Graf organized Iowa City's first support group for people with HIV/AIDS. By March 1987, it became clear that the needs of those living with the illness were far greater than a support group could accommodate. A steering committee was formed to determine the needs of the community and on July 1, 1987, ICARE was incorporated as a non-profit organization, becoming Iowa's very first AIDS service organization. In 1988, ICARE became affiliated with the United Way. Today we serve people in 21 counties in southeast Iowa with care and prevention programs. For more than 16 years, ICARE has worked to ensure that the government hears the voices and heeds the lessons of people living with and at risk for HIV/AIDS. ICARE is dedicated to shaping HIV/AIDS policy through public and media advocacy, policy research, grass roots outreach and education and information dissemination. ICARE provides current information on HIV prevention issues to the community as well as to targeted high-risk groups. High risk groups with which we work presently include youth in shelters, residential care facilities, alternative schools, substance abuse treatment centers, juvenile detention facilities, people who use injection drugs and men who have sex with men. ICARE focuses on care and treatment issues as well. We are involved in Ryan White C.A.R.E. Act reauthorizations, the state wide coordinated statement of need, the medical and psychosocial issues facing HIV positive people, raising the level of participation of HIV positive people in care and prevention programs and monitoring the effect of Medicaid managed cam on C.A.R.E. Act programs. Our most recent accomplishment in the area of care was the award of a $144,000 federal grant for housing assistance. The Housing Opportunities for People with AIDS (HOPWA) grant will enable ICAIiE to provide significant rental, utility and deposit assistance to HIV positive people and their families all over southeast Iowa. For the future, ICARE has proposed the development of an on-line Intemet program to conduct Health Education/Risk Reduction (HE/RR) activities that target HIV positive individuals. These on-line interventions will li~xk participants to programs such as prevention case management (PCM), H1V testing, counseling, and referral (CTR) and care. Agency Name Section 2: Client Profile l~,mn,m.~.lll'l'~r~.,k,~,, nmru~.ll~[ll~B,~,~,.,.~,.,.-H FY '01 FY '02 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 42 DS 33 DS Coralville) did your agency serve? 1,168 PE 2,500 PE 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 4I DS 32 DS no stats, PE no stats, PE 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 1 DS 1 DS no stats, PE no stats, PE *DS (Direct Services), PE (Prevention Education) Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 0 Female: 34 White, non-Hispanic 125 6-17 0 Male 134 African-American 28 20-44 124 Hispanic 11 45+ 44 Asian 4 62-75 0 >75 0 Above indicates only DS clients. No stats available for PE. 3. Briefly describe your service population. Direct Services: Our service population includes both people with HIV/AIDS and those who are concerned about someone with HIV/AIDS. They are primarily Caucasian, between 30-45, male, below the 50 % median income level and have multiple diagnoses (substance use, mental illness, HIV/AIDS, Hepatitis, other health issues). Prevention Education: Our service population is about half and half male and female, predominately teens, overwhelmingly Johnson County residents and HIV negative or of unknown HIV status. Most people have contact ~vith ICARE through group interventions in facilities where youth at high risk for HIV are found. Additionally, we have plenty of people who call in to the office for infom~ation or walk in to get safer sex supplies. 4. How do you determine eligibility for services? Direct Services: Anyone in the 21 county service area is eligible for direct services from [CARE whether they have HIV/AIDS or care for someone who does. People are eligible for housing assistance if at least one person in the household has HIV/A1DS, is at or below the 80% median income level for their county and live in one of 17 southeast Iowa counties that define the service area for the housing program. Prevention Education: There are no eligibility barriers for our Prevention Education programs. 5. Are there fees for your services? Yes No x If yes, please describe your fee structure: not applicable Agency Name ICARE 6. Do you provide services to areas outside of Johnson County? yes Area(s) stowed: Direct Services and Prevention Education: ICARE provides services to the people described above in the following 21 counties in southeast Iowa: Poweshiek, Iowa, Johnson, Cedar, Jackson, Cliuton, Scott, Muscatine, Louisa, Washington, Keokuk, Mahaska, Monroe, Wapello, Jefferson, Hem~y, Des Moines, Lee, Van Buren, Davis, Appanoose. Services Provided: .Direct Services: Case management including intake and psychosocial assessment, care planning, advocacy, applications for Ryan White C.A.R.E. Act assistance and the AIDS Drug Assistance program, crisis intervention, counseling, emotional support, information and refen'al, financial services, client and agency monitoring, transportation, social support, housing and general financial assistm~ce, respite care, support groups, chores and comprehensive benefits counseling. Prevention Education: Programs directed at targeted high risk populations such as injecting drug users (IDU), men who have sex with men (MSM), youth in chemical dependency centers, detention facilities, alternative schools, etc. We also provide prevention education to the community at large through presentations at public high schools, other social service agencies and information fairs, as well as doing street outreach encouraging positive behavior change to reduce the risk of HIV infection. Outreach workers provide risk reduction information and support to alter risky sexual and/or drug behavior. Funding Sources: Special agency events (Pancake Breakfast, MasquerAIDS Ball, etc.) Iowa State Department of Public Health (IDPH) United Way Cities of Iowa City and Coralville Iowa Community AIDS Partnership (ICAP) Broadway Cares National Minority AIDS Coalition (NMAC) Private donations Agency Name Section 3:Community Relations 1. How do you assess satisfaction with your services? Direct Services: We assess client satisfaction with an annual ICARE satisfaction survey and by collaborating with the Southeast Iowa C.A.R.E. Consortia in the client needs assessment they conduct every two years. We also get feedback from clients on an informal basis with some fi'equency. Prevention Education: We assess client satisfaction with surveys after each of our various prevention education interventions. 2. Briefly summarize your findings: Direct Services: Clients rated ICARE services as "good." They appreciate that there is always someone here to talk to if they drop in or call for help, that we help with financial assistance and transportation, that we help them navigate complex benefit programs, that we help with issues faced by HIV positive prisoners and that our Case Manager shows she cares. They expressed concerns about the availability and timeliness of financial assistance, were interested in having more social gatherings and wanted more infol-mation on medication and treatment issues. Prevention Education: Response has been favorable to our interventions, especially relating to facilitators and educational activities. 3. What changes have been made in response to these findings? Direct Services: We i~creased our budget for general financial assistance, have ensured that it is available throughout the year, typically have checks cut within a week of a request, have been hosting monthly social events and sending clients magazines featuring treatment and medication issues. Prevention Education: Developing evaluation tools to measure behavior change, not just knowledge base, over time. 4. Who are your referral sources to your agency? Please list the main sources m~d estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred University Hospital Virology Clinic 45% of direct service clients Johnson County Public Health 20% of all clients Iowa City Fmnily Plamfing 10% of prevention education clients 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Direct Services: No other organization in Johnson County provides similar services to the HIV/AIDS community. While most clients have access to limited social services through their medical treatment centers, hospital social workers utilize a medical model rather than a social service model. ICARE services encompass a broader spectrum, including the psychosocial, financial and practical suppmt issues faced by people with HIV/AIDS. Prevention Education: No other organization provides exclusively HIV prevention education. Agency Name T ~P~RE 6. Describe what distinguishes your agency and/or its services from other agencies that provide sinrilar services in Johnson County. .Direct Services: ICARE services are more flexible, practical and comprehensive than those offered through the hospitals. We are able to spend more time with clients, help with daily living and provide financial assistance. Prevention Education: No other organization provides exclusively HIV prevention education. 7. Outside of referrals, list up to 3 prinrary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. University oflowa Hospitals & Clinics 1. case conferences, care planning, financial concerns, housing, home care 2. Johnson County Public Health 2. sub-contracts for telephone support groups, prevention case management, Injecting Drag Users (IDU) and Men who have sex with Men (MSM) interventions 3. Iowa City Family Plmming 3. co-facilitate prevention education groups in schools Agency Name IC~hRE Section 4: Strategic Planning and Agency Effectiveness I. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Board 1. Develop a nominating committee to coordinate the identification, recruitment and selection of new members. 2. Finances 2. Develop further diversification in our income base. One current strategy is our "Bum the Mortgage" capital campaign. 3. Staffing 3. Plan to increase staffas new grants for particular programs are received. Additional staff will be necessary if we are successful in our grant proposal for an internet outreach program. 2. In what way will the needs of your service population change in the next five years? Direct Services: While we do not anticipate that the needs of our service population will change much in the next five years, the amount of need will increase and the face of our population will change. The federal, state, county and city budget cuts have left many benefit programs utilized by the HIV/AIDS community lacking, increasing the demand for services from agencies like ICARE. For example, our FY03 fnnding request of $20,000 from the JCPH was totally cut last year. As well as $1,200 from the City of Iowa City funding request. Additionally, our clients are increasingly rural, people of color, or parents. Prevention Education: Continued need for prevention education to a greater number of youth at risk lbr HIV. Plan to utilize more HIV positive people in prevention education. 3. How do you plan to address these changes? Direct Services: Our new housing assistance program, Home Base Housing, will help fill the gap caused by cats in housing assistance from local housing authorities. The housing program has brought many new clients to ICARE. These clients are increasingly from rural areas where assistance programs are scarce, especially for the HIV/AIDS community. We are presently collaborating with the Jobnson County Department of Public Health to offer telephone support groups to people in rural areas who do not have access to traditional support groups. The groups have been very successful so far because they are formatted to allow clients to gain a deeper sense connectedness and maintain their confidentiality, two issues with which rural clients are concerned. Prevention Education: Focus on Health Education/Risk Reduction (HE/RR). Agency Name ICARE 4. Describe the evaluation methods you use to measure the success of your se~wices? Direct Services: We assess client satisfaction with an annual ICARE satisfaction smwey and by collaborating with the Southeast Iowa C.A.R.E. Consortia in the client needs assessment they conduct every two years. We also get feedback from clients on an infon~aal basis with some fi'equency. Prevention Education: Utilize skills based evaluation methods. Ie. Contracted through Luther Consulting in Indiana to evaluate State Health Department funded projects to 1 .) determine the extent to which HIV prevention efforts have contributed to a reduction in HIV transmission and 2.) be accountable to stakeholders by informing them of progress made in HIV prevention. 5. What are the results of these evaluations (outcomes)? Direct Services: Clients rated ICARE services as "good." They appreciate that there is always someone here to talk to if they drop in or call for help, that we help with financial assistance and transportation, that we help them navigate complex benefit programs, that we help with issues faced by H1V positive prisoners and that our Case Manager shows she cares. They expressed concerns about the availability and timeliness of financial assistance, were interested in having more social gatherings, wauted more information on medication and treatment issues. Prevention Education: 100% of participants show improved l~owledge. 6. How do you plan to use the evaluation results to enhance/extend your services? Direct Services: We listen to what our clients tell us and, within reason, respond. Ie. A client suggested the idea of making support groups more social and interactive. Hence, we implemented the support group around a "barbeque", another a "garden party", and another a "night out to a "kernels baseball game". We are anxious to get the results of the 2002 Consortia needs assessment. The results of this year's needs assessment should be more credible than that of 2000. The 2000 needs assessment evaluated our performance prior to the employment of our present staff. Having consistent staffing for the last two years, we anticipate positive feedback. Prevention Education: Because response has been overwhelmingly positive, the plan is to keep doing what works. 7. How do your programs/services impact the community? Direct Services: We impact the connnunity by impacting individuals, one at a time. We make living with HIV/AIDS more healthy and hopeful. Prevention Education: Our prevention education targets people at high risk for HIV infection, ~naking a healthy impact on the community at large. Agency Name iCARE 8. How did the agency respond to the UWJC recommendations from last year? Program Evaluation · Goals pertaining to units of service and number of people served in the Direct Services program were overwhelmingly exceeded to FY'02. Our goal had been to provide 4,800 units of service to 50 different people. We actually provided 7,804 services (63% over goal) to 79 different people (58% over goal). We also performed well on our Prevention Education goals. We provided 13,403 units of service to 6,603 people, 47 educational forums to volunteers, clients and the community and 2,965 newsletters. We also have an educational website. · The specificity of what we do for our clients in terms of "Financial support" and "Buddy programs" am defined as follows. "Financial support" means that we have a financial assistance program which entitles any HIV positive person in our service ama to get up to $75 per month to pay for needed services. Presently, these funds are used to pay for home delivered meals for homebound clients, utility bills, nutritional supplements and rent. A "Buddy" in AIDS service organization jargon is a program that matches an HIV positive person with a trained volunteer for emotional, social and practical support. · The client feedback that we have received for the Direct Service program include the following: A Beautiful pencil drawing gift, "Token of appreciation- Just a plain old pencil drawing; not much compared to the kindness I've been shown from you, Ruth. "You simply are above and beyond the call of duty"; "You're and angel"; "Thanks for everything"; "I would be lost without Ruth and ICARE"; "The staff and volunteers have been a HUGE help to me"; and "Much thanks"! Additionally, the results of both the 2000 Consortia needs assessment and the 2001 ICARE satisfaction survey are available for your review. The 2002 Consortia needs assessment should be available by the end of the year. Prevention Education feedback has also been positive, and there are no changes anticipated. Outcome measures also come from participants in prevention education Interventions because they are given pre and post test evaluations to measure knowledge and skill improvement. Fiscal Evahmtion · The unit per service cost is kept for each contact, and is totaled for each client each month. The cost is $35/hr for each unit. · Depth and diversification of funding base continues with a new capital campaign, new grant proposals, more subcontracts with the State and County Public Health Departments, new agency fundraisers such as the MasquerAIDS ball and an Ebay auction fundraising effort. We are writing more grants to more diversified sources than ever before. 10' The Agency_ ICARE nanaeement · In terms of staff, we have had the same three persons working for the past two years. The free medical clinic does not provide social services, they only provide medical care. · The size of the Board and turnover continues to challenge us, but we are making a concerted effort to identify, recruit, select and retain new board members. · The Direct Services program collaborates extensively with the UIHC because that is where most of our clients receive their care. We frequently have case conferences on clients/patients to ensure no duplication of services and that we are addressing the care needs of the consumer. The UIHC has been an instrumental collaborator on our new housing program, being the primary source of referrals for housing assistance and other social services. The Direct Services program also collaborates extensively with the Johnson County Public Health. Through JCPH, our case manager has conducted HIV testing and counseling at the Free Medical Clinic and MECCA, facilitated telephone support groups and counseled clients in Prevention Case Management(PCM). PCM is a short term, behavior based, harm reduction intervention that aims to decrease the likelihood that an HIV positive person will transmit the virus to someone else. We typically meet quarterly to measure our progress on these subcontracts. · The prevention education program collaborates with Johnson County Public Health on MSM and IDU projects, and with the State Public Health Department on youth programs. Other Comments · 1CARE is unique because no other agency or organization provides comprehensive social services to people affected by HIV/AIDS and provides HIV prevention education to five different youth populations. These populations include youth homes, alternative high school, MECCA, detention, and peer education (9-12 graders from Johnson County schools). Agency Name ICARE Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and comnfittee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? 3-4memebrs 4. How is the board involved in strategic planning and governance o£the agency? A yearly retreat is held to review strategic plarming and board governance. Three board members and the executive director attended a seminar in Cedar Rapids sponsored by the Greater Cedar Rapids Foundation and Alliant Energy entitled Lending A Hand To The Community. The speakers i~cluded: Geneva B. Johnson, Milwaukee, retired in 1994 after 11 years as President and CEO of Family Service America and Willard L. Boyd, Iowa City, is Professor of Law and President Emeritus of The University of Iowa and The Field Museum of Chicago. 5. What type of training/orientation do board members receive? Board members receive a board orientation malmal and meet with the Board Chair and Executive Director prior to their first meeting for a personal orientation. 6. Does your agency have written policies and procedures for financial n~anagement? If yes, date of last board approval? Yes. Last updated July 17, 2002. 7. Have you filed the annual repolX with the Secretary of State? If yes, date filed? Last Filed March, 2001. 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? No. lfno to questions 6, 7, or 8, give explanation. Fom~ 990 will be filed prior to November 15, 2002 filing deadline. 9. Does your agency have a yearly audit? Yes No X If yes, Who completed the audit? How much did the audit cost? If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit~ what is in place to assure accountability in the agency's financial management? An almual review is conducted by Board appointees. Agency Name IEhRE 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X $l M b. employment practice liability X $100K General Liability X $1 M Umbrella Liability No Professional Liability No Property or Renters Yes $100 K Vehicle No Agency Name Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Present Executive Director, David Packard, has been employed at ICARE since August 28, 2000. Prior to that he was director of the Rapids AIDS Project, a program of the American Red Cross in Cedar Rapids, Iowa for 8 years. Currently, Mr. Packard is Community Co-Chair of the HIV/AIDS Community Planning Group for the state of Iowa. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director 18 X X $30,000 - 50,000 per year 1.00 1.00 1.00 Case Manager 18 X X $20,000 - 30,000 per year 1.00 1.00 1.00 Program Coordinator 18 X X $17,250 - 30,000 per year ! .00 1.00 1.00 Program Facilitator* Varies per program Program Development 4.5 $15,600 - 26,000 per year 0 .25 .50 $7.50 - $12.50 per hour * Program facilitators are paid on a per program basis as sub contractors and are neither paid benefits nor assigned as FTE's TOTAL FTEs 3.00 3.25 ' 3.50 Agency Name ICg_RE 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 2.25FTE's 4. How much was spent on staff development in the last fiscal year? $150.00; (Conferences and trainings were covered by scholarships or grants) 5. How much is budgeted for staff development in this fiscal year? $1,500 5. What training and support opportunities are offered to staff?. One national and two state conferences are offered to all paid full time staff. Specific trainings are offered to facilitators and staff as needed for educational and care programming. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to cun-ent fiscal year, what was the average % wage increase? 3% Yes No If no, brief explanation 9. Does your agency X have persmmel Last Review policies? If yes, date board 07/02 last reviewed? 10. Does your board X amrually evaluate the director's performance? l 1. Does your agency X have job 2000 descriptions for evmj position? I f yes, date of last board approval? 12. Is there an mmual X performance review for every staff? Agency: ICARE Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) FY oo FY 01 FY 02 Current Assets Cash $8,649 $3,274 $379 Investments $0 $0 $0 Receivables < 90 days $0 $10,961 $11,822 Other $1,762 $934 $904 Total Current Assets' $10,411 $15,169 $13,105 Other Assests Property $150,173 $150,173 $150,173 Equipment $0 $0 $0 less depreciation ($5,426) ($8,765) ($12,104) Receivables > 90 days $0 $0 $0 Other $0 $0 $0 Total Non-current Assets $144,747 $141,408 $138,069 TotalAssets $155,158 $156,577 $151,174 FY 00 FY 01 FY 02 Current Liabilities Accounts Payable $1,572 $4,909 $9,807 Payroll Taxes Payable $423 $6,442 $2,018 Contracts Payable $0 $0 $0 Mortgage Payable-6 months $7,189 $6,406 $6,201 Total Current Liabilities $9,184 $17,757 $18,026 Other Liabilities Mortgage Payable-Balance $119,915 $108,423 $96,167 Other $0 $0 $0 Total Other Liabilities $119,915 $108,423 $96,167 TotalLiabEities $129,099 $126,180 $114,193 NetAssets $26,059 $30,397 $36,981 Liabilities & NetAssets $155,158 $156,577 $151,174 Agency: ICARE Last Year Current Year Next Year B. Income & Expenses FY02 FY03 FY04 ]ncome Local Funding Sources Iowa city $11,000 $9,350 $10,935 Coralvilre $1,000 $1,100 $2,187 Johnson Count), - Board of Health $20,000 $0 $0 U n ired Way - Allocation $16,667 $18,337 $21,902 - Designated Giving $4,470 $3,816 $4,000 Grants-Federal, State, Foundation $61,240 $129,925 $131,000 Net Sales of Service $0 $0 $0 Net Sales of Materials $0 $0 $0 Contributions/Fundraisin~l $34,130 $41,250 $45,000 Investment income $0 $0 $0 Other $5~077 $3,900 $3,676 Total Income $153~584 $207,678 $218,700 Expenses Wa~les & Salaries $94,521 $91,315 $95,881 Benefits $21,535 $23,640 $24,929 Occupancy $9,634 $9,899 $10,439 Non-occupancy $21,806 $25,100 $30,451 Other ~ Program Expenses & Supplies $11~4q5 $52~307 $57~000 Total Expenses $159,001 $202,261 $218,700 C. Fund Balance Revenue $153,584 $207,678 $218,700 Carryover Balance from previous year $0 $0 $0 Total Operating Budget $153,584 $207,678 $218,700 Less Total Expenses $159,001 $202,261 $218,700 Ending Fund Balance ($5,417) $5,417 $0 Less Restricted Balance (explain/ $0 $0 $0 Carryover Fund Balance ($5,417) $5,417 $0 17 Agency: ICARE D. Bd/Donor/Funder Restricted Funds Designated for: Last Year This Year Next Year Note:/CARE has no restricted funds. Total Restricted Funds $0 $0 $0 E. In Kind Support: Last Year This Year Next Year Services/Volunteers # Hours - 2,770 ~ $10 per hour $27,700 $29,085 $30,539 Material Goods Pancake Breakfast donations $2,327 $2,443 $2,566 Space, Utilities, etc $0 $0 $0 Other: (Please footnote) Total In-kind Support $30,027 $31,528 $33,105 F. Grants Description/Purpose Last Year This Year Next Year Housin,q Grant - HOPWA Rental Assistance $1,444 $48,000 $48,000 FDPH Youth Youth Services $26,166 $28,500 $22,500 IIDPH HIV Positive -IIV + Internet Program $0 $20,000 $20,000 !JCHD - CTR Counseling, Testing & Referral $6,998 $925 $0 !JCHD - IDU Harm Reduction Program $6,406 $5,000 $5,000 JCHD - MSM Gay & Bisexual Men $6,066 $5,000 $5,000 IConsortium HIV + Client Services $8,460 $13,500 $13,500 'CAP: Peer Education Program fouth Services $2,000 $4,000 $5,000 Other Grants Direct Services & Education $3,700 $5,000 $12,000 Total Grants $61,240 $129,925 $131,000 AGENCY: ICARE Iowa Center for AIDS Resources & Education BOARD OF DIRECTORS 2002 Dr. Todd Simpson, Chair Chiropractor Iowa City 2000 - present Dr. Wade Swenson, Vice Chair Internal Medicine Coralville 2001 - present Don Ross, Treasurer Statewide Foster Care Review Board Iowa City 1999 ~ present Noelle Murray, Secretary Attorney at Law Coralville 2001 - present Laurie Haag Program Developer, Women's Resource & Action Center Iowa City 1997 - present Board of Directors Dr. Todd Simpson Executive Director David Packard Direct Sarvices ~ro§ram Prevention & Education Pro§ram Ruth Beyerhelm Joseph Dobbert Volunteers Volunteers Volunteers Volunteers HEAT Facilitator HEAT Members Section 1: Background Agency Name: Iowa City Hospice Address: 1025 Wade St, IC Phone: 351-5665 Director Name: Maggie Elliott Signature: .~~, ,. ' ~ Bd. Pres Name: Ina Loewenberg signature: ~ Request Completed By: Maggie Elliott Date: 9-27-02 Check Your Agency's Budget Year: 1 / 1 - 12/31 X 7/1-6/30 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC 6,125 5,975 7,500 .4% Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City Johnson County City of Coralville What were local funds used for this year: Iowa City Hospice's Caregiver Assistance and Emergency Fund Program What will next year's local funds be used for? Same Program Agency Mission Statement: Iowa City Hospice Mission is to provide patient-centered palliative care to anyone affected by a terminal illness. Summarize your programs and services for which you are requesting funding: The Caregiver Assistance Program provides limited funds for patients who desire to stay at home and who, without this resource, would be unable to do so. The Emergency Fund Program provides limited funds to patients/families who need additional support - medical supplies, medications, and other patient/family needs that are not covered by the Hospice Benefit. Both programs are designed to help keep people in their homes and to provide support to the caregivers. Both programs provide limited funds only to patients/families who demonstrate a need and meet financial requirements. List any accreditation and licensure your agency currently has. Explain. iowa City Hospice is a Medicare certified hospice agency. To become Medicare certified, a hospice must meet certain standards and offer specified programs. The Department of Inspection and Appeals routinely evaluates compliance with these standards through unannounced visits to our facility. In addition, Medicare's fiscal intermediary routinely evaluates care through billing edits and claim reviews. Agency Name Iowa City Hospice Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Iowa City Hospice was formed in 1979 when a group of community members formed a task force to bring the concept of hospice, a program of caring for the terminally ill and their families, to the residents of Johnson County. These volunteers were interested in palliative care, care that is comfort-oriented and provides practical and human support to enhance the quality of life. Initial funding came from grants and community donations. Widespread community support, encouraged by Martha Lubaroff and Mary Child grew, enabling the first Board of Directors to appoint a Medical Director, Charles E. Driscoll, MD, in 1982. The first class of volunteers was trained in the fall of 1982. These hospice supporters, along with a patient care coordinator who was hired in 1983, enabled Iowa City Hospice to provide care to their first patient in March 1983. In July 1987, Io~va City Hospice became Medicare certified. This year, Iowa City Hospice honored our volunteers and staffas we served our 2,000th patient. On any given day, there are 46 patients and their families being cared for by an interdisciplinary team of professionals. This team, consisting of nurses, social workers, chaplains, home health aides, therapists, physicians, pharmacists and volunteers, provide aggressive comfort care to the patient and supportive care to family members. Hospice care is available to all persons with a life-limiting prognosis - regardless of diagnosis, age, or ability to pay. Iowa City Hospice is a member of the National Hospice Organization and follows the basic tenets of hospice care. Hospice care treats the person and not the disease and emphasizes the quality of life, not the duration. Caregivers work with the patientffamily to develop a plan of care designed to ease the physical and emotional pain of the patient and family. Hospice care is available in the home, long term care or assisted living facility or hospital. In addition to care and support provided by the hospice team, financial support is also provided for any treatment, medication, and service related to the patient's terminal disease. Grief support services are also provided to anyone in the community affected by a loss as part of lowa City Hospice's care. These services include one-on-one counseling, mailings, support groups, and educational sessions for adults, children and teens. This year, Iowa City Hospice will connect with folks over 15,000 times through these services. Over the years, Iowa City Hospice has added services in response to suggestions from patients, families, staffand community members. Iowa City Hospice's program that receives United Way funding, The Caregiver Assistance and Emergency Fund Program, was initially developed through the strategic planning process in 1999 when the need for additional caregiver support was identified. These funds have allowed numerous patients to remain in their home during their final days and for their caregivers to be supported in the process. Iowa City Hospice is looking forward to our 20tt' year of service as we prepare for celebrations in 2003. Over the years, our service area and the type of services we offer have expanded; our team of professionals and volunteers has grown; and, the Iowa City Hospice staff has remained on the cutting edge of the expanding knowledge base in end-of-life care. Past President Craig N. Willis's gave an overview of the history of our organization in our Report to the Community. In this report, he pointed out that the Mission of lowa City Hospice has "endured as the bedrock value upon which the organization is based and the polestar guiding of all activities." He went on to state, "The other unchanging aspect of Hospice that is particularly worth noting is the fact that, while the care-giving services of the organization are delivered by an extremely competent and caring professional staff, the work of Hospice is, and always has been, assisted, facilitated and enhanced by the contributions, both of time and money, by literally hundreds of volunteers. Their efforts make Hospice a resource of, by and for the community at large, the achievements of which breathtakingly exceed the sum of its individual inputs." j ccoghs\fundingform.doc 2 Agency Name Iowa City Hospice Section 2: Client Profile 2001 20O2 1. How many Johnson County residents (Including lC & 1 Unduplicated Count 144 135 Coralville) did your agency serve? 2. How many lowa City residents did your agency serve? 2 Unduplicated Count 85 77 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 18 23 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-18 2 Female: 123 Caucasian 224 Male 110 Hispanic 2 18-40 4 African American 4 40-64 46 Asian 3 64+ 181 Native American 3. Briefly describe your service population. 78 % of our patients are over the age of 65. 69% are admitted with a cancer diagnosis. 15% are admitted with heart, lung, renal or vascular disease. 16% are admitted with a diagnosis of Alzheimer's, dementia, Parkinson's disease. Although a patient is eligible for hospice care when there is a prognosis of 6 months or less, 20 % of our patients die within 7 days; 51% of our patients die within one month; and, 6% of our patients are in hospice care for over 6 months. 4. How do you determine eligibility for services? The patient's attending physician and Iowa City Hospice's Medical Director must certify that the patient's prognosis is six months or less, if the disease follows the normal course. A patient is allowed to stay on the Hospice Benefit as long as there is disease progression, beyond the six- month time frame. Approximately 10% of our patients are discharged due to a stabilization of the disease process. Individuals can access the Hospice Benefit an unlimited number of times. 5. Are there fees for your services? Yes__ No __X__ 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Cedar, Iowa, Linn, Louisa, Muscatine, and Wapello Services Provided: Hospice care and bereavement services Funding Sources: Iowa City Hospice's funding comes from Medicare (55%), community support (26%), private insurance companies (12%) and Medicaid (7%). j ccoghs\fundingform, doc 3 Agency Name Iowa City Hospice Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client A satisfaction survey is sent to the family member one month after the patient's death for assessment of the hospice care we provided. At 13 months, another survey is sent to assess our bereavement, or grief support services. A satisfaction survey is also sent to the patient's attending physician. (b) Community A satisfaction survey is sent to the Medical Community and agencies, organizations and businesses Iowa City Hospice works with on an annual basis. 2. Briefly summarize your findings: Our strategic goal is to have the outcomes of these surveys fall within a 4.5-5.0 range, with 5.0 being high. In 2001 and so far in 2002, this goal has been achieved. On the family satisfaction survey, Iowa City Hospice is able to compare our family satisfaction results on a state and national level. For the first six months of 2002, Iowa City Hospice rated higher on all categories in comparison to other hospices within the state and nation. 3. What changes have been made in response to these findings? We ask for comments on the survey and frequently incorporate requests or suggestions for care into our strategic planning process. The Caregiver and Emergency Fund Program was created through this process. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred . Medical Community 81% Family member, friend, patient 19% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? There are other hospices that provide hospice care from surrounding areas and one for-profit hospice in the area. There are no agencies that provide hospice care to patients and their families in their home. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Not applicable. 7. Outsideofreferrals, list up to 3 primary collaborations. Brieflydescribethenatureofeach collaboration. Collaborations Briefly describe 1. Johnson County Senior Coalition 1. Work with Elder Services and other community providers to enhance support and education to caregivers. 2. Alzheimer's Association 2. Caregiver support, access to care. 3. Johnson County Case Management 3. Work with other agencies to ensure basic level of support to elderly in the community. j ccoghs\fundingform.doc 4 Agency Name Iowa City Hospice Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1 .Patients are being admitted to hospice care 1. Community awareness campaign to the later in their disease process, community and the medical professionals on the benefits of hospice care earlier in the disease process. 2.Acuity and needs of patients/families is 2. Explore opportunities to provide greater increasing support to patients/families. 3. Funding issues continue to present a fund 3. Board has created a Development raising opportunity! Committee to explore funding opportunities and establish policies and direction. 4. In what way will the needs of your service population change in the next five years? The trend is for patients to be admitted to hospice care later in their disease process, in a more acute situation and with the family in a crisis mode. 5. How do you plan to address these changes? One way we have addressed this situation is the Caregiver and Emergency Program that United Way funds. These funds provide an avenue for patients/families to get extra care giving and financial support, helping them through some of those crisis situations. In addition, we are attempting to educate the public and medical community on hospice care and services that hospice care can provide at an earlier stage in the disease process. 6. Describe the evaluation methods you use to measure the success of your services? Satisfaction surveys give Hospice feedback from a number of sources on our services. Families are asked about the care given their loved one and, after their loved one dies, the care provided to them through our grief support program. The medical community is surveyed for satisfaction and suggestions on how we might improve our care. 7. What are the results of these evaluations (outcomes)? Our goal is to have an average score between 4.5 and 5.0 on a 5.0 scale (with 5.0 being highest). We have maintained that goal in 2001 and so far in 2002. 8. How do you plan to use the evaluation results to enhance/extend your services? All suggestions go before the Quality Improvement Committee. Implementation or planning for improvement can start at this committee or be forwarded to the Strategic Planning Committee if appropriate. 9. How do your programs/services impact the community? Patients and families facing a limited life prognosis receive aggressive comfort care for the patient and support for the family, through the last months of a patient's life and, for the family, as long as needed. This support includes care from ateam of professionals -nurses, physicians, pharmacists, social workers, chaplains, home health aides and therapists. Support also comes in the form of volunteers - folks who do just about anything to add to the quality of each day. Support also comes in relief from financial worries. Hospice care covers all expenses related to the patient's terminal illness - drugs, equipment, supplies, hospitalizations and all services provided by Iowa City Hospice. Grief support services are provided to anyone who has suffered a loss. Support at this time in life has shown to reduce hospitalizations and emergency visits for survivors. 10. How did the agency respond to the UWJC recommendations from last year? Thepanel would like to have a Board member present at future presentations. Hospice will do! j ccoghs\funding form.doc 5 Agency Name Iowa City Hospice Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? Ten 4. How is the board involved in strategic planning and governance of the agency? Board members are on the strategic planning committee (along with staff members). The strategic planning committee puts together a three-year plan and annually updates and presents the plan to the Board of Directors for approval and funding. 5. What type of training/orientation do board members receive? New Board members are oriented to the hospice philosophy and Iowa City Hospice by an educational session put on by current Board members. In addition, Hospice staff members are part of the Board orientation. Staff members routinely attend Hospice Board meetings to present information on aspects of hospice care or a strategic issues the staff member may be working on. 6. Does your agency have written policies and procedures for financial management? Yes If yes, date of last board approval? Fall 2001 7. Have you filed the annual report with the Secretary of State? If yes, date filed? 1-24-01(due on odd years) 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? 3-26-2002 9. Does your agency have a yearly audit? Yes X__ No__ If yes, Who completed the audit? How much did the audit cost? Clifton Gunderson $6,300 If material weaknesses are noted in the audit, what is your plan for addressing them? There were no material weaknesses noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Cheek if agency has Amount Directors & Officers a. fiduciary liability X $1M/$1M b. employment practice liability General Liability X 1M/3M Umbrella Liability X $50,000/occ Professional Liability X 1 M/3M Property or Renters X $584,500 Vehicle x SIM jccoghs\fundingform.doc 6 Agency Name Iowa City Hospice Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Eight years. Masters in Public Administration 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health merit Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director x X X $45,760-66,560/yr 1.0 1.0 1.0 Clinical Director X X X $45-760-66560/yr 1.0 1.0 1.0 Office Manager X X X $22,880-33,280/yr 1.0 1.0 1.0 Financial Manager X X X $24,960-35,360/yr 1.0 .8 .8 Financial Assistants X X X $9-12/hour .5 .5 1.5 Professional Nurse-outreach X X X $33,280-54,080/yr 1.0 1.0 1.0 Community Liaison X X X $32,280-54,080/yr .8 .8 .8 Education Nurse X X X $32,280-54,080/yr 1.0 1.0 1.0 Nurses x x X $16-26/hr 7.0 7.0 8.0 Social Workers X X X $15-25/hr 2.0 2.0 2.5 Home Health Aides X X X $8-13/hr 2.0 3.5 5.0 Chaplains X X X $15-25/hr 1.0 1.0 1.5 Information Specialist X X x $22,880-33.280/yr 1.0 1.0 1.0 Office Assistants X X x $6-1 l/hr .6 .6 2.0 Volunteer Coordinator X X X $11-16/hr .6 .6 1.0 Bereavement X X X $15-25/hr 1.5 1.5 2.0 TOTAL FTEs 23 24.3 31.1 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? An estimate for 2002 would be 15 full time equivalents. 4. How much was spent on staff development in the last fiscal year? $22,300 Hospice budgets 2% of total personnel expenses toward staff education. 5. How much is budgeted for staff development in this fiscal year? $28,500 2% of total personnel expenses is budgeted for staff education. jccoghs\fundingformdoc 7 Agency Name Iowa CityHospice 6. What training and support opportunities are offered to staff?. Every 3 years a staff member is given the opportunity to attend a state, national or regional meeting that is applicable to her/his work at hospice. In addition, there are monthly educational in-services and access to the National Hospice Organization audio conferences available in-house. Iowa City Hospice has an extensive support system developed by the staff education committee. These supports include individual counseling, bereavement support groups, staff support sessions and staff retreats. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase?4% Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board last reviewed? Winter 2001 10. Does your board X annually evaluate the director's performance? 11. Does your agency X have job descriptions for every position? If yes, date of last board approval? Winter 2001 12. Is there an annual X performance review for every staff?. j ccoghs\funding form.doc 8 Agency: Iowa City : Hospice Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end FY 00 FY 01 FY 02 Current Assets Cash 588,357 692,299 442,343 Investments 78,609 78,609 445,227 Receivables < 90 days 229,366 197,009 203,645 Other (prepaid expenses) 5,577 1,786 9,171 Total Current Assets $901,909 $969,703 $1,100,386 Other Assets Property 617,466 617,466 617,466 Equipment 126,908 153,642 157,493 less depreciation 72,893 I118,074 145,407 Receivables > 90 days Other Total Non-current Assets $671,481 $653,034 $629,552 Total Assets $1,573,390$1,622,737 $1,729,938 FY 00 FY 01 FY 02 Current Liabilities Accounts Payable 127,784 83,650 154,030 Payroll Taxes Payable Accrued Liabilities 110,766 134,158 44,977 Current maturities of long-term debt 13,507 14,234 15,000 Total Current Liabilities $252,057 $232,042 $214,007 Other Liabilities Mortgage Payable-Balance 430,224 415,925 406,229 Other Total Other Liabilities $0 $0 $0 Total Liabilities $682,281 $647,967 $620,236 NetAssets $891,109 $974,770 $1,109,701 Liabilities & Net Assets $1,573,390$1,622,737 $1,729,937 .Agency: Iowa City Hospice 200'1 2OO2 2003 B. Income & Expenses LocalFunding Sources Iowa City Coralville Johnson County United Way - Allocation $6.122 $6.014 $7.116 - Designa[ee Giving $40.793 $32.023 $25.000 Grants-Federal, State Foundation $22.000! $15.000 $15.000 Net Sales of Service $1.448.550 $1.878.150 $2.464.032 Net Sales of Materials , Contributions/Fund raising $395 583 $346.963 $427.884 Investment Income $25.558 $14.110 $14,000 Other $7.971 $7.500 $7,500 Totallncome $1,946.577 $2.299.760 $2.960.532 Expenses Wages&Salaries $1.011,819 $1,115.000 $1.427.200 Benefits $31,347 $58,300 $72.000 Occupancy $38,081 $73,700 $73,700 Non-occupancy $758,860 $1,083,723 $1,387,165 Other Total Expenses $1,840,107 $2,330,723 $2,960,065 C. Fund Balance Revenue $1,946,577 $2,299,760 $2,960,532 Carryover Balance from previous year $104,898 $211,368 $180,405 TotalOperatingBudget $2,051,475 $2,511,128 $3,140,937 Less T0tal Expenses $1,840,107 $2,330,723 $2,960,065 Ending Fund Balance $211,368 $180 405 ~ $180,872 Less Restricted Balance (explain) ~ Carryover Fund Balance $211,368 $180~405; $180,872 D: BdlDonorlFunder R~?)~)~d ~Un~s Designated for: 200t ~002 _ 2003: / Massa0~ therapy Grants Descrl~tionlPurpose 20~01 2002 __ 2003 3aregiver and Emergency Programs _ :Support te caregivers &~caregiver education _ $~22,000 $15,000 $~15,000 , __ Tots[Grants $22r000 $15,000 15~0001 IOWA CITY HOSPICE, INC. Board of Directors 02-03 Office: 351-5665 Fax: 351-5729 info@iowacityhospice.com I Name/Position I Mailing Address I Business Phone I Home Phone I Fax/Email ~ Board Assignment Fax: 466-7437 Peg Carstensen 11 Westview Acres NE 354-1876 dDcarst~msn.com 2003 Ethics Friend of Iowa City Hospice Iowa City, IA 52240 Policy & Procedure Kate Gfeller 1 Oak Park Ct 335-1657 or 338-2310 kay-gfeller@uiowa.edu 2004 Personnel, Chair Professor, School of Music Iowa City, IA 52246 356-2014 Fax: 335-9990 Depart of Speech Pathology & Audiology, Music Therapist Melanie Haupert 3692 Forest Gate Dr NE 351-1149 brucemelaniehaupert@ 2004 Development Hospice Volunteer Iowa City, IA 52240 worldnet.att.net Pat Heiden 701 Oaknoll Dr 351-1720 337-6985 351-6772 2004 Strategic Planning Executive Director Iowa City, IA 52246 J;[b~]~)~ Oaknoll Retirement Residence Kris Kwekkeboom 820 Westside Dr. 335-7034 466-0124 kristine-kwekkeboom@ 2003 Vice President Assistant Professor Iowa City, IA 52246 uiowa.edu Policy & Procedure, Chair College of Nursing Quality Assurance Ina Loewenberg 6 Brickwood Knoll NE 351-5084 ina-loewenberg@uiowa.edu *2003 President Hospice Volunteer Iowa City, IA 52240 Quality Assurance, Chair Strategic Planning, Chair Thomas H. McMurray POB 5158 351-6881 351-2555 351-2279 2004 Personnel Attorney 1400 - 5th St McMurray & Backer Coralville, IA 52241 Law Offices Jim Pratt 2525 Potomac Dr 679-2291 338-2825 Fax: 679-2253 *2003 Treasurer Chief Financial Officer Iowa City, IA 52245 jgp071248@aol.com Finance, Chair Hills Bank and Trust Co. Strategic Planning IOWA CITY HOSPICE, INC. Board of Directors 02-03 Office: 351-5665 Fax: 351-5729 info@iowacityhospice.com ['---'---~ame/Position ~g Address Business Phone Home Phone Fax/Email ~ Board Assignment David Scholz 4248 Turkey Creek Rd NE 341-3668 354-8294 354-1014 2004 Development Administrator Iowa City, IA 52240 Town Square Family Foot ~ Finance Care Jeff Spiess 10 Woodland Hts NE 384-9495 688-2906 ieffrev-sDiesF~uiowa ed ! 2003 Strategic Planning Physician Iowa City, IA 52240 - ' Depadment of Internal Medicine U of Iowa Hospitals & Clinics Secretary Glen Winekauf 500 East Market St 887-2893 glen.winekauf@mercyic.org 2003 Development, Chair Director, Community Relations Iowa City, IA 52245 Mercy Hospital Quality Assurance Personnel Ted Yank 200 Hawkins Dr. 356-2367 337-8698 ted-yank@uiowa.edu 2003 Finance Assoc Dir for Administration Iowa City, IA 52246 Holden Comprehensive 356-3862 Personnel Cancer Center U of iowa Hospitals & Clinics Rodney Zeitler 22 Warwick Cr 338-7862 337-5496 338-2517 2004 Policy & Procedure Physician Iowa City, IA 52245 Towncrest Internal Medicine rodz@fyiowa.infi.net *Serving Second Term IOWA CITY HOSPICE ORGANIZATIONAL CHART BOARD OF DIRECTORS EXECUTIVE MEDICAL DIR. CLINICAL BEP-~AVEMENT FINANCE OF~CE ~O~A~ON CO~ITY U~ITY DI~CTO~ SERVICES COORDINATOR D~CTOR COO~ATOR SPECI~IST LI~SO~ I Bereavement Office ~ Suppo~ Frien& [Nurses} ~ SocialWorkers ] Volunteers Volunteers Se~ices Coordiuator J Chaplains of Volunteers Patient Care Volunteers Education Improvement Coordinator Nurse ttomeAidesHealll~ ] Section 1: Background Agency Name: Legal Services Corporation of Iowa (Will be "Iowa Legal Aid" as of 1/1/03)~ Address: 430 Iowa Avenue Phone: (319) 351-6570 Iowa City, Iowa 52240 Director Name: Dennis Groenenboom Signature: 0 Advisory Council Chair Name: Mike Schilling ~gnature. Request Completed By: Jan Rutledge Date: Check Your Agency's Budget Year: 1/1-12/31 X 7/1-6/30 10/1-9/30 Local Funding Summary: 4/1/01 - 3/31/02 4/1/02-3/31/03 4/1/03- 3/31/04 % of Total Budget Amount received from $30,722 $31,044 $48,918 14% UWJC. Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City 0 0 0 0 Johnson County 0 0 0 0 City of Coralville 0 0 0 0 What were local funds used for this year? Legal advice and representation involving civil law cases for Iow-income individuals. What will next year's local funds be used for? Legal advice and representation involving civil law cases for Iow-income individuals. Agency Mission Statement: The mission of the Legal Services Corporation of Iowa (LSCI) is to secure a full measure of justice in public and private affairs for low-income persons with an emphasis on legal problems involving basic necessities, fundamental rights or safety. LSCI seeks to improve the lives of people living in poverty by providing high quality legal services and empower clients with self-advocacy skills through legal education. LSCI strives to treat all people with respect and dignity and works to dispel prevailing myths and misconceptions about low-income people. i As of January 1, 2003, LSCI will merge with the Legal Aid Society of Polk County. The new agency will be "Iowa Legal Aid." The merger will not have any impact on the services being provided under our contract with Johnson County United Way. Legal Services Corporation of Iowa Summarize your programs and services for which you are requesting funding: · To provide low-income people of Johnson County with access to high quality legal service, free o f charge. · To provide opportunities for low-income people in Johnson County to learn about their legal rights and responsibilities. · To continue efforts to enlist the private bar in providing legal assistance to low-income Johnson County residents. List any accreditation and licensure your agency currently has. Explain. We are not aware of any possible accreditation or licensure for our agency; however, all the attorneys are licensed by the State of Iowa. 2 Legal Services Corporation of lowa Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually. LSC1 celebrated its 25th anniversary in 2002, on the eve of a merger with the Legal Aid Society of Polk County. The two organizations will become "Iowa Legal Aid" on January 1, 2003. This merger was required by the major funding source for both organizations, the Legal Services Corporation (L§C) in Washington, D.C. The agency's roots in Iowa City go back even further than 25 years. For l0 years prior to the creation of LSCI, Iowa City was served by the Hawkeye Legal Aid Society. Hawkeye Legal Aid was funded mostly by the Office of Economic Opportunity from 1967 to 1974, and after that by the newly-formed Legal Services Corporation (on the federal level). Hawkeye was one of four legal aid organizations which merged to become LSCI in 1977. LSCI has served 98 of Iowa's 99 counties for 25 years. Iowa Legal Aid will now serve the entire state, which will reduce confusion for clients, and facilitate the creation ofa statewide community ofjustice. The Iowa City Regional Office will continue to serve seven counties: Johnson, Cedar, Des Moines, Henry, Louisa, Muscatine, and Washington. As far as the Johnson County United Way is concerned, the only difference that will result from the merger will be the new name for the agency. LSCI has been the preeminent provider of free legal services for low-income people in Iowa. In 2001, LSCI closed a total of 16,800 cases, which resulted in helping over 42,000 children and adults facing critical legal problems. In 2001, the Iowa City Regional Office closed a total of 1,534 cases, which resulted in helping over 3,640 children and adults. Throughout its 25-year history, LSCI has helped low-income people with problems such as domestic abuse, eviction, disability benefits, funding for medical care, and utility shut-offs. Recently, LSCI expanded its outreach to immigrants, especially in the areas of fair housing and low-income taxpayer clinics, as well as the English as a Second Language Intake Project. During its 25 years of service to low-income people, LSCI faced many fiscal challenges, which prompted LSCI to diversify its funding sources. In 1981, LSCI suffered a federal cutback of about 25%, and closed 5 of its 15 offices. During that time, LSCI sought funding from other sources, including the Johnson County United Way, which first provided funding to LSCI in 1983. In 1995, Congress again cut funding for legal services nationwide. This resulted in about a $1 million loss for the two programs in Iowa. The Iowa Legislature made up nearly all the loss the first year, but since then has reduced the amount appropriated, so that in 2002, the funding is $554,910. In response to the budget cuts in 1995, LSCI began the Iowa Lawyers Campaign for Legal Services, in which LSCI asked private attorneys for contributions. In 2000, LSCI began a more intense campaign in the Iowa City and Sioux City areas. Local leadership committees were set up, which established fundraising goals. The pledges for the Iowa City service area totaled about $75,000 over three years. Other funding sources include the Interest on Lawyers Trust Account Commission (IOLTA), the Southeast Iowa Area Agency on Aging in Burlington, and the Burlington/West Burlington Area United Way. LSCI's efforts to diversity funding have resulted in a significant change in the funding mixture. In the early 1980's, 96% of LSCI's funding came from LSC. Presently, about 55-60% of LSCI's funding comes from LSC. However, LSCI is facing critical reductions in funding from LSC, IOLTA, and the state of Iowa. LSCI is convening a group of interested parties statewide to study options in the face of these reductions. 3 Legal Services Coq>oration of Iowa Section 2: Client Profile ~,~.:~[~®r~ o~ ~®®[~® S®m,®~: ~tx~®r~ ~ Two ~®~: 2000 2001 I. How many Johnson County residents 1 Unduplicated Count * Staff/VLP Slaff/VLP (Including IC & Coralville) did your agency serve? 540/70 521/l 17 2. How many lowa City residents did your agency 2 Unduplicated Count serve? 372/69 350/105 3. How many Coralville residents did your agency 3 Unduplicated Count serve? 67/4 76/8 LSCI tracks number of closed cases rather than clients. · * Note that the numbers represent cases closed by Iowa City staff and cases closed by the Volunteer Lawyers Project (VLP). The first column represents cases closed by Iowa City staff; the second column are cases closed by the VLP. Age (use agency's Gender Ethnicity (use agency's breakdown if needed) breakdown) 0-5 Female: 344 White 365 6-17 (all under 18) 12 Male 177 Black 125 18 -29 Hispanic 15 30-61 (all 18-59) 496 Native American 8 62-75 (all over 60) 13 Asian 8 >75 3. Briefly describe your service population. The target population includes low-income residents of Johnson County who do not have the ability to pay for legal counsel. This population is at risk of losing their homes, health care benefits, individual rights and safety without the benefit of an attorney. Legal representation is ot'ten the individual's only way to access justice and prevent crisis. The attorneys help victims of domestic abuse and their children by securing and enforcing protective orders and also providing assistance related to other issues such as custody, child support and housing. These attorneys prevent people from becoming homeless, in addition to helping families address eligibility issues in relation to needed financial assistance programs. 4. How do you determine eligibility for services? Clients must meet income and asset guidelines. In addition, since the demand for help is great, LSCI has adopted case acceptance criteria. Under the criteria, certain cases are generally considered appropriate for the staff attorneys, while others are more appropriate for the private bar under LSCI's Volunteer Lawyers Project. In general, the staff tend to handle more specialized poverty law matters, or matters with a short deadline. Examples include domestic abuse protective orders, public benefits law, veterans benefits, and Medicaid. Referrals to volunteer attorneys usually are made in cases which fall in the area of general practice, such as divorces, wills, and real estate. Federal regulations impose a few restrictions on case acceptance. 4 Legal Sei~ices Corporation of Iowa LSCI is not permitted to represent anyone who is incarcerated, even in a civil matter, nor certain non-citizens. LSCI is prohibited from handling certain kinds of cases, such as criminal matters. LSCI is not permitted to bring class action lawsuits. However, the 1996 prohibition on challenging welfare reform laws was struck down by the United State Supreme Court. 5. Are there fees for your services? Yes No X If yes, please describe your fee structure: N/A 6. Do you provide services to areas outside of Johnson County? Yes. Area(s) served: Cedar, Des Moines, Henry, Louisa, Muscatine, and Washington Counties. Services Provided: Free legal services to low-income people in civil legal matters. Funding Sources: Legal Services Corporation (national grant source), Interest on Lawyers Trust Account Commission, State of Iowa, Southeast Iowa Area Agency on Aging in Burlington, the Burlington Area United Way, and the Iowa Lawyers Campaign for Legal Services. Section 3: Community, Relations 1. How do you assess satisfaction with your services? LSCI uses both objective and subjective measurements of client satisfaction with our services. LSCI's case management software tracks services by number, type of case handled, level of service provided, the benefits received as the result of the representation and the outcome achieved on behalf of the client. Thus, LSCI can total the number of positive outcomes achieved by its work. LSCI also has a formal complaint process for clients and the public. In 2001, the Iowa City Regional Office received seven complaints. On the subjective level, LSCI mails a client satisfaction survey to each client that has received legal service beyond brief service and legal advice. The comments clients provide on those surveys also provide us a way to assess client satisfaction. In 1999, LSCI completed a comprehensive statewide priority setting process. This process included surveys sent to randomly selected clients, interviews with over 130 key respondents, meetings with LSCI local advisory councils, and staff. Because LSCI has been providing civil legal assistance to low-income clients in Johnson County for over 24 years, local human service providers, private bar members, government agencies and the judiciary are well aware of it services and provide a number of referrals. The Iowa City Regional Office has over thirty legal services brochures and booklets that are distributed to various human service agencies. LSCI has established long standing collaborative relationships with a number of human service agencies such as domestic violence shelters, the Free Lunch program, the Veterans Administration and local area agencies on aging. LSCI also receives feedback from the local private bar community through its Volunteer Lawyer Project. Legal Services Corporation of Iowa 2. Briefly summarize your findings: In general, most of the comments from clients and the community are favorable. When financial resources are involved in a case, LSCI can enumerate the benefits it has achieved for its clients. The main criticism is based on the number of cases that have to be turned away. LSCI's limited human and financial resources make it necessary to establish case priorities. Over 24,000 low- income persons reside in the Iowa City Regional Office's seven-county service area. The office tums away between 65 and 75 individuals each month. Another area that has received comment is LSCI's ability to make changes to meet the legal needs of the increasing immigrant population in Iowa. The local community and government agencies continually refer clients to LSCI and access our legal brochures and booklets. This is a measure of the credibility the community has assigned to LSCI's work. LSCI is viewed as a valuable resource in the community. 3. What changes have been made in response to these findings? In order to attempt to offset the problem of limited human and financial resources, LSCI involves local private attorneys in the provision of pro bono legal services through LSCI's Volunteer Lawyer's Project. In 2001, the Iowa City Regional Office provided 79 volunteer lawyer referrals. The goal for the Iowa City Regional Office for 2003 is to provide 85 volunteer lawyer referrals. The Iowa City Regional Office also involves volunteer attorneys who conduct a regularly scheduled client intake project at the office. These volunteers assist clients by providing legal advice or brief service. LSCI also continues to pursue other project and program funding sources to maintain and increase its service provision. Additional collaborative efforts are being explored. Securing additional funding has become even more imperative in light of the future funding reductions. Other ways LSCI is addressing the inability to serve all clients who need our services include developing supportive services such as LSCI's Legal Hotline for Older Iowans. The Hotline operates a statewide 1-800 telephone service for seniors which give them immediate access to legal advice and counsel for a variety of legal problems. LSCI is currently developing an interactive web site which will enable all clients to have easier access to legal information and other human services they need. LSCI is addressing the problem of the language and cultural barriers faced by the ever-growing immigrant population in the state. Through the English as a Second Language Intake Project, LSCI provides a person who can speak Spanish to anyone who wants to access LSCI anywhere in the state. In addition, LSCI is involved in special projects which target this population, and provide education and outreach in different areas in which they have need. Legal Services Corporation of Iowa 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred · Courts · Lawyers · Domestic Violence Agencies · Providers of Services to Low-Income People (e.g. LSCI does not keep records in this way. General Relief, D.H.S., Veterans Administration Medical Center) 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? No other agency in Johnson County provides similar services. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. No other agency in Johnson County provides similar services. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Iowa Coalition Against Domestic Violence 1. LSCI collaborates with many of the domestic violence shelters to provide legal representation to women who access the shelter for help. 2. The Iowa Civil Rights Commission 2. LSCI collaborates with the Iowa Civil Rights Commission to provide education to immigrants who face discrimination in the area of housing. A proposed collaboration involves the housing rights of the disabled in Iowa. 3. The Iowa State Bar Association 3. The Volunteer Lawyers Projects involve over 2,700 lawyers in Iowa who represent low-income clients on a pro bono basis. LSCI collaborates with the private bar to provide this service to low- income clients. 7 Legal Services Corporation of Iowa Section 4: Strategic Planning and Agency Effectiveness Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them (e.g., staffing, finances, service delivery). Challenges/Opportunities Strategies 1. Funding Reductions 1. In response to addressing the problems created by upcoming funding reductions, LSCI is convening a group of state planners - key community leaders around the state - to discuss options for meeting the problem. No matter what changes are indicated, one of LSCI's responses to the funding reductions will be to focus on raising more funds from other sources. 2. LSCI will need to provide some changes in 2. Providing More Service to More People service delivery in order to be able to serve more people more efficiently. The Legal Hotline for Older Iowans is an example of a way LSCI has adjusted service provision to provide legal services to more people. LSCI will experiment with a centralized intake system on a pilot project basis in the future. 3. Implementing Technology 3. LSCI has continually improved the communication systems in each regional office. LSCI is working on ensuring an up-to-date telephonic system in each office. In addition, ongoing work is being done to implement improved e-mail communication; on-line legal research; case management and case statistic systems software; and the creation of an interactive website. 2. In what way will the needs of your service population change in the next five years? Iowa's population has changed and will continue to change. More of iowa's population is over 60. Another growing aspect of Iowa's population is the number of clients who fall into the working poor category. Finally, there has been a dramatic growth in the number of Hispanics and other immigrants who live in Iowa. 3. How do you plan to address these changes? LSCI will respond to the growing senior population by expanding services to Iowans 60 and over through the Legal Hotline for Older Iowans and other direct representation through LSCI's offices. Currently, LSCI is conducting and planning projects, which deals with some of the different kinds of problems faced by the working poor; i.e., consumer issues, etc. One example of a project being conducted by LSCI is the Low-Income Taxpayer Clinic, which educates people for whom English is a second language about their tax rights and responsibilities, and assists low-income taxpayers who have a tax contraversy. LSCI will continue to develop resources and represent people who are Legal Services Corporation of Iowa working at low-income jobs and facing legal problems. In order to be more responsive to the language and cultural problems faced by the immigrant population, LSCI is implementing a system to provide language access to persons who are seeking legal assistance for whom English is a second language, and will continue to expand outreach efforts to this population. LSCI currently conducts several projects which are targeted to help the immigrant populations, and will plan more in the future. 4. Describe the evaluation methods you use to measure the success of your services? As described in Section Three, LSCI uses both objective and subjective measurements of client satisfaction with our services. LSCI's case management software tracks services by number, type of case handled, level of service provided, the benefits received as the result of the representation and the outcome achieved on behalf of the client. Thus, LSCI can total the number of positive outcomes achieved by its work. LSCI also has a formal complaint process for clients and the public. On the subjective level, LSC1 mails a client satisfaction survey to each client that has received legal service beyond brief service and legal advice. The comments clients provide on those surveys also provide us a way to assess client satisfaction. In 1999, LSCI completed a comprehensive statewide priority setting process. This process included surveys sent to randomly selected clients, interviews with over 130 key respondents, and meetings with LSCI local advisory councils and staff. Because LSCI has been providing civil legal assistance to low-income clients in Johnson County for over 24 years, local human service providers, private bar members, government agencies and the judiciary are well aware of its services and provide a number of referrals. The Iowa City Regional Office has over thirty legal services brochures and booklets that are distributed to clients and various human service agencies. LSCI has established long standing collaborative relationships with a number of human service agencies such as domestic violence shelters, the Free Lunch program, the Veterans Administration and local area agencies on aging. LSCI also receives feedback from the local private bar community through its Volunteer Lawyer Project. 5. What are the results of these evaluations (outcomes)? The case statistics for 2001 show that the attorneys obtained $142,488 in financial benefits (most of these benefits are social security benefits) for low-income Johnson County residents; obtained injunctions for 6 clients and obtained divorces for 7 clients; successfully defended clients in 13 cases; and obtained favorable housing awards for 5 clients. These statistics do not measure all of the benefits obtained for Johnson County clients by LSCI attorneys in 2001. 6. How do you plan to use the evaluation results to enhance/extend your services? These numbers and outcomes indicate the kinds of legal problems people are facing in the community. These results will be used when setting priorities in the future. 7. How do your programs/services impact the community? The civil legal assistance provided by LSCI directly addresses four areas identified as the most serious health and human service issues in Johnson County. Those areas are housing and shelter, employment and economic opportunities, health care, and supportive services for seniors. By handling the legal problems that arise in those areas for Iow-income persons in Johnson County, Legal Services Corporation of Iowa LSCI's service profoundly impacts the community. However, LSCI must turn away some clients that ask for our help. The following are examples of the kinds of cases that LSCI has handled in Johnson County in the past year: Client 1: This client had a life-threatening illness and was hospitalized. Her doctor did not release her to return to work for an extended time. With no employment income, she was dependent on Social Security and child support payments for her son. She was distressed to learn that her bank account had been garnished by a creditor. The money garnished was entirely from child support payments for her son, and so was exempt under Iowa law. LSCI filed a motion to quash the garnishment, which was granted after a hearing. The money was returned to the client. The creditor then filed for a debtor's exam in an effort to find some other money the client might have. LSCI represented her at the debtor's exam, where it became clear that the client had no property that could be taken by the creditor. Client 2: This client had her water shut-off by the city in which she lived. This small town told her she needed to pay the bill of the previous occupants, and her old bill from a different address (which the client disputed), plus interest at 10% per month, or 120% per year. It is unconstitutional to hold someone responsible for the bill of another person, and the interest rate charged exceeded the lawful limit. LSCI negotiated with the city and had the water restored. A new bill was sent, still at too high an amount. LSCI represented the client at a hearing. At the conclusion, the city agreed the client's balance was only about five dollars, and was not overdue. Client 3: This client had a problem with her landlord. The landlord said the client made too much noise, which the client disputed. The client was willing to move, but the landlord would not release her from the rental agreement. Without the release, the client would not be able to retain her housing subsidy. The landlord filed an eviction action, and LSCI represented the client. LSCI negotiated an agreement with the landlord to allow the client to leave. The landlord dismissed the lawsuit at its own expense, and also agreed that the client did not owe any money. Client 4: This client wanted to move because someone on the sex offender registry had moved into the apartment next to her and her children. She said she and her children had not been able to relax or sleep properly since that happened. The client had been sexually abused during her childhood, and she was terrified about what might happen to her children. She still suffered from post-traumatic stress disorder. Her landlord indicated that he would release her from the rental agreement, but then would not sign the form. The Housing Authority would not let her move until she got the release. LSCI called the Housing Authority and asked for a reasonable accommodation under the Fair Housing Act, since the client's disability was being made worse by remaining in her present unit, and the accommodation would be simple and would not cost anything. The Housing Authority agreed to let her move without the release. Client 5: This client had a claim for disability benefits from Social Security under the SSI program. She had a mammogram which was erroneously read as being clear. Over a year later, someone looked at the mammogram again and saw the mistake. The client then underwent a long period of treatment, which left her very weak. At the end of her treatment, they found an additional tumor and did more tests. They found that she had a traveling type of cancer, and said she would need another course of treatment and 10 Legal Services Corporation of Iowa possibly ongoing doses of chemotherapy for some time. She was denied benefits because the agency found her disability would not last 12 months. LSCI represented her before the Office of Hearings and Appeals and helped her submit additional information about her pain and fatigue. The hearing officer awarded benefits to the client without a hearing. 8. How did the agency respond to the UWJC recommendations from last year? · The UVqJC recommended that LSCI provide more data on the types of cases taken by the agency and their results. In addition to the case summary examples that LSCI provides, a listing of the types of cases closed last year and their outcome is attached to the application. · The panel encouraged LSCI to continue fundraising and other efforts to increase revenue for the agency. LSCI is conducting the Iowa Lawyer~ Campaign for Legal Services to solicit donations from the legal and corporate communities through a local volunteer Campaign Leadership Committee. Currently underway, the campaign over the past three years has resulted in $38,988 in revenue for the Iowa City Regional Office area. LSCI continues to focus on seeking other sources of funding in the Iowa City area. · The panel asked that a member of the Advisory Council be present at future presentations. LSCI will secure a presenter and an alternate presenter. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) Attached. 2. How often does your board meet? Quarterly. 3. What is your average attendance at board meetings? Ten. 4. How is the board involved in strategic planning and governance of the agency? The Board establishes policies concerning the functioning of LSCI, with particular regard to eligibility standards, priorities for the problem to be solved, and methods of securing clients. 5. What type of training/orientation do board members receive? Board Members are provided a comprehensive manual that sets forth program policy. New members are provided training in sessions held the evening before the weekend of a Board Meeting. In addition, the Executive Director meets regularly with new Board members for training purposes. 11 Legal Services Corporation of Iowa 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? The Board has approved the use of LegaI Services Corporation's Property Acquisition and Management Manual (PAMM), effective 2001. The Board has set policy and authorized the Executive Director to enter into lease agreements, effective January 2000, set a policy on property and equipment inventory in May 2002, and enacted a fundraising resolution in December 1998. Annual audits arc conducted in accordance with the Legal Services Corporation Audit Guide, which requires LSCI to follow generally accepted auditing standards, Government Auditing Standards and the provisions of the Office of Management and Budget Circular A-133, "Audits of Higher Education and other Nonprofit Organizations." 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Yes, it was filed on January 16, 2001. 8. }lave you filed the IRS form 990 for the most recent year? If yes, date filed? Yes, it was filed on May 8, 2002. If no to questions 6, 7, or 8, give explanation. N/A 9. Does your agency have a yearly audit? Yes X No If yes, Who completed the audit? Robert M. Knapp, PC, CPA of West Des Moines, Iowa. How much did the audit cost? $16,000 for an audit which reflects LSCI as a whole. If material weaknesses are noted in the audit, what is your plan for addressing them? No material weaknesses were noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? N/A 12 Legal Services Corporation of Iowa 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers X $1,000,000/ a. fiduciary liability $1,000,000 b. employment practice liability General Liability X $1,000,000/ $1,000,000 Umbrella Liability Professional Liability X $1,000,000/ $1,000,000 Property or Renters X $697,500 Vehicle Section 6: Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Dennis Groenenboom has held the position of Executive Director of LSCI since 1992. Prior to being named Executive Director, Mr. Groenenboom was a Deputy Director for LSCI from 1985 to 1992. From 1978 to 1983, Mr. Groenenboom was a Staff Attorney and Managing Attorney in LSCI's North Central Iowa (Mason City) and Cedar Rapids Regional Offices. He received his law degree in 1978 from the University of Iowa College of Law. Jan Rutledge is the Managing Attorney of LSCI's Iowa City Regional Office. She has held this position since 1987. She was a staff attorney in the Iowa City Regional Office from 1982 to 1987. Ms. Rutledge graduated from law school in 1982. 2. Staff Salaries & Benefits Check if Applicable Position Paid Health Retire- Current Salary Full-Time Equivalent (FTEs) Leave Ins. ment Plan Range Per Position Last Yr. This Yr. Next Yr. Attorneys X X X $29,000 to $40,2500 5.0 5.0 5.0 Support X X X $22,755 to $24,177 2.0 2.0 2.0 TOTAL FTEs 7.0 7.0 7.0 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff) 7.0 4. How much was spent on staff development in the last fiscal year? $22,707 for LSCI as a whole in 2001. 13 Legal Services Corporation of Iowa 5. How much is budgeted for staff development in this fiscal year? $25,716 for LSCI as a whole for 2002. 6. What training and support opportunities are offered to staff?. LSCI recognizes that training of employees is one aspect of improving the quality of legal assistance provided to clients. Accordingly, each year, in addition to the regional orientation conducted by the Managing Attorney or Office Supervisor of each regional office, one training is held for all new attorneys. Support staff are also given training as necessary in relevant areas. Each attorney is offered training opportunities through the Volunteer Lawyer Project continuing legal education events, which are conducted by LSCI throughout the year. The Managing Attorney may recommend non-LSCI sponsored trainings which are germane to an employee's work. 7. Please attach current organizational chart as Appendix B. Attached as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average wage increase? 7.53% Yes No If no, brief explanation 9. Does your agency have LSCI's non-management/confidential personnel policies? If yes, X staff are governed by a union contract date board last reviewed? which was last ratified May 22, 2002. Management/confidential staff are governed by a Personnel Manual which is currently being updated and will be presented to LSCI's Board of Directors later this year. i0. Does your board annually evaluate the director's performance? X 11. Does your agency have job descriptions for every Each employee is provided a written position? If yes, date of last X job expectations memo in lieu ora job board approval? description. 12. Is there an annual performance review for every staff?. X 14 __ __ ~ ~__ i IA9ency: Legal Services Corp. of la. Section 7: Financial Manag~ement ~" Three Year Hist°rica' Balance Sheet i i i 1 ',As of your fiscal year-end) ! FY00 I FY01 / FY02 | , FY00 FY01 FY02 ~urrentAssets !12/3112000! 12/31/2001 ! 12/31/2002 :CurrentLiabilities i12131/2000~12/3112001~12/3112002 Investments $41 944 $46 337 $35 177 Pa roll Taxes Payable To~! Current Assets _ ~_ ~91,367 ~)07.27§__ $83,321 Total Current Liabilities ~$12.938~ $14,04~ $1~,495 Properly ~ ~ Mortgage Payable-Balance ~ Equipment $74,119' $72,565 $89,523 Other $28,241l ~$33,~ $27,866 less depreciation ($58.680 ($611932)i ($69.;~2) Total Other Liabilities $28,241| $33.150 $27.866 R~ceivab!~s > 96 ~s _ 1 / Total Liabilities $41,179 $47.192 $40,361 Other , Net Assets ~ $65.627 $70,717 $63.341 Total Non-current Assets $15,439 $10,633 $20.381 I Total Assets - I ~$106 806 I $117,9091 $103.702 [Liabilities & Net Assets $106.806 $117.909 $103.70; r! !Agency: I Legal Services Corporation of iowa Last Y Cur Yr Next Yr 8. Income & Expenses Local Funding Sources Iowa~!ty Coralville Johnson County $37,564 $35,044 $52,918 - Designated Giving $2,846 ~ $2,545 $2,545 Grants-Federal, State, Foundation $327,842 $323,319 $292,427 Net Sales of Service Net Sales of Materials $100 Contributions/Fundraising $21,691 $24,282 $8,945 Investment Income Other $276 $250 $250 Totallncome $390,319 $385,440 ;$357,085 Expenses Wages & Salaries $224,452 $243,647 $250,832 Benefits $68,871 $74,054 $76,174 Occupancy . $49,775 $49,657 $49,657 Non-occupancy $26,637 $26,604 $26,604 Other (capitalized expenses) $20,584 $0 ! $0 TotalExpenses $390,319 $393962 $403267 C. Fund Balance Revenue $~390,319 ~$385,440 $357,085 Carryover Balance from previous year -- -- ~- Total Operating Budget ~ $390,3'~ 9 , $385,440 --$357,085_ Less Total Expenses i$390,319 $393,962 $403,267 Ending Fund Balance I $0 ($8,522) ($46,182)i Less Restricted Balance (explain) OarryoverFundBa,anoe $¥ 1' , 22i 1546,,82/i I i . . ~,gency:LegibLe al Services Corp· of Iowa D, Bd/DonorlFander Restricted Funds Designated for: Last Year This Year ~lext Year~ Total Restricted Funds $0 $0 $0 E. In Kind SuEport: . Last Year lhi$ Year ~ext Year Services/Volunteers $g4,340 $g0,858 $91,767 Material Goods Space, Utilities, etc Dther: (Please footnote) Total In-kind Support $94,340 $90,858 $91,767 F. Grants Description/Purpose Last Year This Year ~lext Year Total Grants $0 $0 2001 Value o£donated support (taken from 2001 end of year financial statement $4,492.00 Number of hours donated by attorneys participating in LSCI's VLP( for Johnson County) = 998.48 hrs. x $100/hour $89,848.00 Total $94,340.00 2OO2 Estimated value of donated support for 2002 $210.00 Estimated number of hours donated by attorneys participating in LSCI's VLP (for Johnson County) for 2002 $90,648.00 Total $90,858.00 Legal Services Corporation of Iowa Appendix A LSCI BOARD OF DIRECTORS BEVEL, HENRY* (2002) KINTIGH, THOMAS F.* (2004) Yagla, McCoy & Riley 211 North Washington Suite 300, 327 E. 4th St. Otmmwa, IA 52501 P. O. Box 960 641-684-6517 (Office) Waterloo, IA 50704-0960 319-234~4631 (Office) KUTZKO, DIANE* (2004) Shuttleworth & Ingersoll BUCHANAN, SCOTT G.* (2003) 500 Firstar Bank Building 111 N. Dodge Street P.O. Box 2107 Algona, IA 50511 Cedar Rapids, IA 52406-2107 515-295~3565 (Office) 319-365-9461 (Office) DIAZ, MARTY* (2004) MANWARREN, ELLA (2003) 528 S. Clinton St. 1805 Huron Street Iowa City, IA 52240 Emmetsburg, IA 50536 319-339-4350 (Office) 712-852-2694 (Home) FELTES, JULIA (2002) McELROY, VIRG1NIA (2002) 2616 Stafford Street 100 West Clarinda Avenue Dubuque, IA 52001 Shenandoah, IA 51601 319-557-1531 712-246-1074 (Home) FOWLER, JAMES F.* (2004) McHALE, JOHN M.* (2004) Wilson, Fowler & Fusco 233 Pearl Street 209 N. Howard Street P.O. Box 1078 P. O. Box 197 Council Bluffs, IA 51502 Indianola, IA 50125 712-328-3157 (Office) 515-961-5377 (Office) SMALLEY, JEAN (2004) GRAY, JOHN C.* (2003) 16372 276th Street 70l Pierce Street, Suite 200 Bloomfield, IA 52537 P. O. Box 3086 641-929-3247 (Home) Sioux City, IA 51102-3086 (712) 255-8838 (Office) *Designates Attorney Members Terms expire each year with the conclusion of LSCI's annual meeting. - Rev. 4/30/02 Legal Services Corporation of Iowa Iowa City Regional Office ADVISORY COUNCIL MEMBERS Johnson County Henry County Laura Poisel Deeth (Client) Cynthia Danielson (Attorney) P.O. Box 211 110 North Jefferson Lone Tree, Iowa 52755 Mt. Pleasant, Iowa 52641 629-4657 385-9522 / Fax: 385-3633 Paul McAndrew (Attorney) Louisa County 122 S. Linn Street Iowa City, Iowa 52240 Marcy Gerst (Agency Rep.) 338-9222 Southeast Iowa Community Action Pro.am Vice President 205 E. Access Rd., Suite D Roberta Patrick (Client) P.O. Box 29 515 Oakland Columbus Jct., Iowa 52738 Iowa City, Iowa 52240 728-2314 338-0309 (home) Dave Matthews (Attorney) L. Iay Stein (Attorney) 326 Van Buren St. 21-I/2 E. Washington Street Wapello, Iowa 52653 P.O. Box 2416 523-3331 /Fax: 523-529I Iowa City, Iowa 52244 351-5610 Muscatine County Barbara Schwartz (Attorney) John Wunder (Attorney) University of Iowa 610 Cedar College of Law Muscatine, Iowa 52761 Iowa City, Iowa 52242 263-8525 / Fax: 263-2028 335-9023 / Fax: 335-9019 Washington County Des Moines County Erma Manning (Client) President 1307 North 2nd Michael Schilling (Attorney) Washington, Iowa 52353 Suite 200, Washington Plaza 653-6061 P.O. Box 821 Burlington, Iowa 52601 Secretary 752-3641 / Fmc: 752- d d d 9 Douglas Tindal (Attorney) 222 West Main Street Ms. Lyn Stinson (Agency Rep.) Washington, Iowa 52353 2850 Mt. Pleasant St., Suite 108 653-2159 / Fax: 653-5614 Burlington, Iowa 5260 l 753-0193 Legal Services Corporation of Iowa Organizational Chart Executive Director (Administrative Assistant to~ '. 1/'Administrative Executive Director ~ : ~ Assistant /] Public Information ! Coordinator I Deputy Director of Deputy Director of J Regional Deputy Director of I [ Deputy Vo,unteer Lawyers Program Administration Litigation Office Litigation Director Project Fiscal Development Manager Managing Director Program Attorney : Manager i Technology Staff ~ dministrative Assistant Advocate ! Attorney Attorney ~, Development Unit ~ Referral -- Coordinator Office ~ Manager RSecretary/) eceptlonst~ Legal Services Corporation of Iowa APPENDIX C Johnson County Closed Cases/Outcomes - FY 2001 Type of Case # of Cases Closed Outcome Consumer 1 Debt reduced by settlement 2 Essential services (utilities) reconnected or continued 4 Judgment against client avoided/reduced 4 Other - favorable to client 3 Additional investigation/representation recommended to client, but no provided - limited resources 2 Additional investigation/representation recommended to client, but not provided - client did not follow through 54 Counsel and advice/brief service provided sufficient to meet client's current needs 70 Total Cases Education 1 Appropriate educational placement awarded/continued 2 Additional investigation/representation recommended, but not provided - client did not follow through 5 Counsel and advice/brief service sufficient to meet client's current need 8 Total Cases Employment 1 Additional investigation/representation recommended, but not provided - limited resources 22 Counsel and advice/brief service sufficient to meet client's current need 23 Total Cases Family 1 Government benefits awarded/continued 2 Custody granted/denied - favorable to client 7 Decree granted 1 Documents drafted - Power of Attorney 1 Injunction entered/denied - favorable to client 2 Other - favorable to client 3 Support increased/decreased - favorable to client. L~al Services Corporation of Iowa Type of Case # of Cases Closed Outcome Family (cont'd.) 17 Additional investigation/representation recommended to client, but not provided - limited resources 8 Additional investigation/representation recommended to client, but not provided - client did not follow through 1 Documents drafted 2 Injunction entered/denied - unfavorable to client 2 Other - unfavorable to client 122 Counsel and advice/brief service sufficient to meet client's current need 169 Total Cases Juvenile 1 Program sanction awarded 1 Additional investigation/representation recommended to client, but not provided - client did not follow through 5 Counsel and advice/brief service sufficient to meet client's current need 7 Total Cases Health 1 Government benefits awarded 10 Counsel and advice/brief service sufficient to meet client's current need 11 Total Cases Housing 13 Evictions avoided/delayed 5 Housing subsidy awarded 1 Other - favorable to client 1 Eviction entered 3 Housing subsidy denied/terminated 113 Counsel and advice/brief service sufficient to meet client's current need 136 Total Cases Income 11 Government benefits awarded Maintenance 1 Medical service benefits awarded 1 Additional investigation/representation recommended to client, but not provided - limited resources 2 Additional investigation/representation recommended to client, but not provided - client did not follow through Legal Services Corporation of Iowa Type of Case # of Cases Closed Outcome Income 2 Government benefits denied/terminated Maintenance (cont'd.) 1 Overpayment entered 4 Counsel and advice/brief service sufficient to meet client's current need 67 Total Cases Individual Rights 1 PlacementJcomrmtment terminated/less restrictive 5 Counsel and advice/brief service sufficient to meet client's current need 6 Total Cases Miscellaneous 1 Documents drafted - Power of Attorney 1 Additional investigation/representation recommended to client, but not provided - client did not follow through 22 Counsel and advice/brief service sufficient to meet client's current need 24 Total Cases Section 1: Background Agency Name: LIFE Skills, Inc. Address: 483 Highway 1 West Iowa City, IA 52246-4205 Phone: 319-354-2121 Director Name: Gillian J. H. Fox Signature: X~/~ Bd. Pres Name: Jay Harding Signature: ~' -~'~-~,L.r/''j~ Request Completed By: Gillian J. H. Fox and Barb Bailey Date: 09/17/02 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 × 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated 3,000.00 3,000.00 10,000.00 1.5% giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City Johnson County City of Coralville What were local funds used for this year: Agency operation, stafftraining, strategic planning activities, cost of living increases. What will next year's local funds be used for? Agency operation (state budget cuts), staff training, cost of living increases, Health Insurance Portability and Accountability Act (HIPAA) training and compliance. The funding request for FY04 is significantly higher due to federal and state budget cuts as well as the unexpected expenses of HIPAA training and compliance. Agency Mission Statement: LIFE Skills, Inc. exists to provide in-home and community based services and education in the least restrictive environment while promoting the highest level of independence possible. To this end, the agency serves individuals and their families by providing instruction in targeted areas in a manner based on best practices in service delivery. Summarize your programs and services for which you are requesting funding: LIFE Skills, Inc., provides services to individuals who reside in the community and who need assistance remaining independent in their homes. Programs include: Supported Community Living, Respite, Community Support Services, and Supported Aging Services. List any accreditation and licensure your agency currently has. Explain. LIFE Skills, Inc., is certified by the State of Iowa Department of Mental Health and Developmental Disabilities (MH/DD) to provide Supported Community Living (SCL) Services and, Home and Community Based (HCBS) Waiver Services. The agency is approved to provide Medicaid Waiver Agency Name: LIFE Skills, Inc. Services in the waiver areas of Mental Retardation, Brain Injury, HIV/Aids, Elderly, Ill and Handicapped, and Adult Rehabilitation Option (ARO). Agency History: Executive Director, Gillian J.H. Fox, founded LIFE Skills, Inc., in 1989. LIFE Skills, Inc., provides high quality in-home and community based educational social services to Johnson County and surrounding counties. Individualized programs are designed to assist children, adults, and families in need of supportive services. LIFE Skills, Inc., maintains a professional staff whose training and experience allows them to assist individuals who need community based counseling and support. All interventions are based on individual assessments. We determine current strengths and areas where additional skills or education are necessary for the individual to live in the least restrictive enviromnent and to achieve the highest level of independent living possible. During the past 12 years, LIFE Skills, Inc., has developed programs designed to meet the need for individualized services to Johnson County residents. LIFE Skills, Inc. continually modifies and reorganizes its programs to meet the changing needs of the commuhity and funding sources. The Supported Aging Services Program provides low cost services to individuals who need assistance with home maintenance or homemal(~ng to remain living independently in their homes. The Respite program provides a critical component of care for families that include a member who has mental retardation, brain injury, who is ill or handicapped, elderly, or who has HIV/AIDS. LIFE Skills, Inc. has also developed programs funded through grants or other contractual arrangements. The Housing Support program and Tool Pool assisted individuals with low incomes who were at risk of eviction. The Housing Support program was funded through Community Development Block Grant fimds. The Oakdale Social Skills program was developed to provide educational services to general population inmates and patients of the Oakdale Medical Classification Facility through a contract with the State Department of Corrections. Recently, LIFE Skills, Inc. has developed and implemented a contract with the Magellan Behavioral Health Corporation to provide community support services to eligible individuals. This contract will assist the County by providing an additional funding source for services contracted through the Johnson County Department of Human Services. LIFE Skills, Inc. provides counseling, budgeting, and financial planning for individuals who participate in the Supported Training and Access to Resources grant (S.T.A.R.) The S.T.A.R. grant is a community-based grant that involves many local agencies. Recipients of this service include individuals who are at risk of losing their homes, or are currently homeless. LIFE Skills, Inc. will continue to work to meet the community's need for quality service provision through monitoring current programming and by malting modifications when necessary. The agency staff, together with the Board of Directors, plans to continue to develop outcome based measures to assure that quality is maintained and tracked within our organization into the future. Agency staff serve on the Johnson County MH/DD Planning Council, The Iowa City Community and Restorative Justice Task Force, The Mental Health Task Force, The MH/DD Continuous Quality Improvement/Outcomes Committee, MH/DD Providers Council, Transition Advisory Council (TCA), and the agency is listed as a community parmer in the S.T.A.R. Grant. j ccoghskfunding form. doc 2 Agency Name: LIFE Skills, Inc. Section 2: Client Profile ~ ~ ~ ~ FY01 FY02 1. How many Johnson County residents 1 Unduplicated Count 156 153 (Including IC & Coralville) did your agency serve? 2. How many Iowa City residents did your agency 2 Unduplicated Count 137 I31 serve? 3. How many Coralville residents did your agency 3 Unduplicated Count 14 16 serve? Age (use agency's Gender Ethnicity (use agency's breakdown if needed) breakdown) 0-5 3 Female: 94 African American 14 6-17 13 Male 72 Asian American 2 18-29 42 Caucasian 145 30-61 97 Hispanic 4 62-75 8 >75 1 3. Briefly describe your service population. LIFE Skills, Inc., provides services to adults and children who have mental illness, mental retardation, brain injury, developmental disabilities, autism, and or emotional/behavioral instabilities. 4. How do you determine eligibility for services? Eligibility for services is determined by the Department of Mental Health and Developmental Disabilities (MH/DD). 5. Are there fees for your services? Yes X No__ If yes, please describe your fee structure: Fees for County MH/DD contracted services negotiated between the County and the Provider based on costs reports submitted both to the County and the State. Private pay individuals are charged the same fee that the County pays. 6. Do you provide services to areas outside of Johnson County? Yes. Area(s) served: Lirm Co., Washington Co., Clinton Co., Polk Co., Dubuque Co., Muscatine Co. Services Provided: Supported Community Living, Home and Community Based Waiver Services, Supported Aging Services, STAR Services, Adult Rehabilitation Option Services, and Community Support Services. Funding Sources: Federal, State, County funding, Medicaid, and private pay. j ccoghs\funding form. doc 3 Agency Name: LIFE Skills, Inc. Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: LIFE Skills, Inc., conducts consumer satisfaction surveys and has recemly developed a system of calling or comacting 25 to 30 individuals per month to assess quality and consistency of service delivery. Consumer satisfaction surveys sent to individuals reveal generally positive outcomes: On a scale of 1-5 (l=never, 5=always), individuals responded to a variety of questions with an average rating that illustrates a relatively high level of satisfaction. ~ Does your counselor come on time? 4.59 ~ Does your counselor schedule regular meetings with you? 4.93 ~ Do you feel comfortable with your counselor in your home? 4.89 Does your counselor bring you information and materials? 4.07 Is the information helpful? 4.54 Do you feel you can talk with your counselor even if you are not scheduled to meet with them? 4.28 Of individuals responding: ~ 86% said their counselor was interested in them and their needs ~ 83% said that their counselor treated them with respect (b) Community: Requests for LIFE Skills, Inc., staff to participate in community planning continue to be frequent. The agency continues to be a solid and consistent community employer and requests for service provision continues to be steady. Feedback from contracting case managers and service coordinators is an important assessment tool as well. 2. Briefly summarize your findings: Individual and community satisfaction continue to be high and the agency's referral base and new intakes continue to be consistent. Staff participation in community planning is higher than it has ever been. 3. What changes have been made in response to these findings? Agency staff are always responsive to feed back received. Whether it is an individual service recipient, a contractor, or business associate, LIFE Skills, Inc., is committed to utilizing information to assure quality service provision using best practices. Feed back from both individuals served and contracting agents continues to be positive 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Johnson County MH/DD Services -90% South East Iowa Case Management -5% Linn County MI-VD Services -5% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Community Mental Health Center (CSS, SCL, ARO), Hillcrest Supported Community Living (CSS, SCL, ARO), ARC of Johnson County (SCL, HCBS, RESPITE), j ccoghs\f~ndingform.doc 4 Agency Name: LIFE Skills, Inc. Systems Unlimited (HCBS, RESPITE, SCL), Successful Living (ARO, SCL, CSS), Goodwill (HCBS, SCL, ARO), Reach For Your Potential (HCBS), There are other agencies which provide a variety of SCL programs which are not listed. The funding source develops the program and any agency may apply to provide that service however, the program requirements are the same for any provider. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. LIFE Skills, Inc., is a unique organization in that we have always had a very consistent staff with a relatively low mm over. The agency is stable providing services to a challenging and broad base of individuals and is locally based. LIFE Skills Inc., specializes in serving individuals who have mental retardation, mental illness, developmental disabilities, and other mental disabilities. The organization is unique because it is versatile and does not focus solely on one specific population of individuals. The individuals served generally have a high level of challenge and need, which requires great flexibility on the part of the agency. LiFE Skills, Inc., has a reputation of working with individuals which have been unsuccessful in other programs and who have dual diagnoses of mental illness and substance use. The staff demonstrates patience and commitment to providing consistent and quality services. An additional unique quality of the organization is that all clinical supervisors, including the Executive Director provide direct services. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1 .Agency Staff are members of the Johnson I. Members plan and make funding and County MH/DD Planning Council and sub- quality assurance recommendations to the committees. Johnson County Board of Supervisors. Sub- committee's include; research and development and continuous quality improvement. 2. Agency staff serve on the HIPAA provider 2. The HIPPA task force is a group of local task force, providers who meet to discuss, plan, and pool resources to assure compliance with HIFAA requirements. 3. LIFE Skills is a partner in the STAR Grant 3. The STAR Grant is a cooperative program (Supported Training and Access) to involving many community agencies. The Recourses Grant. primary agency is Emergency Housing and Mecca administrates the grant. LIFE Skills, provides budgeting assistance and double signature checking for grant recipients. j ccoghs~funding form. doc 5 Agency Name: LIFE Skills, Inc. Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Federal, State, and County budget cutbacks 1. Continue to be flexible and implement new for services for individuals who have programs as funding sources shift and are disabilities, eliminated. 2. HIPAA compliance and implementation. 2. The agency actively participates on the HIPAA task force and has participated in training in preparation for mandatory implementation. 3. Quality staff retention and service 3. The agency continues to provide on-going provision, m-service and training opportunities for staff. Financially, the agency strives to increase salaries as the agency budget allows. 2. In what way will the needs of your service population change in the next five years? The need for services will increase as funding cuts create County waiting lists and service cuts create gaps between the need for services and the level at which service is provided. LIFE Skills, Inc., staff will need to focus more on basic survival skills and accomplishing as much as possible within the limited time available. Individuals who receive service will be forced to reevaluate their goals for growth, development, and life improvement and focus primarily on housing, finances, and current health. 3. How do you plan to address these changes? LIFE Skills, Inc., will continue to be flexible with regards to the development of programs when funding changes. The agency will continue to be efficient in budgeting and resource allocation. LIFE Skills Inc., staff will continue to participate in Johnson County Planning Council activities and on committees. The agency will continue to review quality assurance issues and will work on the development and implementation of HIFAA compliance issues. 4. Describe the evaluation methods you use to measure the success of your services? Consumer Evaluations Referring Agent Evaluations Staff Evaluations Quarterly Case Reviews Number of New Referrals Contract Renewal Rates Site Monitoring Visits j ccoghs~fundingform.doc 6 Agency Name: LIFE Skills, Inc. 5. What are the results of these evaluations (outcomes)? The results of evaluations conducted this year are as follows. The Johnson County MH/DD Quality Assurance Team and the Social Security Administration conducted site-monitoring visits. The MH/DD team randomly selected a sample of files and found: 100% to be in compliance with the Johnson County MH/DD Management Plan 100% of the case notes reflected progress toward stated goals 100% of services provided meet the state definitions 100% of agency notes reflect implementation of the case management process 100% of agency notes reflect the Inter-Disciplinary Team process 100% of agency notes reflect responsiveness to client needs 100% of agency notes reflect the client's right to exercise choice 100% of agency notes reflect commitment to community integration and normalization 100% of objectives are specific, measurable and time limited and refiect the individual's ISP (individual service plan) > 100% consumer and case manager were involved in the planning process Evaluation teams stated that the agency policies reviewed were "excellent". "They are reflective of social work standards and ethics. The manual provides new employees with clear direction. Consumers sign off on grievance procedures as part of their contracts, verifying that consumers received this information. Informed consent policy clearly outlines the issue and can be used as an educational tool for staff. It is clear from the files reviewed that LIFE Skills, operates a good program that works collaboratively with other agencies, including case management and is actively involved in the multi-disciplinary process" Recommendations included: The development of a standard face sheet for easy access of consumer emergency information. >' The development of more specific discharge plans. > The development of a system to assure that individual crisis plan are updated annually. The Social Security Administration had no recommendations for our program and noted positive file organization and solid procedures for our representative payee services. They additionally noted a high level of satisfaction when they interviewed individuals served. 6. How do you plan to use the evaluation results to enhance/extend your services? LIFE skills, Inc., will continue to use feed back form site monitoring visits to assure program compliance with, county, state, and federal program regulations. The reconunended face sheet has been developed and distributed to counselors to complete. Agency clinical supervisory staff are in the process of developing a new format for discharge plans and a system, which will assure timely annual update of individual crisis plans. LIFE Skills, Inc., always welcomes feedback and suggestions from all stakeholders involved in the service delivery process. Quality assurance is a top priority for this agency. j ccoghs~fundingform, doc 7 Agency Name: LIFE Skills, Inc. 7. How do your programs/services impact the community? Community impact can be seen by less hospitalization of people who have mental illness. LIFE Skills, Inc., services assist people with maintaining their housing and helps to reduce homelessness in our community. Individuals who have a serious mental illness are at a much higher risk of eviction than any other population. People who receive services have assistance living, working, socializing, and learning in our community, which allows them to live in the least restrictive environment. LIFE Skills, Inc., provides professional positions for people seeking employment in the human service field and a positive environment to practice their counseling skills. 8. How did the agency respond to the UWJC recommendations from last year? The agency has worked diligently to continue with the strategic planning process, which was started a year ago. Board development and expansion has continued to be a priority and continues to be addressed. The site visit results and continued referral base reflect an ongoing commitment to quality and both individual and contractor satisfaction. The diversification of the funding base proves to continue to be a challenge. Grant programs do not support the programs, which are offered because LIFE Skills, Inc., was developed to be a purchase of service business. Therefore State, Federal, and local MH/DD funding will always be the base funding for all programs. The agency does diversify programs as required to continue to be a purchase of service agency, for example the development of ARO last year. j ccoghs\fundingform.doc 8 Agency Name: LIFE Skills, Inc. Subdivision 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly. 3. What is your average attendance at board meetings? 60%. 4. How is the board involved in strategic planning and governance of the agency? The LIFE Skills, Inc., Board of Directors has been extremely involved in strategic planning for the past year. Strategic planning sessions have been a major activity and has included outside facilitation as well as on-going planning and writing sessions. 5. What type of training/orientation do board members receive? All LIFE Skills, Inc., Board of Directors members receive a derailed orientation prior to their first meeting. This orientation includes information regarding services provided by agency staff, agency programs, agency policies and procedures, program staffing patterns, agency history, and detailed fiscal information. An Executive Committee Board member and the Executive Director conduct new Board member training. Additional training opportunities are available through United Way and other community seminars. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Yes, 4/02. 7. HaveyoufiledtheannualreportwiththeSecretaryofState?Ifyes, date filed? Yes, 1/18/01. The state requires these repons to be filed on a biannual basis. 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? Not yet. If no to questions 6, 7, or 8, give explanation. The 990 will be filed on completion of the FY 2002 audit. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? Trimmer & Associates, PC How much did the audit cost? $4,587.00 If material weaknesses are noted in the audit, what is your plan for addressing them? No material weaknesses were noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? j ccoghs\funding form.doc 9 Agency Name: LIFE Skills, Inc. 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers X 1,000,000 a. fiduciary liability Pending b. employment practice liability X 1,000,000 General Liability X 1,000,000 3,000,000 Umbrella Liability Professional Liability X 1,000,000 3,000,000 Property or Renters X 54,813,00 Vehicle X 1,000,000 j ccoghs\funding form. doc 10 Agency Name: LIFE Skills, Inc. Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. The Executive Director is also the founder of LIFE Skills, Inc., and has held the position since November 1, 1989. Qualifications include: > Bachelor of Science, Secondary Special Education, U of I } Iowa Licensed Bachelor of Social Work ~ 18 years of experience providing in-home and community based counseling in Iowa City ~' Currently enrolled in the U of! Graduate Program for Counseling, Rehabilitation, and Student Development 2. Staff Salaries & Benefits Check if Applicable Retire Full-Time Paid Healt Current Salary Range Equivalent Position Lear h ment Per Position (FTEs) e Ins. Plan Last This Next Year Year Year Executive Director X X X 38,000-50,000 1 1 1 Business Manager X X X 28,000-30,000 0 1 1 Administrative X X X 18,000-21,000 1 1 1 Assistant SCL Coordinator X X X 28,720-36,000 1 1 1 Team Leaders X X X 22,500-23,670 2 2 2 HCBS Coordinator X X X 28,000-31,125 1 1 1 Skills Counselors X X X 18,000-23,670 9.94 9 10 TOTAL FTEs 15.94 16 17 j ccoghs\fundingform.doc 11 Agency Name: LIFE Skills, Inc. 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? Approximately 14 4. How much was spent on staff development in the last fiscal year? $4,357.00 5. How much is budgeted for staff development in this fiscal year? $4,750.00 6. What training and support opportunities are offered to staff?. LIFE Skills, Inc., attempts to budget as much as possible for stafftraining. All clinical staff are required to attend a minimum of two Kirkwood Community College Continuing Education seminars per year. All clinical staff are required to attend a monthly in-service at the agency conducted by local community professionals. The agency's Clinical Supervisory staff is responsible for selecting journals and professional resources to purchase for staff reference. Finally the agency strongly encourages those who hold professional licensure to maintain their certificates and licenses upon renewal date. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 5.46% Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board last reviewed? 4/02 10. Does your board X annually evaluate the director's performance? 11. Does your agency X have j ob descriptions for every position? If yes, date of last board approval? 4/02 12. Is there an annual X performance review for every staff?. j ccoghs~fundingform, doc 12 LIFE Skills, Inc. !Agency: LIFE Skills, Inc Section 7: Financial Management A. Three Year Historica~ Balance Sheet As of your fiscal year-end) : EnterYr i EnterYr i EnterYr ; EnterYr EnterYr EnterYr I Fy 2000 i FY 2001 I FY 2002 Current Assets i FY 2000 , FY 2001 I FY 2002 ICurrent Liabilities Cash I $34,133 $56,616 ' $79,500 I Accounts Payable I $5,845 $4,788 I $7,577 Investments ~_ Payroll Taxes Payable !$8,474 $6,497! $6,188 Receivables < 90 days $70,434 $56,606 $65,189 Contracts Payable i I Other i $3,080 i $7,373 $3,983 i Mortgage Payabe-6monthsi , Total Current Assets ; $107,647 i$120,595 $148,672 i Total Current Liabilities i $14,319 $11,285 ! $13,765 Property --- I $0 $12,621 [ $12,621 Mortgage Payable-BalanceII $16,452' --Equipment __ ! $46,941 i $39,758 I $54,164 Other__I $8,661 __ less depreciation ($37,457)! ($21,592 ($27,263 Total Other Liabilities I $0 $16,452 $8,661 Receivables > 90 days Total Liabilities ! $14,319 $27,737 $22,426 Other I $1,080 $2,000 $6,345 NetAssets 15103,892 $125,645I $172,113 Total Non.current Assets I $10,564 $32,787 $45,867 TotalAssets I $118,211 15153,382 $194,539 Liabilities & Net Assets i$118,211 $153,382I $194,539 13 Agency Name: LIFE Skills, Inc. Lest Yr Cur Yr Next Yr B. Income & Expenses FY 2002 FY 2003 FY 2004 Local Funding Sources iowa City I Coralville Johnson County $0 $10,000 $0 !One time grant for FY '03 Unite~ ~:,A,!!ecati~r~ t $3~000 $3,000 t $10,000 - Designated G!ving ~ $2~ $2,400 J $3,000 Grants-Federal, State, Foundation 2 $0 $0 ~ $0 Net Sales of Service $686,512 $669,240 ~ $670,000 Projecting no growth Net Sales of Materials $660 $500 ! $600 Contributions/Fundraising $495 $500 $500 Investment Income $585 $850 $600 May need to dip into operating reserv T Other $318 $225 I $250 Total Income , $694,503 $686,715~] $684,950 Expenses Wages & Salaries $386,513 $402,285 $414,350 Assuming 3% increase Benefits $89,041 . $107,732 $110,000 Health insurance increase? Occupancy $31,610 $33,085 $35,000 [ Non-occupancy $142,109 $139,551 $135,000 'Will cut costs as much as possible Other Total Expenses $649,273 $682,653 $694,350 C. Fund Balance Revenue $694,503 $686,715 $684,950 Carryover Balance from previous year $21,753 $59,978 $58,640 TotaIOperating Budget . $716,256 $746,693 $743,590 LessTotal Expenses . $649,273 $682,653 $694,350 Ending Fund Balance _ $66,983 ~ $64,040 $49,240 Less Restricted Balance (explain) $7,005 $5,400 $6,000 Carryover Fund Balance $59,978 $58,640 $43,240 14a Agency Name: LIFE Skills, Inc. I Agency: D, Bd/Donor/Funder Restricted Funds Designated for: Last Year This Year Next Yeal Board Restricted Commercial loan repayment $3,022 $0 $0 Board Restricted Staff Development $3,983 ! $5,400 $6,000 Total Restricted Funds I $7,005 $5,400 $6,000 E. In Kind Support: i Last Year This Year Next Yeal ServicesNolunteers $725 $0 $0 Material Goods $0 j $0 $0 Space, Utilities, etc $0 , $0 $0 Other: (Please footnote) $0 $0 $0 Total In-kind Support $725 I $0 $0 F. Grants Description/Purpose Last Year This Year Next Yea; Johnson County DHS Community Education Grant, provides $0 $10,000 $0 funding for consumers to take classes. Total Orants I $0 $10,000 $0 14b LIFE Skills, Inc. Board of Directors Appendix A. Jay Harding, Bd President Sam Neuzil, Bd Vice President Iowa City Iowa City Research Project Coordinator, U of I Salon Coordinator 10/96 - 10/02 01/00 - 01/06 Jeffrey Fields, Bd Secretary/Treasurer John Lee, Bd Member Iowa City Coralville Attorney at Law Research Assistant, U of I 10/96 - 10/02 11/01 - 1107 Mel McMorris, Bd Member Orville Townsend, Bd Member Iowa City Iowa City Realtor Executive Director 11/01 - 11/07 Division of Vocational Rehabilitation 09/02 - 09/08 James Schmeling, Bd Member Iowa City Program Associate, U of I, Law, Health, and Disability Center 11/01 -11/07 Joel Streif, Bd Member Kathy Kikendall, Bd Member Iowa City Iowa City Evert Conner Center for Independent Living Therapist 01/02 - 01/08 10/02 - 10/08 Sandie Bass- Ringdahl, Bd Member Iowa City Doctor, Center for Disabilities and Development, UIHC 10/02 - 10/08 *At this time the board functions as a full body and no committees other than the executive committee exist. LIFE Skills, Ina. Appendix B. LIFE Skills, Inc. Table Of Orqanization August 8, 2002 LIFE Skills Board of Directors* Gill[an J.H. Fox* Executive Director Sara[ Logue -- Shelley Marston Tonya Burkett Barb Bailey SCL Service Coordinator HCBS Coordinator Administrative Assistant Business Manager Mike Ward Florence Ejiwale SCL Team Leader HCBS Team Leader SCL Skills Counselors Theresa Harper Marion Jacobs Erik Milbrandt Janice Plate Phet Sadakhom Jolene Switzer Alina Timmerman Dave Vincent Miranda White *Represents direct authority for policy making The Executive Director provides direct super[son to all agency positions. excel/admin/table of organization 17 Section 1: Background Agency Name: Mid-Eastern Council on Chemical Abuse Phone: 351-4357 Address: 430 Southgate Avenue, Iowa City, IA 52240 Director Name: Arthur J. Schut Signature: Bd. Pres Name: Stephen arndt Signature: ~ Request Completed By: Ron Berg Date: [ Check Your Agency's Budget Year: 1 / 1-12/31 7/1-6/30~X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $ 42,372 $ 42,372 $ 44,491 .9 Does not include designated giving FY 02 FY 03 FY 04 City of Iowa City $ 27,840 $ 29,962 $ 31,460 .6 Johnson County $ 309,000 $309,000 $324,450 6.6 City ofCoralville $ 1,800 $ 1,980 $ 2,079 .04 What were local funds used for last year: local funds were used to support the salary for medical director, prevention services, detoxification, committal hearings, and crisis intervention What will this year's local funds be used for? Medical director salary, prevention services, detoxification services, committal hearings, and crisis intervention. Agency Mission: To enhance the health of individuals and communities through community-based substance abuse, mental health, and other health services. Summarize your programs and services: MECCA offers a wide range of services related to the treatment, management, and prevention of behavioral health concerns. We divide our services into broad categories of Substance Abuse Treatment, Substance Abuse Prevention, and Community Services. Substance Abuse Treatment includes the following programs: evaluation and assessment, crisis intervention, family assistance, and referral; outpatient programs that range from programs consisting of 2-4 hours of services each week to Intensive Outpatient Programs that require 9 hours of services each week for clients; aftercare and relapse prevention services for clients who have completed a primary treatment program; detoxification services that provide a safe environment for clients to withdraw from drug and alcohol use, committal hearings for Johnson County and other counties who contract for this service; residential treatment that involves clients in 24 hours per Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) week, seven days per week services; halfway house services that provides transitional living with treatment; and our newest program, 12 transitional apartment units that will allow us to provide safe monitored housing for clients who have children, have completed treatment and are involved in our aftercare or case management services. Substance Abuse Prevention are grant funded programs typically targeting a specific population: Comprehensive Prevention is our prevention flagship providing activities targeting the general community, this year's grant will focus on coalition development, workplace initiatives, and mentoring projects; Tobacco prevention is a collaborative project with the Johnson County Tobacco Free Coalition; Strengthening Families is a Federal grant involving MECCA, UAY, NCJC and area schools to provide the Strengthening Families curricula to families with children in 4-7 grades; Juvenile Crime Prevention grant is a collaborative effort with seven other agencies in Johnson county targeting youth services, MECCA's activities on this grant are centered in the two Iowa City high school buildings. Community Services include our Case Management services, collaborative research projects with U of I, mental health services, dual diagnosis services, Employee Assistance Programs, OWI treatment program located at Hope House, and OW1 education groups, and STAR program on behalf of EHP providing support services to homeless population. List any accreditation and licensure your agency currently has. Explain. MECCA is licensed by the Iowa Department of Public Health (1DPH). Licenses are available to agencies for a variety of"levels of care" and for a range of time periods. MECCA is currently operating with a two year license, the longest license available to agencies, and is awarded agencies scoring 90% or higher on the inspection report. The inspection examines MECCA's compliance with Iowa Administrative code and covers such things as financial operations, board involvement, quality improvement, staff training, performance evaluation, clinical services, meal preparation and menus, building maintenance, tornado and fire safety procedures, client file organization and documentation, medical services, urinalysis procedures, and medication control. MECCA's next review will be conducted in July, 2003. MECCA has also secured a 270 day initial license to provide Outpatient Psychotherapy/Counseling Emergency, and Evaluation services. j ccoghs\fundingform.doc 2 Agency Name:Mid-Eastem Council on Chemical Abuse (MECCA) Agency History (Using this page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) The parent group of the Mid-Eastern Council on Chemical Abuse (MECCA) was founded in 1964 by a group of concerned Johnson County residents and named the Johnson County Citizens Committee on Alcoholism. The primary purpose of the Committee was to serve as a community resource to alcohol abusers, their families, employers, schools, jails, court system, and other community agencies coming into contact with alcoholics. Today MECCA is a private not-for- profit corporation providing comprehensive substance abuse treatment and prevention services to a four county area in Eastern Iowa and two counties in Central Iowa. In 1986 construction was completed on a new facility that allowed MECCA to expand our outpatient and halfway house services to include residential and social detoxification. As funding sources at federal, state and local levels altered their view of substance abuse, and as treatment of substance abuse has evolved, MECCA has developed into a comprehensive substance abuse treatment agency. Some of the changes in the mid 1980's included: moving to outpatient programs which utilize group services allowing greater access for the public to MECCA's programs and in a more defined manner; residential services growing from being limited to half- way house services for men to include residential and half-way house services for men and women; finally, a "free-standing (non-hospital) detoxification and mental health crisis stabilization unit was open to fill a void in the continuum of substance abuse and mental health services available to area residents and limit county expenditures at the state hospitals. In 1999 MECCA was asked to provide management services for a substance abuse treatment provider in Ottum~va operating offices in a ten county region. In 2000, MECCA applied for and was awarded the contract to provide outpatient and residential treatment services in Polk and Warren counties. In 2002 construction was completed on an office and apartment building allowing MECCA to provide transitional housing services to clients involved in substance abuse afiercare services. Prevention services have grown since first organized at MECCA in 1981. There are four prevention staff members who provide comprehensive prevention services to area youths and adults regarding substance abuse issues. In addition, prevention activities have expanded to include specific efforts targeted at tobacco, and include federal and state program specific grants. Today we continue our mission of providing area residents with the best possible substance abuse treatment and prevention services. j c coghs\funding form. doc 3 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) Section 2: Client Profile ~ 2001 ~02 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 7976 10910 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 4702 6185 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 1067 1485 ' and Coralville resident counts are estimates based on census Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-4 54 Female: 7276 Caucasian 14137 5-17 7410 Male 8226 Hispanic 383 18-24 1461 African/American 610 25-44 4716 Native American 48 45-64 1506 Asian 100 , >64 73 Multi 102 Not reported 282 Other 4 Total 15502 Not reported 118 Total 15502 3. Briefly describe your service population. MECCA provides services to any person expressing concerns about substance abuse, or to the general population through our prevention programs. Individuals participating in our programs range in age from preschool children to elderly clients involved in treatment or prevention services. 4. How do you determine eligibility for services? Anyone expressing a concern about substance abuse or who has a family member involved with substance abuse is eligible to participate in our programs. 5. Are there fees for your services? Yes X No__ If yes, please describe your fee structure: Fees for treatment services are based on a sliding fee schedule such that anyone below 300% of poverty has the cost of treatment subsidized to varying degrees with state and federal money. Clients with little or no income will pay 5% of the cost of our treatment, or about $3.00 for an individual session. 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: In addition to Johnson county, we serve residents from Cedar, Iowa, Washington, Polk, Warren Counties, as well as clients from across the state in our residential treatment program. Services Provided: Substance abuse treatment is provided in all six counties listed, while prevention programs are only offered in Cedar, Iowa, and Washington counties in addition to Johnson. Funding Sources: Funding for services outside of Johnson County are through contracts for those specific services and are sufficient to cover the cost of those programs without impacting Johnson County services. jccoghs\fundingform doc 4 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: All clients are asked to complete a feedback form at the conclusion of their treatment episode. (b) Community: MECCA does not have as formal an assessment of community satisfaction with the community as we do with individual clients. MECCA makes every attempt possible to solicit and incorporate community feedback through informal channels and through staff involvement in a variety of community projects. 2. Briefly summarize your findings: Clients are overwhelmingly satisfied with the services they receive at MECCA. They report to us that staff are helpful and genuinely concerned for their well being, that the treatment experience is beneficial to them. Complaints center around the cost of treatment, especially among clients required to be at MECCA through some legal event, or that group size is too large and the rooms not comfortable. 3. What changes have been made as a response to these findings? We attempt to offer groups at a variety of times of day including both evening and day groups to try and reduce the class size and make the rooms more comfortable. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Alcohol and Drug treatment providers 3.69 Civil Commitment 2.30 Community Mental Health Clinics 0.45 Drug Courts 0.21 Employer/EAP 0.62 Health Care Provider 2.79 Other Community Member 7.88 Other Criminal Justice 29.30 Other Individual 2.21 OWI 27.80 School 5.50 Self 15.00 TASC officer 0.16 Zero Tolerance 2.17 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? No other organization provides comprehensive substance abuse services. Some organizations provide a single service, including: St. Luke's Hospital from Cedar Rapids operates an outpatient substance abuse program in Iowa City; the University of Iowa operates an outpatient substance abuse program as well; the Area Substance Abuse Program, a private practice office in Iowa City provides treatment services; agencies involved with prevention services includes UAY, NCJC, Big Brother/Big Sister, Youth Homes etc. j c coghs\funding form. doc 5 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) 6. Describe what makes your agency and/or its services unique to Johnson County. We are the only community based organization dedicated to providing substance abuse treatment and prevention services to Johnson County. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe relationship 1. Johnson County Juvenile Crime Prevention 1.We are a participating member in this seven agency collaborative effort addressing juvenile crime issues. 2. United Action for Youth, Comprehensive 2. For about 15 years MECCA has Prevention Contract subcontracted with UAY for alternative activities for youth in Johnson County as part of our Comprehensive Prevention Grant. MECCA provides funding to UAY to support their drop in center. 3. DVIP 3. MECCA has been involved in joint planning and training with DVIP on a research grant through UNI. Staff have participated in joint training exercises to increase staff awareness of substance abuse and domestic violence. j cc oghs\funding form. doc 6 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) Section 4: Strategic Planning and Agency Effectiveness 1. Describe no more than 3 challenges your agency is currently facing and how your agency is addressing these challenges? (e.g., staffing, finances, service delivery) Challenge Strategy for addressing challenge 1. Reduction in state funds supporting services 1. Diversify our income, maximize income to indigent clients from non-governmental sources 2. Increased severity of client need 2. Improved training for clinical staff 3. Nurse recruitment 3. We are promoting MECCA as an alternative work site for nurses that provides opportunity for unique direct care of clients, and we are negotiating arrangements with temp nursing agencies. 2. In what way will the needs of your service population change in the next five years? This is a difficult question to respond to because the changes we have seen in recent years include issues of severity, acuity, and specific drugs, i.e. meth. Unfortunately, we do not anticipate the trend line on these issues to change. The only change that we anticipate is moving from Meth to another drug, but we really have no way at this point of knowing what that drug may be. The Drug Abuse Warning Network (DAWN) has not identified any specific trends in Iowa that would permit a prediction in this area. We hope that we will see the needs of our clients level off to some degree. We are concerned that we are better equipped to identify substance abuse in areas not previously identified, but not so adept at identifying appropriate treatment responses. For example, our communities are doing a much better job of identifying clients struggling with depression and referring them for treatment that also includes substance abuse evaluation, but the mental health and substance abuse fields are still researching best treatment approaches for these clients. 3. How do you plan to address these changes? Because we do not anticipate new issues to confront us, we continue to focus on improving the infrastructure of MECCA and enhancing the clinical services available to clients. We are in the midst of standardizing our treatment programs and implementing research based treatment approaches, revamping our staff training and orientation functions, and implementing support services designed to make direct service staff more productive. Our focus is on quality of services, looking to research findings to define our treatment approaches, and strengthening our infrastructure to ensure our ability to continue providing services. j ccoghs\funding form. doc 7 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) 4. Describe the evaluation methods you use to measure the success of your services? MECCA collects client satisfaction surveys that monitor client's reactions to services received at MECCA and we participate in statewide evaluation/outcome project that tracks comparative pre and post treatment statistics. In addition, we have been involved in two research projects, one with the University of Iowa, the other with the University of Northern Iowa, that will provide useful feedback to MECCA regarding our services. 5. What are the results of these evaluations? Our client satisfaction surveys have been used to adjust intake procedures, to make facility changes, and so on. In terms of the pre and post treatment data MECCA compares very favorably with other agencies in the state. We believe this comparison is significant because the data makes no adjustment for client severity at the time of admission, and because we operate a residential treatment program, by definition we provide services to the most needy clients. 6. How do you plan to use the evaluation results to enhance/extend your services? A review of the post discharge information presented below, as well as other internal monitoring we conduct (60 days with no service, participation in aftercare programs), highlights concerns about aftercare and follow up. MECCA responded to these concerns with the recently opened transitional housing services made possible with the support of Iowa City CDBG and the Iowa City Housing Authority. This service will allow longer term support services for clients recently discharged from MECCA. MECCA also created a new staffposition this past year to specifically relate to aftercare clients, but the position fell victim to other funding cuts and was not fully implemented. 7. How do your programs/services impact the community? Provider Actual Statewide Average No Substance Use in Past 6 52% 45% months since discharge Client arrest Since Discharge 14% 13% Client employed or in school at 81% 66% follow up Monthly taxable income under 69% 72% $1000 at admission Monthly taxable income under 48% 55% $1000 at follow up Client completion of treatment 55% 55% DPH client satisfaction 92% 90% Soume: Magellan Statewide Provider Profiling Report, July, 2001 through June 2002. 8. How did the agency respond to the UWJC recommendations from last year? A board member will be present at future Joint Funding hearings. A strategic planning process has not been formalized to the point that a document could be provided, however, board discussions are typically related to long range planning issues such as funding diversity, computer infrastructure, facility issues, and service provision. A fbrmal strategic planning document is currently on the Board's agenda for completion during FY 03. j ccoghs\funding form.doc 8 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) Section 5: Board Governance 1. Please provide a board roster with names, addresses, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? 9 4. How is the board involved in strategic planning and governance of the agency? The Board debates and approves all policy decisions, approves annual budgets, supervises the Executive Director/CEO, and approves periodic financial and service reports. 5. What type of training/orientation do board members receive? The CEO meets individually with all new board members to orient them to MECCA services, history, philosophy, and financial standing. Board members are provided with a binder that contains meeting minutes from the previous six months and brochures explaining MECCA services. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? _yes, April 26, 2001 - board approves our policies annuallv~ 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Yes The Biennial report ~vas filed electronically on February 16, 2001. 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? This form is required to be filed by November 15 for the most recent fiscal year. MECCA's auditing firm completes and files these reports in compliance with IRS regulations and has done so successfully every year. The current year form 990 will be filed prior to the IRS deadline. Comments: 9. Does your agency have a yearly audit? Yes X No__ It' yes, Who completed the audit? McGladrey and Pullen How much did the audit cost? $11,000 If material weaknesses are noted in the audit, what is your plan for addressing them? None found If you do not have an audit, What is in place to assure accountability in the agency's financial management? j ccoghs\funding form. doc 9 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) Section 6:Personnel and Staff Development 1. State thc length o£ employment o£ the Executive Director and his/her qualifications. Art Schut has worked at MECCA since December 1982, or 20 years in December 2002. Mr. Schut has a Masters Degree in Clinical Psychology. 2. Staff Salaries Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Chief Executive Officer x x x 66,000 - 93,200 1 1 1 Chief Operating Officer x x x 54,250 - 67,750 1 1 1 Clinical Director x x x 48,000 60,000 1 1 1 Chief Financial Officer x x x 45,000 61,000 1 1 1 Clinical Operations x x x 34,500 - 46,400 2 2 2 _Manager Supervisor MA/MS x x x 32,000 - 45,5000 6 6 6 Supervisor x x x 28,500 -41,000 5.5 2.5 2.5 -Program Coordinator-MA x x x 27,500 - 38,500 1 0 0 Program Coordinator-BA x x x 24,500 34~500 0 1 1 Nurse Manager x x x 33,000 43,000 1 0 0 Nurse x x x 30,000 43,000 4.5 5 5 Case Mgr MA/MSW x x x 28,000 - 40,000 1 2 2 Counselor II/Prevention x x x 28,000 40,000 6 11.5 11.5 _ Spec. MA/MSW Case Manager x x x 23,000 32,000 10 7 2 Counselor lI/Prev Spec x x x 24,000 - 35,000 14 12 ! 12 Certified Counselor I x x x 20,000 24,000 2 0 0 Info Technology Spec x x x 33,000 - 50,000 2 2 2 Senior Tech x x x 22,000 32,000 0 3 3 Executive Assistant x x x 26,500 39,200 2 3 3 Accounting Supervisor x x x 26,500 - 39,200 1 1 1 Accounting Tech x x x 22,000 - 33,000 1.5 2.25 2.25 j ccoghs~funding form. doc 10 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) Retire- Full-Time Equivalent Paid Health merit Current Salary Range (FTEs Position Leave Ins. Plan Per Position Last This Next Year Year Year Data EntTy x x x 16,640 -- 26,000 1 1.25 1.25 Secretary/Reception x x x 18,000 - 26,000 5.3 5.675 5.675 Tech/Cook/Childcare x x x 18,000 26,000 22 19 19 Admissions Clerk x x x 18, 000 26,000 2 2 2 HR/Community Rel Mgr x x x 34,500 -46,400 2 2 2 TOTAL FTEs 95.80 94.175 89.175 3. If serving multiple counties, how may FTE's serve Johnson County (include administrative and direct service staff)? 71 4. How much was spent on staff development in the last fiscal year? $14,600 5. How much is budgeted for staff development in this fiscal year? $14,780 6. What training and support opportunities are offered to staff? Training for staff takes many different forms. There is an initial orientation to agency policy and clinicaI procedures. Monthly staff meetings provide a forum to introduce new agency procedures and provide in-services on topics ranging from new clinical techniques to presentations from other community agencies. Weekly clinical training meetings help to improve the skills of counseling and prevention staff. In addition, staff are encouraged to attend trainings provided by the Iowa Department of Public Health and Iowa Substance Abuse Program Directors Association. These trainings generally meet the CEU requirements to maintain the counselor certification. 7. Please attach current organizational chart as Appendix B. 8. Was the agency able to provide raises? The Board has delayed agency wide salary increases pending review of current year financial performance. The salary line in the budget sheets does not directly reflect this overall delay in salaries because MECCA reduced FTE's this past year in response to funding cuts and some positions were given salary increases where it was determined the position salary was not competitive with the market. 9. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 0% Yes No Comments Does your agency X have personnel policies? If yes, date board last reviewed? April 26, 2001 j ccoghs\fundingform, doc 11 Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) Does your board X annually evaluate the director's performance? Does your agency X have job descriptions for every position? If yes, date of last board approval? April 26, 2001 Is there an annual X performance review for every staff?. 10. Insurance coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability b. employment practice liability X $4,000,000 General Liability X $4,000,000 Umbrella Liability X $1,000,000 Professional Liability X $4,000,000 Property or Renters X $3,800,000 Vehicle X $1,000,000 j ccoghs\funding form. doc 12 [ ~ I Agency: MECCA Section 7: Financial Management _ Three Year Historical Balance Sheet at June 30, I 2000 _ 2001 2002 -- 2000 _ 2001 ' 2002 urrent Assets ! Current Liabilities $212,177 Cash $182,068 $152,195 $264,989 Accounts Payable $88,394_ $100,808 Investments $0 $0 $20,956 Payroll Taxes Payable $7,333 $11,701 : $0 Receivables < 90 d~y~ $293,747 ~3,~1~ $337,142 Cqntr~!~ Pab, able $80,000 $47,952. $75,217 Other $10,807 = $10,291 $31,682 Mortgage payeb!~;~ months $24,840 $33,121 $77,845 Total Current Assets $486,620 $556,400. $654,748 Total Current Liabilities $200,567 $193,582 $385,240 Other Assets Other Liabilities Property . $996,225 $1,352,306 $2,225,175 i Mortgage Payable-Balance $545,998 $797,264 $1,531,356 Equipment $957r582 $1,121,773 $1,174,984 . Other $220,739 $356,115 . $333,431 less depreciation ($1,058,375) ($1 193,128); ($1 321 993l Total Other Liabilities $766,737 . $1,153,379 $1,864,787 TotalNon-currentAssets $902,208 $1,295,7433I $2,085,410 TotalAssets $1,388,828 $1~852r14~$2,740~158 ILiabilities&NetAssets i $1,388,828 , $1r852~143 $2~740~158 2002 2003 2004 B. Income & Revenue i Revenue Loca[[~ndi~g Sources ' ' ,owaC,ty ] 27,i4; 29,962 ;;17 01 Coralville ~ $1,800 $1,980: $2,079 Johnson County $309,000 $309,000 $324,450 tJnited Way; AIIoca!!on . $43,763 $42,372~J $44,49~1 - De~!gnated Giv!~g~ $1,o67 $1,120 I $1,176 Grants-Federal, State, Foundation $979,812 $820,156 I $584,883 Net Sales of Service $3,844,018 $3,628,709~ $3,761,157 Net Sales of Materials $0 $0 $0__. Contribution$(Fundraising , $13,4:33 . $4,172 $8,19~9 Investment Income $1,535 , $980 $1,035 Other* _ . $32,860 I $122,552 i $149,752 Total Revenue $5,255,1~,961,0031 j $4,908,682 *increase reflects rental income Wages & Salaries $3,078,840 $2;820,0 8,450 Benefits $692,793 $593,280, $617,107 OccuPancy _ $381,832. $347,137 $350,69~5 Non-occupancy .$1,096,715~ $1,199,780 _ $1,238,773 Other _ C. Fund Balance Revenue $5,255,129 ,$4,961,003. $4,908,68~2 Carnzover Balance from previous year . $505,182 $510,131 $510,937 Total Operating Budget $5,760,311 $5,471,134 $5,419,619 . LessTotal Expenses $5,250,1~80 $4,960,197 $4,895,025 Ending Fund Balance $510,131 $510,937 $524,594 Less Restricted Balance explain) $0: $0 ~,~;$0|941 Carryover Fund Balance $510,131 $510,937 Su~,+, E. In Kind Sup~ort~ __ Laser Year This Year Next Year __ Services/Volunteers Material Goods Other: (P!ea§e footnote) Agency Name:Mid-Eastern Council on Chemical Abuse (MECCA) APPENDIX A Board of Directors *Stephan Arndt, Ph.D. [2003], President Doug Burrier [2004]; Facilities Committee Personnel Committee Iowa City, IA 52240 Research Scientist/Professor Represents: Community Iowa City dbrfierl~qwest.net Represents: University/Dept. of Psychiatry _Stephan(~avalon.net Jack Dillon [2005]; Facilities Committee Washington County Board of Supervisors *Polly S. Pagliai [2004], Vice President Washington, Iowa 52353 Personnel and Facilities Committees Represents: Washington County Iowa City, Iowa 52240 jd71110(~_~netins.net Represents: Community supervisorsCb,,co.washin~ton.ia.us appags~lcom.net Jeff Edberg [2004]; Facilities Committee *Chief R.J. Winkelhake [2005], Treasurer Iowa City, Iowa 52246 Personnel/Budget & Finance Committees Represents: Business/Real Estate Iowa City Police Department jeff(~,,icrealestate.com Iowa City, Iowa 52240 Represents: Law Enfomement/Policy Chief) Ray Garringer [2003]; Budget & Finance rj-winkelhake@iowa-citv.org Committee Iowa County Board of Supervisors *Karen Moline [2004], Secretary Marengo, Iowa 52301 Personnel/Women & Children Committees Represents: Iowa County Marengo, Iowa 52301 rgarringer~co.iowa.ia.us Represents: Iowa County School Teacher kmmoline~hotmail.com Phil Reisetter [2005]; Women & Children's Iowa City, Iowa 52245 Jean Bartley, [2005]; Budget & Finance Represents: Legal Iowa City, Iowa 52240 RGS~,,avalon.net Represents: Legal jeanb~meardonlaw.com Valarie Lovaglia [2004]; Women & Children's Iowa City, Iowa 52246 Dermis Boedeker [2003]; Facilities Committee Represents: Community Cedar County Board of Supervisors VJLovaglia(~aol.com Tipt0n, Iowa 52772 Represents: Cedar County W. Fred Mims [2005]; Women & Children's drbm~gus _(~yahoo.com Assoc. Athletic Director Iowa City, Iowa 52242-1020 Ken Caes [2003]; Budget & Finance Represents: University Marengo, Iowa 52301 fred-mims~uiowa.edu Represents: Rural Community kecaesC~,msn.com Sally Stutsman [2003]; Budget & Finance Johnson County Board of Supervisors Iowa City, Iowa 52240 Represents: Johnson County * Executive Committee sstutsma~netins.net j ccoghs\funding form.doc Section 1; Background Agency Name: Mayor's Youth Employment Program (MYEP) Address: 1425 N. Dodge P.O. Box 307 Phone: 319-341-0060 Iowa City, IA 52244 Director Name: Cokie Ikerd Signature: Bd. Pres Name:: Deb Noel Signature: Request Completed By: Cokie lkerd Date: C~ Check Your Agency's Budget Year: 1 / l- 12/31 ___ 7/1-6/30__ 10/1-9/30_3~__ 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC 11,910 100 12,00-~ 2.2% Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City 43,483 43,483 47,000 8.7% Johnson Count? 3,500 0 4,0002 .7% City of Coralville 2,500 2,750 3,000 .6% What were local funds used for this year: To help youth attend MYEP programs that assist youth with employment related issues. The funds helped youth with interviewing skills, resume writing, transportation, attend the bike shop, and a variety of other activities related to employment training. What will next year's local funds be used for? To assist youth in attending MYEP programs such as our summer program, career exploration program, employment training program, or bike shop. There are numerous youth in the community that would like to attend and would benefit from attending MYEP programming, but because of lack of financial backing they are unable to participate. 1 MYEP is requesting for FY04 approximately the amount that ill was receiving in FY02. In FY03 the amount was decreased to $100 due to concerns from the United Way Citizen Review Panel and Allocation Committee. These concerns have been addressed by MYEP staff, the Board of Directors and the Agency on Community Needs Committee. 2 Due to budget cuts at the county level, MYEP did not receive any funding in FY03. In FY04, MYEP is asking for a slight increase from what it was receiving in FY02, before the budget cuts. Agency Name: Mayor's Youth Employment Program (MYEP) Agency Mission Statement: Provide disadvantaged youth and young adults with experiences and opportunities that promote the completion of high school and the development of skills necessary for the world of work Summarize your programs and services for which you are requesting funding: MYEP offers a variety of services to youth and young adults in the community. We would utilize the funding to assist youth in attending summer programming, employment training, career exploration, participation in the bike shop, and after school programming. The youth and young adults would acquire such skills as: ~ Interview techniques Resume development Social interaction Arriving to work on time Getting along with co-workers Work Quality Dependability Following directions Independent Living Time management Leadership development Decision making The youth and young adults that attend MYEP programming have a wide variety of issues to be addressed during their course of focus with MYEP. We individualize each young person's plan with MYEP to suit their particular needs, whether it be getting and keeping a job, learning appropriate social skills, life skills, or just dealing with daily living activities. Many of our young people require basic employment seeking skills, but others require more preparatory work that would focus more on pm-employment skills. List any accreditation and licensure your agency currently has. Explain. MYEP is a licensed daycare provider through the Department of Human Services, and as such are required to follow all of the child care guidelines set forth by the Department of Human Services. MYEP is inspected each year by the Child Care Consultant from the Department of Human Services. In April, 2002, MYEP became a certified Home and Community Based Service (HCBS) provider which will require a check of the files, documentation, case plans, etc., to assure that we are in compliance with state and federal regulations. We are currently in the process of becoming accredited through the Council on Quality and Leadership. This is a national organization "dedicated to providing world wide leadership for greater accountability, responsiveness, and quality performance in human and social service organizations and systems." They use an outcome based approach in assessing organizational quality. The above mentioned accreditation and licensum is for MYEP's youth and young adults who have developmental disabilities that attend our daycare, summer program, and after school program. j cc oghs\funding form. doc 2 Agency Name: Mayor's Youth Employment Program (MYEP) Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) · MYEP (Mayor's Youth Employment Program) came into existence in 1968 as a federal initiative encouraging cities to provide summer employment opportunities for disadvantaged youth and young adults - primarily between the ages of 14 -24. · From 1968 through 1996, MYEP was considered a quasi-department of the City of Iowa City. During 1996, MYEP filed for and became a 501C3 private non-profit corporation. · MYEP was built around the concept of summer conservation projects, which emphasized working in small groups to complete projects, which benefit the entire community. Such projects have been completed in collaboration with the ARMY Corps of Engineers, Project Green, City of Iowa City, City of Coralville, and the University of Iowa. If you have been to any of the area's parks, you have seen the results of some of these youth projects. · For many years, MYEP operated programs funded through the Iowa Workfome Development (or Job Service), Department of Economic Development, Community Development Block Grants, and Department of Justice. These programs were built around the concept of youth working, individually (as opposed to small groups), assigned to a mentor in the public or private non-profit sector. In addition to paid employment, education was often a required component. · As funding from some of these sources dwindled, MYEP expanded sales of services to other organizations and agencies, such as DHS, MH/DD and the Iowa City School District. Many of these agencies were later hit with difficult financial situations and have decreased or eliminated funding available for these services. · MYEP has provided services to a variety of populations including: o pregnant and parenting teens o juvenile offenders o low-income youth and young adults o developmentally and physically disabled youth o youth with behavioral disorders and learning disabilities o homeless youth and young adults · All populations served by MYEP have a commonality - barriers to competitive employment · Until FY97, MYEP had shared space with UAY at 410 Iowa Avenue. Growth within both organizations made for cramped headquarters. At this time, MYEP relocated to 1425 North Dodge Street. · MYEP remains at 1425 North Dodge Street and operates the following at that site: o MYEP Bicycle Repair Shop (accepts donated bikes and bike parts; youth refurbish them; bikes are donated to low-income youth, Project Holiday or sold for a donation). o TeenPlace (a summer day program for youth with disabilities and an after-school program) o Career Exploration providing youth with opportunity to learn about different careers in the community o A variety of employment-related, educational and counseling services j ccoghs\funding form. doc 3 Agency Name: Mayor's Youth Employment Program (MYEP) Section 2: Client Profile ' ~ FY00 FY01 1. How many Jahnson County residents (Including IC & 1 Unduplicated Count 116 113 Coralville) did your agency serve? 2. How many lowa City residents did your agency serve? 2 Unduplicated Count 92 85 3. How many CorMville residents did your agency serve? 3 Unduplicated Count 10 12 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 Female: 50 Caucasian 99 6-17 77 Male 65 African American 12 18-29 38 Hispanic 1 30-61 Asian 2 62-75 European 1 >75 3. Briefly describe your service population. MYEP provides services to youth and young adults that have a variety of "disadvantages", which can be a physical or mental handicap, low income, single parent household, on probation, etc. 4. How do you determine eligibility for services? MYEP has intake process that requires individuals seeking our services to fill out forms with various questions pertaining to eligibility. For example, the Urban Youth Corps Grant requires that the individual be between the ages of 16 to 21 who face barriers to employment. The HCBS Waiver program requires that the individual be on the Waiver and has a case manager. Thus, we have to determine eligibility per each individual youth and their needs for services. 5. Are there fees for your services? Yes X No__ If yes, please describe your fee structure: Grants prohibit charging fees for participation, so grant-funded activities are offered free of charge to eligible participants - the only exception to this would be if a grant required matching funds and allowed participants to pay for services as eligible match. Parents are charged a flat fee if applicable. That is, if the youth is attending MYEP and the cost is covered by other sources, such as the Johnson County DHS, or MH/DD then they will not pay. If the youth is not eligible for funding through other sources, then the family pays a flat fee. j ccoghs\funding form. doc 4 Agency Name: Mayor's Youth Employment Program (MYEP) 6. Do you provide services to areas outside of Johnson County? Yes, particularly surrounding communities. Because of the nature of the after school programs, this primarily takes place during the summer months. If a referral comes from another county, MYEP will attempt to serve them or direct them to another provider that can serve their needs. Area(s) served: Washington, Iowa, Linn, and Cedar. Services Provided: Youth attend some of our in house programs, such as Teen Place, from other counties. We also have just begun providing Home and Community Based Services (HCBS) to individuals as referrals are made. We have had youth from other counties apply to our summer Urban Youth Corps. Funding Sources: The summer Teen Place youth am funded through the Mental Health/Developmental Disabilities Department, parent pay, Department of Human Services, Career Exploration, or HCBS Medicaid Waiver program. The Urban Youth Corps is a grant funded program. j ccoghs\funding form.doc 5 Agency Name: Mayor's Youth Employment Program (MYEP) Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client- Surveys, attendance, number of complaints (b) Community- Surveys 2. Briefly summarize your findings: The most recent survey MYEP has performed was in conjunction with our summer teen place program to assess the satisfaction of the parents, staff, and consumers. The general overall response was very positive. The following is the break out: We are clear on Summer Program rules, policies, and procedures. YES: 90% Our communication with MYEP has been good. YES: 100% My child is benefiting from the Summer Program. YES: 100% MYEP has worked to make the Summer Program affordable for us. YES: 100% Summer Program is meeting/exceeding our expectations. YES: 100% 3. What changes have been made in response to these findings? MYEP has and continues to make available the rules, policies, and procedures to parents, case managers, and consumers. We have a bulletin board at the door which contains this information, as well as a file box for parents to check for documentation/information regarding upcoming events and activities for the youth and families. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Johnson County MH/DD Case Managers 55% Iowa City Community School District 20% Juvenile Court Officers 15% Parents 5% DHS 5% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? United Action for Youth, Youth Homes, Neighborhood Centers, Big Brothers/Big Sisters, Goodwill, ARC, Lifeskills, Systems Unlimited, Reach for Your Potential, and Workforce Investment Act/Job Training Partnership Act. j ccoghs\funding form.doc 6 Agency Name: Mayor's Youth Employment Program (MYEP) 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. MYEP provides a summer program that specifically fits the needs that youth, parents, and case managers are requesting. We provide Johnson County's only full day program, Monday through Friday, during the summer, to assist youth with a wide variety of skills developed to suit the individuals needs of the young person. During the school year, we provide Johnson County's only after school program that also caters to the individual youth's needs and skills. Our employment services are available year round to individuals seeking employment or assistance with resumes, interviewing, conduct, etc. MYEP owns and operates its own bike shop to assist youth with developing work skills needed for employment in the community. The bike shop provides the ability for MYEP to do skills assessments in house before making the transition to competitive employment in the community. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Corps of Engineers - Coralville Lake 1. MYEP applies for a youth summer employment grant that requires match money. The Corps of Engineers provides match money, work sites, staff assistance and MYEP administers the grant and hires the youth. 2. Sixth Judicial Department of Corrections - 2. MYEP operates a bicycle repair shop in Hope House our building and residents from Hope House have the opportunity to participate in bike repair activities. They are able to repair bicycles that will be donated to Project Holiday or sold to the public at a very minimal price. These individuals are learning various employment skills as well as obtaining some self-worth for what they are doing. MYEP provides the site, equipment, and staff, while Sixth Judicial provides the individuals to attend and is assisting in getting several of the bikes painted. 3. Iowa City Community School District 3. MYEP was allowed to utilize a class room during the summer of 2002 as a site for some of our Teen Place youth. Also, a special education teacher assisted MYEP in delivering services to these individuals during the summer. MYEP provides the young people and staff, the ICCSD is providing the site and some staff time. j ccoghs\funding form. doc 7 Agency Name: Mayor's Youth Employment Program (MYEP) Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. The overwhelming need in the community to 1. - Strategic Planning serve the physically/mentally challenged - Secure Funding individuals in a summer and after school program. 2. Improve governance 2. - Revise Board size, membership, terms, duties, etc. - Revise agency by-laws 3. Redefine vision and mission 3. - Strategic Planning - Cooperation with funders and community needs assessments - Assess agency strengths/needs 4. In what way will the needs of your service population change in the next five years? The needs of MYEP's youth will continue to expand due to the loss of funding for services that they need. In reviewing the economic state of funding, there continues to be less money to serve more individuals, leading to an even greater need. There will be an even greater need for employment training for our service population in light of the fact that economic factors are making jobs scarce. Also, there are increasing numbers of two parents working outside of the home and single parent households, which leads to a rising need for after school and summer care. The reduction/elimination of MH/DD funding will increase desire for unfunded services by target population (youth under age 18 desiring employment services and school age youth (up to age 21) in special education desiring summer daycare and summer daycare services). Also, middle income families over 300% of the federal poverty level are ineligible for MH/DD funding assistance but unable to pay for 100% of services are going to be seeking alternatives that are less expensive or partially funded through other revenue sources. Currently, we are seeing a steady increase in the number of referrals of these individuals and expect that this will continue. 5. How do you plan to address these changes? MYEP most recently went through a strategic planning process in which many of these issues came forward. MYEP currently has a summer and after school program in place, but needs to develop it further by securing funding that will assist those individuals that "fail through the cracks." Seeking out grants is always something that is being done at MYEP, but possibly a more aggressive approach will need to take place in order to assure funding for these individuals. We also plan on utilizing United Way, City, and County funding to catch some of these individuals that are "falling through the cracks," and that need the wide variety of services that MYEP is able to provide. j ccoghs\funding form. doc 8 Agency Name: Mayor's Youth Employment Program (MYEP) 6. Describe the evaluation methods you use to measure the success of your services? We utilize surveys given to the consumers, parents, staff, community members, and funding sources. Most recently, MYEP participated in a Quality Assurance check done through the Johnson County Mental Health/Developmental Disabilities Department. We applied and became HCBS certified in April 2002 and we are currently working with the Council of Quality and Leadership to become accredited through their program which is a national organization. These are all outcome-based measures of success. We also know that MYEP is seeing an increase in the number of referrals being made. 7. What are the results of these evaluations (outcomes)? The results of MYEP's most recent survey is stated in Section 3, #2. MYEP has not yet received the results of the most recent Quality Assurance check done through the Johnson County MH/DD Department. This should be forthcoming fairly soon. Also, we just became an HCBS certified provider in April 2002, and are in the process of going through the accreditation process through the Council of Quality and Leadership. The evaluation process for these entities should take place within the next year. 8. How do you plan to use the evaluation results to enhance/extend your services? MYEP plans on continuously surveying the consumers, parents, staff, community members, and funding sources in order to assure the quality of our services. We will utilize this information to improve/change our services in order that they are meeting the needs of the individuals involved with MYEP. Once we receive the evaluations from the other sources, we will utilize it to make adjustments where deemed necessary to provide high quality services to the individuals. It is imperative that we are correctly documenting our services, keeping appropriate documents in the files, etc., in order to continue providing quality services. 9. How do your programs/services impact the community? MYEP provides programs/services that keep youth in the community involved in positive activities in a safe, healthy, and nurturing environment. Thus, these youth are not out on the streets or left home alone to fend for themselves while their parents are at work. We work with these individuals to teach them employment training, career exploration, life skill building, community activities, and a wide variety of social and recreational activities. These young people are the future of our community and we feel that we are assisting in preparing them to be productive tax paying citizens that will be active members in our society. 10. How did the agency respond to the UWJC recommendations from last year? The Citizen Review Panel felt that MYEP was creative in their programming for disadvantaged youth, but had some concerns about the stability of the agency and its ability to meet the challenges ahead. The panel recommended that MYEP expand and strengthen its Board and that a Board j ccoghs\funding form.doc 9 Agency Name: Mayor's Youth Employment Program (MYEP) member be present at future Joint Funding hearings. They also recommended that MYEP develop a more realistic budget and a strategic plan. MYEP held a strategic planning session in September, 2002, with a facilitator from Grant Wood AEA assisting the process. This was one of the recommendations made by the UWJC and was taken very seriously. At this strategic planning session, several of the recommendations made by the UWJC were discussed and plans were made to review/revise some of the practices at MYEP. The board, director, and staffwill work closely to develop a mission statement, vision, and more realistic budget for the upcoming year, as well as the following year. The board members also believe that board governance needs to be reviewed and revised. Discussion took place on increasing the size of the board, more involvement, longer meetings, and the need for the board president to be present for the review hearing meeting. j ccoghs\funding form. doc 10 Agency Name: Mayor's Youth Employment Program (MYEP) Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? 5 people 4. How is the board involved in strategic planning and governance of the agency? On September 11, 2002, MYEP staff and board utilized a facilitator from Grantwood AEA to assist with a strategic planning session. This was the first one to take place in several years. At this strategic planning session, the board members expressed many ideas to improve their involvement in the governance of the agency, such as improved financial policies, more involvement by board members, increased amount of time spent at board meetings and possibly a greater number of board members. Major Outcomes from the strategic planning session: Review/revise mission statement, direction, and scope of services Realistic budget for upcoming fiscal year Review/revise board governance Future plans: Establish a fundraising program Stable, ample sources of revenue Establish direction and goals Seek out a different facility 5. What type of training/orientation do board members receive? The Agency Director and/or the Board President meet with each prospective Board Member before a commitment is made to join the board. The following information is provided in a binder: > Budget > Program Information ~' Staff Policies and Procedures By-laws Articles of Incorporation Past Minutes from Meetings (at least 3 months) Board Members The Board President discusses the responsibility of the Board using materials for serving on non-profit boards. Each Board Member receives a copy of "Roberts Rules of Order" and "Managing a Nonprofit Organization" to use as a reference. j ccoghs~funding form.doc 11 Agency Name: Mayor's Youth Employment Program (MYEP) 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Yes, 4/02 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Yes, 06/01 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? No MYEP's FY02 has not ended by the time that this report is due, thus the IRS form 990 will not have been filed for the most current fiscal year end. If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? How much did the audit cost? Steve Kuhl, Greenwood and Crim $2,700 If material weaknesses are noted in the audit, what is your plan for addressing them? No material weaknesses were noted in the most recent audit. If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X b. employment practice liability 1,000,000 General Liability X 1,000,000/ 2,000,000 Umbrella Liability Professional Liability X 1,000,000/ 2,000,000 Property or Renters X 50,000 Vehicle X 500,000 j ccoghs\funding form. doc 12 Agency Name: Mayor's Youth Employment Program (MYEP) Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Cokie Ikerd has been employed with MYEP since January, 1991, in a variety of capacities to the organization. Most recently, she was appointed the Interim Director. She has a BA in Psychology, and most recently has received her MBA from the University of Iowa. She opted to take elective classes during her MBA studies that would lend itself to the non-profit arena., such as "Training and Development" taught by Jude West and "Non-Profit Management" taught by Sandy Boyd. 2. StaffSalaries &Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X X $39,000 to $43,000 1.00 1.00 1.00 Waiver Services X X X $29,000 to $33,000 .58 1.00 1.00 Coordinator Director of Services X X X $34,000 to $38,000 .50 1.00 1.00 Assistant Director~ X X X $34,000 to $38,000 .58 0 0 Direct Care Staff $8/hr. to $11/hr. 1.75 1.21 1.51 Bicycle repair specialist $8/hr. to $11/hr. .50 .83 .83 Summer Staff $8/hr. to $1 I/hr. 2.88 2.76 3.00 Crew Leader3 $9/hr. to $11/hr. .15 .15 .15 TOTAL FTEs 7.94 7.95 8.49 1 The Executive Director resigned in May 2002. The MYEP Board of Directors appointed the Associate Director at that time as the Interim Director for 6 months of FY02. This position for FY03 and FY04 is not going to be replaced. 2 The summer staff are individuals that work in our 10 week program for approximately 40 hours per week. It is many individuals working for a short period of time during the fiscal year. 3 The Crew Leader is a grant funded position for the summer Urban Youth Corps program. It is an eight week program. j ccoghs\£unding form. doc 13 Agency Name: Mayor's Youth Employment Program (MYEP) 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? Approximately 7.71 FTE's serve Johnson County (that is approximately 97% are Johnson County). 4. How much was spent on staff development in the last fiscal year? $1,715 5. How much is budgeted for staff development in this fiscal year? $5,500 6. What training and support opportunities are offered to staff?. All staff is constantly researching and reviewing training opportunities that will lend itself to MYEP providing quality services. Staff is continuously encouraged to participate in any relevant training that would assist in their ability to perform their job at MYEP. All relevant training opportunities are reviewed by staff and decided if and how many staff should attend. Some of the training opportunities MYEP encourages/requires are the following: > CPR ~ First Aid >' Blood Born Pathogens Mandatory Reporting Center for Disabilities Training - Behavior Management Employment related training/seminars, such as child labor law issues, policies and procedures ~ Child care regulations/guidelines ~' HCBS Waiver training 7. Please attach current organizational chart as Appendix B. Please see Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? The permanent full time staff have not received salary increases from FY01 to FY02 (current fiscal year). This is due partially to staff turn over and new positions being added to the organization which has instituted some reorganization of staff. The part time staff in general received increases at some point during FY02. We have a large number of part time staff, thus this varies, but it was approximately 5%. j ccoghs\funding form. doc 14 Agency Name: Mayor's Youth Employment Program (MYEP) Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board last reviewed? 4/02 10. Does your board X annually evaluate the director's performance? ! 1. Does your agency X have job descriptions for every position? If yes, date of last board approval? 3/02 12. Is there an annual X performance review for every staff?. j ccoghs\fundingform, doc 15 Agency: Mayor's Youth Employment Program (MYEP) A. Three Year Historical Balance Sheet (As o~ yeur fiscaI year-end) , t 0~98-9~99 t 0100-910 Current Assets Current LiabiJities Cash ! Accoun!s Payable Investments / Other ~ i blortg~ge p~yab!e-6 months Total Current Assets $0 ~ $0J $0 Total Current Liabilities $o $o Other Liabilities Property i ! IM°rtgage Paya ble~B~ia~ less depreciation : Total Other Liabilities $0 $0 Re~!v~ble[~0 da~vs Total Liabilities $0 $0 $0 Total Non-current Assets $0 $0 $0 I Totsl Assets $0 $0 $0 Liabilities & Net Assets $0 $0 Agency Name: Mayor's Youth Employment Program (MYEP) ! i0;°,-9,02 9'02-9'0; Iowa City $43,483 $44,362549 250 lhese numbers differ due to MYEP's odd Coralville [ $2,563 ~ $2,813 t $3,250 fiscal year. Johnson County $2,625 [ $1,000 $5,500 UnitedWay-AIIocation [ $6,052 [ $6,000 i $13,500~ - Designated Giving $1,912 $2,000 ~ $2,200[ Grants-Federal, State, Foundation i $64845 $97695 [ $108,456/Increase in FY03 & FY04 dueto SAMHSA grant ~lncrea~e in FY03 due to a full year of providing / Net Sales of Service I $239,521 L $330,740 $343,740 HOBS Waiver Services Contdbufions/Fundraising $1,078 $3,000 $4,000 J Investment [nceme i $2,759i ~ $2,900 [/ othe? I I T°t~l Income / $365~238 I $492 610 $535 796 ~ $223,257 $257 024 $283 722 Wages & Salaries Benefits i $46,080 ! $65,000 $71,000 Occupancy / $22,621 I $30,000 I $54,000 hncrea.~,e in FY04 due to new/different facility Non-occupancy $62,300 $127,020 $132,300 ,$ervicesthrougha¢ontractwithMYEP Total Expenses / $354,258 ~ $479 044 $541 022 Revenue $365,238 $492,610 $535,796 Carryover Balance from previous year $182,440 $193,420. $206,986 . Total Operating Budget $547,678 $686,030 $742,782 Less Total Expenses $354,258 $479,044 $541,022 Ending Fund Balance $193,420. $206,986 $201,760 Less Restricted Balance (explain) Carryover Fund Balance $193,420 I $206,986 $201,760 1'7 Agency Name: Mayor's Youth Employment Program (MYEP) / Restricted Funds Desiilnatsd for: 10/01-9/02 [ 10~02~9i03 D. Bd/Donor/Funder IowaDept of Transportation Grant purposes $31,123 ~ $32,000 $32,000 'vlH/DD supported employment ~C°ntra~ur~°ses $47,295 $0 J 'vlH/DD Teen Place lontract purBoses . $50,000 $0 $0 City of Coralville - grant match ~Grant pu~oses $4,000 $4,000 D00 Teen Place - Parent Fees ~ontracl purposes $9,500 $4,500 I. Gran~ ~orps Of ~n§ineer~ / $201000 $20,000 SAMHSA Grant"urp°se~ i $0 ~ii~95 $50,456 Total Restricted Funds ~! $161,918; $102,19~ $110,956 =. in Kind ~;pport.' t '1°/01-9102 i0i02 work study, board m~n~bers, community ServicesNolun eers Iservce | $10,440 $15,840 I $19,800 Uat ria, eoods [bikes, food, quipment, oomputers, $8,766i $10,0001 $12,000 Total In-kind Support i~wGar~ptsa rtment o f Trans~oort ation Yout h EmplDo:~::tiOnlPurpOse :::::::::::::::::::::::::::: Johnson County MH/DD Accreditation $5,000 $0 $0 SAMSHA [Violence Prevention fo~ Vulnerable Y0u'h $0~ $41,695 $50456 Total Grants $36,123 $73,605 82, ~ M¥[P currently ~a~s $1 000/month for a facility with a market rent ~alue of al least $3,000/month. There sre plans to expandlNOrth Dodge Agency Name: Mayor's Youth iEmployment Program (MYEP) Appendix A MYEP BOARD OF DIRECTORS - OFFICERS May, 2002 Town: Iowa City, IA Work: U of I Student Occupation: Student Term: 10/01-9/03 Linda Fairchild Finance Committee/Special Committee to address concerns of UW Town: Iowa City, IA Work: Community Corrections Improvement Association Occupation: Grant Writer Term: 11/01-10/03 T_o_l!!__C. ffit0_k, gfl Finance Committee/Special Committee to address concerns of UW Town: Solon, IA Work: ACT Occupation: Accountant Term: 12/01-11/03 ~flc[ll~(Treasurer)/Execntive Committee Town: Iowa City, IA Work: U of I Library Occupation: Finance Department Term: 8/02-7/04 Ed McElen~e,X Town: Iowa City, IA Work: Coldwell Banker Occupation: Realtor Term: 6/01-5/03 Deb Noel (President)/Executive Committee Town: Iowa City, IA Work: Noel's Tree & Crane Service Occupation: Business Manager/Owner Term: 1/00-12/02 Pat Moffitt Town: Solon, IA Work: Eye Physicians & Surgeons LLP Occupation: Office Manager Term: 10/01-9/03 Agency Name: Mayor's Youth Employment Program (MYEP) Appendix B MYEP TABLE OF ORGANIZATION MYEP Board of Directors President, Secretary, Treasurer Plus, 4 Directors ] Funding ] ¢ Clienta Sources Parents Referral Sources Executive Director I Director of Services 14 ,~l HCBS Waiver Services Coordinator Crew Leaders Direct Care Staff Bicycle Repair Specialist Summer Staff Youth Employees Program Participants Section 1: Background Agency Name: Community Mental Health Center for Mid-Eastern Iowa Address: 507 East College Street, Iowa City Phone: 338-. 78/~4 Director Name: Stephen Trefz Signature: ~ Bd. Pres Name: David Schuldt Signature:/~,~"/z-~/ ~--------- Request Completed By: Date: Q'/~ '7/0 ~_. Theresa Uilerich, Sherri Zastrow, Stephen Trefz / / Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated $25,873 $23,999 $26,000 ivin or S ecial Needs Grants FY 02 FY 03 FY 04 City of Iowa City Johnson County City of Coralville What were local funds used for this year: United Way funds were used as matching funds for the Performance Partnership Federal Block Grant for community mental health services. The grant funds two programs, the PACE program and the School Liaison Program. What will next year's local funds be used for? In Fiscal year 2004 United Way funds will be used for the same two programs. Agency Mission Statement: The Community Mental Health Center for Mid-Eastern Iowa promotes and provides quality, accessible, accredited mental health services to any child or adult in need of care. Summarize your programs and services for which you are requesting funding: PACE focuses on families where one or both parents have a mental illness. The staff provides personal support, helps develop community support, and assist in developing individualized treatment plans in collaboration with clients, family and significant others reflecting the client's goals, and create crisis plans to reduce and/or eliminate the number and/or intensity of crisis times. They provide education for the children about mental illness, a group for mothers, and help families connect to needed resources such as mental health services, housing assistance, assistance in the schools, the Crisis Center, legal aid, transportation, etc. Agency Name: Community Mental Health Center for Mid-Eastern Iowa The School Liaison Program provides a combination of consultation/education and direct service to children with severe mental illness. Consultation occurs with teachers, school counselors and other school personnel who identify significant mental health concerns about a child. The liaison teaches strategies for reducing stress in the child, understanding and improving behavior, improving student-teacher relations and promoting cooperation between families and schools. The service occurs primarily in the school and consists of providing mental health assessments, counseling, referral and assistance with accessing mental health services. List any accreditation and licensure your agency currently has. Explain. I. Accreditation as a community mental health center by Iowa Department of Human Services for the following programs: Outpatient Psychotherapy, Psychiatry, Emergency, Psychiatric Rehabilitation Services, and Supportive Community Living Services. May 2002 through May 2005 2. Rehabilitative Treatment and Supportive Services accredited by Iowa Department of Human Services. July 2002 through June 2004. 3. All staff maintain current pro fessional licenses. Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Community Mental Health Center is one of thirty-two community mental health centers in the state of Iowa. The community mental health center movement was launched in 1963 with passage of the Community Mental Health Centers Act in the Kennedy administration. The Center opened in 1969, offering outpatient Psychotherapy and Psychiatry services, consultation, education and evaluation services. We now provide those services plus the Supported Conxrnunity Living program, Intensive Psychiatric Rehabilitation Services, Family Support Services, Family Centered Services, the Homeless Outreach Program, Clubhouse Adult Rehab Option, Community Employment Assistance Program, and School Liaison Program. The Center strives for community involvement, encouraging our staff to serve on boards and consult with local agencies. Our Board of Directors is the policy-making body of the Center. The current Board is made of seventeen people from four counties (Cedar, Iowa, Louisa, and Johnson counties.) We are now in the third year of our 5 year strategic plan. This document was a joint effort of the Board of Directors and CMHC staff. It is a living, working document. County MH-DD dollars are in a managed system with a universal application process and a fee-for- service reimbursement system. The requirements of managed care are demanding. Managing our increased costs is very difficult. Current activities, as well as future plans, will involve our need to both influence and respond to a continuing environment of health care reform. We are CUITently looking to replace or upgrade our 10-year-old management information system to better handle client file management, billing requirements, and federal Health Insurance Portability and Accountability Act (H1PAA) regulations. HIPPA regulations address policies and procedures to ensure client confidentiality. This encompasses everything from rewriting privacy policies, to reconfiguring reception area desks, to computer firewalls and security. HIPPA compliance is proving to be an expensive endeavor as well as being very demanding of staff time. j ccoghs\funding form. doc 2 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Currently, the greatest issue we face is the increasing complexity of managing mental health care services. Nationally, 87% of people who are fortunate enough to have health insurance are now enrolled in managed plans. County dollars are managed by Central Points of Coordination. While contracting to provide services to four mid-eastern Iowa counties, we bill up to 69 counties each month based on the legal settlement of each individual client. Ifa person is legally settled in another state they become a State of Iowa case and the State of Iowa must be billed. We have over 250 state cases per year, compared to fewer than ten annually at most community mental health centers. Future plans will require our being aware of changes in state funding to the MH-DD system, the standardization of both financial and clinical eligibility criteria and changes in the notion of payment based on legal settlement. Working to support parity for mental health care, building relationships with our state and federal legislators, and community programming to raise awareness for mental health issues are all part of our strategic plan. Since 1976 the Center has been housed in what is now four buildings at the comer of College and Van Buren Streets. Our Board of Directors has begun studying the question of how to best meet our current and future space needs. j ccoghs\funding form. doc 3 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Section 2: Client Profile F¥0 Y02 1. How many Johnson County residents (Including IC & 1 Unduplicated Count Coralville) did your agency serve? 1770 1834 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 1221 1306 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 260 253 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 32 Female: 1426 African American 98 6-17 245 Male 958 Native American 11 18-29 648 Asian 14 30-61 1376 Hispanic 39 62-74 69 White 2177 > =75 17 Multiracial/unknown 48 3. Briefly describe your service population. · The majority of our service population is low income. 69% of our clients have income under $15,000 per year. · The majority of our service population is state or county funded. 59% are state or county funded; 16% are on Title 19 · Most people in our service population present with at least 6 different problems or life stressors at time of intake. · We see people that no one else will see. *NOTE The PACE program served 27 families. The School Liaison served 23 children. 4. How do you determine eligibility for services? Any U.S. citizen is eligible. 5. Are there fees for your services? Yes X No__ If yes, please describe your fee structure: We use the sliding fee scale required by the Johnson County Management Plan. 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Cedar County (Tipton office), Louisa County (Wapello office), Iowa County (Marengo office). Services Provided: Psychiatry, Psychotherapy, Supported Community Living, PACE, School Liaison Program, Consultation & Education j ccoghs\funding form.doc 4 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Funding Sources: Counties' MH/DD funds, private insurance and fees for service, federal block grant funds, Medicaid, Medicare, state payment program. jccoghs\fundingform, doc 5 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: We conduct client satisfaction surveys, the most recent one being in February, 02. (b) Community: Every three years our programs, clinical records and quality assurance activities are reviewed by the MH-DD division of the Iowa Department of Human Services. Satisfaction surveys are given to all participants at our community educational programs. 2. Briefly summarize your findings: Clients: Results: 91% indicated it was easy to make an appointment; 100% rated our support staff as being helpful and courteous; 100% said they would use our services again; 100% said they would refer a family or friend for services if needed; 90% rated their individual services as excellent. Community: We are accredited for 3 years, until 2005, on all services reviewed Educational Programs - Surveys reveal both satisfaction and encouragement to do more. 3. What changes have been made in response to these findings? We have a standing staff quality assurance committee to review our programs, charts, and business practices so as to maintain the high ratings of our consumers and the community. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Physician 33% DHS/other agency/caseworker 21% Family or friend 26% School 7% Self 13% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? The University of Iowa and private practice physicians and therapists provide psychotherapy and psychiatry services. Life Skills, Goodwill, Hillcrest Family Services, Lutheran Social Services provide in-home Community Support Services. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. We tend to see the sickest people, the tough cases that no one else will take. j ccoghs\funding form. doc 6 Agency Name: Community Mental Health Center for Mid-Eastern Iowa We provide services to people whose fees are paid by insurance (which some private practices do not), by the county, and by Medicare and Medicaid. We are the last resort for many patients. Ours is the only client-driven Clubhouse for people living with chronic mental illness. Our services are comprehensive. We have psychiatry, psychotherapy, and community support programs on-site. We see all ages. Our fees are based on the sliding the scale, and we accept title 19. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Emergency Housing Project, DV1P, Free 1. PATH program - outreach to homeless or Lunch, Free Medical Clinic, Salvation Army near homeless individuals with a mental illness. Our PATH employees work intimately will all of these agencies serving common clients 2. Iowa City Community School District 2. School Liaison Program - We provide a licensed psychotherapist on-site at Mark Twain Elementary School. This person is available for consult throughout the ICCSD 3. NAMI, Hillcrest Family Services, JCCOG, 3. Programming for community education UIHC, UAY, Elder Services, Iowa City and awareness of mental health issues Community School District j cc oghs\funding form.doc 7 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Section 4: Strategic Plannin~ and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies l.An increased willingness and understanding Active collaboration with these providers to from collaborating providers for the need for enhance existing relationships and to provide Mental Health services in their training and/or direct services for and with facilities/programs such as schools, businesses these other providers. and corrections. 2.Decreasing funds and services on all levels to 2. Advocacy and relationship building with provide increasingly more complicated and law and policy makers locally and nationally. complex services to a population of clients that Working collaboratively with other providers are becoming more complicated, complex and to make the most out of limited resources. ~vith fewer resoumes available to them. Exploring the development and implementation of prevention and educational )rograms. 3. Increased external demands and need for l.Exploring technological answers with other communication, data and documentation from providers to share the expense and the and to governmental bodies and funders and complexity of the technological "solutions". increased request for information from collateral providers. 2. In what way will the needs of your service population change in the next five years? We anticipate that we will be seeing clients that are younger and are experiencing symptoms of mental illness sooner in their development. We also are seeing our clients age which presents new challenges for families and providers of mental health services. We will be able to utilize far more effective and expensive psychiatric medications. More of the clients that we serve will be coming to us with co-occurring disorders such as mental illness and substance use, mental illness and chronic physical health problems. Our clients will have fewer services, fewer natural support systems and fewer funds available. 3. How do you plan to address these changes? Strengthening and expanding our services to schools and families with school age children will address the acute needs of today's children that require care and support now and it will also act as a prevention program for the children and families that are yet to enter the system. We will teach children how to take care of themselves emotionally as well as be aware of signs and symptoms of mental illness for early intervention. We have begun to research programming and funding for serving the elder population and to utilize staff that have training and expertise in this area. Looking to work with more primary care physicians who still write the most prescriptions for anti- j ccoghs\funding form. doc 8 Agency Name: Community Mental Health Center for Mid-Eastern Iowa depressant medications to collaborate in the provision of mental health services in a primary care setting. 4. Describe the evaluation methods you use to measure the success of your services? The Center and the staff are accredited by the MH/DD division of the Iowa Department of Human Services every three years as well as audited by our local MH/DD services at the county level. Virtually all the clients that come to the Center are members of some type of managed care plan that continually audits and reviews the outcomes of the services we provide. In addition to these external sources we do internal reviews of our services/outcomes ranging from client satisfaction surveys that are done annually to specific instruments that measure quality of life changes to specific goal attainment scales that are established by clients and their therapists that are reviewed regularly. 5. What are the results of these evaluations (outcomes)? For the purposes of this report I will focus on out comes for the two programs that United Way allocates funds to which are PACE and SLP. PACE: Clients enrolled in the PACE program: 1 ] 77% reported improvement in their ability to balance their family responsibilities 2] 55% report that they manage their mental illness better 3] 55% reported better relationships with their children 4] 44% report improvement in their housing arrangements 5] 22% reported improvement in their employment status 6] 33 % reported they had increased resources to use in the event of a crisis 7] 89% of those enrolled in the program decreased unplanned hospitalizations or remained hospital free. One client went from 6 hospitalizations per year to one 8] 79% of the families reduced their foster care placements or had no placements 9] 93% of the families decreased their need for child psychiatry placements or remained free of these placements SLP: Students involved in the SLP: 1] had deceased number of visits to the principals office for class room behavior problems 2] had increased homework completion 3] decreased number of tardies and absences form school 3] class room staff report increased involvement with parents in their child's school life 4] communication between the school staff and the mental health staff improved and treatment was facilitated. 6. How do you plan to use the evaluation results to enhance/extend your services? 1] Collaborate with ICCSD to expand the SLP in to other elementary schools 2] Increase collaborative educational and prevention programming with ICCSD and other community providers 3] Provide increased in service training to other collaborating agencies regarding mental health/illness 4] Explore funding options to enhance mental health services to the elders of our community. 5] Expand services that will enhance and increase natural support systems for our clients. 7. How do your programs/services impact the community? The Community Mental Health Center for Mid-Eastern Iowa provides a full continuum of accredited outpatient mental health services to the Johnson County community. This last year 1,369 Johnson County residents were served. Because 70% of these clients earn less than $15,000.00 per year our center was the only provider where they could receive this type of care. The Center also brings state and federal funds to the Johnson County community to provide these services. The United Way allocation has allowed us to leverage approximately $68,000.00 in federal funds and our status as a Community Mental Health Center has allowed us to draw down approximately $120,000.00 in state funds to provide services to the mentally ill. The relationships that the center has established with pharmaceutical companies brings approximately $750,000.00 in sample psychiatric medications to our community that allows people to use medications that have no other means to purchase them. The j ccoghs\funding form.doc 9 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Center provides an enviromnent of hope and support along with gifted, skilled and compassionate staff for people from our community with mental illness to recover and return to their roles in our community. The Center also provides a wide array of informational and educational programming concerning mental health and mental illness to the public and businesses. 8. How did the agency respond to the UWJC recommendations from last year? United way asked us to continue to do strategic planning, which we have and asked us to bring a Board member to the Allocations hearing which we have. j ccoghs\funding form. doc 10 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Bimonthly 3. What is your average attendance at board meetings? 11 4. How is the board involved in strategic planning and governance of the agency? Our strategic plan was a joint effort of board and staff. A report is given to the board on each of the four components of the strategic plan (Organizational Processes and Effectiveness, Financial Stability, Service Development, and Marketing). A yearly retreat is held, facilitated by Ron Mirr, to evaluate the strategic plan. 5. What type of training/orientation do board members receive? New board members are given a notebook with historical, financial, & service data plus an orientation meeting to go over the information. We begin each meeting with an education component related to service delivery, center programming, and the like. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? _2000 7. Have you filed the annual report with the Secretary of State? If yes, date filed? 7/18/01 __ 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? ~Nov 15, 2001__ If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes x No If yes, Who completed the audit? Clifton Gunderson How much did the audit cost? $8,400 If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X $2,000,000 b. employment practice liability X $2,000,000 General Liability X 1 mil/3 mil Umbrella Liability X 1.000,000 Professional Liability X 1 mil/3 mil Property or Renters X 2,250,000 Vehicle X $1,000,000 j ccoghs\funding form. doc 11 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Length of employment: 16 years, 2 months, Education: Coe College, Cedar Rapids, IA, BA, 1973, University of Iowa, Iowa City, IA, MSW, 1979, Licensure: License of Iowa Social Workers: State of Iowa, Positions Held at Community Mental Health Center: 1986-Present Clinical Social Worker, 1992-1996 Outpatient Coordinator, 1996-2001 Director o f Clinical Services, 2001-Present Executive Director. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X X $63,500-$74,000 1.00 1.00 1.00 Clinical Social X X X $22,000-$49,000 13.72 13.28 13.28 Workers Clinical Psychologist X X X $40,000-$51,000 1.00 1.00 1.00 SCL Counselors X X X $2000-$30,000 5.25 5.15 6.02 Psychiatrists X X X $115,000-$145,000 2.00 2.00 2.00 Physician Assistant X X X $56,000-$63,500 1.00 1.00 1.00 Nurses X X X $35,000-$40,000 1.75 1.75 1.75 Financial Director & X X X $25,000-$37,000 2.00 2.00 2.00 Accountant Director of Insurance, X X X $37,500-$42,000 1.00 1.00 1.00 Billing & Intake Intake, Billing X X X $26,000-$30,000 2.99 3.00 3.00 OfcMgr/Secretaries/ X X X $11,000-$30,000 6.26 6.43 6.43 Med Records Clerk, Clerical Temp Maintenance X $10,000-12,000 0.51 0.50 0.50 Director Of Operations X X X $43,000-$47,000 1.00 1.00 1.00 Program Director X X X $14,500-16,500 0 0.46 0.50 Contracted part-time $70-$125 per hour 0.33 0.33 0.33 psychiatrists TOTAL FTEs 39.81 39.9 40.81 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 37.42 4. How much was spent on staff development in the last fiscal year? $19,403 j ccoghs\funding form.doc 12 Agency Name: Community Mental Health Center for Mid-Eastern Iowa 5. How much is budgeted for staff development in this fiscal year? $18,000 6. What training and support opportunities are offered to staff?. Professional publications, conferences and seminars, professional organization membership dues, professional training, licensure exam fees and renewal fees, in-house training. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3% Yes No If no, brief explanation 9. Does your agency have personnel X policies? If yes, date board FY2000 last reviewed? 10. Does your board annually evaluate X the director's performance? 11. Does your agency have job X Not a board responsibility, except Executive descriptions for Director every position? If yes, date of last board approval? 12. Is there an annual performance X review for every staff'?. j ccoghs\funding form.doc 13 Agency Name: Community Mental Health Center for Mid-Eastern Iowa Appendix A FY02 Board of Directors: 17 Board Members ? Johnson County, 4 Iowa County, 4 Cedar County, 1 Louisa County Officers: David Schuldt, President Coralville Retired: Director, Wesley House Term: 1998 - 2004 Bonnie Sierk, Vice-President Iowa City Community Volunteer Terns: 2001, renewed to 2004 Carol McGhan, Treasurer West Branch Biological Safety Professional U of I Health Protection Office Term: 2000 - 2003 Johnson County Members Jeny Meis Iowa City President, Lenoch & Cilek True Value Hardware Stores Iowa City & Coralville Term: 1997 - 2003 Jo Bowers Iowa City Program Assistant, Rehabilitation Therapies, UIHC Term: 1998 - 2004 Mike Cilek Iowa City Realtor, Coldwell Banker Term: 2000 - 2002 Charles Hesse, M.D. Iowa City Retired physician Term: 2000 - 2003 Pat Dustin Iowa City Retired ICCSD Counselor Term: 2000- 2002 j ccoghs\fundingform.doc 14 I Board of Directors I ! ........................ .?. ~,.o.~.~ ............... ....... _0_~_ _ra_t,_o ri_s_ ......................... [ ShemZastrow ]Operations Director iAgencyI Community Mental Health Center _ for M!dTE;,~tern Iowa Section 7: Financial Management A. Three year H~is~orical Balance Sheet -- -- (?s ~f your fiscal_year~en~ FY O0 FY 01 FY 02 Current Assets -- Cash $503,334 $32ii~72 $616117~ Investments $0 $207,30~7~ $~i4,505 i ReCeivables ~_90 d~ys ~7 ~ .- $194,94-8 - $232,762 I $178,3_25 Other-prepaid expenses $10,644 $5,100 $12,756 Total Current Assets __ $708,926 $766,541 $1,021,756 Other Assests Property $791,365 $797,065 $800,098 E_qu!pment _ _ $151,738 $157,6_34~ $175,83~3 less depreciation -- , ~$318,982)1 ($363,869 ($41~,~25) Receivable§~ 90 days ~ _~ ~$0~ $0 $0 Other $0I $0 $0 Total Non-current Assets $6241121 $59018.30~$559,406 TotaiA~sets -- - ~'11333,047 -$1,357,371 $1,581,162 FY 00 FY 01 FY 02 Current Liabilities Accounts ~a~vable ~ $39,094 $24,532. $23,150 Pa~Yroll Taxes Payable -- I $0 $0 $3,5,036 Acc~uecl Exj3ense~ ~ ' $35,585 $52,034 ~ ~°ntract~pay~ble-lease phon~§tem ~ ~ $10,3(~9 $9,218 I $0 Advance Payment from Johnson County ~ $31,487 $151928 -Total Current Liabilities _ _ $80,890 $85,283 ~ ~110,220 Other Liabilities / Mortgage Payable Balance ,' $0 1 $0 ' $0 ~bli§ation ~nd~rr capital lease, les~ curren{ $9,218 ~ $0 $0 Total Other Liabilities i $~,218 ~ $0 $0 Total Liabi-lities $90,~ 08~: $85,26~ $110,220 NetAssets $1,242,939 $1,272,108 $1,470,942 Liabilities & Ne{Assets $1,333,047 $1,357,37~ $1,581,162 Page 16 Agency Overview ;ency: Comm. Mental Health Ctr for Mid-Eastern Iowa FY02 FY03 FY04 B. Income & Expenses Income Local Funding Sources Iowa City 0 0 0 Coralville 0 0 . 0 Johnson County * 1,238,00: 1,127,505 1,200,000 United Way - Allocation 25,558 24,323 29,067 - Designated Giving 2,737 2,692 3,000 Grants-Federal, State, Foundation ** 128,675 97,382 *** 107,200 Net Sales of Service 1,323,843 1,403,541 1,450,000 Net Sales of Materials 0 0 0 Contributions/Fundraising 36,632 46,295 54,233 Investment Income 13,465 15,000 17,000 Other 19,691 12,200 24,000 Total Income 2,881,456 2,728,938 2,884,500 Expenses Wages & Salaries 1,578,752 1,666,820 1,750,000 Benefits 407,861 422,000 437,500 Occupancy 70,716 83,500 95,000 Non-occupancy 300,031 300,701 302,000 Other -Johnson County medication 357,771 300,000 300,000 Remodeling lower level for more space 34,000 Total Expenses 2,715,131 2,807,021 2,884,500 C. Fund Balance Revenue 2,881,456 2,728,938 2,884,500 Carryover Balance from previous y 20,097 186,422 108,339 Total Operating Budget 2,901,553 2,915,360 2,992,839 Less Total Expenses 2,715,131 2,807,021 2,884,500 Ending Fund Balance 186,422 108,339 108,339 Less Restricted Balance (explain) Carryover Fund Balance 186,422 108,339 108,339 · includes $43,456 one time grants note: $100,000 restricted · *includes $25,000 RWJF grant for Compeer for future space needs · * *includes $10,000 RWJF followup funds I Page 17 Agency:. Community Mental Health Center for Mid-Eastern Iow PACE / Family S~pport Services FY02 FY03~FY04 ! -- United Way- Allocation j 12,706 12,245 13,000~ - Designated Giving ~ 1,368 1,193 1,400. ~rant~-Federa!, State, Foundation Net Sales of S~ice 0 0 Net Sales of Materials - Contributions/Fundraising 7,289 11,464 10,000] Investment Income 7,289 7,0~ 5,520 Other Total Income 63,267 66,234 64,120 Expenses B~ge;[;~Salaries 14130,159609 41;,;5674 ~10:690070 - Total Expenses 6~,267 66,234 64,120/ C. Fund Balance Reyenue ~ Car~over Balance from previous ye O~ 0 Total Operating Budget 63,26~ 66,234' 64,120~ Less Total Expenses ~ 63,267;~ 66,234i 64,1201 Ending Fund Balance ~ 0/ 0 0~ }~ Less hestr~ct~ B~an;e (exPi;i~) ~ Car~over Fund Balance ~ 0 0i 0/ Page 18 _ ~Agency~ community Mental Health Cente[ to[ Mid-Easte[p Iowa School Liaison Program _ [FY02 FY0_3 ~FY04 B. !ncome_ & Exp~pse~ i 1 Income ' 1 10wa City _ 0[ _ 0~ 0~ Coralville 0 O' ~:~;u~ti~n ~ ~ ~12170~I ~,~4~ 13,0~ Grants-Fede[al, St~, Fougdation 24,61~ 34,332/ Sales of Se~ice 0 O' 0 Ne~ Net ~ale~of Mate[ials 0 Contributions/Fundraising ' 2,304 4,400 3,16~ I~vestme~ Incom~ ~ 2,304[ 41404000~ 3,164~ Other 0l Total Income ~ ~},297~ 56,5~54,~ _ Expenses Wages & Salaries Benefits ~cuPanc¢ -- - [ 2,419 3,947 4,200 Non-occ,pa~cy ~ 5,667 6,000] __6,0 pther _ _ _ ~ ~i 0. 0 Total Expenses } 53,297 56,570~ 54,928 C. Fund Balance , Reven;e ~ ~ ~ 5~;29~q ~6,;7~ 54,928~ Car~ov~r Balance frpm p[eviqus year { ~p~ Total~perating~udget ~ ~3,297~ 56~054~28j Less~ot~Expense~ }~ ~ ~ ~ ~ 53;297; 5~ 54,;28 Less Restricted Balance (explain) _ ~ Cat,over Fund Balance/ 0i Page 19 Agency: Community Mental Health Center for Mid-Eastern Iowa D. Bd/Donor/Funder Restricted Funds Designated for: FY 02 FY 03 FY 04 Temporarily restricted net assets - CDBG for building improvements-see audit $86,937 $79,937 $72,937 Robert Wood Johnson foundation grant Compeer Program $0 $25,000 $10,000 Building Fund for building and remodeling $34,000 $134,000 $100,000 Total Restricted Funds $120,937 $238,937 $182,937 E. In Kind Support: FY 02 FY 03 FY 04 Services/Volunteers Social work students-371 hrs at $12 $4,453 $3,000 $4,500 Material Goods Computers from REACT $780 $800 $800 Space, Utilities, etc Other: (Please footnote) Total In-kind Support $5,233 $3,800 $5,300 F. Grants Description/Purpose FY 02 FY 03 FY 04 PATH grant Homeless Outreach $33,213 $29,212 $30,000 Johnson County Mini Block Grants homeless outreach, consultation and ed $47,080 $47,080 $47,080 Federal Block Grant PACE and SLP $69,230 $68,400 $67,500 ISU Extension Grant services to farm and rural families $1,202 $0 $0 Johnson County Ed Equip. Grant )urchase of equipment for education * $5000 $0 $0 Johnson County Quality Improvement Grar to defray costs * $28,456 $0 $0 Johnson County grant for Compeer Compeer program * $10,000 $0 $0 Total Grants $150,725 $144,692 $144,580 · One time year-end grants Page 20 Section 1: Background Agency Name: National Alliance for the Mentally BI of Johnson County Address: P.O. Box 3087 Phone. 319/337:5~0 Iowa City, IA 52244-3087 /'//'~/~---- ~/_ ~f Director Name: Rita Offutt Signature: Bd. Pres Name: Carol Spaziani Signature: ~~ ~r~._~ Dan Hug Request Completed By: Helen Dailey/Rita Offutt Date: 09/27/02 Check Your Agency's Budget Year: 1/1-12/31 X 7/1-6/30 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $2,500 $2,414 $5,000 18% Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City 0 0 0 Johnson County 0 0 0 City of Coralville 0 0 0 What were local funds used for this year: Funds were used to provide educational and outreach materials for the community, and to provide daily phone services for advocacy and support for crisis intervention and information referral. What will next year's local funds be used for? Requested to support the answering service, Tell Me Where To Turn brochure, and educational services and outreach materials for the community. Agency Mission Statement: NAMI-JC provides support, education and advocacy to family members, providers and individuals living with a mental illness. Summarize your programs and services for which you are requesting funding: Education/Advocacy A monthly program meeting featuring expert speakers who are involved with treatment or care of individuals with mental illnesses. An expanding library of books, pamphlets and films are made available at each program meeting to provide educational resources. NAMIJC provides speakers to educate schools and local community groups about issues concerning mental illness, stigma and treatment and recovery. Distribution of about 480 copies of our recently expanded monthly newsletter to members, local, county and state officials, care providers and all of the local agencies that serve persons with mental illnesses. Agency: National Alliance for the Mentally I11 of Johnson County We collaborate with local mental health agencies to provide seminars and panels that will address mental health issues. Members serve on county and state bodies, meet with legislators, write letters, and try to promote parity with care and treatment available for other illnesses. Family/Client Support A support group meets monthly to share information and personal experiences. An answering service is employed to refer inquiries to members who are available to discuss matters of concern to the callers. Limited assistance is provided for family members and consumers to attend regional and national meetings. NAMIJC collaborates with the Mental Health Task force in the purchasing and publishing of the Tell Me Where to Turn brochure that will be revised and published this year. NAMI-JC printed 4,000 copies of our new NAMI-JC brochure that is being placed throughout Johnson County to inform family members, consumers and providers about our services, support groups and classes. Educational Classes Family-To-Family: NAMIJC offers an intensive 12-week class to help support and educate family members of the mentally ill. The course is sponsored by NAMI-IOWA. Five members of NAMI-JC have been trained to teach the course and we presently offer 2 classes per year. Merit Behavioral Care Corporation of Iowa primarily funds the program. Visions for Tomorrow is a new course for caregivers of children who have brain disorders. It is a comprehensive course similar to the Family-To-Family but focuses on children's issues. The course will address treatment, diagnosis, support, and school issues. Four members of NAMIJC have been trained to provide instruction. We are planning on offering 2 new classes next year. They are as follows: Peer-To-Peer: A class taught and designed for individuals who have a mental illness. It teaches information about illnesses, treatment, resources and coping strategies. Provider Training Course: NAMI family members and individuals with a mental illness will teach the course to providers of mental health services. The class follows the Family-To-Family model and will cover treatment, diagnosis, medication and recovery. We allocate funds from our budget to manage and publicize these educational programs. List any accreditation and licensure your agency currently has. Explain. There is no accreditation or licensure required. jccoghs~fundingform.doc 2 Agency: National Alliance for the Mentally I11 of Johnson County Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) The National Alliance for the Mentally Ill of Johnson County (NAMIJC) was incorporated as a nonprofit organization in 1986. In 1985 the Mental Health Center (MHC) organized a program for relatives of persons with schizophrenia. These family members began to meet for further education and mutual support with the guidance of Carol Lear of the MHC. Within a year, the group organized and affiliated with the National Alliance for the Mentally Ill (NAMI, the umbrella organization with nearly 200,000 members). The group then expanded to include family members and individuals with all the major brain disorders, including schizophrenia, bipolar illness, panic attack, obsessive-compulsive disorders and severn depression. Our organization holds meetings where members can share concerns, learn about brain disorders and receive practical information about health insurance, medical treatment, housing, employment and community resources. In addition to these program meetings, there have been support group meetings devoted to the needs of clients who are seriously mentally ill and their families. In addition to the educational programs for our mutual support groups, we have also developed outreach programs to provide speakers to local groups and to participate in county, state and national activities. The principal advocacy tasks are to improve public knowledge about the nature of brain disorders in order to reduce the stigma and discrimination applied to our relatives and friends with mental illnesses. In the past, we have also supported local agencies for items to improve services to persons with serious mental illnesses (SMI). Some examples during the past 4 years include support to Hillcrest Supportive Living to assist with emergency expenses for persons with SMI, funds to the IPACT program at University Hospitals to provide enrichment activities for which they cannot be reimbursed, funds to the U1HC Behavioral Health Services, Life Skills Inc, and the Crisis Center for books and other educational materials to assist family members and others who care for persons with SMI and at Chatham Oaks. We have also supported the NAMI of Iowa state office and NARSAD the major private organization that supports scientific research for brain diseases. Two years ago in 2000 a subcommittee of NAMIJC studied the possibility of hiring a part-time staff person to assist with the administration of the organization. Following a careful review of all aspects of this position, the subcommittee recommended that NAMIJC staff a part-time director's position. The new director works 40-45 hours a month and is responsible for coordinating volunteers, educational programs, fundraising activities, grant writing, outreach and membership development. This year NAMI-JC developed new databases to collect information regarding volunteers. We improved our membership access database to collect information about our members and donors and present mailing list. We developed a satisfaction survey to better understand the needs, ideas and satisfaction of people that use our services. jccoghs~fundingform.doc 3 Agency: National Alliance for the Mentally I11 of Johnson County Section 2: Client Profile 1. How many Johnson County residents (Including IC & 1 Unduplicated Count Coralville) did your al~ency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 3. How many Coralville residents did your agency serve? 3 Unduplicated Count Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 Female: 6-17 Male 18-29 30-6l 62-75 >75 The newsletter is mailed 12 times a year to about 480 addresses, including ail facilities providing services for persons with mental illnesses. We increased our membership by over 40% this year. We presently have over 140 paid members. An average of 40 persons attend the monthly program meetings. An average of 12 people attend classes each month. Six thousand copies of the Tell Me Where to Turn brochures are distributed every other year. We plan to print a new Tell Me Where to Turn brochure this spring. Four or five NAMI-JC volunteer members on a continuous basis provide support to approximately 200 persons calling the telephone answering service. We recently printed 4,000 copies of an updated NAMI-JC brochure, which is continuously distributed to agencies and offices throughout Johnson County. No records of ethnicity or age of persons who attend our functions are kept. 3. Briefly describe your service population. We serve family members, providers of mental health services and individuals who have a mental illness. 4. How do you determine eligibility for services? We do not have any eligibility requirements for our programs and support groups. Our support group is open to family members and individuals living with mental illnesses. We do have some requirements for our classes. Visions For Tomorrow is open to caregivers of children with brain disorders only. Family-To-Family class is only open to family members of individuals living with a mental illness. Peer-To-Peer class is only open to consumers of mentai heaith services. 5. Are there fees for your services? Yes No x If yes, please describe your fee structure: j ccoghs~'unding form.doc 4 Agency: National Alliance for the Mentally Ill of Johnson County 6. Do you provide services to areas outside of Johnson County? We do provide services to areas outside Johnson County. Area(s) served: We serve many people from Iowa, Linn, Washington, Cedar and Keokuk Counties because we arc the closest NAMI affiliate in area. We do not have statistical data about all the people we serve. Services Provided: Telephone answering service: We estimate 15-20% of calls come from outside Johnson County Educational Classes. We estimate 15-20% of students come from outside Johnson County. Program meetings and Support groups: We estimate 10% of members come from outside Johnson County We also have 75 people from outside Johnson County receiving our newsletter Funding Sources: United Way of Johnson County Merit Behavioral Care Corporation of Iowa $500 in resource materials First annual fundraising campaign $1,000 Annual NAMI Garage Sale $5,600 Memorial Funds $1,000 NAMI membership drive $1,800 jccoghs~fundingform.doc 5 Agency: National Alliance for the Mentally I11 of Johnson County Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client (b) Community At the last Joint Funding meeting it was recommended that NAMI-JC do a satisfaction survey to assess how members and people that utilize our services feel about the programs and services we provide. NAMI-JC with a team of interested volunteers designed a satisfaction survey, which we are inclosing with our request. We presently do a satisfaction survey to assess success of all of our educational classes. 2. Briefly summarize your findings: We plan to mail our survey in October and should have the results by our Joint Funding Meeting in December or January. Our Family-To-Family Class has received excellent responses from the family members that have taken classes. 3. What changes have been made in response to these findings? We plan to discuss results of our satisfaction survey at our annual strategic planning meeting in January of 2003. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % Of clients referred We do not have any statistic regarding Answering Service referrals to our organization Newspaper Agency Referrals Family and or friend NAMI Newsletter Brochures ! NAMI website Care providers 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? None jccoghs\fundingform.doc 6 Agency: National Alliance for the Mentally Ill of Johnson County 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. NAMI-JC is the only organization in Johnson County that supplies an answering service providing support and referral sources to family members, and individuals living with mental illnesses. We are primarily a volunteer organization providing support groups to family members and individuals with mental illness. We provide free classes to family members of individuals living with mental illness. We offer classes to caretakers of children with brain disorders. We plan to offer classes to consumers and providers of mental health services taught by trained family members and consumers. We are vocal advocates for individuals living with mental illnesses and work with national, state and local providers, legislators and research organizations to improve services for families and individuals living with mental illness 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1.COMPEER 1. Our members serve on this community organization committee. 2.Mental Health Awareness Week 2. Our members (4) meet with other community organizations to plan activities. (Hillcrest, ICCSD, CMH for Mid-Eastern Iowa, UAY, UIHC, JCCG) 3. Mental Health Task Fome 3. NAMIJC provides the services to collect Tell Me Where To Turn and disburse the booklets. At times, money has been allocated for the printing. 4. Chatham Oaks & NAMI-JC 4. NAMUC's housing committee dialogs with Supportive Housing Program Chatham Oaks to explore possible housing arrangements. jccoghs\fundingform.doc 7 Agency: National Alliance for the Mentally I11 of Johnson County Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Develop a housing plan that stands between 1. Apply for federal housing grant from institutional and independent, appropriate source. 2. Increase hours of service by director. 2. Seek new sources of fundraising or grants. Opportunity to coordinate administrative tasks, develop new educational programs, increase membership, recruit and coordinate volunteers and improve the overall administration of our organization 3. Educate a largely ignorant public about the 3. Provide panels and educational forums. hope of treatment and the shame of stigma for Mental Illness Awareness week sponsored the Seriously Mentally Ill. with 6 other organizations and with 9 presentations in the local community. 2. In what way will the needs of your service population change in the next five years? The number of consumers will grow because many of these illnesses persist a lifetime and the resources will decline because of budget cuts. We see growing numbers of younger consumers of mental health services and family members coming to NAMI-JC for support and information. 3. How do you plan to address these changes? Classes, programs, radio and TV, talks, brochures etc., to inform the public that mental illness deserves support like the mentally retarded. We need to create and provide more educational programs and support groups to meet needs of families and individuals living with mental illnesses of all ages. 4. Describe the evaluation methods you use to measure the success of your services? Survey. 5. What are the results of these evaluations (outcomes)? The survey has been designed and will be mailed in October of 2002. We hope to have results that can be shared at the hearings. 6. How do you plan to use the evaluation results to enhance/extend your services? We will consider how these results can help us improve our program and goals. jccoghs\fundingform.doc 8 Agency: National Alliance for the Mentally I11 of Johnson County 7. How do your programs/services impact the community? For example, over 20 attended our last two support group meetings and some of these attendees were confused and bewildered and needed to talk with people who understood their unique problems. We cannot measure the impact of our telephone service, support groups, etc.. These are some issues that are being addressed: A mother from the Chicago area whose son, age 20, lives by choice in Iowa City. He became ill with schizophrenia while living here and wants to stay here. He has no case manager and is medication resistant. He is temporarily with his parents in the Chicago area while he is between apartments in lowa City. Mother is concerned that he needs some supportive housing situation. A mother from Fairfield, Iowa has a 44-year-old daughter, now in Clarinda. She has schizophrenia. Residential situations in the Fairfield area will not take her and mother wants to explore supported living facilities in Johnson County in preparation of her daughter being released from Clarinda. A mother from Johnson County, whose son was recently diagnosed with schizophrenia, needed to talk to someone about what she could do to help her son and herself cope with the trauma and loss they were experiencing due to his illness. 8. How did the agency respond to the UWJC recommendations from last year? We designed and developed a comprehensive satisfaction survey that we plan to send out in October 2002. We formalized record keeping for those attending meetings and classes, and tracked volunteer hours. We recently updated our membership database and created a volunteer roster and database. jccoghs~fundingform.doc 9 Agency: National Alliance for the Mentally I11 of Johnson County Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Our board meets monthly. We also have several committees that meet to discuss projects during the month. Support Group Committee, Housing Committee, Satisfaction Survey Committee, Membership database Committee, Fundraising Committee. 3. What is your average attendance at board meetings? There are about 8 people at our executive board meetings and about 40 people at our business meetings each month. 4. How is the board involved in strategic planning and governance of the agency? In January of 2002 the NAMI board had a strategic planning meeting to decide the activities and projects that NAMI-JC wanted to accomplish for the year. A monthly plan of goals and timelines was presented to the new director. 5. What type of training/orientation do board members receive? NAMI does not provide specific training to board members but board members are encouraged to go to NAMI state and National conventions which provides training and educational opportunities. 6. Does your agency have written policies and procedures for financial management? Ifyes, date of last board approval? __ Yes, January, 15, 2002 7. }lave you filed the annual report with the Secretary of State? If yes, date filed? 8. }lave you filed the IRS form 990 for the most recent year? If yes, date filed? If no to questions 6, 7, or 8, give explanation 990 is required if you have receipts of over $25,000 9. Does your agency have a yearly audit? Yes No X If yes, Who completed the audit? How much did the audit cost? If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, what is in place to assure accountability in the agency's financial management? NAMIJC annual budget is small, therefore we are unable to cost-justify an annual audit. The Co- Treasurers process receipts and issue checks. The Fund-raising Chair reviews all transactions and the checkbook reconciliation is provided to the executive committee monthly. jccoghs\fundingform.doc 10 Agency: National Alliance for the Mentally Ill of Johnson County 10. Insurance Coverage: (check what coverage your agency has): Insurance Check if agency has Amount Directors & Officers a. fiduciary liability b. employment practice liability General Liability Umbrella Liability Professional Liability Property or Renters Vehicle We are exploring the costs of obtaining D&O coverage. jccoghs\fundingform.doc 11 Agency: National Alliance for the Mentally Ill of Johnson County Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Director 0 0 0 Contract Position .25 .25 .375 Aug- Dec TOTAL FTEs .25 .25 .375 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? One 4. How much was spent on staff development in the last fiscal year? 5. How much is budgeted for staff development in this fiscal year? jccoghs~fundingform.doc 12 Agency: National Alliance for the Mentally Ill of Johnson County 6. What training and support opportunities are offered to staff'? Director attended national NAMI convention where educational opportunities were provided in fundraising and educational programs. Director attended fundralsing training in Cedar Rapids, which was paid for by NAMI-JC 7. Please attach current organizational chart as Appendix B. Board of Directors -) Committees --> Director 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? N/A Director hired in 200t Yes No If no, brief explanation 9. Does your agency X have personnel policies? 01/15/02 If yes, date board last reviewed? 10. Does your board X annually evaluate the director's performance? 11. Does your agency X have job descriptions for 01/15/02 every position? If yes, date of last board approval? 12. Is there an annual X performance review for every staff? jccoghs\fundingform.doc 13 I I I IAgency: National Alliance for the Mentally Ill of Johnson County Section 7: Financial Management A. ThreeYear Historical Balance Sheet LAs of your fiscal year-end) 2001 2002 2003 2001 2002 2003 Current Assets Current Liabilities Cash $21,603 $17,382 $19,882 AccountsPayable $0 $0 $0 Investments __ $0 $0 $0 PayrolITaxes Payable $0 $0 $0 Receivables < 90 days $0 $0 $0 Contracts Payable $2,100 $12,000 Other Mor~ga~le Payable-6 months $0 $0 ' $0 Total Current Assets $21,603 $17,382 $19,882 Total Current Liabilities $0 $2,100 $12,000 Other Assets Other Liabilities Property ~$0 $0 $0 Mortgage Payable-Balance Equipment $0 $500 $500 Other less depreciation ..... $0 $0 $0 Total Other Liabilities $0 $0 $0 Receivables > 90 days $0 $0 $0 TotalLlablll#es $0 $2,100 $12,000 Other $0 $0 $0 Net Assets $21,603 $15,782 $8,382 Total Non-current Assets $0 $500 $500 TotalAssets $21,603 $17,882 $20,382 Liabilifles&NetAssets $21,603 $t7,882 $20,382 Agency: ~National Alliancefor the Mentally III of Johnson County 2001 ~ _2002 2003 / B. Income & Expenses Income __Local Fundi_ng Sources Iowa Cig $0 $0 $0 Coralville $~0 $~0 $0 ~Johnson Co~unty _ $0 $0 $0 United W~ay - AllocatJon $2,500 $2,414 $5,000 __ - Designated Giving $3,478 $2,779 $3,000 Grants-Federal, State, Foundation i - $0 $0 $5,000 Net Sales of Service $0 $0 $0 Varies trom year to year depending on purchase of Net Sales of Materials $30_0 $1,000 $500 inventory 2 cars were donated for garage Con~tributions/Fundraising $6,877 $9,070 $11,000 sale in 2002 Investment Income I $0 $~0 $0 Other - Dues $884 $1 ~836 $3~000 Total Income $14,039 $17,099 $27,500 _Expenses .. Wages & Salaries $3,150 $8,40~0 $12,000 Benefits $0 $0 $0 Occupancy $0 $0 $0 __ Non-occupancy $9,147 $12,920 $13,000 Other Total Expenses $12,297 $21,320 $26,000 C. Fund Balance Revenue $14,039 $17,099 $27,500 ~Carryover Ba_lance from p_revious year $19,861 $21,603 $17,382 Total Operating Budget $33,900 $38,702 $44,882 Less Total Expenses $12,297 $21,320 $25,000 Ending Fund Balance $21,603 $17,382 $19,882 Less Restricted Balance (explain) Carryover Fund Balance $21,603 $17,382 $19,882 Agency: National Alliance for the Mentally III of Johnson County D. BdlDonorlFunder Restricted Funds Designated for: 2001 2002 2003 None __ .$__0. $0 $0 Total Restricted Funds $0 $0 $0 E. In Kind Support: 2001 2002 2003 Services/Volunteers 3200 hrs @$8/hr; 4000 hrs; 4000 hrs @$9/hr $25,600 $36,000 $36,000 Material Goods Workbooks for classes $500 $1,000 $1,000 Space, Utilities, etc __ Mercy; Director; Cards - space for meeting, office _ $3,600 $3,600 $3,600 Other: (Please footnote) Total In-kind Support $29,700 $40,600 $40,600 F. Grants Description/Purpose 2001 2002 i 2003 NAMI - In our Own Voice Train consumers to present information on mental illness $0 $0 i $2,800 Humanities Grant Written histories in Iowa of people with mental illness $0 $0I $2,000 Library Local funding for library .._~ $0 $0 $200 i Total GrantsI $0 $0 $5,000 APPENDIX A: JBOARD ROSTER - National Alliance for the Mentally III of Johnson Co_unt~ . Executive, Art, Membership, Compeer, Library, Carol Spaziani Iowa City City of lC Library Director- Retired 02-04 Co-President Answering Service, Personnel, Finance Executive, Caring and Sharing, Veterans Affairs, Dan Hug Coralville Bio-chemist - Retired 02-04 Co-President Finance, Personne Don Fett Iowa City ICCSD Administrator- Retired 02-04 Co-Vice Presidant Executive, Personnel, Finance, Veterans Affairs Fran Fett Iowa City ICCSD CEC Secretary - Retired 02-04 Co-Vice President Executive, Personnel, Finance Margaret Warner iCoralville Staff- Dept of Internal Medicine UI 02-04 Co-Secretary Executive, Caring and Sharing, Publicity Martha Yoak Iowa City Teacher- Retired 02-04 Co-Secretary Executive -- Executive, Mailings, Membership, Finance, Ed AIIgood Iowa City Staff- Central Mail UI 02-04 Co-Treasurer ,~Pers°nnel' Recordkeeping/Reporting Jean AIIgood Iowa City Staff- Dept of Sociology UI 02-04 Co-Treasurer Executive, Mailings, Membership, Finance - Assist. To I Exec~tive~in~, Membe~h~, Personnel, Helen Dailey Iowa City Staff- UI Foundation 02-04 Treasurers ~Finance __. / COMMITTEES: ~nal~ce for the Me~ntal~ III of John_son ? Art Committee Joyce Carman, Mary Anne Madden, Grace Piro, Carol Spaziani Awards Board ~ '-- ~ '-- -- Caring and Sharing Dan Hug, Wayne & Ruth Osborn, Margaret Warner } Finance Carol Spaziani, Dan Hug, Ed/Jean AIIgood, Helen Dailey, Don and Fran Fett Fund Raising elen Dailey, June Judge, Susan Spaziani, Grace Piro, Housing Eugene Spaziani, Marva Abel, Fran Fett, Rose Marie and Bruce Friedrich, Brenda Hollingsworth, June Judge, Lowel Luhman Bean Martinolich, Rita Offutt, Richard Tetrault, Jose ~hine Tornabuoni Legislation/Advocacy - National, State and Local Levels [Linda Hug, Claudine Harris Laisons to Local Mental HealthOrganizations/Agencies: Compeer Advisory Board Joyce Carman, Lolly Eggers, June Judge, Ken Kunt~ Rita Offutt, Carol Spaziani JC Mental Health Task Force Rita Offutt I JCMHDD Plannin, owell Luhman, Rose Marie Friedrich, Claudine Harris, Brenda Hollingsworth, June Judge, Rita Offutt, Carol Spaziani UW Rita Offutt ] Library Rita Offutt, Carol Spaziani, Jane Cranston__ ~ Mailings Ed and Jean AIIgood, Bruce Friedrich, Mary and Jim McCue Membership lEd and Jean AIIgood, Bruce Friedrich, Helen Dailey, Carol Spaziani Newsletter ~-- ~ W I_ ~ Nominating IRose Marie Friedrich, Brenda Hollingsworth, Carol Porch ~ .... ~ ' ----- ~d. H len Da Personnel ~C_a:_o., Spaz,an,, Dan Hug, Don and Fran Fett, Ed Allgoo , elen ey Program [Betsy H~ene spazi~i~i Publicity !Margaret Warner Answering Services lCarol Spaziani, Mary McCue, Rita Offutt, Eugene Spaziani, Frank Fleming Veteran Affairs ~June Ju'dge, ~byn Adkissin, Don Fett, ~n Hu~] I Section 1: Background Agency Name: Neighborhood Centers of Johnson County Address: P.O. Box 2491, lC 52244 Phone: 319-358-0438 Director Name: Brian Loring Signature~: Bd. Pres Name: Stephen Trefz Signature: Request Completed By: Brian Loring Date: Septem~, 2~_~ Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 '/ 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $98,811 $97,363 $114,000 7.6% Does not include designated ~ecial Needs Grants FY 02 FY 03 FY 04 City of Iowa City $62,856 $62,856 $72,284 4.8% Johnson County $66,025 $66,025 $75,929 5.1% City of Coralville $0 $0 $0 What were local funds used for this year: The funds were used primarily to match to match state and federal grants, strengthen existing programs, and provide comprehensive services. Local dollars also support administrative salaries, building expenses and community activities. What will next year's local funds be used for? We intend to use the money in generally the same manner with additional dollars going into direct service activities. Agency Mission Statement: Neighborhood Centers of Johnson County is dedicated to building a better future for people in neighborhoods through programs that educate, strengthen families and create a sense of community. Summarize your programs and services for which you are requesting funding: We use funding from United Way, Iowa City and Johnson County in all of our programs. · Child Development: Programs lbr children birth to 5 years. Includes child care for infants, toddlers and preschoolers. · Youth Development: Programs for school-age children that include afterschool programs, enrichment programs (music, art, etc.), AmeriCorps Youth Connections, tutoring and in-school mentoring. Agency Name: Neighborhood Centers of Johnson County · Family Development: Provides support to parents and families through home visitation programs, parenting classes, English as second language, adult basic education and issue/activity focused adult groups. · Community Development: This area of programming responds to issues and concerns that affect the entire neighborhood or the larger community. Examples are the work we have done to reduce crime and improve the image of the Broadway neighborhood through the Broadway Improvement Group (BIG). Other examples include the Restorative Justice collaboration, our summer lunch program, and a wide variety of community building events. Community development relies upon neighborhood councils at each of the center. List any accreditation and licensure your agency currently has. Explain. Our child care programs are licensed through the Department of Human Services. Child care programs have been accredited through the National Association for the Education of the Young Child. We are currently undergoing reaccredidation and are awaiting our site visit scheduled for October 14, 2002. j ccoghs\funding form.doc 2 Agency Name: Neighborhood Centers of Johnson County Agency I~istory (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and currenL activities and furore plans. Please update annually.) In fall of 1973, a small group of parents from Pheasant Ridge neighborhood (then known as Mark IV Apartments) came together out of concern for their neighborhood. They were troubled by high incidences child abuse, vandalism and disputes among neighbors. They decided what they needed was a place where families could come together for community gatherings and activities for children. The group approached the apartment management and was granted the use of a three-bedroom apartment to serve as the first Neighborhood Center. Meanwhile, the University of Iowa School of Social Work helped recruit volunteers to organize afterschool and teen programs. Since 1973, the Pheasant Ridge Center has offered on-site educational and recreational opportunities, connected people to resources in the community, and encouraged a sense of community. The success of the Pheasant Ridge center prompted the Iowa City community to support the addition of a second Center. In 1988, we expanded our efforts to the Broadway Street neighborhood. Like Pheasant Ridge in 1973, the need for prevention programs was evident in the disproportionate number of child abuse cases, police reports and juveniles on probation. Neighborhood Centers joined forces with Head Start and built a 6,000 square foot facility in 1990. Since the Broadway Street Neighborhood Center has been in operation, the quality of life in the neighborhood has improved, as seen by the decrease in child abuse reports. In 1995, we started work in the western part of Johnson County, bringing resources and programs to some of the underserved mobile home parks in that area. In 1996, we opened the Clear Creek Neighborhood Center. The Neighborhood Center concept is unique in that we bring programs to the people who would otherwise have difficulty accessing services, either because of transportation, child care, or financial constraints. In addition to neighborhood-based services, an important function of our agency is to connect our neighbors to other resources in the community. We are also very reliant upon partnerships with a diverse array of community agencies, institutions and businesses. Our shared efforts have added value to our programming and yielded important successes for families. Through collaborative work with partners such as the Iowa City and Clear Creek schools, Iowa City Police Department, Wendell Johnson Speech and Hearing Center, United Action for Youth, MECCA, and the Sixth Judicial District, neighborhoods are safer, children are healthier and better prepared for school, adults are returning to school and learning new job and life skills, parents and children are learning English, and people in all of our neighborhoods are discovering and rediscovering what it means to be part ora neighborhood and community. Over the years Neighborhood Centers' methods have evolved to meet the changing needs of our neighborhoods and our community. One striking example is in the area of child care. The welfare reform initiatives of the 1990s created a great demand for full-day childcare. As more parents move from welfare to work, we retooled the agency to meet these changing demands. As a measure of the increased demand, it is worth noting that in 1995 we offered a total of 12 childcare spaces in our cooperative - this year we have 106 full day childcare spaces. We are also very proud of the quality of our early childhood programs. In 1998, the National Association for the Education of the Young Child (NAEYC) accredited childcare programs at Broadway and Pheasant Ridge. This past year, we maintained our efforts in areas outside of Iowa City as we continued prevention programs in the Clear Creek area of western Johnson County. In addition, we were the recipients of United Way special needs funding. The grant has helped us respond to some of the requests for services and support from senior citizens in Tiffin and surrounding areas. We have also continued to see significant change in the population in the Pheasant Ridge area. Sudanese refugees now represent a solid majority of families in the neighborhood. This year we implemented a new Even Start Literacy grant for Pheasant Ridge that allowed us to add ESL and GED classes and additional literacy programming for young children. We also continued the PREP program (Preschoolers Reaching Educational Potential). PREP as an intensive 11-week summer program intended to prepare children for kindergarten. j ccoghs\funding form. doc 3 Agency Name: Neighborhood Centers of Johnson County Section 2: Client Profile 1. How many Johnson County residents (Including 1 Unduplicated Count 2636 1940 IC & Coralville) did your agency serve? 2. How many Iowa City residents did your agency 2 Unduplicated Count 2209 1346 serve? 3. How many Coralville residents did your agency 3 Unduplicated Count N/A N/A serve? Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 295 Female: 1087 African Amehcan 427 6-17 622 Male 853 Asian 78 18-29 237 Hispanic 155 30-75+ 786 Native American 6 Multi-Racial 33 Caucasian 1241 3. Briefly describe your service population. Very iow-income families. 4. How do you determine eligibility for services? Families that are low-income and live in one of our neighborhoods are a priority; however, low-income persons often are eligible for specific programs regardless of where they live in the county. 5. Are there fees for your services? Yes ~/ No__ If yes, please describe your fee structure: Parents with children in child development programs receiving Title XX child care subsidies sometimes have a co-payment. That co-pay is set by the Department of Human Services and is based upon income. In addition, school age children may pay a portion of the cost of field trips. 6. Do you provide services to areas outside of Johnson County? Area(s) served: There are children that attend the Clear Creek Amana Middle School that are residents of Iowa County. Services Provided: In-School mentoring and academic support. Funding Sources: Clear Creek Amana School District. j ccoghs\funding form. doc 4 Agency Name: Neighborhood Centers of Johnson County Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: Through Neighborhood Advisory Councils, surveys and issue-based focus groups. (b) Community: Through United Way, our board of directors and informal input from panners and community members. 2. Briefly summarize your findings: Pheasant Ridge: · Residents want more community events; · More enrichment programs such as music lessons and language classes for school-age youth; · Residents are looking for more one-on-one support for parents with very young (infants) children. Broadway: · Parents and youth want employment opportunities and more organized activities for school- age youth; · There are always requests for more daycare and respite care; · More support for neighborhood crime prevention; · More recreational opportunities for youth and adults; · Enrichment programs for youth and adults; · Employment support and training opportunities; · More fun, community-building events in the neighborhood. Clear Creek: · Mentoring program for youth; · Quality preschool and other daycare opportunities; · Pre-employment and employment opportunities for youth; · Recreational and community-building events. 3. What changes have been made in response to these findings? · We have added enrichment programs and more community-building events. · This past summer we added some recreational opportunities for children at Broadway through the summer 3v3 basketball league. · We are currently working on a plan for a sustainable youth employment program and perhaps an adult employment program. · There are discussions under way with the Clear Creek Amana School District to review the feasibility of a preschool in Tiffin. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Department of Human Services 6% Johnson County Empowerment Area 1% United Action for Youth less than 1% Iowa State Extension less than 1% j ccoghs\funding form. doc 5 Agency Name: Neighborhood Centers of Johnson County Head Start 2% Clear Creek Amana School Dis~ict 3% Iowa City Community School District 2% Domestic Violence Intervention Program less than 1% Emergency Housing Project less than 1% Mid-Eastern Council on Chemical Abuse less than 1% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? HACAP 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Neighborhood Centers is a neighborhood-based and looks for resources within the community and the neighborhood. HACAP is part of a large Federal initiative and bring services from Federal programs that are generally less flexible but better funded. Neighborhood Centers also provides afierschool programming and afierschool daycare, ESL and GED programming and community- building events. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Iowa City Community School District 1. We work with the school district in a number of different areas including the PREP (Preschoolers Reaching Educational Potential program), in-school mentofing and translation at Roosevelt Elementary, and an afierschool Kids Club at Mark Twain. 2. Clear Creek Amana School District 2. Although over $200,000 in funding cuts over the past 2 years have decreased our capacity, we still work closely with the district. We currently have a staffworking in the middle school. CCASD has also asked us to partner with them in providing services in their new alternative learning center. We are also talking with them about starting a collaborative preschool program in Tiffin. 3. Wendell Johnson Speech and Hearing Center, 3. For the past four years, staffand students University of Iowa from Wendell Johnson have provided classroom support for testing children to identify potential reading and language problems and offer effective interventions in reading and language development. The outcomes from children graduating from those programs clearly demonstrate the success of this collaboration. j ccoghs\fundingform.doc 6 Agency Name: Neighborhood Centers of Johnson County I Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Building our pool of discretionary funds 1. Develop an annual giving campaign and build upon a newly established endowment through larger individual and planned gifts 2. Expansion into new neighborhood and rural 2. Our current strategy is to maintain our area of the county commitment to existing neighborhoods and programs, but reach out to smaller communities for input on how we might assist them in addressing their programming needs while remaining true to our mission. 3. Rebuilding youth and adult pre-employment 3. Our challenge and opportunity is to create and employment programming programming that is effective in giving youth and adults the soft and hard skills necessary to find and keep a job. We are currently implementing a plan to create a pre- employment and employment program that generated sufficient revenues to sustain itself with little or no outside support. 2. In what way will the needs of your service population change in the next five years? Under the Federal welfare reform initiative enacted in 1996, welfare benefits to neighborhood families will begin to expire. We have also noticed, anecdotally, a trend in the Broadway neighborhood that is represented by younger children exhibiting more violent behavior. In addition, there appears to be a significant increase in drug use and thc other illegal activities associated with that usage. These will be some of the most salient challenges of the next few years. 3. How do you plan to address these changes? In the past four years we have started offering more employment support for families. Unfortunately, grants that have supported this activity in the past have been eliminated and future prospects for additional funding opportunities look bleak. Nevertheless, we have started to inventory available community resources in the area of employment support to look at how we can facilitate better coordination and access for neighborhood families. In addition, this year we have a licensed aftcrschool program at the Broadway Center that is designed to better address the behavior issues of some of thc more troubled children in thc neighborhood. j ccoghs\funding form. doc 7 Agency Name: Neighborhood Centers of Johnson County 4. Describe the evaluation methods you use to measure the success of your services? · The Creative Curriculum for Early Childhood Development and Learning Checklist assesses young children's developmental progress twice each year. The Curriculum provides a framework of the philosophy, goals, objectives, and teaching strategies that address all aspects of a child's development--socio-emotional, cognitive, and physical. · Family Snapshot measures family well-being and progress over eight variables such as housing, childcare, safety, etc. Each family completes a pre- and post- Family Snapshot and their perceptions are measured with the number of agency programs the family participates in over the course of a year. · Educational records for in-school youth and adults in GED and ESL classes from the school district and Kirkwood Community College. Includes CASAS (which measures English skill development) and attendance and grades. For the preschooler entering kindergarten, the Kindergarten Skill Readiness Assessment tracks emerging skills in the areas of social behavior, self- management, work, communication and classroom rules. · Juvenile crime andpoltce reports are collected annually and serve as indicators of the neighborhood profile and assist in guiding programs. · Partnership agencies also complete various types of assessments on enrolled children. The Grant Wood Area Education Agency completes a formal developmental screening on each child. Grant Wood AEA screens each child in the areas of fine motor, cognitive/verbal, speech, social/behavior, gross motor, hearing and vision. In addition, Community Mental Health assesses the mental health, social, and behavior levels of children. The University of Iowa - Wendell Johnson Speech and Language Center completes literacy assessments on each child, and more importantly, makes classroom and referral recommendations. 5. What are the results of these evaluations (outcomes)? · Child Development: All children enrolled in NCJC Child Development programs were assessed using the Creative Curriculum. Although improvement was observed in all general categories of the assessment including social-emotional, cognitive, and physical development, significant gains were made in area of language usage. For example, 69% of the children showed remarkable improvement in the area of general literacy from the pre- and post- assessments; 77% of the children are now at or above age level in this area. In addition, similar gains were observed between the pre- and post- test results in the areas of language development, phonological awareness, and book knowledge and appreciation. In these areas, children were significantly below age level at the pre-test marker (77% below age level in one domain), but were measured at or above age level in the post-test assessment. · Employment and benefits: The number of families moving into the employment market remained constant during FY02, with significant gains seen in improved income and job-related benefits. Adults working record a 14% gain in income at the end of this program year and 45% have gone from no job related benefits in Time 1 to one or more (i.e. sick, vacation, medical, life, retirement) in Time 2. Also from Time 1 to Time 2, 25% of respondents moved from meeting basic needs with assistance to without assistance. In general, this is a movement from receiving state funded grants for housing, child care, etc., to employment providing a livable wage and benefits. These figures show not only an increase in employment but also an increase in the quality of employment. · Adult Education: Of the families participating in high school completion programs, 23% received their GED in FY02. · School Success/Youth Education: Over 95 students from NCJC participated in summer school, with one of those students not moving to the next grade in the fall. Five elementary students participating in the in-school mentoring program moved from remedial math and reading programs to attending enrichment sessions. j ccoghs\funding form. doc 8 ,Agency Name: Neighborhood Centers of Johnson County · Kindergarten Readiness: During the summers of 2001 and 2002, the PREP program provided intensive school readiness programs for children at-risk for school failure (as identified by a referring agency) due to one of the following: non-English speaker, limited literacy skills, severe behavior issues. At this time, all of the 24 children from PREP are in a "regular" classroom within the district. · Developing networks/support systems: Overall, families said they were slightly less involved with their community during FY02. 11% decreased involvement in community activities such as church, clubs, and children's school events. However, it is important to note that 85% of participating families have attended parent/teacher conferences. 6. How do you plan to use the evaluation results to enhance/extend your services? · Pre-employment and career training: While the Family Snapshot figures show that many situations improved, there was increased recognition ora need for job training in Time 2 families. These families said that they needed additional .job training that was either not available or they were not enrolled in. Our experience at Neighborhood Centers has been that it is harder to find child care assistance for job training programs or education than for work. This may be a barrier to these families. In the upcoming year, NCJC hopes to extend services to include a self-sustaining pre-employment program for youth and career development programming for adults. · Child development: By analyzing the data in the Creative Curriculum, NCJC teachers determine what aspects of the program are effective and which need attention. Each quarter, lead teachers in the Child Development programs complete a home visit with each classroom parent. In these visits, assessment information is compiled and discussed with the family. Teachers and parents together then create individual goals for each child, which are followed during the year. The Creative Curriculum also identifies those children with special needs, which in turn helps to efficiently bring appropriate resources to the child. · Youth Education: It has been difficult to track youth school performance during FY02 and link to programming efforts at NCJC. At Pheasant Ridge, where staff work in-school with participating students, we see improved attendance and grades. Staffpresence in neighborhood schools assists in identifying attendance issues quickly. It also helps to address issues such as not having warm clothing and fighting on the bus, which in the past have led to attendance issues. We hope to continue to coordinate with schools to provide effective programs. 7. How do your programs/services impact the community? Neighborhood Center programs touch on each of the many of the areas identified as serious issues by the Johnson County Capacity Assessment. In the area of child care, we continue to expand the availability of child care/child development programs. This past year we served over 150 children in our licensed child care programs for children birth through school age. A Johnson County Department of Human Services study revealed that 50% of children placed in foster care in the county come from the Twain/Broadway area. And in FY02, we facilitated protective and foster day care for a high percentage of those children. Of the available child care slots at Broadway that are non-grant funded, 55%, are filled with children in foster or protective care. We have only begun to touch on the immediate issues related to employment and economic opportunities. We also recognize the growing need for more employment services for families and are collaborating with service providers to bring more of those resources to our neighborhoods. We are proud of twelve staff working at Neighborhood Centers who also live in the neighborhood. We have increased prevention programs with a health care focus. We are offering health clinics to families through a collaborative effort with the Department of Public Health and University of Iowa j ccoghs\funding form.doc 9 Agency Name: Neighborhood Centers of Johnson County Hospitals and Clinics. We are also offering nutrition programming to children aged two to eleven and their parents. In the area of substance abuse, every afierschool and teen program incorporates drag prevention programs in monthly plans. It is vital to offer a variety of alternatives in activities, as well as, increased evening and weekend times for youth programs. 8. How did the agency respond to the UWJC recommendations from last year? The UWJC only recommendation to Neighborhood Centers is to keep up the good work. We hope to have accomplished that recommendation. j ccoghs\funding form. doc 10 Agency Name: Neighborhood Centers of Johnson County Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Bimonthly 3. What is your average attendance at board meetings? 80% 4. How is the board involved in strategic planning and governance of the agency? The entire board is involved in a biannual strategic planning session that yields a 2 year plan for action. The executive committee is charged with periodic review of the plan and tracking progress on the goals set forth in the plan. The executive committee meets 12 times per year outside of the board meeting and makes recommendations on implementation strategies. 5. What type of training/orientation do board members receive? A member of the Executive Committee and the Executive Director handle training and orientation. We also have a mentoring program where new board members are matched with long~time board members. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? 11/16/00 7. Have you filed the annual report with the Secretary of State? If yes, date filed? 1/2002 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? 5/7/2002 If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes ~ No__ If yes, Who completed the audit? How much did the audit cost? Greenwood & Crim $3,500 If material weaknesses are noted in the audit, what is your plan for addressing them? None noted If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance ,/if agency has Amount Directors & Officers $1,000,000 j ccoghs\ funding form. doc 11 Agency Name: Neighborhood Centers of Johnson County a. fiduciary liability ~/ b. employment practice liability General Liability '/ $2,000,000 Umbrella Liability '/ $1,000,000 Professional Liability '/ $1,000,000 Property or Renters '/ $1,000,000 Vehicle '/ $500,000 j ccoghs\fundingform, doc 12 Agency Name: Neighborhood Centers of Johnson County Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Seven and a half years. Mr. Loring has his Master in Social Work (1987) from thc University of Iowa and has worked in thc field of human services for twenty years. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X $52,500 1 1 Associate Director X X $48,048 1 1 1 Fiscal Manager X X $39,478 1 I 1 Site Directors X X $38,613-39,121 3 2 2 On-Site Child Care Director X X $26,500-28,600 2 2 2 Youth Leaders X X $28,080-31,856 3 3 3 Family Support Workers X X $26,000-33,280 6 6 6 Lead Teachers X X $17,680-26,000 6.5 6.5 7 Assistant teachers X X $15,600-18,928 11.25 11.75 11.75 Administrative Assistant X X $18,720-19,413 2 2 2 Clerical Assistant $14,560 0 .5 .5 Food Service Supervisor X X $16,640-18,720 .5 .5 .5 AmeriCorps Members X X $9,600 6 6 6 TOTAL FTEs 43.25 43.25 43.75 3. If serving multiple counties, how many FTEs serve Johnson County (include administrative and direct service staff)? 4. How much was spent on staff development in the last fiscal year? $8,901 5. How much is budgeted for staff development in this fiscal year? $10,000 6. What training and support opportunities are offered to staff?. j ccoghs\fundingform.doc 13 Agency Name: Neighborhood Centers of Johnson County All staffrec¢iv¢ training in CPR, First Aid, Mandatory Reporting of Child Abuse, and program specific training. In recent years, we have had Agency-wide training in Diversity and Crisis Prevention. Staff members at the Broadway Center have attended Spanish classes. Staffalso attend appropriate off-site training opportunities. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 4% Yes No If no, brief explanation 9. Does your agency V/ have personnel policies? If yes, date board last reviewed? 7/16/02 10. Does your board ~/ annually evaluate the director's performance? 11. Does your agency ~/ have j ob descriptions for every position? If yes, date of last board approval? N/A 12. IS there an annual V/ performance review for every staff? j ccoghs\fundingform.doc 14 Agency Name: Neighborhood Centers of Johnson Coun~ Agency Neighborhood Centers Section 7: Financial Management A, Three Year Historical Balance Sheet FY01 FY02 FY03 FY01 FY02 FY03 (As of your fiscal year-end) Enter Yr Enter Yr Enter Yr Enter Yr Enter Yr Enter Yr Current Assets 6/30/01 6/30/02 6/30/03 Current Liabilities 6/30/01 6/30/02 6/30/03 Cash $0 $24,197 $6.950 Accounts Payable ($79) $3,806 $5,000 Investments $0 $0 $0 Payroll Taxes Payable $190 $12,959 $2,500 Receivables < 90 days $54,996 $90,959 $90,959 Other: Line of credit $41.767 $0 $0 Other Mortgage Payable-6 months Total Current Assets $54.996 $115.156 $97.909 Total Curmnt Liabilities $41.878 $16.765 $7.500 Other Assets Other Liabilities Property $853,470 $861,053 $896,053 Mod.gage Payable-Balance $94,879 $94,879 $50,000 Equipment $196,446 $199.879 $209,879 Other less depreciagon ($280,149) ($327,128) ($372,128 Total Other Liabilities $94,879 $94,879 $50,000 Receivables > 90 days Total Liabilities $136.757 $111.644 $87.500 Other NetAssets $688,006 $737,316 $774,213 Total Non-current Assets $769.767 $733.804 $733.804 Total Assets $824,763 $848,960 $831,713 Liabilities & Net Assets $824,763 $848,960 $831,713 j ccoghs\fundingform.doc 15 Agency Name: Neighborhood Centers of Johnson County Agency: Neighborhood Centers Last Yr Cur Yr Next Yr B. Income & Expenses FY02 FY03 FY04 Income Local Funding Sources Iowa City $62,856 $62,856 $72,284 Coralville $0 $0 $0 Johnson County $66,025 $66,025 $75,929 United Way - Allocation $98,452 $101,517 $114,000 - Special Needs Funding $2,962 $5,924 $5,924 - Designated Giving $1,672 $1,000 $1,000 Grants-Federal, State, Foundation $912,723 $871,119 $872,629 Net Sales of Service $274,356 $327,540 $327,540 Net Sales of Materials $0 $0 $0 Contributions/Fundraising $12,880 $15,000 $15,000 Investment Income $1,590 $2,000 $2,000 Other Total Income $1,433,515 $1,452,981 $1,486,306 Expenses Wages & Salaries $899,904 $935,900 $954,618 Benefits $156,951 $177,821 $181,377 Occupancy $103,936 $105,495 $105,495 Non-occupancy $248,527 $251,012 $251,012 Other $1,409,318 $1,470,228 $1,492,503 C, Fund Balance Revenue $1,433,515 $1,452,981 $1,486,308 Carryover Balance from previous year $0 $24,197 $6,950 Total Operating Budget $1,433,515 $1,477,178 $1,493,256 Less Total Expenses $1,409,318 $1,470,228 $1,492,503 Ending Fund Balance $24,197 $6,950 $753 Less Restricted Balance (explain) Carryover Fund Balance** $24,197 $6,950 $753 j ccoghs\funding form. doc 16 Agency Name: Neighborhood Centers of Johnson County Agency: Neighborhood Centers FY02 FY03 FY04 D. Bd/Donor/Funder Restricted Funds Designated for: Last Year This Year Next Year Board Restricted/Emergency Funds $ 10,000 $ I0,000 $ 10,000 Total Restricted Funds $ 10,000 $ 10,000 $ 10,000 FY02 FY03 FY04 E. In Kind Support: Last Year This Year Next Year Services/Volunteers Board member, Tutors $ 118,279 $ 120,645 $ 123,057 Material Goods Table to Table, Hacap $ 6,630 $ 6,763 $ 6,898 Space, Utilities, etc Space in churches and schools $ 10,800 $ 11,016 $ 11,236 Total In-kind Support $ 135,709 $ 138,423 $ 141,192 FY02 FY03 FY04 F. Grants Description/Purpose Last Year This Year ~ Next Year AmeriCoq~s Prevention (BS, CC, PR) $ 124,204 $ 128,529 $ 128,529 BASICS Ed And Support (BS and PR) FY04 CC also $ 24,230 $ 30,219 $ 30,219 Clear Creek Amana School District Ed. And Support (CC) $ 30,000 $ 30,000 $ 30,000 Community Juvenile Justice Prevention (BS) $ 46,155 $ 44,841 $ 44,841 Department of Education Ed. And Support (BS and PR) $ 332,866 $ 298,759 $ 298,759 DepartmentofPublicHealth Prevention(PR) $ 36,981 $ 36,981 $ 36,981 DecaffLEAD Prevention (PR) $ 3,354 $ $ Decat/Clear Creek Prevention (CC) $ 36,962 $ $ HeadStart Ed. And Support (BS and PR) $ 101,467 $ 130,000 $ 130,000 Empowerment/PREP Summer Preschool (Twain) $ 10,000 $ 10,000 $ 10,000 Strengthening Families Prevention (BS, CC, PR) $ 22,097 $ 20,200 $ 20,200 Successfi~l Families Initiative Prevention (BS, CC, PR) $ 45,291 $ 9,000 $ Summer Food Service/Dept.of Ed Ed. And Support (BS, CC, PR) $ 11,059 $ 12,000 $ 12,000 Empowerment/Shared Visions Ed. And Support (BS and PR) $ 8,100 $ 8,100 $ 8,100 Empowem~ent/Family Dev. Group & NAC Prevention (BS, CC, PR) $ 6,296 $ 15,000 $ 15,000 Other grants Grant Purposes: Mini-grants & grants sought $ 5,501 $ 15,000 $ 60,000 Child Food Service/Dept. of Ed Children's meals/BS and PR $ 41,435 $ 45,000 $ 45,000 ?reg. Prev. Grant/Dept. of Health & Human Prevention (BS) $ 3,113 $ 3,000 $ 3,000 ~'ommunity Development Block Grant Rehabilitation at BS and PR $ 23,61 I $ 34,490 Total Grants $ 912,723 $ 871,119 $ 872,629 j ccoghs\ftmding form.doc 17 NEIGHBORHOOD CENTERS OF JOHNSON COUN'I~ BOARD OF DIRECTORS 2002 PRESIDENT: Stephen Trefz Community Mental Health 505 East College Street Iowa City, Iowa 52240 338-7884; fax: 338-7006: email: STrefz~meihc.org VICE-PRESIDENT: Roger Reilly Hills Bank & Trust 1401 Gilbert Street Iowa City, lA 52240 338-1277; email: rireill¥~hillsbank.com SECRETARY/TREASURER: Fred Mims Mens Athletics - University of Iowa 301 Carver Hawkeye Arena Iowa City, IA 52242-1020 335-9598; email: fred-mims~uiowa.edu Harry Wolf Emily Hughes Southgate Development Co. Public Defender's Office P.O. Box 1907 725 S Clinton Street Iowa City, Iowa 52244-1907 Iowa City, Iowa 337-4195; fax: 337-9823; email: hwolf~sgdev.net 351-1327 Sue Dulek Kris Petersen 201 South Lowell Street CC Neighborhood Council Iowa City IA 52245 493 Potter Street 356-5031; email: Susan-Dulek~iowa-city. org Tiffin, Iowa 52340 645-9917 Bedrelddin Ahmed PR Neighborhood Council Dawn Barker-Anderson 2402 Bartelt Road, #2C ACT Iowa City, IA 52246 45 Heron Circle H: 351-3764 Iowa City, Iowa 52240 Karin Franklin H: 358-8333; W: 341-2446 City of Iowa City email:andersond~act.org 1618 Wilson Street Iowa City, lA 52240 Bryce Freeman 356-5232; fax: 356-5009 Procter & Gamble email: lcarin_franklin~iowa-city, org 318 Linden Court Iowa City IA 52245 John Roffman W: 339-2297;H: 358-1901 email: RoffmanConstruction freeman.bj@pg.com 1314 Burry Drive iowa City, Iowa 52246 Robin Sueppel 351-3141 Lepic-Kroeger Realtors Mary McCue 2346 Mormon Trek Blvd. 447 S Summit Iowa City, Iowa 52246 Iowa City, Iowa 52240 351-88l 1; sueppel~aol.com 338-6134; mccue~zeus.ia.net Neighborhood Centers of Johnson County N~gh~h~od Centers ofJlJlllS<ll CoJ~ty Organizational Chart FY03 I Broad,~y II Ph .... t Ri~II~'~ I I I I Ex.ut ire Dir~ [ J D ir~ J J ~"~r~Z~m J [ Priam Dir~ I I I Al~iC~ I ~ J ~A'--ic~ml ~ I Y-h l~/d~ M~n~' Assi;~l~ ch~ M~ Assis;Tn&~ ch~ C~dir~ t~/ES Assi;r nt~ch~ C~dinat ~ AsSi;r~h~ ch~ Section 1: Background Agency Name: Nest of Johnson County Address:1500 Sycamore St. ,Iowa City, IA 52240 Phone: (319)887-1209 Director Name:Bonnie French-Watters Signature: Bd. Pres Name:Charles F. Hesse Signature: Request Completed By: C. Hesse Date: 09/26/02 Check Your Agency's Budget Year: 1/142/31 7/1-6/30 x 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $2224 $4613 10-15 Does not include designated __~ecial Needs Grants NA FY 03 FY 04 City of Iowa City Johnson County NA City of Coralville NA What were local funds used for this year: General budget and salary support for services What will next year's local funds be used for?NA Agency Mission Statement:The Nest of Johnson County seeks to promote healthy births and families In the community by encouraging medical care and educational opportunities for pregnant women in High risk situations and for new mothers. Summarize your programs and services for which you are requesting funding:NA List any accreditation and licensure your agency currently has. Explain. None Nest of Johnson County Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and furore plans. Please update annually.) The Nest originated in Johnson County in 1993, due to the efforts ora few committed Health care and human service workers. First opened an office at Mercy Hospital in 1995. The office and store were subsequently moved to the Pheasant Ridge Neighborhood Center in July 1996. Due to space needs of the Center, the Nest moved to a larger and more participant friendly space in the lower level of the 4C'c building at 1500 Sycamore St. in January 1999. The Nest employs a 60% time director/coordinator and we also have an office assistant part time by the hour. A group of dedicated volunteers helps with the store, child care during parent activities at the Nest, and with fund drives. The coordinator makes numerous appearances in other Johnson County communities to promote the Nest. The classes, educational materials and the store are currently housed only at the Sycamore St. address in Iowa City. The coordinator is responsible for the following activities. 1) maintain and expand educational classes and materials, 2) home visits to followup on adjustment concerns and provide referrals for identified needs, 3) collect data for outcome evaluation and program revisions, 4) coodinate fund raising activities, 5)provide training for staff, volunteers and report to the board. The board has three main committee functions: 1) Program - data management, education, incentive store, 2) Management - personnel, board composition, general program evaluation, finance (budget), 3) Funding - public relations, financial development, fund drives and locating funding sources. The board meets at least six (6) times a year for regularly scheduled meetings. Future plans include expansion of the program to better serve the communities outside of Iowa City. Currently evaluating audio-visual reproduction of classes for possible off-site presentations. Also, expanding home visit opportunities for closer followup and feedback as well as expanding followup beyond the first year of life. Section 2: Client Profile ~ ~ 2001 !2002 1. How many Johnson County residents 1 Unduplicated Count 71 66 (Including IC & Coralville) did your agency serve? 2. How many Iowa City residents did your agency 2 Unduplicated Count 51 51 serve? 3. How many Coralville residents did your agency 3 Unduplicated Count 13 7 serve? 10-~9 121 I Female: 66 I white 140 African-American ] 11 jccoghsXfundingform.doc 2 Nest of Johnson County 26-30 13 [ Latino 7 31-35 7 36-40 3 340 0 Asian 1 biracial 3 Native American 1 Other or no answer 3 3. Briefly describe your service population. Pregnant women with high risk criteria 4. How do you determine eligibility for services? Screened by questionnaire and interview 5. Are there fees for your services? Yes__ No x__ If yes, please describe your fee structure: 6. Do you provide services to areas outside of Johnson County? no Area(s) served: Services Provided: Fnnding Sources: jccoghskfundingform.doc 3 Nest of Johnson County Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client Nest intake, post-delivery and 1 year followup form and Nest Coalition Data Collection form (b) Community NA 2. Briefly summarize your findings: general s.~tisfaction 3. What changes have been made in response to these findings? Updating classes and materials 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Health Care Providers (M.D., PA, CNP) Social Service Agencies Community members Mecca Free Medical Clinic 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? UAY, Mother to Mother, '~'qA, our approach to the services are unique. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Incentive program for women with high risk pregnancies. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1.All About Me Child Fair - Penn Elementary 1. Nest assisted with evening event hosted by the North Liberty Family Resource Center, focusing on information, resources, and 2. Girl Scouts of America activities geared toward children ages birth to five and pregnant families. 3. Celebration of the Young Child - Sycamore 2. Scout requested assistance and Mall collaboration on an activity for her Gold Award project. This involved several ' ccoghskfunding form.doc 4 Nest of Johnson County meetings and a planning session. She then presented her hand-crafted items to Nest participants. 3. planned by 13 agencies including the Nest as well as child care providers. 33 exhibitors as well as programs of children's activities. Also included Safe Kids, Iowa City Fire Dept. and JC Ambulance Service j ccoghs\fundingform.doc 5 Nest of Johnson County Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (c.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Task management 1. Increase board and volunteer participation by identifying specific tasks and pairing with the appropriate committee or volunteer 2. Program expansion 2. Evaluating methods to better serve outside 3. Data collection Iowa City/Coralville: also increase home visits and followup beyond 1 yr. of life. 3. Recent computer program set up to better evaluate outcomes 2. In what way will the needs of your service population change in the next five years? unknown 3. How do you plan to address these changes? NA 4. Describe the evaluation methods you use to measure the success of your services? Data collection and client questionnaires. 5. What are the results of these evaluations (outcomes)? Waiting for data 6. How do you plan to use the evaluation results to enhance/extend your services? We would like to show that with this incentive program, high risk pregnant women are getting early prenatal care, become compliant patients, and have better outcomes than other high risk populations without the education and followup our clients receive. 7. How do your programs/services impact the community? Healthier and more health conscious mothers, involving fathers in supporting the program and ultimately healthier babies. 8. How did the agency respond to the UWJC recommendations from last year? NA j ccoghsLfimdingform.doc 6 Nest of Johnson County Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Six regularly scheduled meetings 3. What is your average attendance at board meetings? 60-70% 4. How is the board involved in strategic planning and governance of the agency? Committee structure designed to address each segment of the program. Changes require a majority vote of a quorum and election of officers takes place yearly 5. What type of training/orientation do board members receive? Receive a notebook of information and we attempt a retreat every other year. New board applicants are usually interviewed and must provide a curriculum vitae 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? ~ves, 2000 7. Have you filed the annual report with the Secretary of State? If yes, date filed? NA__ 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? yes, Sept 2002 If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes No __x If yes, Who completed the audit? How much did the audit cost? If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, what is in place to assure accountability in the agency's financial management? Board approval of financial statements and budget, check writing restrictions. Plan a financial review in next year. 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers X 1 million a. fiduciary liability b. employment practice liability General Liability x 1 million Umbrella Liability j ccoghs\funding form.doc 7 Nest of Johnson County Professional Liability Property or Renters X $10,000 Vehicle jccoghsXfundingform.doc 8 Nest of Johnson County Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. 5 years, BSN, over 25 years experience in community health with a focus on maternal/child health/parenting programs, issues and education 2. Staff Salaries &Benefits Check if Applicable Position Retire l~ll-Time Paid Healt Current Salary Range Equivalent Leav h ment Per Position (FTEs) e Ins. Plan Last This Next Yea Yea Year r r Director/Coordinator x $18445 50% 60% ?? TOTAL FTEs 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? NA 4. How much was spent on staff development in the last fiscal year? _none j ccoghs\funding form.doc 9 Nest of Johnson County 5. How much is budgeted for staffdevelopment in this fiscal year? 6. What training and support opportunities are offered to staff?. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3% Yes No If no, brief explanation 9. Does your agency x have personnel policies? If yes, date board last reviewed? 2000 10. Does your board x annually evaluate the director's performance? 11. Does your agency x have j ob descriptions for every position? If yes, date of last board approval? 2002 12. i Is there an annual x performance review for every staff?. j ccoghs~fundingform.doc 10 tAgency: Nes~ of Johnso~ CountM Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fi. scal year-end)~ 2000 2001 2002 Current Assets Cash $21,785 $43,550 $58,533 Investments Receivables < 90 days Other ~ Inventory $1,081 $1,081 $1,081 Total Current Assets $22,866 $44,631 $59,614 Other Assests _ __ Property _ $0 $0 $0 Equ~ment $0 $0 $1,115 less depreciation J $28 Receivables > 90 days $0~ $0 $0 Other Total Non-current Assets $0 $0 $1,143 Total Assets $22,866 $44,631 $60,701 2000 ~2001 2002 Current Liabilities ~ Accounts Payable __ ~ Payroll Taxes Payable $340 $233 $ 0 Contract~p ~ _ Mo~qage Payab!p~-6 months Total Current Liabifities $340 $233 $0 Other Liabilities Mortgage Payable-Balance Other Total Other Liabilities $0 $0 $0 Total Liabilities $340 $233 $0 Equi~ (Net Worth) $22,526 $44,398 . $60,701 Liabilities 8, Net Assets $22,866 $44,631 i $60,701 11 iA~ancy: Nes/: of Joh,~s,~n Cour~y 2000 2001 2OO2 B. Income & Expenses Income Local Funding Sources Iowa City~ Coralville Johnson County United Way - Allocation - Designated Giving $0 $1,695 $3,429 Grants-Federal, State, Foundation $0 $0 $0 Net Sales of Service Net Sales of Materials Contdbutions/Fundraising $30,179 $47,404 $40,455 Investment Income $510 $1,136 $1,575 Other Total Income $30,689 $50,235 $45,459 Wages & Salaries $15,132 , Benefit__s $~0 $1,400 Administrative $4,794 $4,186 $9,501 Occupancy $605 $3,650 $1,170 Other- Program $0 $5,883 $1,941 $20,531 $28,363 $29,156 , CJC.. Fund Balance t Revenu~e $30,689 $50,235 $45,459 Carryover Balance from previous~/ear $12,368 $22,526 ~ $44,398 Total Operating Budget $43,057 $72,761 I $89,857 Less Total Expenses $20,531 $28,363 $29,156 Ending Fund Balance $22,526 $44,391 $60,701 Less Restricted Balance (explain) Carryover Fund Balance $22,526 $44,3 $60,701 12 Nest of Johnson County D. BdlDonor/Funder Restricted Funds Desi;rnated for: Last Year This Year ~J Total Resb'icted Funds $0 i Last Year This Year E. In Kind Support: Services/Volur~eers $500 $500 Material Goods $4,000/ $4,000 Space, Utilities, etc ~ Other: (Please footnote) Total In-kind Support $4,500 S4,500 F. Grants De~urpose Last Year This Year Total Grants 13 APPENDIX A: Nest of Johnson County Board of Directors NAME ADDRESS OCCUPATION COMMITTEE TERM ENDS Mary Berg 4781 Dingleberry Rd. Faculty - Lq College Program 6/30/04 Iowa City, IA 52240 of Nursing Lawrence Blades 324 Woolf Ave. Attorney - retired Management 6/30/04 Iowa City, IA 52246 Charles Hesse 3948 Stewart Rd. N.E. Physician - retired Management 6/30/03 Iowa City, IA 52240 Chr. of Board Amy Juby 313 Moss Wood Lane Past participant Management 6/30/03 Iowa City, IA 52246 Grill manager Vice Chr. Betty Ketchum 1546 Somerset Lane Administrator - ret. Management 6/30/03 Iowa City, IA 52240 child health prgm Anne Peacock 2000 Lynncrest Dr. Cert. Nurse Midwife Program 6/30/04 Coralville, IA 52241 UIHC Alan Sherburne 2032 Ridgeway Dr. Physician- retired Program 6/30/04 Iowa City, IA 52245 Kathy Shey 3753 Cottage Reserve Rd. Social Worker Funding 6/30/04 Solon, IA 52333 Rhonda Vardy 605 12th Ave. RN - Mercy Hosp. Funding 6/30/04 Coralville, IA 52241 Secretary LaVern Vauble PO Box 473 CPA Management 6/30/03 Hills, lA 52235 Greenwood et al Treasurer Noel Verducci 22 fairview Knoll N.E. Homemaker Funding 6/30/04 Iowa City, IA 52240 Broker Carol Winter 336 Koser Ave Nurse Manager Program 6/30/03 Iowa City, IA UIHC OB/GYN NEST COORDINATOR: Bonnie French-Watters lin 1859 Hollywood Ct. Iowa City, IA 52240 14 Nest of Johnson County APPENDIX B: ORGANIZATIONAL CHART: I Board of Directors I ! Director-Coordinator Management Program Funding Includes finance, personnel, general management I such as board composition and responsibilities, policy statements, staffing decisions, budget i Includes data management, education program, incentive store Includes locating funding sources, public relations, fund drives 15 Section 1: Background Agency Name: Pentacrest, Inc./Pathways Adult Day Health Center Address: 817 Pepperwood Lane, Iowa City IA 52240 Pll,0ne: 319.339.6162 Director Name: Jeff Kellbach Signature: .~, Bd. Pres Name: David Brown Signature: Request Completed By: Jeff Kellbach Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $8,000 $8,000 $12,000 3 % Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 _ City of Iowa City 0 0 0 _ Johnson County $40,000 0 0 City of Coralville 0 0 0 What were local funds used for this year: Client fees, which enable those without means and resources to attend. Funds were also used to pay the difference between those that paid on a sliding fee scale and the total client cost. What will next year's local funds be used for? Client fees which enable those without means and resources to attend. Funds will continue to pay the difference between the amount paid on a sliding fee scale and the total client cost. Agency Mission Statement: The Pentacrest, Inc mission is to prevent premature or unnecessary institutionalization of physically and/or psychologically challenged adults. Our Center strives to do three things: keep challenged adults independent and living within the community; reduce the overall cost of long-term care by offering an affordable alternative; and keep family units intact. Summarize your programs and services for which you are requesting funding: Pathways Adult Day Health Center provides adult (18 years of age or older) day health services that identify and meet the needs of those who are physically and/or psychologically challenged including those with mental health or developmental disabilities. These services include an individual treatment plan emphasizing treatment activities designed to prevent institutionalization while providing relief to caregivers. All services are provided on a sliding fee scale and no one is denied services due to inability to pay. Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ List any accreditation and licensure your agency currently has. Explain. Pathways is voluntarily accredited by CARF, (The Rehabilitation Accreditation Commission) There are currently no state requirements for Adult Day Providers to have certification, accreditation or licensure. (Pentacrest, Inc. staff continues to work on the state level to achieve some form of State standards for certification, accreditation and/or licensure. This was one of the issues addressed by the Department of Elder Affairs task force with recommendations to the Governor of svhich Jo Benson- Vorwald was a member) Pathways is committed to quality, value, and optimal outcomes of services. We are currently one of four Adult Day providers in Iowa who are accredited. In meeting CARF requirements we meet the only national adult day standards supported by the National Adult Day Service Association. j ccoghs\funding form.doc 2 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ Agency History In 1979, the Adult Day Care program of Johnson County started as a practicum project by Doreen Nidey, under the Aging Studies Program at the University of Iowa. The program has continued through a variety of relationships and financial support mechanisms. Through the years it has provided medical students and various University programs access in order to gain experience in working with older adults. VNA, the Johnson County Health Department and the Johnson County Department of Public Health all served as sponsors of the Adult Day program. Each sponsor found it financially challenging. In 1996, the Advisory Board of the Johnson County Public Health Department solicited proposals to provide management services to the Adult Day Care program. The main goal was to broaden the scope of adult day care services available to meet community need. Pentacrest, Inc. was selected to establish a local not-for-profit agency to provide oversight and administration services to the adult day care program. Pentacrest, Inc. renamed the adult day program Pathways Adult Day Health Center. At that time, (July 1996) Pathways budget was 65% funded by Johnson County with Client fees generating 22% of the total budget. In March of 1998, Pathways became a part of Johnson County United Way. This past FY 2002 Johnson County support was completely eliminated. Currently, client fees make up 62% of the operational budget; Heritage Area Agency on Aging, the Child and Adult Care Food Program, donations and Johnson County United Way comprise the rest. Highlights that have occurred under the direction of Pentacrest, Inc. include: · Increased operational hours and target population was expanded to include individuals 18 and over. · Enhanced staffing to include a professional multi-disciplinary team consisting of a R.N. Program nurse, medical director, dietitian, licensed social worker, certified recreation therapist, and certified nursing assistants. A volunteer program was also added. · Added a full breakfast, special diets and nutritious snacks to the core serves. · Added transportation in rural areas and a part time program driving assistant to enhance rural accessibility · Added ancillary services including, bathing/showering, hair washing, medication box set-ups, 1; 1 feeding, and disease management (Diabetic Disease Management) · Added a therapeutic program structure H.E.A.L./Healthcare, Environmental Design, Arts and Humanities, and Lifelong Learning as its core programming philosophy. Among the many program offerings are arts and crafts, computer instruction, music, horticulture, and culinary arts. (H.E.A.L. has since been trademarked and used as an example of successful day programming throughout the country) · Established third party reimbursement through the Title XIX Waiver Program, including the Elderly Waiver, BI Waiver, Ill and Handicap Waiver, and Physical Disability Waiver. This past year we also added the MR Waiver. Established funding via the Department of Education and Department of Agriculture through the Child and Adult Care Feeding Program. (CACFP) · Added access to physical, speech and occupational therapies. · Achieved a three year accreditation from the Rehabilitation Accreditation Commission (CARF) August, 2000 · Moved to 817 Pepperwood Lane in order to expand and further meet the needs of community residents (March 2001) · Received $300,000 from Community Development Block Grant funds for purchase of and renovation of facility. Funding was granted May 2001 and received July 2001) Purchased 817 Pepperwood Lane July 2001 · Board of Directors initiated a Capital Campaign to raise funds for purchase and renovations of Pepperwood property · Completed renovations July 2002 (Design promotes cognitive stimulation, encourages client independence and increases staff efficiencies) Designed a transitional unit for significantly challenged individuals (completed July 2002) · Board of Directors initiated a campaign to raise funds for furnishing the transitional unit. · Average daily client census increased from 13 January 1996 to 27 July 2002 j c coghs\funding form.doc 3 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ Section 2: Client Profile 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 65 65 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 46 46 3. Ho~v many Coralville residents did your agency serve? 3 Unduplicated Count 15 14 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 0 Female: 44 African American 2 6-17 0 Male 21 CaucasiaM'qon-Hispanic 63 18-29 1 30-61 12 62-75 18 >75 34 3. Briefly, describe your service population. Pathways Adult Day Health Center provides adult day services to individuals with a variety of challenges who require support, supervision, and structure to remain as independent as possible. This target population consists primarily of frail individuals who are moderately handicapped or experiencing early to middle stages of dementia. Participants may experience conditions such as blindness, hearing impairments, partial paralysis, bone fractures, strokes, arthritis, Parkinson's and other chronic ailments that limit their ability to live independently. Pathways also provides services to individuals experiencing problems as a result of physical incapacity, mental illness, developmental disabilities, the aging process, social isolation, the death of family and/or friends, retirement, or the loss of social supports. 4. How do you determine eligibility for services? Any individual who is 18 and older may be referred for service(s). Upon receipt of a referral, an admission visit/intake assessment is conducted by one of the following: the Pathways Director, Nurse, or Social Worker. During the initial visit, the client is determined appropriate if they meet admission criteria. Adult Day is not appropriate for those persons who are in an infectious state of a communicable disease, and/or unable to transfer with assistance, are bedfast or do not have the stamina to attend. Individuals are not appropriate if experiencing unmanageable incontinence, are in an active state of substance abuse, are abusive to self or others, are disruptive in a group setting, are acute in psychiatric symptoms that cannot be accommodated, or demand one to one attention throughout the day, or are unable to function within available staff/client ratios. j ccoghs\ funding form.doc 4 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ All Pathways Adult Day Health Center referrals are evaluated without regard to race, creed, sex, sexual orientation, national origin or physical and mental challenges. A free visit day is offered to all potential clients to determine and assess client needs and program appropriateness. Pathways reserves the right to admit potential clients for a 10 or 30 day trial basis and reserves the right to reassess health status for program appropriateness at any time. 5. Are there fees for your services? Yes X No If yes, please describe your fee structure: Pathways Adult Day Health Center assesses the needs of participants by using the FA II Based on the assessment core and ancillary services are identified, then the appropriate number of days to schedule client attendance are determined. Fees for services are as follows: Level I & II Acuity @ $45.00/day Includes 4-8 hours of care, transportation within Johnson County, breakfast lunch and snacks, nursing/dietary assessment and oversight, social work services, therapeutic programs, music therapy, medication management (at the center) and personal assistance (ADL's including ambulation, personal hygiene, and grooming) Level III Acuity ~ $49.00/day Includes services listed above for program participants assessed at level III level of functioning. (Includes increased supervision in TLC transitional unit) Level III Acuity with Ancillary Services @ $63.00/day Includes all services of Level III up to 10 hours, bathing, showering, hair washing/care, 1:1 feeding, intensive dietary assessment intervention, shaving, and oral care. (Also includes increased supervision in TLC transitional unit) 6. Do you provide services to areas outside of Johnson County? Area(s) served: Individuals attend from Iowa, Cedar, Benton and Washington Counties Services Provided: Adult Day Health- and transportation if needed, see above Funding Sources: Medicaid Waiver programs, East Central Chapter of the Alzheimer's Association, and private pay. j ccoghs\ funding form.doc 5 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client Client feedback/satisfaction surveys are conducted annually. Client council meetings are conducted monthly. Client assessments are conducted routinely by the multi-disciplinary team, including family and caregiver. Tracking and trending of client demographics are conducted monthly. (b) Community A Stakeholders satisfaction survey is conducted annually, the Board of Directors evaluates on a monthly and ongoing basis and staffmeet regularly (minimum monthly to review comments, suggestions and trends). 2. Briefly summarize your findings: Pathways programs are designed to provide affordable, accessible adult day health services that meet the needs of adults with impairments, and help them to remain in the community for as long as possible. Statistics and surveys indicate that census and enrollment continue to grow. (Average Daily attendance from FY 01 to FY 02 increased by five clients, total enrollment increased from 37 to over 50 clients). Pathways does not have a waiting list and was able to accommodate ail referrals. Client attendance increased once enrolled in the program, (which demonstrates once clients attend they wish to attend more), 31 surveys were returned of the 50 satisfaction surveys mailed in June 2002, a 62% return. Of those returned 93% indicated the Center's hours were satisfactory, 84% indicated that Pathways offers a wide variety of educational programs, 100% of those responding indicated staff to be professional, knowledgeable, and able to attend to needs in a timely and dignified manner. 93% indicated Pathways was helpful in preventing premature long term care placement and 41% of those indicated it was delayed by over 2 years. One of most limiting factors found in Pathways programming and the main cause of discharge was the dementia client at risk of eloping. The staff identified safety and the inability to maintain an individual in the program once the individual was at risk of eloping in 20% of those discharged. 3. What changes have been made in response to these findings? Expanded capability to serve Dementia specific population by developing the TLC specialized care unit. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Medical Community ( University of Iowa physicians, Community physicians, Hospital 25% social workers and home health staff) j ccoghs\funding form.doc 6 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ Case Management 20% Elder Services (Caregiver's Specialist) 12% The % of clients referred is estimated: Pathways received 76 referrals from 31 different sources including self and family members, clients, board members, United Way staff and volunteers, information obtained through the web, phone book, The Heritage Agency, Mercy and the U of I Home Health agencies, the Alzheimer's Association, newspaper and magazine articles and the Chamber of Commerce. 5. What other agencies/organizations in Johnson Cotmty provide similar services to the same clientele as your agency? None 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Not Applicable 7. Outsideofreferrals, list up to 3 primary collaborations. Briefly describe the nature ofeach collaboration. Collaborations Briefly describe 1 .Elder Services 1.Case Management 2.University of Iowa 2.Practicums, educational offerings (enabling access to seniors), work study program, student volunteers 3.Visiting Nurses Association 3.Community Flu vaccination clinic, back-up nursing services, case management j ccoghs\funding form.doc 7 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Lack of oversight (Certification, 1. a. Testified to the Legislative Oversight Accreditation, or Licensure) in Adult Day Committee on the need for State oversight Services in the state of Iowa. August 27 2002. b. Member of the Department of Elder Affairs Task Fome recommending to the Governor the need for Adult Day Oversight. 2. Low reimbursement for Adult Day Services 2. a. Increase reimbursement through provided in Iowa Medicaid Waiver program for Home and Community Based services.(Participating on the State level as a Board Member of the Iowa Adult Day Service Association, currently conducting reseamh as to real cost of doing business. Providing DHS and DEA State Departments survey information. Visiting with legislators and participating on DEA task force). 3. Need for one additional Certified Nursing assistant to staff the TLC unit. 3. a. Developing budget based on projections of dementia and significantly challenged clients to be served in TLC unit. Require minimum of 3 clients daily to support unit staffing. j ccoghs\ funding form. doc 8 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center 3. In what way will the needs of your service population change in the next five years? Home and community based service providers of older and challenged adults will continue to see growth of the aged, frail and rural populations. An increased acuity in the level of care required will challenge providers of community based programs to be more creative in their ways to serve the increased numbers of Pentacrest, Inc.individuals and their increased acuity. Community resoumes will remain accessible for those with average or above incomes however, decreasing State and County dollars will impact consumers who are challenged to find and access services with limited or moderate means. Standards of care and definitions of Adult Day Health will continue to be an issue of public policy until Medicare mandates standards for reimbursement. 4. How do you plan to address these changes? Continue to act as an advocate for the elderly and their caregivers so that all who wish to may remain in their community rather than be placed in a nursing facility using public funds. Continue to work on public policy to enhance home and community based services and work to increase their funding to reflect more accurately the cost of doing business. Increase information and assistance to family caregivers through a "Caregivers Series" offered to caregivers and family members of clients of Pathways, and continue to provide financial assistance to those unable to pay full client fees through a sliding fee scale. 5. Describe the evaluation methods you use to measure the success of your services? We believe that the best sources of information to measure the outcomes and success of our services are our participants and their family caregivers. Therefore, an annual survey of our participants and caregivers is conducted, focusing not only on program satisfaction, but also on the impact of attending Pathways. We are interested in determining whether our services are meeting the individual needs of our participants, whether caregiver stress is being positively affected, and whether we are providing services that actually help our participants remain independent. The program also tracks statistical information such as average daily census, referrals, admissions, discharges, levels of acuity, and costs to assess need and financial viability. Stakeholder surveys are conducted annually to assess pemeived effectiveness of our services in the community. This information is useful in determining Pathways future goals and objectives regarding public relations and marketing, program structure, future transportation needs, and potential collaborations and partnerships to continue to assist and address community needs. j ccoghs\ fundflag form.doc 9 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center 6. What are the results of these evaluations (outcomes)? Statistics indicate the average length of participation at Pathways is approximately 2 years, and that the primary reason for discharge from the program is for placement in a Nursing Home, usually due to the need for increased level of care as the result of significant dementia. Client, caregiver, and stakeholder survey responses indicate 90% satisfaction in all core areas at this time. Core services include personal cares, meals, social and educational programming, access to rehabilitative services, nursing, medication management and transportation. These are the services most requested by our families. Caregiver responses indicate that Pathways has helped keep their family members independent for approximately 2 years longer than they would have been without adult day health services and cost analyses indicate adult day health services are being provided for approximately 1/2 to 1/3 of the cost of nursing home care. Stakeholder responses indicate perceived strength in community collaboration, caring and knowledgeable staff, operation hours are not an issue and that volunteers feel appreciated. Community awareness and public relations activities need to be ongoing. 76 Referrals during FY 02 came from 31 different sources. 7. How do you plan to use the evaluation results to enhance/extend your services? In response to the need to provide services to participants with increased needs, particularly significant dementia, Pathways is developing a transitional unit specifically designed to serve these participants. This program will serve approximately 6 individuals per day with higher needs, thereby extending their ability to remain at home. It is anticipated this unit will be operational by January 1, 2003. In order to better address the needs of our family caregivers, Pathways, in collaboration with Elder Services of Johnson County has established a Caregiver Support series that will begin later this Fall. (2003). Pathways will also host the Iowa City Chamber of Commerce, Business PM, Oct. 24th. 8. How do your programs/services impact the community? Information included in the Johnson County Capacity Assessment and Iowa City's "City Steps" indicate a need to provide cost effective strategies to help seniors remain their homes safely. Pathways Adult Day health Center is designed to provide services to seniors at risk of premature or even unnecessary institutional placement, at approximately 1/2 to 1/3 the cost of nursing home placement. In addition, by accessing these services, caregivers, in many cases are able to maintain their jobs and reduce the stresses that accompany providing care for an older adult, thereby increasing the amount of time families can remain intact. j cc oghsSfunding form.doc 10 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ 9. How did the agency respond to the UWJC recommendations from last year? Last year's UWJC recommendations included encouragement to Pathways to develop its outcomes evaluation, focusing on impact of services, in addition to satisfaction surveys, and encouragement to broaden Pathways' strategic plan to address identified challenges and anticipated changes in services and funding environments. In response to these recommendations the agency: Established a Participant Client Council that meets monthly with the Director and provides participant feedback directly to our staff, related to their individual experiences at Pathways. The Board of Directors reviews this feedback at their monthly meeting. We believe this information is important as not only a measure of our participant's satisfaction with the program, but also their ability to maintain their independence in their own homes. While it is difficult to accurately measure the actual impact of our services, we believe our clients and their families to be the best soume of this information. Therefore, our client and family surveys do not only focus on satisfaction with services provided at Pathways, but seek information that tells us if families believe their caregiver stress has been reduced, whether individual care plans are accomplishing what they are designed to do, and whether the services we provide at Pathways actually do help their family member remain dependent, which of course is our primary goal. The results of these surveys help us to determine whether we are actually meeting individual and family needs. We will continue to focus on the actual outcome information primarily, but will also utilize the satisfaction information obtained to assist with program design, and statistical information such as average daily census to help us determine financial efficiency and feasibility. In an effort to broaden the Pathways Strategic Plan, the Board has recently established a Planning Committee that will take on the task of more formally addressing identified challenges and anticipated changes in services and funding environments. This committee is made up of the Executive Committee of the Board at this time. The development of a more formal Strategic Plan will coincide with our plan for re-accreditation through CARF, which will begin this fiscal year. Challenges currently identified to be addressed in the Strategic Plan include: · Eliminated County Funding · Potential for reduced State Funding · Increased Acuity level of participants · Possibility of State Licensure · Staffing of program · Plan to address increased need j c coghs\funding form.doc 11 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) See attached Appendix A 2. How often does your board meet? The Board meets monthly 3. What is your average attendance at board meetings? Average attendance--The bylaws of the organization allow for a minimum of 7 Board members and a maximum of 12. Since the establishment of Pentacrest, Inc., in 1996, the size of the Board has increased from seven to the current ten members, with two new members beginning terms in July 2002. The average attendance at Board meetings for FY 02 was 6. For several months in FY 02, the Board consisted of 8 members. 4. How is the board involved in strategic planning and governance of the agency? The Board helps to establish, reviews, and approves the Pathways Strategic Plan, which is included in the CARF Accreditation. 5. What type of training/orientation do board members receive? New Board members receive an Orientation that includes an Orientation Manual that contains: *List of Current Board Members, Terms, Officers *Agency Structure *Articles of Incorporation *Agency Bylaws *Personnel Policies *Last Fiscal Year Board Minutes *Last Fiscal Year Financial Report *Description of Agency Services and Community Relations Materials In addition, each new board member tours the facility and reviews the Agency Mission and services in detail with staff members. 6. Does your agency have written policies and procedures for financial management? YES- If yes, date of last board approval? __Policies and Procedures approved 4/02 Financial management through approved Treasurer's report, Sept. 25, 2002 j ccoghs\fundingform, doc 12 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ The agency Bylaws state that the business and affairs of the Corporations shall be managed by its Board of Directors. The Powers and Duties of the Board of Directors are explained in detail in Section 6.06 of the Bylaws. The Bylaws also indicate that the Corporation's accounts shall be audited annually by a qualified, bonded accountant. In addition, the Treasurer of the Board of Directors receives and reviews Financial Revenue and Expense Reports, the Balance Sheet, the Detailed Trial Balance, and Check Register each month. The Treasurer presents the Monthly Financial Report to the full Board for consideration each month. The Treasurer also reviews the Annual Audit in detail and presents to the Board each year. 7. Have you filed the annual report with the Secretary of State? Yes- If yes, date filed? _2/16/0 l__Biennial Report__ 8. Have you filed the IRS form 990 for the most recent year? Yes- If yes, date filed? _2/15/02 __For FY 01__ If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? Clifton-Gunderson completed the FY 01 Annual Audit for Abbe, Inc. and affiliates How much did the audit cost? Pentacrest pro-rated amount was $487.00 If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers X $3,000,000 a. fiduciary liability Pending b. employment practice liability X $3,000,000 General Liability X $1,000,000/ $4,000,000 Umbrella Liability X $4,000,000 Professional Liability X $1,000,000/ $4,000,0O0 Property or Renters Vehicle X $1,000,000/ $5,000,000 j c coghs\funding form.doc 13 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center-- Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Executive Director/Licensed Social Worker, employed by Abbe, Inc. 22Years, served as Executive Director Aging Services, Inc 10 years Director Home and Community Based Services, Pentacrest, Inc. employed 2.5 years R.N., MHA, CMC, Geriatric Fellow, U of I 1998-1999 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health merit Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year HCBS Director X X X $45,000-$50,000 0.20 0.20 0.20 Pathways Program Director X X X $28,000-$32,000 1.0 1.0 1.0 Program Registered Nurse X X X $35,000-$40,000 1.0 1.0 1.0 Licensed Social Worker X X X $24,900-$30,000 1.0 1.0 1.0 (LBSW) Administrative Assistant X X X $18,000-$21,000 0.50 0.50 0.50 C.N.A. X X X $18,000-$21,000 1.0 1.0 2.0 (Certified Nurse Assist.) Program Assist/Driver X X X $18,000-$21,000 0.50 0.50 1.0 Activity Specialist X X X $18,000-$21,000 0.50 0.50 0.50 C.N.A./On-Call $7,000-$10,000 0.0 0.3 0.3 TOTAL FTEs 5.7 6 7.5 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? All 4. How much was spent on staff development in the last fiscal year? _$1,200 5. How much is budgeted for staff development in this fiscal year? $1,500 jccoghs\funding form.doc 14 Agency Name Pentacrest, Inc. / Pathways Adult Day Health Center~ 6. What training and support opportunities are offered to staff?. Mandatory management in-service every other month, Voluntary management in- service/educational offering every other month for managers. Quarterly Iowa Adult Day Service State Association meetings for Program Director, Mandatory CPR training annually (all staff), 1.5 hours of continuing educational offerings to maintain RN Licensure every year at offering(s) of choice, additional as requested and budget allows. 7. Please attach current organizational chart as Appendix B. see attached Appendix B 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 4% Yes No If no, brief explanation 9. Does your agency have personnel policies? X If yes, date board 4/02 last reviewed? 10. Does your board The Program Director's performance is evaluated by the annually evaluate X Director of Home and Community Based Services. Board the director's input is solicited and welcome performance? 11. Does your agency have job Job Descriptions were last approved in April, 2002 as part descriptions for X of Personnel Policies. every position? 4/02 If yes, date of last board approval? 12. Is there an annual performance X Every staff person is evaluated at least annually. review for every staff?. j c coghs\funding form.doc 15 I I I I en : I Pentacrest, Inc. I Section 7: Financial Management ~.. Three Year Historical Balance Sheet IAs of your fiscal year-end) FY '00 FY '01 FY '02 FY '00 FY '01 FY '02 ~urrent Assets =urrent Liabilities Cash 29,995 16,529 8,583 Accounts payable 3.510 5,982 9,228 investments Payroll Taxes Payable 2,891 3,208 Receivables<90 days 19.804 330.213 41.211 Contracts Payable 11.510 55,144 70,632 Other 4,075 22.101 25.993 Mortgage Payable- 6 monks 4,575 Total Current Assets 53.874 368.842 75.787 Total Current Liabilities 15,020 64.017 87.643 Other Assets Other Liabilifies Property 848.173 Mortgage Payable - Balance 388.183 Equipment 21.338 104.162 33.292 Other 20.633 less depreciation (5.007 (8,4611 (33.453) Total Other Liabilities 408,816 Receivables>90 days Total Liabilities 15.020 64,017 496,459 Ot~er Net Assets 55.185 400,527 427,340 Total Non-Cu rrent Asseta 16,331 95.701 848.012 Total Assets 70,205 464.543 923.799 Liabilities & Net Assets 70.205 464,543 923,799 Agency: Pentacrest/Pathways Last Yr Cur Yr Next Yr B. Income & Expenses FY '02 --Y '03 FY '04 Income Local Funding Sources Iowa City $0 $0 $0 Coralville $0 $0 $0 Johnson County $40,000 $0 $0 United Way - Allocation $8,000 $8,000 $12,000 _ - Designated Giving $3,861 $3,700 $3,500 _Grants-Federal, State, Foundation $28,421 $27,572 $27,572 Net Sales of Service $249,271 $278,000 $287,300 Net Sales of Materials $0 $0 $0 Contributions/Fundraising $43,408 $32,000 $22,500 Investment Income $12,811 $17,400 $18,000 Other $10 $500 $100 Total lncome $385,782 $367,172 $370,972 Expenses Wages&Salaries $150,336 $152,335 $167,500 Benefits $21,398 $27,500 $30,700 Occupancy $59,831 $46,005 $48,000 __N~on-occupancy $127,403 $114,160 $122,200 Other $0 $2,200 $2,000 Total Expenses $358,968 $342,200 $370,400 Net Income $26,814 $24,972 $572: C. Fund Balance Revenue $385,782 $367,172 $370,972 Carryover Balance from previous year $400,527 $129,159 $124,131 Total Operating Budget $786,309 $496,331 $495,103 Less Total Expenses $358,968 $342,200 $370,400 I Ending Fund Balance $427,341 $154,131 $124,703 Less Restricted Balance (explain) $298,182 $30,000 $20,000 Carryover Fund Balance $129,159 $124,131 $104,703 Restricted fund balance consists of United Way Fund balance increased significantly in pledge receivable (FY '02 only) and fundraising FY '01 because of a one-time grant of revenue for building $300,000 to purchase a building E. In Kind Support: Last Year This Year Next Year Services/Volunteers $5,000 $5,500 $5,(~00 Mate~al Goods $4,227 $12,935 $5,000 Space, Util~ies, etc Other: (Please footnote) Total In-kind Support $9,227 $18,435 $10,000 F. Grants Description/Purpose Last Year This Year Next Year Total Grants $0 $0 SD Pentacrest, Inc./Pathways Adult Health Center Board Roster Appendix A David Brown, Chairperson Ann Rhodes Executive & Ex-Officio all Fund Coralville, IA Iowa City, IA Hayek, Hayek, & Brown Professor, University of Iowa 3rd/July 2005 lSt/February 2004 Catherine Lane, Vice Chairperson Rev. Paul Akin Executive, Fundraising, & CR CR Iowa City, IA Iowa City, IA Community Volunteer Pastor 2"d/July 2005 lSt/July 2005 Robert Hall, Secretary Dr. James Worrell Executive & Facility Fund Iowa City, IA Iowa City, IA Insurance Neurologist 3rd/June 2005 lSt/July 2005 Sharla Borg, Treasurer Executive & Finance Iowa City, IA VP Iowa State Bank and Trust 3rd/July 2005 Hermine McLeran Nominations & CR Fund Coralville, IA Retired Educator Brd/July 2005 Dr. Paul Collins Nominations & Facility Iowa City, IA Dentist lSt/November 2003 Teri Garrett Facility & CR Fund Iowa City, IA Occupational Therapist 1 st/February 2004 APPENDIX B Pentacrest, Inc. 817 Pepperwood Drive iowa City, IA 52240 Agency Structure Board of Directors Executive Director I Director, Home and Community Based Services I I INurse I V~luUndte~ntrsS/I IAsOsiffsit~ent I,Driver,IPrc~ram~sistant/I ~ I I~°°'°'W°rkerI Victim Advocac, Section 1: Background Agency Name: Rape Victim Advocacy Program Address: 320 S. Linn Street, Iowa City, IA 52240 Phone: ~¥19-335-6~0~1 ~idr. e~tr~i ~i~i:: ~h~liTS~?milf;r' Interim Dir. S~ng~ruf~: Request Completed By: Karla S. Miller Date: 9/17/02 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30_X__ 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $24,440 $22,867 $24,010 5% Does not include designated giving or Special Needs Grams FY 02 FY 03 FY 04 City of Iowa City $14~850 $12,200 $12~810 3% Johnson County $14~700 $13,230 $13~892 3% City of Coralville $ 2,400 $ 2,640 $ 2,772 .6% What were local funds used for this year: Direct victim/survivors and outreach services, administrative costs, and agency director's salary (part). These funds are critical to attracting other funding by providing matching grants and demonstrating local support. What will next year's local funds are used for? These funds will continue to be used as they were this year since this funding structure worked well and was supplemented by other grant funding. Agency Mission Statement: The Rape Victim Advocacy Program provides confidential, accessible support and advocacy to victim/survivors of sexual abuse and their partners, friends, and family members and works to create a community free from sexual violence by providing education and prevention strategies and by promoting social change. Summarize your programs and services for which you are requesting funding: 1. Rape Crisis Services 24 hour Rape Crisis Line, in-person medical, legal, and court advocacy, short-term peer-counseling, systems advocacy, support groups and other direct services for victim/survivors of sexual abuse and their partners, friends, and family members in Johnson County. Agency: Rape Victim Advocacy Program 2. Education Present programs on topics related to sexual violence to civic, community, and school groups. Provide training for professionals and volunteers working with survivors. Operates information bureau and lending library. 3. Rape Crisis Services for Washington, Cedar, and Iowa Counties 24-hour Rape Crisis Line, 24-hour in-person medical and legal advocacy, counseling and other direct services for victims/survivors of sexual abuse in Washington, Cedar, and Iowa Counties. Also provide education programs for these communities. 4. Statewide Sexual Abuse Hotline Provide 24-hour toll-free hotline available to the entire state. Provide telephone support, information, and referral to local resources. Maintain a referral database for resources throughout Iowa, publicize the services throughout the state and publish a newsletter providing information about the hotline. List any accreditation and licensure your agency currently has. Explain. Staff members receive certification as victim advocates following a 40 hours training program conducted by the Iowa Coalition Against Sexual Assault. Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and futura plans. Please update annually.) AGENCY HISTORY In 1973, a Rape Victim Advocacy Program volunteer slept on a small cot next to the RVAP telephone every night to respond to women who suffered from sexual assault. Since that time, RVAP has provided a 24-hour-a-day Rape Crisis Line that is answered by trained volunteers. RVAP's work developed community education, individual counseling and support groups for victim/survivors and their significant others. Through creative community education, networking and collaboration, individual support groups and free counseling, RVAP supports victim/survivors and their significant others in many ways. Our primary reason for existence remains to provide crisis services to victims. In 2001, RVAP celebrated its 28'h year of offering essential services to Johnson County and since 1996, the program has expanded its scope through the acquisition of federal and state grants. In 1998 the State of Iowa awarded a grant to expend our services to neighboring Washington, Cedar and Iowa counties. In 1998 the State of Iowa awarded RVAP a grant that enabled us to provide telephone support for the Iowa Sexual Abuse Hotline (ISAH). RVAP now provides telephone counseling, information and referral throughout the state. Our Education Services provide numerous education programs within area schools. Our Youth Education Services have increased programs in which we collaborate with United Action for Youth and the Domestic Violence Intervention Program. We emphasize collaboration in all the work we do at RVAP. One project that we are particularly excited about is the Sexual Assault Nurse Examiner program (SANE) with the Johnson County Sexual Assault Response Team 0CSART). SANE was implemented in July 2000. Victim- centered protocol has been established to include all members of the team in responding to individual sexual assaults. JCSART produced its first statewide training for members of SARTs across the Midwest last January. Soon after, the State of Iowa requested that the Johnson County SART be the training institute for SART/SANE for the State of iowa. Additional funding has been made available to RVAP to make this happen. Most recently, we sponsored four nurses attending a j ccogs\funding form.doc 2 Agency: Rape Victim Advocacy Program forensic nursing conference and seven nurses total in taking the SANE certification test in Minneapolis. The RVAP developed the "Latina Collaboration Project" having recognized the growing Latina population in our community. Through collaborative efforts with members of the Latina population, RVAP is increasing our ability to provide services to Spanish speaking service users. This collaboration includes joint planning and funding for future services at the RVAP. The positive reputation of the RVAP has been earned because of our dedication to listening to what survivors tell us they need for support and healing. During the recent year, RVAP has consulted with the Urban Institute, the National Resource Center on Sexual Violence, the Iowa Coalition Against Sexual Assault and the Crime Victim Assistance Division. RVAP is also working with the University of Iowa International Center to develop a rape response protocol. Local funds provide a critical source of support for program administration because most of our grants are used for direct service activities. The other function of local funding is to provide matching funds for our federal grants. Local funds specifically support the local crisis line and Youth Education services. This past year, RVAP has experienced a significant amount of staff turnover, including the Executive Director's position. Currently, a search is underway for a new Executive Director. Following that, all open staff positions will be filled. RVAP is also reviewing policies, procedures, and programs to make sure they are current and are addressing needs using a"best practices model" and with an eye toward cost-effectiveness. Section 2: Client Profile 1. How many Johnson County residents (Including IC & 1 Unduplicated Count * 12,456 3824 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count *7,396 2625 3. How many Coralville residents did your agency serve? 3 Unduplicated Count *2,950 620 · The figures from last year appear to include media broadcasts, information tables, and brochures. · *The figures this year include number of people receiving direct services and attending educational programs. Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 0 Female: 179 African American 9 6-17 17 Male 37 Asian 3 18-29 102 European 87 30-61 50 Hispanic 5 62-75 0 Native American 5 >75 0 Unknown 107 Unknown 47 3. Briefly describe your service population. We serve primarily people over the age of 18. Our service population includes anyone who has experienced sexual abuse, harassment, date rape, and stalking. 4. How do you determine eligibility for services? Everyone is eligible for our crisis services and prevention/education outreach programs. 5. Are there fees for your services? Yes__ No__X__ j ccogs\fundingform.doc 3 Agency: Rape Victim Advocacy Program If yes, please describe your fee stmctare: N/A 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Cedar, Iowa, and Washington Counties; State of Iowa Services Provided: 24-hour Rape Crisis Line, 24-hour in-person medical and legal advocacy, counseling and other direct services for victims/survivors of sexual abuse in Washington, Cedar, and Iowa Counties. We provide education programs for these communities. We are the home of the Iowa Sexual Abuse Hotline. This is a toll-free 24 hour line that serves people throughout the state of Iowa. The Sexual Assault Response Team is a group of specially trained and certified nurses Funding Sources: Funding for the above projects comes from Crime Victim Assistance Division as the Victim of Crimes Act (VOCA) grant, the Sexual Assault Response Team Grant, and the Violence Against Women Act (VAWA) grant. The Iowa Coalition Against Sexual Assault awarded us a grant for prevention/education and outreach. Washington Community Chest awarded us a grant that we use primarily for renting an office in Washington County. Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: We have a two-page evaluation that is given to clients. Additionally, this year, the Board commissioned an extensive RVAP Performance Evaluation and Review that included surveys mailed to clients. (b) Community: The surveys were also mailed to many constituencies in the community including law enforcement, attomeys, schools, agencies, etc. 2. Briefly smnmarize your findings: Mostly, people were pleased with the level of knowledge exhibited by staff. Areas for improvements included timeliness of reports, consistency, and organization. 3. What changes have been made in response to these findings? The report commissioned by the Board contained suggested recommendations for changes and additions to update the Policy & Procedure Manual to include "best practices" models. They are also reviewing the structure of the agency to assess its effectiveness and efficiency considering the economic picture and the suggestions for improvement. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Law Enforcement 10% Hospital/Medical Personnel 20% Therapists/Counselors 2% Other Agencies 10% Self-referrals/personal referrals 50% School Personnel 8% jccogs\fundingform.doc 4 Agency: Rape Victim Advocacy Program 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Domestic Violence Intervention Program, United Action for Youth-we have some overlap but we focus on sexual abuse/assault and often work with their clients on those issues. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Providing direct services to victims of sexual assaulffabuse, harassment, exploitation, date rape, and stalking make us unique. Further, our prevention/education and outreach of those crimes are considered our area of expertise in the communities, although we do extensive collaborative efforts with several agencies, schools, and organizations with programming. Our volunteers and staff are trained to accompany victims to the hospital, police department, County Attorneys' offices, and court. Staff and volunteers are trained to provide phone counseling, and staff members provide peer counseling to victim/survivors and their family and friends. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Johnson County Sexual Assault 1. This team includes representatives from Investigation Team (JCSAIT). law enforcement, the County Attorney's Office, medical personnel, including the Sexual Assault Response Team (SART), and other agencies and organizations who meet regularly for the purpose of networking, coordinating efforts, and monitoring needs in the community as they relate to sexual assault. 2. Johnson County Coalition Against Domestic 2. This coalition has representatives from the Coralville Police Department, Department of Violence Human Services, Domestic Violence Intervention Program, the Department of Correctional Services, Emma Goldman Clinic, HACAP-Headstart, the Iowa City Police Department, J.C. Attorney's Office, JC Dept. of Public Health, RVAP, neighborhood centers, churches, and other agencies and institutions. We share information and resources on projects. 3. Iowa Coalition Against Sexual Assault 3. This coalition is comprised of IowaCASA) representatives from sexual assault centers across the state of Iowa. We receive training and resources from this organization as well as conducting joint campaigns and projects such as Sexual Assault Awareness Month. jccogs\fundingform.doc 5 Agency: Rape Victim Advocacy Program Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Increase communication, networking, 1. High staff turnover ~romote teamwork. 2. Provide superior training opportunities. 3. Develop ways to decrease work-related stress by increasing case management support, de-briefing on difficult cases, and attending to regular time off. 2. Timeliness of reports and organization. 1 .Separate duties into administration and crisis so that crisis does not affect smooth and uninterrupted administration of the program. 2. Hire an Administrative Assistant responsible for bookkeeping/accounting and administration of the office. 3. Change the role of the Executive Director so that the person in that position is not responsible for routine crisis work. 3. Establish clear lines of accountability and 1. Provide staff and Board training on responsibility throughout the agency, organizational structure and the roles and responsibilities of the Board, the Executive Director, and the staff. 2. Establish good, cooperative working relationships with clear boundaries between the Board and the Executive Director and the Executive Director and the Staff. 3. Recruit Board members with specific skills to provide balance and be able to augment each committee. 3. In what way will the needs of your service population change in the next five years? (I) We anticipate a continuation and even increasing number of requests for services from people who work with agencies who have had to cut their services. This would be especially true for people who have chronic mental illness and significant sexual abuse histories. (2) The Clergy sexual abuse scandal has created a number of issues: people who were sexually abused and their families coming forward for services and a great need for educational programming about sexual abuse and the impact on people in general regarding the violation of trust as well as spirituality. jccogs\fundingform.doc 6 Agency: Rape Victim Advocacy Program 4. How do you plan to address these changes? We will plan our staff and volunteer numbers accordingly and will develop additional services (such as groups specifically designed to address clergy abuse, including the impact on trust and spirituality), and we will develop and present programs offering analyses of such situations as well as information about offenders in general and the impact of clergy abuse on victims and communities. 5. Describe the evaluation methods you use to measure the success of your services? Evaluation forms are given to program attendees and direct service users. We did a comprehensive survey designed to assess our performance. Additionally, we monitor media coverage and solicit opinions regarding our services through people we network with and with whom we work individual cases. Finally, our Board members represent various constituencies and serve as a conduit for feedback from the communities they represent. 6. What are the results of these evaluations (outcomes)? As mentioned previously, consistency, structure and organization, and timely reporting were some of the areas in which we received suggestions for improvement. Further, public relations could be improved. We also received feedback that our physical office space needed improvement. 7. How do you plan to use the evaluation results to enhance/extend your services? The Board hired interim directors to begin attending to the issues. The Board is in the process of updating and improving written policies and procedures and introducing the latest "best practices" models we obtained from other centers. We have cleaned and reorganized our offices and are planning cosmetic improvements that will make the environment more welcoming and comfortable to work in. The Board is planning on receiving training regarding their roles and responsibilities and the staff will be trained in the new policies and procedures. The Board, Executive Director and staff will be trained on their relative roles, boundaries, and teamwork. We have improved our case management to ensure the best possible services on a consistent basis. 8. How do your programs/services impact the community? For victims of sexual abuse, harassment, and stalking, our services assist them very directly in helping them deal both with the practical procedures and issues involved following victimization and with the emotional impact of the abuse. Increased awareness and prevention is critical in communities to lower the risk to all citizens. 9. How did the agency respond to the UWJC rcconunendations from last year? 1. We have re-designed our statistics reports so that they are clearer and more useful to law enforcement, planners, funding bodies, and the general public. 2. We have made changes so that our reports and billings will be submitted in a timely manner. 3. We have gathered and will continue to gather report data on client satisfaction and direct service outcomes. jccogs\fundingform.doc 7 Agency:Rape Victim Advocacy Program 4. We have recognized the value and importance of having the University of Iowa as a funder and parmer. We receive a significant amount of in-kind services such as office space, access to university resources, legal coverage, accountability and oversight, and direct funds from the UI Student Government. 5. We continue with our Latina project, including translation of materials and moving toward providing services to Spanish-speaking people in their native language, and we also continue and strengthen our many collaborative efforts in the community. 6.We have greatly improved our accounting department and we are working a balanced budget. 7. We will also be completing financial measurement instruments that include more accurate cost- per-unit assessments. 8. We are also continuing to seek funding from outside the community and to develop creative ways of fundraising within the community. 9. We are continuing to develop our Board and to seek Board members who represent diverse populations and who possess specialized skills that enhance our planning, development, and accountability. 10. We will continue our rural outreach and work to expand services and programming specifically designed for smaller towns and rural areas. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) See attachment. 2. How often does your board meet? Monthly and more frequently when needed. Additionally, committees meet according to their functions. 3. What is your average attendance at board meetings? 6-10 members. 4. How is the board involved in strategic planning and governance of the agency? The Board is currently heavily involved in strategic planning, including reviewing the structure, organization, and policies and procedures. This is being done with consideration of the economy, as well as emerging and projected needs. They will be working more collaboratively on planning with input from the new Executive Director and staff members. 5. What type of training/orientation do board members receive? Board members are asked to attend a twelve-hour agency orientation, which is offered three times a year. Some Board members have gone through the advocate training. In-service training opportunities are presented (sometimes by outside speakers) at Board meetings three times a year on topics like RVAP services (completed internally), cultural competence, fundraising, and facilitating meetings. 6. Does your agency have written policies and procedures for financial management? If yes, date of last Board approval? __X__ We are currently involved in reviewing and updating our fiscal policies and procedures and adding new ones to enhance current practices and ensure 7. Have you filed the annual report with the Secretary of State? If yes, date filed? No. We are included in the annual report of the University of Iowa. jccogs\fundingform.doc 8 Agency: Rape Victim Advocacy Program 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? Again, we file under University of Iowa. If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X__ No__ If yes, Who completed the audit? How much did the audit cost? Greenwood and Crim $2,400 If material weaknesses are noted in the audit, what is your plan for addressing them? None noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? N/A 9. Insurance Coverage: (check what coverage your agency has) The University of Iowa is self-insured and provides RVAP liability coverage for the program and the Board, Executive Director, staff, and volunteers. Figures for this coverage are unavailable but, especially considering post-911 rates, they would be prohibitive for our program if not provided by the University of Iowa. One unofficial estimate exceeds $30,000. Insurance Check if agency has Amount Directors & Officers a. fiduciary liability see above --- b. employment practice liability General Liability see above --- Umbrella Liability see above --- Professional Liability see above --- Property or Renters see above --- Vehicle see above --- Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. This position is currently open. Karla Miller and Diane Funk (both past RVAP directors) are serving as Interim Directors until the new Executive Director is hired. j ccogs\ funding form.doc 9 Agency: Rape Victim Advocacy Program 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director x x x 38,000-4s,000 1.0 1.0 1.0 Administrative x X X 32,000-35,000 .25 1.0 1.0 Assistant Support Staff Work-Study and hourly .5 1.5 1.5 $7-$10fhour Sexual Abuse Hotline X X X 1.0 1.0 1.0 Director Crisis Counselors, X X X 27,000-32,000 6.0 5.0 6.0 including Volunteer Coordinator, and county outreach Prevention/Education X X X 27,000-32,000 2.0 2.0 1.0 TOTAL FTEs 10.75 I1.5 11.5 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 9.5 F.T.E. 4. How much was spent on staff development in the last fiscal year? $899 We had significant staff turnover this year. As a result, our staffdid not attend as many training sessions and participate in continuing education as we have in the past. 5. How much is budgeted for staff development in this fiscal year? $5,000 Note: We will be hiring most of the positions for this agency so our training costs will be higher for this fiscal year. 6. What training and support opportunities are offered to staff?. The staff receive 40 hours of certification training from the Iowa Coalition Against Sexual Assault. There is other training offered by the coalition. Additionally, staff members usually have opportunities to attend conferences in specific areas and to attend in-house in-services. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3% jccogs\fundingform.doc 10 Agency: Rape Victim Advocacy Program Yes No If no, brief explanation 9. Does your agency X We are in the process of reviewing and updating the Policy have personnel & Procedures Manual. We are also adding new policies and policies? procedures. If yes, date Board 2002 last reviewed? 10. Does your Board Yes annually evaluate the director's performance? 11. Does your agency Yes have job descriptions for every position? If yes, date of last 2001 Board approval? 12. Is there an annual Yes This is being updated and implemented on a more regular performance basis. review for every staff?. j ccogs\funding form.doc 11 A~ency: Rape Victim Advocac ~ Program _ Section 7: Financial Management A. Three Year Historical Balance Sheet (~As of your fiscal year-end) FY 00 FY 01 FY 02 Current Assets Cash $28,923 $56,832 $42,464 Investments Receivables < 90 days Other (a) $450 Total Current Assets $28,923 $57,282 $42,464 Other Assets Property Equipment $58,687 $63,043 $64,202 less depreciation ($34,334) ($42,922 ($50,405) Receivables > 90 days $23,968 $20,283 $36,046 Other (b) $102,367 $102,387 $100,586 Total Non.current Assets $150,68~ $142,791 $150,429 Total Assets $179,611 $200,073 $192,893 FY 00 FY 01 FY 02 Current Liabilities Accounts Payable $12,371 $3,416 $988 Payroll Taxes Payable Contracts Payable Mortgage Payable-6 months Total Current Liabilities $12,371 $3,416 $988 Other Liabilities Mortgage Payable-Balance Other (c) $57,583 $67,740 $83,127 Total Other Liabilities $57,583 $67,740 $83,127 Total Liabilities $69,954 $71,156 $84,115 NetAssets $109,657 $128,917 $108,778 Liabilities & Net Assets $179,61 $200,073 $192,893 *Note: FY00 and FY01 figures are audited. FY02 figures will be audited soon. (a) Other Current Asset at FY01 year-end was prepaid rent of $450. (b) Other Assets include University of Iowa Foundation funds from donors. (c) Other Liabilities for FYO0 includes: accrued vacations of $25,807; amounts due to U of I $31,776 Other Liabilities for FY01 includes: accrued vacations of $19,707; amounts due to U of I $48,033 Other Liabilities for FY02 includes: accrued vacations of $19,707; amounts due to U of I $63,420 Agency: Rape Victim Advocacy Program FY02 FY03 FY04 B. Income & Expenses Income Local Funding Sources Iowa City $14,850 $12,200 $12,810 Coralville $2,400 $2,640 $2,772 Johnson County $14,700 $13,230 $13,892 United Way-Allocation $24,046 $22,867 $24,010 - Designated Giving $4,122 $3,585 $3,764 Grants-Federal, State, Foundation $359,070 $366,745 $389,341 Net Sales of Service Net Sales of Materials Contributions/Fundraising $30,211 $30,463 $32,047 Investment Income $2,093 $4,000 $4,500 Other $7,486 Total lncome $458,978 $455,730 $483,137 Expenses Wages & Salaries (a) $233,995 $301,257 $310,295 Benefits $85,142 $96,403 $99,295 Occupancy (b) $2,520 $1,920 $1,920 Non-occupancy $46,811 $18,267 $18,815 Other (c) $51,730 $53,399 $52,000 Total Expenses (d) $420,198 $471,246 $482,325 C. Fund Balance Revenue $458,978 $455,730 $483,137 Carryover Balance from previous year $108,778 $147,558 $132,042 Total Operating Budget $567,756 $603,288 $615,179 Less Total Expenses $420,198 $471,246 $482,325 Ending Fund Balance $147,558 $132,042 $132,854 Less Restricted Balance (explain) $76,613 $87,000 $98,000 Carryover Fund Balance $70,945 $45,042 $34,854 (a) Due to staff tumover, salary & benefits during FY02 were lower than usual. FY03 salary & benefits may also be lower than projected above due to additional staff tumovec (b) Occupancy expenses are for outreach offices only. Our main Off.Ice occupancy costs are paid in-kind by U of l. (See section E. In Kind Support on following Page.) (c) Other expenses for FY02 is comprised of: $21,815 for telephone costs; $12, 800 for agency consulting fees; $9,358 in publicity expenses; and $7,757 in travel costs. Projected other expenses for FY03 includes: $20,801 in telephone costs; $12, 652 in printing & publicity costs; and $19,946 for travel and training expenses. (d) FY03 total expenses are larger than total income due to $17,320 grant extensions in FY02 and carded over to FY03. j ccoghs\fundingform.doc 13 Agency: Rape Victim Advocacy Program D. Bd/Donor/Funder Designated for: FY02 FY03 FY04 Restricted Funds U of I Foundation - private Income used for operating $76,613 $87,000 $98,000 donors expenses Total Restricted Funds $76,613 $87,000 $98,000 E, In Kind Support: FY00 This Year Next Year Services/Volunteers (a) $210,924 $214,747 $217,987 Material Goods Space, Utilities, etc Rent, utilities, custodial services $23,487 $23,487 $24,192 Other: {Please footnote/ Total In-kind Support $234,411 $238,234 $242,179 F, Grants Description/Purpose Last Year This Year NextYear Victims of Crime Act Provide services to victims of $136,000 $132,000 $138,600 sexual crimes Sexual Abuse Grant Funds pay for salaries, benefits $43,363 $36,550 $38,378 & temp. help Statewide Hotline Grant Telephone support & referrals $62,019 $62,000 $65,10¢ throughout Iowa VAWA Counties (b) Advocacy, counseling & other $22,298 $17,348 $18,21," direct services VAWA Sexual Assault Provides exams for victims of $27,194 $38,517 $40,442 Response Team sexual assault IowaCASA Youth education services $14,875 $15,167 $15,92~ U of I Student Government UI student fees used to pay for $40,864 $40,886 $42,93(2 costs below (c) Iowa Women's Foundation (d) Crisis services to the Latina $1,579 $4,079 $2,50(2 population Washington County For providing services to $3,00(2 $5,000 $5,2512 Community Chest Washington County U of I Parents Association (e) Mentors in Violence Prevention $7,87~ $0 SC Misc. Grants Operating costs, supplies, $¢ $15,198 $22,00(2 salaries, misc. exp. Total Grants $359,07¢ $366,745 $389,341 (a) FY02 volunteers: Crisis Services Volunteers (13,312 hours) x $12.96/hou/=$172,524 POWER Peer Educators & Information Advocates (963 hours) x $12.96/hour= $12,480 Board Members (2,000 hours) x $12.96/hour = 25,920 FY03 volunteers: Crisis Services Volunteers (14,000 hours) x $12.96/hour=-$181,440 POWER Peer Educators & Information Advocates (750 hours) x $12.96/hour=- $9,720 Board Members (1,820 hours) x $12.96/hour = $23,587 FY04 volunteers: Crisis Services Volunteers (14,000 hours) x $12. 96/hour=-$181, 440 POWER Peer Educators & Information Advocates (1,000 hours) x $12.96/hour= $12,960 Board Members (1,820 hours) x $12.96/'hour = $23,587 (b) VAWA Counties grant allows services to be provided to Washington, Cedar and Iowa counties. (c) Funds used toward Education Director salaQ/, off/ce supplies, publicity, educational programs & phone cos; (d) Funding is given on a calendar year basis, causing grant to be recognized over FY02 & FY03. (e) This was a one-time funding source to support the Mentors in Violence Prevention program. j ccoghs\funding form.doc 14 Agency: Rape Victim Advocacy Program Attachment A Board of Directors Lauri Lehn, Board Co-Chair Professor/University of Iowa Membership Committee 1998 Tipton-Cedar County Grad Student, Janet Lyness 2001 Nominations Committee Iowa City Chad Thomas-Board Co-Chair Assistant County Attorney, Johnson Development Committee County Attorney's Office West Liberty 1990 Attorney-Student Legal Services 2001 Resmiye Oral Iowa City Kathy Stepp-Treasurer Pediatrician-UI Hospitals Finance Committee 2002 North Liberty Accountant McGladrey & Pullen Para Dallege 1999 Development Committee Atalissa Holly Kriener-Secretary 2002 Development Committee Coralville Barbara Claire Grad Student Cedar Rapids 2001 Community Program Monitor 6th Judicial District Sue Lafky 2000 Publicity Committee Iowa City j ccoghs\fundingform.doc 15 Rape Victim Advocacy Program I Attachment B I RVAP BOARD V.P. Student Services U.I. I Finance-Office Agency Director Manager I I Admin. Team Dir. of Johnson Director of Director. of Dir of Cedar Dir. of Dir. of Dir. of Co. Services ISAH Washington Co. Iowa Co. Volunteer Education Youth Ed. I I I I Crisis Services Team Education Team Crisis Line Volunteers Latina/ALFA Volunteers POWER and ASC Volunteers Administrative Support staff Rape Victim Advocacy Program Table of Organization Section 1: Background Agency Name: American Red Cross, Grant Wood Area Chapter Address: 328 S. Clinton St, STE 6, Iowa City Phone: (319) 337-2119 Executive Director: Betty Hargraves Director Name: Angela Schmucker Signature: Bd. Pres Name: Clare Slattery Signature: -~ ~ ~ c Request Completed By: Angela Schmucker Date: 9/26/02 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/3 !/04 Total Amount received from UWJC Does not include designated 17,930 12,984 19,767 5.9% giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City 5,500 5,500 6,038 1.8% Johnson County 6,890 0 7,500 2.3% City of Coralville 1,250 1,100 1,500 0.5% What were local funds used for this year: These funds were used to provide relief to victims of disasters in the form of emergency food, shelter and clothing, and to teach individuals disaster preparedness and response. The funds supported our efforts to provide emergency military communications and support. They were also used to teach people health emergency skills, including CPR, first aid, and water safety. What will next year's local funds be used for? Funds received in the coming fiscal year will be used to support the activities described above in our Emergency Services and Health Services programs. Agency Mission Statement: The mission of the American Red Cross is to assist victims of disasters and to help people prevent, prepare for and respond to emergencies. Summarize your programs and services for which you are requesting funding: Emergency Services has two aspects to its program - Disaster Services and Emergency Family Services. The American Red Cross is mandated by Congress to provide relief to victims of disasters, and emergency communication and reunification assistance to military families. No direct federal aid is received by the American Red Cross for these services. The Health Services programs provide health education and prevention to help people prevent, prepare for and respond to emergencies. These are accomplished by offering prevention education courses in Cardiopulmonary Resuscitation (CPR), first aid, water safety, and disease transmission. Health Services volunteers also assist at local blood drives. List any accreditation and licensure your agency currently has. Explain. Each chapter of the American Red Cross is rechartemd every five years. Our chapter was last rechartered in 1999. This process involves an extensive review of all aspects of chapter business, including such things as Section 1: Background Agency Name: American Red Cross, Grant Wood Area Chapter Address: 328 S. Clinton St, STE 6, Iowa City Phone: (319) 337-2119 Executive Director: Betty Hargraves Director Name: Angela Schmucker Signature: Bal. Pres Name: Clare Slattery Signature: Request Completed By: Angela Schmucker Date: 9/26/02 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated 17,930 12,984 19,767 5.9% ~cial Needs Grants FY 02 FY 03 FY 04 City of Iowa City 5,500 5,500 6,038 1.8% Johnson County 6,890 0 7,500 2.3% City of Coralville 1,250 1,100 1,500 0.5 % What were local funds used for this year: These funds were used to provide relief to victims of disasters in the form of emergency food, shelter and clothing, and to teach individuals disaster preparedness and response. The funds supported our effbrts to provide emergency military communications and support. They were also used to teach people health emergency skills, including CPR, first aid, and water safety. What will next year's local funds be used for? Funds received in the coming fiscal year will be used to support the activities described above in our Emergency Services and Health Services programs. Agency Mission Statement: The mission of the American Red Cross is to assist victims of disasters and to help people prevent, prepare for and respond to emergencies. Summarize your programs and services for which you are requesting funding: Emergency Services has two aspects to its program - Disaster Services and Emergency Family Services. The American Red Cross is mandated by Congress to provide relief to victims of disasters, and emergency communication and reunification assistance to military families. No direct federal aid is received by the American Red Cross for these services. The Health Services programs provide health education and prevention to help people prevent, prepare for and respond to emergencies. These are accomplished by offering prevention education courses in Cardiopulmonary Resuscitation (CPR), first aid, water safety, and disease transmission. Health Services volunteers also assist at local blood drives. List any accreditation and licensure your agency currently has. Explain. Each chapter of the American Red Cross is rechartered every five years. Our chapter was last rechartered in 1999. This process involves an extensive review of all aspects of chapter business, including Agency Name _American Red Cross, Grant Wood Area Chapter such things as service delivery, volunteer involvement and leadership, strategic planning, financial development and accounting, and fiscal controls. In addition, at the beginning of fiscal year 2003, our chapter became what our national office calls a SCOPE chapter. These are the 175 largest chapters in the country. With this designation, we now have to provide quarterly financial information to our national office in addition to the annual financial and service data we have already been providing. j ccoghs~funding form. doc 2 Agency Name _American Red Cross, Grant Wood Area Chapter Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Since 1881, people have turned to the Red Cross to provide relief to victims of disasters and to help people prevent, prepare for, and respond to emergencies. The American Red Cross began providing services to people in Johnson County in 1917. In 1993, Johnson County merged with the Grant Wood Area Chapter. The chapter provides services to people in six Eastern Iowa counties: Johnson, Linn, Benton, Jones, Dela~vare, and Iowa, serving an estimated 371,000 people. Red Cross plays a vital role in county emergency response plans. The chapter works closely with the Johnson County Emergency Management Agency (EMA) and other emergency response agencies in preparation for possible emergencies. Volunteers in Disaster Services respond to emergencies in their counties at all times of the day and night. They work with disaster victims and emergency responders to help meet immediate emergency needs such as food, clothing and shelter. To help reduce the number of fires in our community, the Red Cross and Iowa City fire department work together to provide the Battery Up program for low-income, elderly and at-risk populations in the area. The Red Cross has begun ~vorking more closely with various organizations in Johnson County to provide information and education about our international and military support services. We conduct educational sessions with the local National Guard units to inform families about services that the Red Cross provides. We are also working with the United Nations Association and the University of Iowa Law Center to coordinate international services tracings and messages. This is the second year of our collaborative eftbrt with the Clear Creek-Amana school digtrict to train rural Johnson County middle school students in safety and management issues regarding babysitting. We will also be working with the Solon School District this year. These training opportunities were made possible by a grant from the United Way of Johnson County Special Needs Fund. CPR and First Aid training to assist people continues to be needed in the Johnson County community. Individuals take the class for both personal and professional reasons. We trained over 1,000 more people in CPR and first aid this year than we did last year, bringing us closer to our goal of having at least one member of every household trained in these lifesaving skills. We also collected over 100 more units of blood in Johnson County this year than last. Each one unit of blood can help three separate individuals needing blood products. The American Red Cross continues to be a leader in human services in our community. Johnson County residents can expect the Red Cross to be there during times of disasters and to help the community prevent, prepare for, and respond to emergencies. j ccoghs~funding form.doc 3 Agency Name _American Red Cross, Grant Wood Area Chapter Section 2: Client Profile 1. How ninny Johnson County residents (Including IC & 1 Unduplicated Count 6,246 7,099 Curalville) did your agency serve? 2. How many lowa City residents did your agency serve? 2 Unduplicated Count 5,497 5,877 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 562 997 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 8 Female: 4,127 Not available consistently for services 6-17 444 Male 2,582 i8-29 2,719 Unknown 390 30-61 3,800 62-75 81 >75 47 3. Briefly describe your service population. Our agency provides services to all residents of Johnson County and the other five counties we serve. Some of our programs target specific populations. For example, we have youth education programs in both Disaster Services and Health Services. Our Battery-Up program targets low-income, elderly and at-risk populations. Disaster services are provided free of charge to any person who has experienced a disaster. 4. How do you determine eligibility for services? Specific programs have guidelines for eligibility. Disaster Services clients are referred to us by municipal agencies such as Iowa City Fire Department, Johnson County Emergency Management, or other agencies that can verify a disaster event. Families receiving Armed Forces Emergency Services are either active duty military servicemen and women, veterans, or immediate family members. International Services clients are members of families separated due to war or disaster. All members of our communities are eligible for community referrals, community disaster education, presentations on military support and services, and international services. Health Services training programs are open to the public. 5. Are there fees for your services? Yes X No If yes, please describe your fee structure: Fees are charged for many of our Health and Safety Services training programs. The chapter conducts a cost analysis of our classes to ensure the appropriate fee is charged. On a case-by-case basis we can provide full or partial scholarships to individuals based on need. j ccoghs\funding form. doc 4 Agency Name _American Red Cross, Grant Wood Area Chapter 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Linn, Benton, Iowa, Jones and Delaware counties in eastern Iowa. Services Provided: We provide Emergency Services programs including disaster response and preparedness, military support and communication, tracing and reunification services. Also, Health Services programs including CPR, first aid, water safety, disease prevention, blood collection. Finally, in the other counties that we serve, we provide prevention education about HIV/AIDS, and financial support and casework for clients living with this disease. We do not provide HIV/AIDS services directly to Johnson County but work collaboratively and supportively with the Johnson County Health Department and other agencies doing this work. Funding Sources: Our chapter's fiscal year 2002 revenue was composed of the following unaudited income soumes: United Way - 27% Program Fees - 21% Direct Marketing - 19% Grants- 13% Major Gifts - 10% Bequests - 4% Special Events 4% Miscellaneous/Investment Income - 2% j ccoghs\funding form. doc 5 Agency Name _American Red Cross, Grant Wood Area Chapter Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: Clients are surveyed within one month of receiving services. These surveys are then analyzed to determine satisfaction and quality of services. (b) Community: Our Board of Directors, along with paid staff, implement 3-year strategic plans. Paid and volunteer staffregularly meet with community members via other agency meetings, volunteer fire department associations, and project collaborations. Input from conmmnity leaders is also solicited through involvement on chapter committees. 2. Briefly summarize your findings: Our evaluation process shows that we provide appropriate, timely and quality services to our clients. We also achieve progress toward our annual objectives within the strategic plan. We do need to continue to work on volunteer recruitment in rural areas and diversity of our volunteer base. In addition, we need to continue to interact with agencies, organizations and schools in all areas of our chapter. 3. What changes have been made in response to these findings? A part-time Community Liaison has been added to the paid staff of Emergency Services. This position focuses on building relationships with other community groups. In addition, an AmeriCorps member is also working with schools and community groups to provide community disaster education information and materials, and to enhance age diversity of our volunteer base. We use the feedback from surveys and community resoumes to make corrections and adjustments to programs to enhance our services. We have also sought to establish more partnerships with other organizations within the area. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Local Fire Departments, including Iowa City, 25% Coralville, North Liberty, Lone Tree and Hills. National Guard Command 25% Crisis Center 25% U of I 10% Daycare Facilities 14% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? j ccoghs\funding for tn. doc 6 Agency Name _American Red Cross, Grant Wood Area Chapter We work with other agencies to ensure no duplication of services. Some of the other agencies/organizations we collaborate with for Emergency Services clientele include: Salvation Army, Crisis Center, VA and other area hospitals, Veterans Affairs, Goodwill, and local churches. The American Heart Association also provides CPR training for the community. There are, however, important differences between the two programs. The American Red Cross believes that a one-year certification for CPR is critical to ensure that lifesaving skills are current. However, the American Heart Association has a two-year certification for the same program. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Because of our trained and organized Disaster Services volunteers, we are able to respond to local disasters within 45 minutes. We identify the emergency needs of Disaster Services clients, and then refer those clients as needed to the other agencies. The American Red Cross has a mandated role in communications and leave requests made between servicemen and women and their families. We verify information needed by the military for notification or leave requests. In addition to the certification differences, we have scheduled health and safety courses and an established training site. We also provide on-site training to businesses and organizations. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations i Briefly describe 1. Fire Departments 1. Partners for Battery-UP project. We work with the fire department to identify households that need smoke alarms or new batteries. We then go out with the fire departments. While the fire department installs or replaces the smoke alarms or batteries, our volunteers provide safety information to the residents. 2. School Districts 2. We are begirming to work on implementing "Masters of Disasters" with the Iowa City schools. This curriculum-based disaster education system allows teachers to integrate disaster preparedness and safety information into their daily lesson plans. We also work with Clear Creek-Amana and Solon schools to implement our Babysitter's Training Program. 3. Johnson County Emergency 3. Because of the proximity of the Duane Management Agency Arnold Energy Center, Johnson County is j ccoghs\funding form. doc 7 Agency Name _American Red Cross, Grant Wood Area Chapter considered a "host county". An evacuation of Linn County would bring thousands of people into Johnson County for sheltering. Red Cross volunteers work with Johnson County Emergency Management for sheltering, feeding, mental health support, and other disaster services. Drills for the potential evacautions occur five times each year. 4. University of Iowa College of Nursing 4. We work with the college to train their students in CPR and first aid. j ccoghs\fundingform.doc 8 Agency Name _American Red Cross, Grant Wood Area Chapter Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Staffing, both volunteer and paid. 1. Facing this issue, the Grant Wood Area Chapter applied for and has been awarded five AmeriCorps positions from two different AmeriCorps programs to better recruit volunteers in rural and urban areas, and to provide community disaster education and disaster response services in our chapter area. The AmeriCorps member will also help us to recruit volunteers of various backgrounds and ages. Our paid staff time must be divided between nurturing and supporting our volunteers and ensuring that services are provided in an effective and efficient manner. Balancing these two things is sometimes difficult. 2. Providing services to University of Iowa 2. We seek to build on existing partnerships students, staff, and administration, such as those with the College of Nursing. In addition, the Community Liaison position for Emergency Services was created in part to increase and strengthen our relationships and services to the University of Iowa community. 3. Providing services to areas outside of the 3. We seek to build on partnerships such as urban centers, those with outlying community fire departments, schools and other organizations. We are working on recruitment of additional volunteers in outlying areas. 2. In what way will the needs of your service population change in the next five years? The "graying" of Ioxva means that percentage of older Iowans will continue to increase. At the same time, as baby boomers have children, the number of young people is increasing. Emergency Services will need to both diversify its volunteer base, and examine the types of services needed to ensure we continue to meet the emergency needs of Eastern Iowa. We also see growth in the need for automated external defibrillator (AED) training as more schools and businesses require AEDs to be accessible. 3. How do you plan to address these changes? j ccoghs\funding form.doc 9 Agency Name _American Red Cross, Grant Wood Area Chapter Emergency Services has already made staffing changes to help us better meet the needs of our community. By adding AmeriCorps members and a Community Liaison position, we are better able to recruit and maintain volunteers that can meet the needs of Emergency Services clientele. We are also working to ensure that adequate materials and equipment are available to meet the growing demand for AEDs and training through promotional events and information, and grant funding. 4. Describe the evaluation methods you use to measure the success of your services? We analyze the age and location of current volunteers to ensure we have a diverse workforce. We use surveys, community collaborations and informal feedback to monitor services provided. We also rely on our volunteer service committees and other community leaders to determine if we are meeting the needs of the community. Our Board of Directors monitors services and progress through monthly activity reports and our strategic plan. 5. What are the results of these evaluations (outcomes)? Progress toward strategic plan objectives is overseen by the Board of Directors. One of the main goals of the 3-year plan we are completing was to establish a new chapter headquarters building. We have accomplished that goal and are finishing up the capital campaign to complete the process. Surveys of clients show a high degree of satisfaction with direct services. For Disaster Services, 100% of respondents to our survey rated their experience with the Red Cross as excellent. Services are provided promptly and meet the identified needs of the clients. For our military programs, 89% of respondents rated our services as excellent or very good. Collaborations with other organizations have shown us that we need to continue to increase our cooperation and communication with other agencies to better publicize the services we provide, and to better identify disaster education and preparedness needs of the community. In Health Services, surveys show: 75.2% ofpeople take training for school or their job. 92.8% feel that the instructor was very good or excellent. 97.5% would feel comfortable using the skills they learned in class. 6. How do you plan to use the evaluation results to enhance/extend your services? Working with our paid and volunteer staff we are increasing our visibility and presence in Johnson County. We are contacting more schools, community agencies, and interested individuals to discuss American Red Cross services and opportunities, and are determining what changes are needed to further serve individuals' needs. We also continue to monitor community perception of programs and services, and assess needs. 7. How do your programs/services impact the community? Our programs assist people in Johnson County in preparing for, preventing and responding to emergency situations through disaster education and response, provide 24-hour emergency communication and assistance to active military members and their families, and re-establish communication between family members who have been separated due to conflict, political unrest or disaster. Our programs make Johnson County a safer place to live and work by teaching people how to perform CPR and first aid, and other lifesaving skills. 8. How did the agency respond to the UWJC recommendations from last year? j cc oghs\funding form.doc 10 Agency Name _American Red Cross, Grant Wood Area Chapter The recommendations from last year were: Continue to develop specific and measurable objectives and to report on the success or impact of its programs and services. It is essential that Red Cross ensure that there are no further fundraising violations during the blackout. We continue to work to make goals and objectives for our programs more measurable. It is a continual process. We also strive to utilize the outcomes to demonstrate the success and improvements made to our programs and services. Our chapter has worked very hard this year to ensure that there are no further violations of the United Way blackout period. Information has been shared extensively with paid and volunteer staff about the restrictions of the blackout period. Unfortunately, not all activities associated with the American Red Cross are under the control of our chapter. In late August a mailing was sent from our national headquarters to known donors within our chapter area to generate planned giving leads for our State Planned Giving Officer, We immediately contacted headquarters and arranged that no future mailings would be sent during the blackout. We are also trying to collect the names of the people that this piece was sent to. We are working with the Agency and Community Needs Committee to resolve concerns around the blackout issue. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How oi2en does your board meet? Monthly 3. What is your average attendance at board meetings? We almost always have a quorum at monthly meetings. There have been occasions, during the summer month of July, when having a quorum present is a challenge. 4. How is the board involved in strategic planning and governance of the agency? Board members participate in retreats involved in establishing the strategic plan for the agency. They also serve on committees and oversee various aspects of the plan. As a full Board, members receive bi-annual updates to the strategic plan. Each month the Board reviews financial data about the chapter and wrestles with issues that the chapter is facing. For example, much of the Board's attention this past year has been focused on financial development, our new building and service delivery. 5. What type of training/orientation do board members receive? An initial one-one-one orientation occurs with the Executive Director. Then, new Board Members participate in a 3-hour orientation program which the National American Red Cross has developed. Local information is used to supplement the structure provided by the national office. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? ~We do have policies but they are established by our national organization. 7. Have you filed the annual report with the Secretary of State? If yes, date filed? Not applicable to our organization. j ccoghs\funding forrn, doc 11 Agency Name _American Red Cross, Grant Wood Area Chapter 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? Our national office files the 990 for our organization. The 990 for fiscal year 2001 was filed on February 15, 2002 If no to questions 6, 7, or 8, give explanation. Our organization is not incorporated in the State of Iowa. We are a chapter of a national organization and all reports are filed on a national level. 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? Bergan, Paulsen & Company, P.C. How much did the audit cost? $4,725 If material weaknesses are noted in the audit, what is your plan for addressing them? No material weaknesses were noted. If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X $26 million b. employment practice liability X $26 million General Liability X $1 million Umbrella Liability X $5 million Professional Liability X $1 million Property or Renters X Replacement cost Vehicle X $1 million jccoghs\fundingform, doc 12 Agency Name American Red Cross, Grant Wood Area Chapter Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Our Executive Director has been with our chapter for over 13 years. Her experience with the Red Cross, however, spans more than 20 years. She began her involvement as a volunteer and then became a paid staff member. Betty also has her master's degree in Human Resource Development. Our Johnson County Site Director has almost five years of experience with the American Red Cross. Prior to that, she was employed by the United Way of East Central Iowa. Angela also has her master's degree in Urban and Regional Planning. 2. Staff Salaries &Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X X $54,114-$127,169 0.05 0.05 0.05 Site Director X X X $25,738 - $ 60,484 0.36 0.40 0.40 Health & Safety Program X X X $17,750 - $ 41,713 1.05 1.05 1.05 Coordinator Community Liaison X X X $17,750 - $ 41,713 0.38 0.38 0.38 Emergency Services X X X $25,738 - $ 60,484 0.10 0.25 0.25 Director Health Services Director X X X $25,738 - $ 60,484 0.25 0.25 0.25 Assistant Director X X X $17,750-$ 41,713 0.15 0.15 0.15 Emergency Family Services Assistant Director Disaster X X X $17,750 - $ 41,713 0.25 0.20 0.20 Services Health & Safety Services X X X $17,750 - $ 41,713 0.10 0.10 0.10 Program Manager Marketing Coordinator X X X $17,750 - $ 41,713 0.30 0.30 0.30 Director of X X X $25,738 - $ 60,484 0.20 0.20 0.20 Communications Coordinator of Volunteers X X X $17,750-$ 41,713 0.15 0.15 0.15 Receptionist X X X $17,750 - $ 41,713 0.15 0.15 0.15 Workplace Instructors X X X $17,750 - $ 41,713 0.50 0.50 0.50 Other Support Staff X X X $17,750 - $ 41,713 0.25 0.25 0.25'- TOTAL FTEs 4.30 4.44 4.44 j ccoghs\funding form.doc 13 Agency Name _American Red Cross, Grant Wood Area Chapter 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? As noted above, 4.3 FTE served Johnson County last year, with 4.44 serving the county this year and next. 4. How much was spent on staff development in the last fiscal year? __$674 5. How much is budgeted for staff development in this fiscal year?__$2,310 6. What training and support opportunities are offered to staff?. Staff are provided opportunities to take advantage of various local, state, regional and national training opportunities. Staff take advantage of training offered through local United Ways, Kirkwood Community College, the State of Iowa, and State, Regional and National Red Cross training programs. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? Average percent wage increase is 3%. Yes No If no, brief explanation 9. Does your agency have personnel X policies? If yes, date board last reviewed? 2000 10. Does your board annually evaluate X the director's performance? 11. Does your agency Paid staffjob descriptions are the prerogative of the have job X Executive Director and are adjusted as needed to reflect descriptions for changes to staff duties. every position? If yes, date of last board approval? 12. Is there an atmual performance X review for every staff? j ccoghs\funding form. doc 14 American Red Cross Grant Wood Area Chapter Section 7: Financial Management A. Three Year Historical Balance Sheet --(As of your fiscal},ear-end) FY00 FY01 FY02 FY00 FY0'I FY02 Current Assets i Current Liabilities Cash $15,414 $8,371 $138,994 Accounts Pa2/able $11,532 $46,288 $196,817 Investments $571,601 $593,927 $1,361,431 Payroll Taxes Payable $6,279 $10,669 $6,544 ~ece!vab!es ~ ~? d~ys $336,521 $420,497 $325,458 Contracts Payable $0 $0 , $0 Other $21,247 $20,798 $14,691 Other Current Liabilities ~ $26,042 $25,201 ~ $799,524 TotalCurrentAssets $944,783 $1,043,593 $1,840,574 Total Current Liabilities $43,853 $82,158 ! $1,002,885 $423,186:i $432,050 $2,847,146 Other Liabilities $0I $1 466 667 Other Assests ~ _ Property Modgage Payable-Balance $0 ' , , ~quipment ! $218,391 $213,491 $186,660 Other $0 $0 L $0 less depreciation ($302,975) ($343,488)~ ~$109,046~) $0 $0 $1,466,667 Receivables>90da~vs $0 $88,117 i $961,331 TotalLiabilities $43,853 $82,158 i $2,469,552 Other $10,228,1 $7'174 II $58,368 NetAssets i1,249,760 $1,358,779i Total Assets $1~293r613 I $1~440r937 I $5r785'033 Liabilities & Net Assets 1 ~293r613 $1,440~937 I $5r785'033 American Red Cross Grant Wood Area Chapter FY02 FY03 FY04 , Income & Expenses Revenue Johnson County $6,890 United Way-Allocation ] ;i'4,492 $14 - Designa[¢d Giving $11,253_____ $14,000 ~ $14,000 : Special _N~¢ds Fund $2,200 $2,000~ $2,000 I Grants-Federal, State,_Foundation $3,813 $7,50© ;7,500' Net Sales of Service $54,532 $69,291 $75,719 Net SalesofMaterials i 155,293! $5,i43! ;;,875! Co~ntEibutions/Fundraising $81,400 ' $198,732 $194,457 Contributions were $190,000 in FY01 Investment Income 250 Other ' $8,697, $0 $0 This is from Gain of Sale of Fixed Asset Total Income ;;;',401 15318,~;s ,33~,;~6~ Exp_enses ' Wages& Salaries Ben~efits _ $23,097 $26,746 i $29,686 C)ccupan,y $21,454 $21,695 [ $21,813i Non-occupancy $119,545 $156,314~:4 ~$165,613 IDisaster Supplies, Financial Assistanc( Other , ~ iTechnology,, Trainin~ Equipment, Ch_apt~ Total Expenses $263,888 $318,216 $334,606 Assessment, PosSe, Administration C. Fund Balance Revenue $195,401 . 4,606 ~ar-ry°ver Ba!anca fr°m previ°us yearTotal Op~!ing Budget ~195~401 Less Total Expenses ;$2638885318216 $334606 Less Restricted Balance (explain) Carryover Fund Balance 8,487)i $0 $0 American Red Cross Grant Wood Area Chapter D, BdlDonorlFunder Restricted Funds : Designated for: FY02 FY03 _FY04 I I : Total Restricted Funds . $0 $0 $0 E. !0 Kin0 Support: FY02 FY03 FY04 Other: (Please footnote~ i L performing services Thi~ [igure T0ta! !n-kind Support : $53 022 ~ $51 420 $53 920 represents about 450 voluntee[~ B~y~!tting/~AT $2,100 i $3 500 $3 500 Battery Up j ~ ~500 I $500; Grant Wood Area Chapter Board of Directors (37 member board) Johnson County Representation FY2003 Name City Board Responsibilities Dr. Alan Kim Johnson Iowa City Human Resources Committee International Services Committee Doug Peters North Liberty Emergency Services Council Gerald Rose Iowa City Treasurer Finance Committee Chair Executive Committee Bob Ross Iowa City Financial Development Committee Audit Committee Gary Wicklund Coralville Vice Chair/Chair Elect Finance Committee Executive Committee Chapter Officers Clare L. Slattery, Chair Gary Wicklund, Vice-Chair, Chair Elect Michael A. Wapp, Secretary/Technology Jerry Rose, Treasurer Grant Wood Area Chapter Organizational Chart, FY2003 Board of Directors Executive Director Betty Hargraves / Assistant Executive Director Johnson County Site Dimcfor ~- Angaia Schmucke~i / Health and Safety HIV/AIDS Program Emergency Services Director of FJnandal DJl,ect or of Communicaltons Director of Financial Coordinator of Volunteers Services Director Director Director Administration Renee Uecker Devaiopme~l Joan Shaffer Ginnie Weber Tdcia Kitzmann Karen Wehlleben Karen Eppard Heathe~ Stoltzfu s I I I Judy Grishaber Health and Safety HIV/AIDS Client Assistant Director for Data En~ Manager Marketing Coordinator Financial Development Program Development Se~ces Manager Outreach Coordinator Disaster Se~ices Henry Montag Carde Ebel Assodate Coordinator Julie Copping Miohelle Filling Cheryl Bohne-Meier Jill Dutoher Health and Safety HIV/AIDS Educalton Assistant Director for Services Coordinator Coordinator Emergency Family Services Ruthanne Bernhart Shannon Decker Cynthia Ritch Johnson County [ H[V/AID S Grants Emergency Services Health and Safety 1 Data Administrator Community Liaison Services Coordinator Dusltn Jones Claim Cardwatl Jeff LJndberg Administrative Coordinator Sue Grant Health and Safety AmeriCorps Sewices Workplace Members Instructors Receptionist Financiaf Development Kathy Sohooley Administrative Assistant Fran Mason Pad*time Secretary Ann Duder Attachment B 9/17/2002 Section 1: Background Agency Name: Joan Buxton School Children's Aid Address: 509 S. Dubuque Street Phone: (319) 688-1000 Iowa City, Iowa 52240 Director Name: Nancy Spalj Signature: ~f~-~e..~. Bd. Pres Name: --- Signature: Request Completed By: Nancy Spalj & Joan Vanden Berg Date: 9/23/02 Check Your Agency's Budget Year: 1/1-i2/31 x 7/1-6/30 10/1-9/30__ 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC Does not include designated 9,936 9,936 12,500 25.8% FY 02 FY 03 FY 04 City of Iowa City Johnson County City of Coralville What were local funds used for last year: Clothing, eye glasses, medical care, medication, medical supplies, school supplies. What will this year's local funds be used for? Same as above. Agency Mission: To provide support to students to overcome obstacles of poverty, allowing them to come to school ready to learn. Summarize your programs and services for which you are requesting funding: Through referrals from both school and agency personnel, assistance is provided to low-income students in Johnson County to meet immediate needs of clothing, eye glasses, medical care and school supplies. List any accreditation and licensure your agency currently has. Explain. None. Agency Name Joan Buxton School Children's Aid Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Over the past 43 years, the School Children's Aid fund has provided much needed financial support to thousands of low-income children in Johnson County. School Children's Aid was established in 1959 by Frank Bates, director of health and physical education for the Iowa City Community School District (ICCSD.) Frank Bates recognized that students who ~vere not clothed properly, did not have appropriate health services, eye glasses or dental care could not come to school ready to learn. School Children's Aid continues to provide for students in need of financial assistance; however since 1959 the number of children in poverty has grown in Johnson County, and so has the available resources in the community. In addition to providing direct support, the health services staff connect families in need to other resources, such as the Hawk-I medical insurance program, services at the Free Medical Clinic, clothing distributions sponsored by churches in the community and Dental Services for Kids. Support from the United Way of Johnson County has been instrumental to the program since 1971, when it became a member agency. The United Way continues to be our single largest funding source. Being a United Way affiliate has increased community awareness of the program, ~vhich has generated both cash donations and inkind support, such school supplies. The program was renamed the Joan Buxton School Children's Aid fund in 1996 when Joan retired. Joan has been instrumental in the continuation of the program. She has worked tirelessly for years to secure resources from other funding sources, such as churches, businesses and individual donations. One hundred percent of the dollars generated for the program is directed to children in need. The ICCSD Director of Health Services and the health services staff have been responsible for the School Children's Aid fund since 1982. Staff time is an inkind contribution from the Iowa City Community School District (and personally donated.) The program prides itself in the fact that all of the funding goes directly to children in need. However, not having administrative support presents real challenges for evaluation, fundraising and board governance. For 2002-2003 the ICCSD at-risk committee will provide oversight to the program. The at-risk committee will also consider the costs and benefits of obtaining 501( c ) 3 status from the 1RS to align the program more with the standards for agencies set by the United Way of Johnson County. The additional funding requested will be to support administrative time and legal and filing costs associated with obtaining non-profit status from the IRS. j ccoghs\funding form.doc 2 Agency Name Joan Buxton School Children's Aid Section 2: Client Profile ~~ 2000 7.eo, 1. How many Johnson County residents (Including IC & 1 Unduplicated Count Coralville) did your agency serve? 484 586 2. How many lowa City residents did your agency serve'? 2 Unduplicated Count 322 370 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 76 111 * through August 2002, 354 children, unduplicated count. (This does not include peak season of back to school shoes, winter coats and boot~9 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 Female: 6-17 Male 18-29 30-61 Profile data not available until 62-75 2003 >75 3. Briefly describe your service population. Low-income children in Johnson County. 4. How do you determine eligibility for services? Eligibility for the free and reduced lunch program. 5. Are there fees for your services? Yes No x If yes, please describe your fee structure: 6. Do you provide services to areas outside ofJohnson County? No Area(s) served: Services Provided: Funding Sources: jccoghs\fundingform.doc 3 Agency Name Joan Buxton School Children's Aid Section 3:Community Relations 1. How do you assess satisfaction with your services? Noformalprocess exists. (a) Client (b) Community 2. Briefly summarize your findings: 3. What changes have been made as a response to these findings? 4. Who are your referral sources to your agency? Please list the main sources and estimate the pementage of clients that are referred by each source. Soume of Referral % of clients referred School Personnel: teachers, Family Resource Center staff, counselors, principals 75% Parents 20% Community Agencies: Department of Human Services, Area Education Agency, Domestic Violence Intervention Program, Crisis Center, Neighborhood Centers of Johnson County 5% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? [CCSD Family Resource Centers and LINKs program for students who are homeless, Johnson County Juvenile Justice Youth Development Program, "Shoes that Fit "program, Lions Club, Dental Care for Kids, Crisis Center, Salvation Army, Ecumenical Consultation--Clothing and School Supply Distribution 6. Describe what makes your agency and/or its services unique to Johnson County. It is a school-based program, allowing services to be highly accessible to families. School personnel have contact with almost all of the children in the community and provide an excellent system for early identification of need jccoghs\fundingform, doc 4 Agency Name Joan Buxton School Children's Aid 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe relationship 1. Iowa City Community School District Youth 1. Receive referrals for supplies, make and Family Development Programs-- referrals to Youth and Family Development Family Resource Centers, Juvenile Court Program for: Liaison Program, Alternative Education and · "Shoes that Fit" program LiNKS program for homeless youth, · other direct needs (i.e utilities, housing) · parenting and/or counseling concems · transportation 2. Iowa City Community School District Administration 2. Provision of space and administrative time 3 Johnson County Empowerment Program 3. In collaboration with Family Resource Centers, received funding to provide car seats for infants and toddlers in Hills and North Liberty j cc oghs~funding form. doc 5 Agency Name Joan Buxton School Children's Aid Section 4: Strategic Planning and Agency Effectiveness 1. Describe no more than 3 challenges/opportunities your agency is currently facing and how your agency is addressing these challenges? (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Increased demand for resources--funding 1. More collaboration with Family Resource and time Center programs and develop new business )artners to provide supplies, clothing and cash donations. 2. Tracking clients and getting more detail 2. More support from ICCSD's Youth and about who is served Family Development Coordinator to establish a data base. 3. Lack administrative time to provide over 3. ICCSD's At-Risk Committee serve as sight to the program and to actively pursue oversight committee. Explore the possibility additional funding of 501(c)3 status with the IRS. 2. In what way will the needs of your service population change in the next five years? The number of children eligible for free and reduced lunches has increased from 13. 7% in 1996 to 18. 7% in 2001--for a total 2090 students in the district. The number of homeless children served increased by lO0%, from 84 in 2000-2001 to 169 in 2001-2002. We expect to continue to see more children in extreme poverty, we have already seen significant increases in the number of homeless for 2002-2003. 3. How do you plan to address these changes? Increased collaboration with agencies and Family Resource Centers, increase business partnerships. 4. Describe the evaluation methods you use to measure the success of your services? No formal evaluation system is currently in place. 5. What are the results of these evaluations (outcomes)? 6. How do you plan to use the evaluation results to enhance/extend your services? 7. How do your programs/services impact the community? The School Children's Aid program provides another resource to help families meet immediate, fundamental needs. 8. How did the agency respond to the UWJC recommendations from last year? See above challenges/opportunities. j ccoghs\funding form. doc 6 Agency Name Joan Buxton School Children's Aid Section 5: Board Governance 1. Please provide a board roster with names, addresses, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) See attached list of lCCSD At-Risk Committee. 2. How often does your board meet? The At-Risk Committee meets three times a year. 3. What is your average attendance at board meetings? Participation in the At-Risk Committee averages about 70%. 4. How is the board involved in strategic planning and governance of the agency? The administrative structure of the School Children's Aid program will be discussed at our November meeting. Based on that discussion, a sub-committee may be formed to explore future ot~tions. 5. What type of training/orientation do board members receive? N/A 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? 7. Have you filed the annual report with the Secretary of State? If yes, date filed? N/A 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? N/A Comments: 9. Does your agency have a yearly audit? Yes No If yes~ Who completed the audit? How much did the audit cost? If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, What is in place to assure accountability in the agency's financial management? Health services staff all have a role in the management of the finances so there are checks and balances in the system. Beginning for the 2002-2003 academic year , that at-risk committee will also receive financial reports for the program. j ccoghs\funding form. doc 7 Agency Name Joan Buxton School Children's Aid Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Nancy St~alj has been the Health Services Director for 21 years. She has administered the School Children's Aid program since 1982. 2. Staff Salaries and Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year N/A TOTAL FTEs 3. If serving multiple counties, how may FTE's serve Johnson County (include administrative and direct service staff)? N/A 4. How much was spent on staff development in the last fiscal year? 0 5. How much is budgeted for staff development in this fiscal year? __ 0__ 6. What training and support opportunities are offered to staff?. N/A 7. Please attach CUiTent organizational chart as Appendix B. N/A 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? N/A j ccoghs\fundingform.doc 8 Agency Name Joan Buxton School Children's Aid Yes No Comments Does your agency have personnel x policies? If yes, date board last reviewed? Does your board annually evaluate x the director's performance? Does your agency have job x descriptions for every position? If yes, date of last board approval? Is there an annual performance x review for every staff? * Health Services staff are all employees of the Iowa City Community School District. The district has personnel policies, job descriptions and performance review for overall job performance. j c coghs\funding form. doc 9 Agency: J. Buxton School Children's Aid Section 7: Financial Management A. Three Year Historical Balance Sheet (As of your fiscal year-end) 1999 2000 2001 Current Assets Cash $3,006 $3,917 $5,208 Investments Receivables < 90 days Other Total Current Assets $3,006 $3,917 $5,208 Other Assests Property Equipment less depreciation Receivables > 90 days Other Total Non-current Assets $0 $0 $0 Total Assets $3,006 $3,917 $5,208 2001 2002 2003 Current Liabilities Accounts Payable Payroll Taxes Payable Contracts Payable Mortgage Payable-6 months Total Current Liabilities $0 $0 $0 Other Liabilities Mortgage Payable-Balance Other Total Other Liabilities $0 $0 $0 Total Liabilities $0 $0 $0 NetAssets $3,006 $3,917 $5,208 Liabilities & Net Assets $3,006 $3,917 $5,208 Agency: Joan Buxton School Children's Aid r 2001 2002 2003 B. Income & Expenses Income Loca! Fund~ Sources · owa Cty United Way - Allocation $9,936 $9,936 - Designated Giving Grants-Federal, State, Foundation t $0 $2,600i $6,000i Net Sales of Service Net Sales of Materials Contributions/Fundraising i $6,247 ~ $4,750 $7,000 OtherlnVestment Income . Total Income $20,074 $20,191 $28,000 Expenses Wages&Salaries Benefits Occupancy / Non-occupancy Other: clothing, eye glasses, med. supplies, car seats TO, th~i:E~ntracted~rvices, legal and fiiing ;~e;- $~ ;0, $2,500 ! ota penses $22,487 $20,500 $27,500 C. Fund Balance Revenue $20,074 $20,191 $28,000 Carryover Balance from previous year $5,208 $2,795 $2,486 Total Operating Budget $25,282 $22,986~ $30,486 Less Total Expenses $22,487 i $20,500 $27,500 Ending Fund Balance $2,795 $2,486 $2,986 Less Restricted Balance (explain) Carp/over Fund Balance $2,795 $2,486 $2,986 5. In Kind Support: 2001 _ 2002 _ 2003_ Services/Volunteers 125 volunteer hours x $22.50 . $2,812 $3,512 $3~977 $6,000 Space, Util!ties, etc office space, secretanal~uppo~z phone ~ $3,~69 ~,3~9 $3,369 Total In;kind SUpport ~i~2~3~' $~3,131 $i;10;8 . Grants D~ril3tionlPui'pos~ 2001 2002 2003 Johnson County Empowerment Program car seats for Iow-income infants and ~children in Hills and North Liberty $0 $2,500 I'BN-foundations, businesses $0 ~ Total Grants IOWA CITY COMMUNITY SCHOOL DISTRICT AT-RISK COMMITTEE 2001-2002 Community Representatives Cheryl Whitney, Department of Human Services Diane Dingbaum, Neighborhood Centers of Johnson County Jodi Gibson, Johnson County Juvenile Court Office Dee Dixon, Domestic Violence Intervention Program Gretchen Holt, UIHC Children and Adolescent Services Elementary School Representatives Linda Nelson, Guidance Counselor, Mann Pam Johannes, 1st / 2nd Grade Teacher, Twain Jill Winders, Family Resource Center Coordinator, Penn Sandy Lawrence, Principal, Wood Sheila McCarville, Resource Teacher, Hills Peggy Jeffdes, Reading Recovery Teacher, Roosevelt Junior High Representatives Kay Yanecek, Alternative Education, South East John Cooper, Guidance Counselor, Northwest Senior High Representatives Jane Fry, Associate Principal, West High Stephanie Phillips, Principal, Senior High Alternative Center Eric Traynor, Counselor, City High Central Office Representatives Marian Coleman, Equity Director Nancy Spalj, Health Services Director Para Ehly, Director of Curriculum Jim Behle, Associate Superintendent Joan Vanden Berg, Youth and Family Development Coordinator Section 1: Background Agency Name: Special Care Program Address: Dental Science Building Phone: 335-69~///~/ Director Name: Dr. Howard Cowen Signature: 5~(~~/~,~ Bd. Pres Name: Signature: Request Completed By: Dr. Howard Cowen Date: 9/25/02 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC 16,738 16,303 16,000 .49 Does not include designated Needs Grants FY 02 FY 03 FY 04 City of Iowa City Johnson County ~ of Coralville What were local funds used for this year: Dental services for qualified residents of Johnson County including: examinations, radiographs, fillings, deotures, extractions, root canals and cleaniogs. What will next year's local funds be used for? The same as above. Agency Mission Statement: Our mission is to provide dental services to special needs populations who would not otherwise have access to oral health care and to train future generations of dentists to provide this care in their own communities. Summarize your programs and services for which you are requesting funding: Our agency has traditionally been composed of two programs that work together to provide dental services to populations at risk. The Geriatric Mobile Dental Program provides comprehensive dental care to residents of long-term care facilities in five counties surrounding and including Johnson County. The program now serves four nursing homes in Johnson County. The Mobile Dental Program operates on a rotational schedule with approximately 12 months elapsing between a visit to Johnson Cmmty facilities. To maintain continuity of care, a preventive maintenance program (i.e. cleaning and fluoride treatments, etc.) is offered to participating nursing home residents every. 6 months. The Portable Outreach Program will continue as an extension of our mobile dental program to see various populations whose access to dental care is difficult. This may include the homebound, nursing home residents needing care in-between GMU visits, hospice patients and the ho~neless. The Special Care Clinic (SCC) provides comprehensive dental services by specially trained staff at the University of Iowa College of Dentist~,. It is designed especially for the care of the elderly and Agency Name Special Care Program medically complex, and physically compromised adult. Assistance is provided in arranging transportation and financial support for the patients if needed. We are requesting United Way funds to provide dental care to the residents of the 4 participating Johnson County nursing homes, patients seen in the Special Care Clinic and patients seen in the Portable Outreach Program who could not otherwise afford to have needed dental treatment, including the homebound and hospice patients. List any accreditation and licensure your agency currently has. Explain. None j ccoghs\fundingform.doc 2 Agency Name Special Care Program Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) The Geriatric Mobile Dental Program began providing dental care to the residents of nursing homes and county care facilities in 1980. The program was developed to meet an unidentified need fro' routine and preventive dental care for elderly institutionalized persons. One major advantage of the Mobile Deotal Program is that it takes dental care to the patient, thus avoiding the problem of transporting patients to a dentist's office. The program currently serves 10 long term care facilities (LTC) in 5 counties surrounding and including Johnson County. The program serves 4 nursing homes in Johnson County. The Geriatric Mobile Dental Program (GMU) operates on a rotational schedule and usually remains at each facility for approximately 5 to 8 weeks. In the past, the GMU has visited the nursing homes in Johnson County only every other year, but due to new federal regulations and our decision to provide a more frequent level of service, we will now be visiting the homes in Johnson County every year. This will put an obvious increased demand on funds for the residents of these local nursing homes. During the past year, we provided services to the residents of all four nursing homes in Johnson County. All 4 homes will again receive care from the GMU this fiscal year. Residents of LTC facilities pay for their care from various sources. In Johnson County, 57% are private pay, with the remaining 43% supported by Title X1X funds. The dollars allocated to the GMU from United Way are for those private pay residents whose resources are unable to finance their necessary dental care. The Special Care Clinic (SCC) is available at the College of Dentistry. It is a special dental clinic established to care for the complicated needs of the older and/or compromised adults. This clinic is also available for any patients from the Geriatric Mobile Unit (GMU) in need of emergency care during the interim period if the GMU staff would be unable to deliver individual attention to these special adults. In addition, we coordinate transportation, work with social workers and agencies to coordinate services for our patients. This past year, United Way funds assisted 187 patients residing in Johnson County. This reflects a slight increase in the number of patients who were funded last year (173), which is reflected by a $1,500 increase in expenditures. This increasing need is due to: 1) the continuing dental needs of the medically, physically, and cognitively handicapped adults, 2) a substantial increase in referrals from the Free Dental Clinic, 3) the ongoing services rendered to the homeless population, and 4) the reduction in benefits for adults covered by Title XIX. This is the eighth year we have provided care for the homeless population of Johnson County, providing care to 36 people. This compared to 32 last year and 38 the year before. We have also maintained treatment of patients with HIV/AiDS (4), hospice (2), and homebound (8). This increasing need for dental health care services is only the tip of the iceberg with the coming of managed health care and the restructuring of Medicaid, which has eliminated root canals, crowns and periodontal therapy from its coverage plan. The demand for dental services is expected to increase as our population lives longer and retains more of their own teeth, leaving even a greater problem for access to dental services in Iowa. We have provided a wide variety of services to our patients, including exams, x-rays, fillings (amalgam and composite), root canal treatment, extractions, full dentures, partial dentures and an occasional crown. We have not provided any bridgework and only provide partial dentures when esthetics or function are severely compromised. The request for funding from Johnson County DHS is for the dental health needs of Johnson County's indigent population. This past year we treated 52 patients, significantly more than last year's total of 45. Most of these people were referred by DHS and local social service agencies. These are people who cannot afford dental care, but are really trying to get back into the mainstream of society. Their mouths have become unsightly and a little dental care has provided some smiling faces, increased self-esteem and even new jobs for many. This is a very worthwhile service to potentially valuable members of our local community. This year we also provided dental care to 14 inmates of the Johnson County jail at the request of Johnson County DHS. These patients pay for their treatment if they have funds. j ccoghs\fundingform.doc 3 AgencyName Special Care Program Section 2: Client Profile ~~ FY01 'Y02 1. How many Johnson County residents (Including lC & 1 Unduplicated Count 173 181 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 101 94 3. How many Coralville residents did your agency serve?3 Unduplicated Count 46 51 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 0 Female: 56% Unknown 6-17 .1% Male 44% 18-29 7% 30-61 26% 62-75 44% >75 23% 3. Briefly describe your service population. We provide dental services to special needs populations including: nursing home residents, medically, physically and/or cognitively compromised adults, homeless, homebound, hospice, indigent, j ail inmates, phobic and profound MR patients. 4. How do you determine eligibility for services? Referral from other United Way agencies, or social service programs, and discussion of need with individuals. 5. Are there fees for your services? Yes X No Patients who qualify for United Way funding do not pay out of pocket unless they have the ability to. If yes, please describe your fee structure: Our fees are based on fee-for-service and are procedure driven. They are approximately 50% of private practice fees. We also accept no interest monthly payments and have a sliding fee schedule for those who can afford some, but not all of their treatment costs. United Way funds pay the fee-for-service cost of the dental treatment rendered, The funds are not used for any administrative, personnel, supply or equipment costs. 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Nursing homes in Linn, Iowa and Washington Counties Services Provided: the same services provided in Johnson County Funding Sources: private pay and Title XIX j ccoghs\fundingform.doc 4 Agency Name Special Care Program Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client - patient satisfaction questionnaire filled out at patient's convenience (b) Community - feedback from nursing facilities 2. Briefly summarize your findings: WE CARE SURVEY (FY02) (313 Total Surveys Received) I. How would you rate our ability on the telephone regarding courtesy, information given, scheduling, etc? Excellent-205 (65%), Good-91 (29%), Fair-8, Poor-2, No answer-4 2. Generally, how would you rate our staff and students in terms of courtesy and service? Excellent-231 (73%), Good-68 (22%), Fair-6, Poor-5, No answer-3 3. Do you feel that you were adequately informed about fees, time involvement and dental procedures? Yes-257 (82%), No-19, Sometimes-33, No answer-4 4. Have we made it clear to you how best to maintain your mouth in good health? Yes~287 (91%), No- 11, Sometimes- 12, No answer-5 5. How do you rate the quality of your dental care at the dental clinics? Excellent-213 (68%), Good-76 (21%), Fair- 10, Poor- 10, No answer-4 6. Since a practice is built and maintained with the help of good friends, do you feel that you can recommend us to others? Yes-290 (93%), No-13, No answer-10 3. What changes have been made in response to these findings? No changes have been made, but results are discussed with faculty and staff. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Emergency Housing Project 20% Free Medical & Dental Clinic 15% Hospice .5% 5. What other agencies/organizations in Jolmson County provide similar services to the same clientele as your agency? None j ccoghs\fundingform.doc 5 AgencyName Special Care Program 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. N/A 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Emergency Housing Project 1. Presentation to Johnson County Dental Society to solicit funds and support for special needs patients in the community. 2. Free Medical & Dental Clinic 2. We have a working relationship with the administration of these agencies to treat emergency and overflow patients. 3. Nursing facilities 3. Nursing facilities provide space, electricity and assistance with patient care. j ccoghs\fundingform.doc 6 Agency Name Special Care Program Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) __Challenges/Opportunities -~_gies 1. Staffing - hiring of a full-time dentist 1. Advertising in national journals as part of a national search. 2. Delivery of dental care to more nursing 2. Hire another full-time faculty dentist and facilities and homebound in the surrounding purchase a van which can transport portable Johnson County area equipment efficiently. 2. In what way will the needs of your service population change in the next five years? The future outlook for dental services of the institutionalized and medically complex adult is expanding rapidly. In order to satisfy this growing need of a much more dentally complex patient, the dental school has made it mandatory for senior dental students to participate in this program. The tremendous increase in demand for our services have made it imperative that United Way understand not only the need, but the importance of oral health care to people in need. In Iowa, the demand for dental services from those underprivileged populations will mushroom with the aging population and the coming of managed health care and the recent state budget cuts reducing dental care services for Title XIX adults. 3. How do you plan to address these changes? By maintaining our current level of care and possibly increasing emergency services and frequency of routine services by hiring another faculty dentist. 4. Describe the evaluation methods you use to measure the success of your services? The success of our agency's efforts is measured in 2 ways: 1) the number of Johnson County residents served, and 2) the total units of services provided. We have also tried to measure the success of our program by determining how many of our graduates are now treating compromised adults. 5. What are the results of these evaluations (outcomes)? We served slightly more Johnson County residents this fiscal year (181) compared to last (171) and more homeless (36) compared to last year (32). The results from our statewide dental survey shows practicing dentists who went through the Special Care Program at the University of Iowa are significantly more likely to treat compromised adults, hospice patients, and nursing facility residents, j ccoghs\fundingform.doc 7 AgencyName Special Care Pro_gram both in their own private practice and in nursing facilities. The following table illustrates the specific services provided this year compared to last year. Service FY01 FY02 __ Exams 173 181 Cleanings 56 95 Radiographs 198 264 Fillings 80 133 Full Dentures 18 16 Partial Dentures 18 22 Root Canals 4 17 Extractions 134 121 Relines 12 8 Crowns 0 6 I.V. sedation 4 2 6. How do you plan to use the evaluation results to enhance/extend your services? We hope that these evaluation results continue to enhance the oral health of special needs populations in all communities of Iowa. 7. How do your programs/services impact the community? By providing emergency and routine dental care we can reduce the amount of time lost in the workplace and can even help some people obtain jobs through increased self-esteem. We also help many nursing facility residents with decreased pain and infection and an increased ability to eat and maintain good nutrition. 8. How did the agency respond to the UWJC recommendations from last year? The survey of Iowa dentists has shown that the Special Care Program is the most significant educational factor in determining whether practicing dentists care for compromised adults. The Special Care Program does not have a functional governing board. It's long-term viability is dependent on the support of the dental school administration. We have recently received a $30,000 grant from Oral B for the purchase of a vehicle to support portable dental care to more homebound, hospice and nursing facility residents. jccoghs\fundingfbrm.doc 8 AgencyName Special Care Program Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) The Special Care Program is part of the College of Dentistry, University of Iowa. We do not have a board. The following paragraph was generated by Charlie Anderson and myself to describe our governance and oversight structure. SPECIAL CARE DENTAL SERVICES (Howard Cowen) - Oversight is provided for the Special Care Dental Services through the faculty and chair of the Department of Preventive and Community Dentistry. This group meets at least four times per year to review program policy, care of patients, equipment and supply needs, staff concerns, welfare of patients and quality assurance reviews. 2. How often does your board meet? 3. What is your average attendance at board meetings? 4. How is the board involved in strategic planning and governance of the agency? 5. What type of training/orientation do board members receive? 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? 7. Have you filed the annual report with the Secretary of State? If yes, date filed? 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes No __ If yes, Who completed the audit? How much did the audit cost? If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability b. employment practice liability General Liability Umbrella Liability Professional Liability Property or Renters Vehicle jccoghs\fundin form.doc 9 Agency Name Special Care Program Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Howard J. Cowen, DDS, MS (Masters of Science in Dental Public Health) - employed for 20 years. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Director X X X 1 1 1 Assistant X X X 3 3 3 Hygienist X X X 1 1 Faculty dentist X X X [I I 1 I TOTAL FTEs 6 I 6 6 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? (same) 4. How much was spent on staff development in the last fiscal year? __ 0 5. How much is budgeted for staff development in this fiscal year?__0 j ccoghs\fundinglbrm.doc t 0 Agency Nanm Special Care Program 6. What training and support opportunities are offered to stafP? All opportunities are offered free of charge through Staff Support Services and Work Life at the University of Iowa. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 3% Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board Jan last reviewed? 02 10. Does your board X annually evaluate Mar the director's 02 performance? 11. Does your agency X have job descriptions for every position? If yes, date of last July board approval? 01 12. Is there an annual X performance review for every staff?. jccoghs\fundinglbrm.doc 11 .... ~AAgency Special Care Program __ -- __ ~cti_on 7: F~il!~ncial M~bagem~bt _ . Three Year Historical Balance Sheet i i (As of your fiscal year-end ~ ~ I FY02 ~ FY03~FY04~: i 4 Y03 FY04 Current Assets j Current Liabilities Cash j 54,481 $3,284 ! $284 ACcounts Payable__ -- Investments ! I , PayrolITaxes Payable .Receivables < 9~ days I Contracts Payable Other _ ~ _ ~ _ _ Mpdgage ~ayable-6_ month~ TotaI Current Assets - - ~ $4,4814- $3,284~ $283~ To~! Curr~.n. ~L~a~il_~es , $0 , $0 i $0 Other Assests r ~ Ii ~Other Liabilities Property~ ~ i Mortga~.e Payable-Balance E~uipmen, ~ i ~ Other _ less de~oreciation ~ Total Other Liabilities $0 $0 ' _ $~0. Receivables > 90 days -- I Total Liabilities $0 i _$_0 $0 Other I~ ___~ NetAssets $3,284 ! $284 ........ ~ .. ~ $4,481 Total Non-current Assets I $0 $~ $0 , I TotalAssets $4,481 I $3,284 I $284 I Liabilities & NetAssets i $4,481 $3,284 $284 _ _ _ _ Agenc~y: S~pecia~ C~are Program _ ~LastYr.~urYr . NextYr~ B. Income & Expenses I Incpme_ ............. Loc~al Fun~ding So_u_rces .... ~ . __~_ _ ~ _ iowa City i' ~+~ Coralville ~ · Johnson Count(OHS) ' $6,500 i $6,500 $6,500 i : United Way- Allocation ~ $16,738 $16 303 $16 000 - De~ign~t~Givin~ ] $1,935 $1,500 ' $1,500 Grants-Federal, State, Foundation $~0,000 I $10,000 I' $10,000 CDid not include in Total Income Net Sales of Se~ice ~ ~ Contributions/Fundraisin~ ~ ~ ~ .i Investment Income ~ _ Other I Totallncome I $25,173~ $24,303 $24,000 [_ E~enses Benefits /~ r ~ Occupanc~ I Other: Dental Se~ices (United Way) ~ $15,494~ $17,500 $19,000 Dental Se~ices (DHS) $7,808 ~ $8,000 ! $8,000 ¢ Fund Balance ~ Revenue ' $25,173, $24,303 $24,000 Carwover Balance fro~previou}.year ~ $2,610 $4,481 I $3,284 ~ Teta!~Rera~BgBu¢~t $~783 i $28,784. $27,284~ Less Total Expenses ~ $23,302! $25,500; $27,000 ~ Endin~ Fund Balanc~ ! $4,481 __$3,2~4 % $284 [ _ _ Less~estrict~d Balance (e~plain) ~ _~ ~ ~ ~ Car~over Fund Balance ~ $4,481 : $3,284; $284 , IAgency' Seca Care Program D, BdlDonorlFunder Restricted Funds __ ~ T~his Year__~Next Year · __ ...... Desl~]nated for: _ Last Year ~Total Restrl¢~t¢~ Funds _ i $o !__ . $0 i $o E. In Kind S~p_ort: , ~astY_ear~ Th!sYear IN. extYear ~pace~ Utilities~ etc _ _J i $11,~00£ $1] ,500r $~ 2,000 ~ther: Please f~ootn_~ote Faculty, Salary~D~ental service at no charge .... !$16,5~00/3,500 I__$.17~000/4,00~_ $~17,500/~4:?0__0 __ Tota, ,?klnd~S_upport .... ~ ~ $50,0004 $53,500 ~$55,000 i :. *rants . __ Descripflp_ntPurpose [ Last Year ~ Year [Nex~t Year~ 3ral B Laboratories ~New van/e~uipment i $10,000 $10,000 ~_ $10,00~0 ~ rotalGrants $10rOOO ! $101000 ; $10~000 Organizational Chart Appendix B PREVENTIVE AND COMMUNITY DENTISTRY SPECIAL CARE PROGRAMS/SCC AND GMU Kuthy Clinic Operations Pre-doctoral Staff Affairs Cowen Student Affairs Cowen Cowen l Faculty Extramurals Dental Hygienist AEGD Dental Assistants Clinic Clerk Section 1: Background Agency Name: Table to Table Food Distribution Network Address: 20 East Market Street, Iowa City, Iowa 52245 Director Name: Robert Andrlik Signature: Bd. Pres Name: Tom Surer Signature: ~'~~ Request Completed By: Robert Andrlik Date: September 24, 2002 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30~X~ 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $7,250 $8,073 $12,557 14% Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City 0 0 0 Johnson County 0 0 0 City of Coralville 0 0 0 What were local funds used for this year: Operational support What will next year's local funds be used for? Operational support Agency Mission Statement: The mission of Table to Table is to gather donations from food providers and to channel them to area shelters, soup kitchens and local agencies who serve the hungry, homeless and at-risk populations in the Iowa City area. Summarize your programs and services for which yon are requesting funding: We request funding for our program of collection and distribution of food donations to area social service agencies. This program includes soliciting new food donors, coordinating volunteers and scheduling pick-ups. Operational support will be used for our community garden project, which has expanded this year to 8 gardens (up from 3 last year). Our food rescue in the schools project (begun in the 1998-99 school year) to establish food rescue from area school lunch programs continues as a non- funded program. List any accreditation and licensure your agency currently has. Explain. There is no licensing body covering food rescue organizations. We do hold ServSafe accreditation in food handling procedures. Agency Name Table to Table Agency Itistory (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) Table to Table (TtT) was formed in April 1996, by a group of concerned members of the Iowa City/Coralville area. The group consisted of members of agencies serving disadvantaged populations, food distributors looking for an outlet for surplus food, dietitians, chefs and community activists. The goal of the organization was not to feed the hungry directly but to channel resources through area homeless shelters, soup kitchens, and other agencies working to improve lifestyles and skills of disadvantaged people. Table to Table was developed to fill the need for a coordinated effort for rescuing and distributing surplus foods that would otherwise go to waste. It has often been frustrating for both donors and agencies seeking food to find the time and manpower to complete the connections. Table to Table strives to centralize the food rescue and distribute the food equitably to all agencies who need it. It also provides some relief to agencies typically facing budget and volunteer constraints. Table to Table initially began with minimal support from religious and community groups. It ran through the efforts of volunteers using their own resources. In 1997, Table to Table received a grant through the Iowa Department of Economic Development (IDED) to fund a van for the program. Since then, funding has been received for part time staffsalaries as well as office supplies and equipment. Funding has been primarily through the IDED Emergency Housing and Shelter grants. The rest has been raised through an annual gourmet dinner prepared by area chefs, United Way funds, a Radio-thon, corporate foundation, individual and church donations. Table to Table is involved in creating community gardens. Currently, we have 8 gardens placed around town. One portion of the project is designed to work with children of low-income families and establish the connection with agriculture and the nutritional benefits of gardening. The other gardens are for Iow-income and no-income persons to learn a skill, to build self-esteem through involvement in planning, growing and harvesting the produce from the gardens. We are also demonstrating how you can grow even a few nutritional vegetables around your apartment or home. j ccoghskfunding form. doc 2 Agency Name Table to Table Section 2: Client Profile 1. How many Johnson County residents (Including IC & 1 Unduplicated Count N/A * Coralville) did your agency serve? 2. How many lowa City residents did your agency serve? 2 Unduplicated Count N/A * 3. How many Coralville residents did your agency serve? 3 Unduplicated Count N/A * Age (use agency's Gender N/A* Ethnicity (use agency's breakdown) breakdown if needed) N/A* N/A* 0-5 Female: 6-17 Male 18-29 30-61 62-75 >75 * Note: We are an agency that serves other agencies. We have no ability to count the clients who consume our food. Our food is distributed to our receiving agencies. Therefore we estimate, under USDA guidelines, that one meal equals 1.5 pounds of food. We are meticulous in measuring the amount and destination of all our food. (See appendix C) 3. Briefly describe your service population. The agencies we serve encompass hunger relief, housing and at-risk populations. 4. How do you determine eligibility for services? A recipient agency needs to be a 501(c) (3) non- profit organization serving a hungry, homeless or at-risk constituency. 5. Are there fees for your services? Yes No X If yes, please describe your fee structure: 6. Do you provide services to areas outside of Johnson County? On occasion, when there is an abundance of donations that cannot be fully utilized in Johnson County, we will see if other areas can use them so the food does not go to waste. Area(s) served: Cedar Rapids, West Branch, Services Provided: Delivery of donated food. Funding Sources: Table to Table receives funding in the form of grants from United Way of Johnson County, General Mills Foundation, Emergency Shelter Grant and FEMA. We also have an annual dinner/silent auction, KCJJ Radio-thou (in conjunction with the Crisis Center) and direct mail solicitation. j cc oghs\funding form. doc 3 Agency Name Table to Table Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client The agencies we serve are our clients. We have almost daily contact with our recipient agencies vis-/~-vis our driver/delivery people. This rapport ensures the agency is receiving what it can use and is satisfied with the donations provided. If there are any requests or special needs, we strive to accommodate them. Agencies are also in contact with us by phone and e-mail communication. (b) Community (see above) 2. Briefly summarize your findings: We are pleased with the positive responses from our agencies and gratified when we are able to meet requests. Our recipients understand that requests may not always be met due to the daily variety of donations. However, we are almost always able to meet a portion, if not all, of these requests. 3. What changes have been made in response to these findings? We feel we are on the right track with the system we have in place. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Self-referred Virtually 100% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? We are an agency that serves other agencies in Johnson County. The service we provide is unique within this area (indeed, we are the only food rescue organization in the state). Table to Table channels food donations to a wide range of agencies that provide services to a broad range of clientele in multiple categories. These categories include the hungry, homeless and at-risk populations served by such agencies as Free Lunch, Emergency Housing Project and DVIP. In all, we provide to approximately 30 other agencies on a regular or periodic basis. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. As stated above, we serve a broad range of agencies in Johnson County. Consequently, the positive impact we have on the community is greater in scope than the majority of those agencies taken individually. j ccoghs\funding form. doc 4 Agency Name Table to Table 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. Crisis Center Food Bank 1. We collaborate in the KCJJ Radio-thou fundraiser. 2. Crisis Center Food Bank 2. We have a walk-in freezer and a walk-in refrigerator placed at the CCFB. 3. Salvation Army 3. We have a walk-in refrigerator placed at their location. Section 4: Strategic Planning and Agency Effectiveness I. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Secure funding to increase director's 1. We continue to search foundation position to full time. databases and media to find and apply for funds. 2. We are working with the School of 2. Increase awareness of Table to Table's Journalism at the U of I to develop a public mission in the community, relations package to promote our mission and awareness of hunger and food waste issues. 3. Develop an outreach program for 3. We are working with VISTA to have a surrounding areas, volunteer placed with us to develop an outreach program. The proposal has been approved but, as yet, we do not have the position filled. The program would encompass evaluation of need, acquisition of new donors, distribution and local contacts. 2. In what way will the needs of your service population change in the next five years? We anticipate the needs of our recipient agencies will continue to grow. This given the cuts in funding that most are facing while the numbers asking these agencies for aid continues to rise. j ccoghs\funding form. doc 5 Agency Name Table to Table 3. How do you plan to address these changes? We strive to acquire new donors and encourage our current donors to provide as much product as possible to meet the increased needs of our recipient agencies. 4. Describe the evaluation methods you use to measure the success of your services? We determine our success on the basis of pounds we are able to recover and distribute to recipient agencies. We then, in turn, can derive the dollar amount we are saving them. (See appendix C) 5. What are the results of these evaluations (outcomes)? We have increased our poundage recovered by approximately 90,000 pounds over last year. This reflects an additional savings to recipient agencies of over $120,000. 6. How do you plan to use the evaluation results to enhance/extend your services? We use the poundage data to ensure we are providing adequately for our current recipients and evaluating the pace and scope of outreach efforts for potential new recipients. 7. How do your programs/services impact the community? We feel we have a great impact on the community via the many agencies who utilize our donations. These agencies are able to save the money they would otherwise be spending on the food we provide and apply those funds to other aspects of their services. 8. How did the agency respond to the UWJC recommendations from last year? Recommendation: Response: "... Table to Table continue to develop We continue to develop a measured strategic plan their strategic plan to guide future growth to ensure growth without short-changing any of our and evaluate agency's progress" current recipients as we expand. "...encourage the agency to continue to We continue to maintain precise records of the gather and report outcome and impact pounds recovered and distributed. We can data to demonstrate the value of their extrapolate the savings to recipients agencies. services" "...continue to develop additional We are consistently seeking additional funding sources of revenue..." sources. The director has attended seminars on _ grant writing to hone the skills needed to be effective in this regard. Our board is very active developing new fund-raising strategies. "... add rural representation to their We currently have a member on our board fulfilling board." this category. As new members are added, we anticipate further representation of rural interests. "... (is) concerned about inadequate We carry a $1M dollar general liability and a $1M liability insurance for the agency's staff umbrella liability policy. Additionally, we are and directors." protected under the provisions of the Emerson Good Samaritan Food Donation Act (Public Law 104-210) and Iowa Code Ann. 122B.1 (1989). (Appendix D) j ccoghs\funding form. doc 6 Agency Name Table to Table Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Once per month. 3. What is your average attendance at board meetings? 70% 4. How is the board involved in strategic planning and governance of the agency? The board takes an active role in goal setting, fundraising and budget oversight. 5. What type of training/orientation do board members receive? They receive an orientation packet and mentoring by other board members. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? 2000 7. Have you filed the annual report with the Secretary of State? If yes, date filed? January 15~ 2001 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? August 15, 2001 If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes No X If yes, Who completed the audit? How much did the audit cost? If material weaknesses are noted in the audit, what is your plan for addressing them? If you do not have an audit, what is in place to assure accountability in the agency's financial management. We have monthly oversight by the board of directors. 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability b. employment practice liability General Liability X $1 M Umbrella Liability X $1 M Professional Liability Property or Renters X $28 K Vehicle X $500 K Note: Additionally, Our donors, recipient agencies and ourselves are covered under the Emerson Good Samaritan Food Donation Act (public law 104-210) and Iowa Code Ann. 122B.1 (1989) j c coghs\funding form. doc 7 Agency Name Table to Table Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. The Executive Director has been with Table to Table for one year. He received his B.L.S. degree from the University of Iowa in 2000. Prior to coming to Table, he was an assistant supervisor at Tanager Place in Cedar Rapids and worked for many years at Goss Graphics Systems in Cedar Rapids. 2. Staff Salaries &Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health merit Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Executive Director X X $25,252 .5 .5 .5 Operations Manager X X $11,302 .5 .5 .5 Transportation Manager X X $3,222 .13 .13 .13 Business Manager X X $4,250 .13 .13 .13 TOTAL FTEs 1.26 1.26 1.26 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? N/A 4. How much was spent on staff development in the last fiscal year? $800 5. How much is budgeted for staff development in this fiscal year? $800 j cc oghs\funding form. doc 8 Agency Name Table to Table 6. What training and support opportunities are offered to staff?. Attendance at conferences and seminars are evaluated and approved on a case-by-case basis. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 4.5% Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board last reviewed? 09/17/02 10. Does your board X annually evaluate the director's performance? t 1. Does your agency X have job descriptions for every position? If yes, date of last board approval? 09/21/01 12. Is there an annual X performance review for every staff?. j ccoghs\fundingform, doc 9 t Agency: Table to Table Section 7: Financial~Management A. Three Year Historical Balance Sheet _(As of your fiscal year-end) June 30 t FY00 FY 01 FY 02 Current Assets Cash ~_$3,233 $19,432 $22,113 Investments ~ $0 $0 $0 Receivables < 90 days~ ___ $0 $0 $0 Other $60 $31 $297 Total Current Assets $3,293 $19,463 $22,410 Other Assests Property $0 $0 $0 ~uipment $40,181 $40,181 $52,062 less depreciation _($~10,479~ ($20,510) ($29,120) Receivables > 90 days $0 $0 $0 Other $0 $0 $0 Total Non-current Assets $29,703 $1~9,671 $22,943 Total Assets $32,996 $39,134 $45,353 FY O0 FY 01 FY 02 ~u~rrent~e~ Accounts Payable $0 $0 $24 ~Payr011 Taxes_Payable ~$1,085 $0 $2,010 _ _Contracts Payable $0 $0 $0 Mortgage Payable-6 months $0 $0 $0 Total Current Liabilities $1,085 $0 $2,~34 Other Liabilities Mort~gage Payable-Balance $0 $0 $0 Other $0 $0 $0 Total Other Liabilities $0 $0 $0 Total Liabilities $1,085 $0 $2,034 NetAssets $31,911 $39,134 $43,319 Liabilities & Net Assets $32,996 $39~134 $45,353 ............ Agency: Table to Table Last Yr Cur Yr Next Yr prepared 9/25102 FYE06/02 FYE06/0~- FYE06104 i projected B. Income & Expenses Income Local Funding Sources Iowa City $0 __ $0 $0 Coralville $0 $0 $0 Johnson County $0 _$0 $0 United Way - Allocation $7,461 $8,0~_3. $8,759 - Designated Giving $4,144 $3,500 $_3,798 Grants-Federal, State, Foundation $23,988 $24,976 _$27,099 Net Sales of Service Net Sales of Materials Contributions/Fundraising _. $40,66~. __$46,345 $50,284 Investment Income $201 $0 $0 Other $0 $0 $0 Total Income $76,46_1_. ..-$82,894 $89,940 Expenses _ ._ Wages & Salades $33,079 $37,572 $40,766 Benefits $2,482 $~3,209 $3,482 Occupancy $13,863 $12,346 $_1_3,395 Non-occupancy $14,240_ __$23,908 $25,940 Other (depreciation) $8,609 $5_,674 $6,156 $72,275 $82,709 $89,739 C. Fund Balance Revenue ___ $_76_,461 $82,894 I $89,94~0 Cam/over Balance from previous year $43,320 $47,505 ! $_~_7,690 Total Operating Budget $119,780 $130,399~ ~1~37,~630 Less Total Expenses ....... $72,275 $82,'~09 $89,739 Ending Fund Bala~n_c.e_ __ $47~,50~5_ .__$47,690 $47,891 Less Rssthcted Balance (explain) $19,788 $19,976 $21,674 admininstation or food delivery exper~es, Carryover Fund Balance $27,717 $27,714 $26,217 Appendix A Table to Table Board of Directors Name Town Occupation Affiliation Joined Board Tom Snter IowaCity KC J J-AM Community 12/99 Dick Braverman Iowa City Chairman, Hawkeye Food Donor 10/99 Food Systems, Inc. Colleen White Coralville CoralvilleHyVee FoodDonor 4/99 Janie Schmidt Coralville Community 2/97 Karl Dixon Iowa City Emergency Housing Food Recipient 7/01 Project, Inc. Courtney Graglia Iowa City Hometies Food Recipient 10/02 Julie Teachout Iowa City Hills Bank and Community 7/00 Trust Co. Jim Kelly Iowa City UI Comxnunity Community 8/00 Credit Union Carol Hunt Iowa City Johnson County Community 5/99 Soil and Water Conservation District Jane McCune Iowa City Blank and McCune Community 7/99 Real Estate Co. Betty Loan Iowa City Mercy Hospital Community 10/99 Jodi Demeulenaere Iowa City Blooming Prairie Food Donor 3/00 Mary Monson Iowa City U of I Community 5/00 Mark Allen Coralville KXIC-AM Community 9/00 Theresa Carbrey Iowa City New Pioneer Co-op Food Donor 11/00 Dayna Ballantyne Iowa City Cr/sis Center Food Food Recipient 12/00 Bank Ann Snter Iowa City Community 10/02 Meg Strohmer Iowa City Community 8/02 Officers (Executive Committee) TomSuter Chair, BoardofDirectors Dick Braverman Treasurer Betty Loan Secretary Co-chair is currently vacant Fundraising/PR: Suter, White, Monson, Hunt, Demeulcnaere, Loan, Carbrey, McCune, Alle, Schmidt, Kelly Finance: Braveman, Kelly, Teachout Personnel: Ballantyne, Dixon 1 Appendix B Table to Table Organizational Chart Appendix C Table to Table 2 Table Outcome Measurements FY 7/01/01-6/30/02 EQUIVALENT AGENCY L. BS~ RECEIVED MEALS $ SAVED Agape 2861 1907 $3,814 Anchor Bay (Oxford) 74 49 $98 Crisis Center 239,480 159,653 $319,306 DVIP 14,899 9,932 $19,864 EHP 20,350 13,572 $27,144 Hills Family Resource Center 3,142 2,094 $4,188 N. Liberty Family Resource Center 693 462 $924 Free Lunch 17,972 11,981 $23,962 Hometies 3,242 2,161 $4,322 Mayor's Youth 110 74 $148 MECCA 4,601 3,067 $6,134 MH Clubhouse 1,865 1,243 $2,486 NCJC Broadway 13,374 8.916 $17,832 NCJC Pheasant Ridge 3,280 2,187 $4,374 New Horizons 19,282 12,854 $25,708 Oxford House 921 614 $1,228 PAL 721 481 $962 Ronald McDonald House 6,995 4,663 $9,326 Salvation Army 38,956 25,971 $51,942 Successful Living 22,279 14,853 $17,514 UAY 2,102 1,401 $2,802 Youth Homes 7,867 5,245 $10,490 Other* 5,484 3,656 $7,312 * RVAP, 4Cs, etc. Section 1: Background Agency Name: United Action for Youth Address: 410 Iowa Avenue, Iowa City, IA 52240 Phone: 319-338-7518 Director Name: Jim Swaim Signature: Bd. Pres Name: Don Carstensen Signature: Request Completed By: Jim Swaim Date: September 26, 2002 Check Your Agency's Budget Year: I/1 - 12/31 7/1-6/30_~X_ 10/1-9/30__ 4/I/01- 4/l/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Budget $56,779 $55,939 $67,000 4% FY 02 FY 03 FY 04 65,000 65,000 68,250 5% 97,275 97,275 102,000 7% 2,500 2,750 3,000 /1% What were local funds used for this year: Funds were used to support the general operating costs for both the Counseling and Youth Development programs at UAY. Local funds were also used as match to several state and federal grants that exceeded $500,000 for the year. The funds allowed us to serve over 2,500 clients including over 1,000 clients who received counseling. What will next year's local funds be used for? Funds will be used to continue this operation of the counseling and youth development programs, increasing the match used to develop additional grant opportunities to support services to youth and families. Agency Mission Statement: q~he mission of UAY is to assist youth and families by offering counseling and intervention programs that assist them in resolving problems they encounter; and to provide prevention and youth development programs that make use of young peoples' talent and energies in helping themselves to a healthy future. Summarize your programs and services for which you are requesting funding: 1) Counseling/Intervention: Provides counseling, intervention, and related services to youth in Johnson County for the purpose of preventing or reducing delinquency and assisting victims of abuse and maltreatment. Professional outreach counselors and volunteers maintain trusting relationship with at-risk youth in the community, helping them develop the skills to address problem situations without becoming involved in juvenile delinquency. Staff are on call 24 hours a day to provide in-person response to runaways and youth in crisis. UAY also acts as a resource to the court to provide in-home service to families. UAY's family counseling and assistance to teen parents has increased in the past three years as UAY offered parent skill training. A nurse practitioner is under contract to assist pregnant and parenting teens and their children. 2) Prevention/Youth Development: Provides programs to reduce/prevent delinquency, substance abuse, unplanned teen pregnancy, and child maltreatment by engaging youth in positive youth development activities. It includes Synthesis, an innovative arts environment for youth to become involved in Agency Name: United Action for Youth communication arts and the use of electronic media as a compelling alternative to inappropriate or illegal behavior. Professional youth workers provide support and counseling in addition to instruction in various arts activities. The program's drop-in component has had steadily increasing use for the last few years. UAY's prevention has more than doubled. The development ora teen line has enhanced the overall program and helped us increase the use of both teen and adult volunteers. Youth volunteers provided over 2,000 hours of assistance to peers in the program this year. We are involved in a comprehensive juvenile crime prevention progrmn with several other agencies. School based centers are used in counseling (as well as prevention) to provide outreach and aflerschool activities in the community. List any accreditation and licensure your agency currently has. Explain. UAY is reviewed by the U. S. Dept of Health and Human Services and a peer review process every 3 years based on RMYA's 14 performance standards. UAY's Medicaid contract is reviewed and the site visited for compliance annually. Several grant sources also do annual site visits during which records and fiscal data is reviewed. The child care program is DHS approved but does not require a license based on how it is used in the Teen Parent program. UAY utilizes licensed/accredited programs under subcontracts with Mercy, MECCA and Youth Homes/Four Oaks for runaway youth, teen parents, and youth needing substance abuse treatment. Staff are accredited in various areas including family therapy, licensed art therapy, recreation therapy, as well as in using various curriculum that require training such as Strengthening Families and Parents as Teachers. UAY JCCOG request FY 04 2 Agency Name: United Action for Youth Agency History (Using one page only, please summarize the history of your agency, emphasizing Johnson County, past and current activities and future plans. Please update annually.) United Action for Youth is a community-based service agency which offers crisis intervention, confidential counseling, creative activities, and other helping services to youth and families in Johnson County and surrounding communities. Supported with funds from the Board of Supervisors, Iowa City, United Way, and other public and private sources, UAY charges no fees for its services. Incorporated in 1970 and governed by a community-representative Board of Directors, UAY is recognized by the IRS as a non-profit to,x-exempt organization. The primary purpose of UAY is to assist youth and families by offering counseling and intervention programs that assist them in resolving problems they encounter; and to provide prevention and youth development programs that make use of young peoples' talent and energies in helping themselves to a healthy future. UAY receives funds, in addition to its local suppo~ from grants and under contracts or subcontracts with other state and federal agencies to provide the following: 24-hour in-person crisis intervention to adolescents; outreach aftercare, follow-up, referral, and prevention to runaways, their families, homeless young persons, or those in jeopardy of becoming homeless; in-home counseling; coordinated substance abuse prevention and pregnancy prevention services; and specific intervention programs to respond to adolescent victims of maltreatment. UAY has staff persons on call at all times, 365 days of the year. UAY will respond immediately to parents' requests for counseling or assistance and works closely with other agencies to coordinate its intervention and other activities. UAY makes a special effort to respond to requests from the police, court, Youth Homes, DHS, Crisis Center, Emergency Housing Project, DV1P, RVAP, and school counselors. UAY is a member of the National Network of Runaway and Youth Services. UAY concluded a national demonstration and reseamh project to study the impact of its programs on teen pregnancy and teen parenting. It is a current participant in the national Community Youth Development (CYD) project sponsored by the DeWitt Wallace Foundation. It has secured an AmeriCorps grant with Neighborhood Centers which will provide UAY with 2 fulltime and 6 half-time AmeriCorps members to assist in using CYD in the community this year. UAY's services are provided in a variety of settings; chiefly its Youth Center and adjacent Family Service Center. We have purchased space at 355 Iowa Avenue, The Tower Place, for an expanded youth center. Besides the Youth Center location at 410 Iowa Avenue, the settings include schools, individual homes, and places young people frequent. In addition to its professional staff, UAY relies on community volunteers and trained peer helpers to help meet the growing needs of young people. UAY's program components include an outreach counseling program, a creative arts workshop, a family assistance program, and a growing volunteer program. Progrmns are also offered in Spanish for non-English speaking clients. UAY sponsors a situational drama troupe composed of area youth to help educate and provide information to adolescents about a variety of issues, including sexual abuse, dating violence, children of divorce, substance abuse, children of alcoholics, and peer pressure. UAY statistics indicate continued use of prevention and youth development programs. Counseling services increased significantly last year; we believe as a result of greater economic stress and the post 9/i I crisis. UAY's Synthesis program has significant drop-ins and use of the studio which is expected to continue. The agency has had increased requests for service from surrounding non- Johnson County towns and has received grant funds to serve them. UAY has helped develop collaborative projects with other agencies to impact teen pregnancy (Neighborhood Centers/planned parenthood/FADS) and homelessness (Youth Homes/Four Oaks), substance abuse (MECCA), and several with area schools. UAY JCCOG request FY 04 3 Agency Name: United Action for Youth Section 2: Client Profile 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 2510 2272 Coralville) did your agency serve? 2. How many Iowa City residents did your agency serve? 2 Unduplicated Count 1731 1619 3. How many Coralville residents did your agency serve? 3 Unduplicated Count 400 229 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-9 149 Female: 1079 Asian 50 10-12 470 Male 1013 African American 205 13 - 15 932 * youth only Caucasian 1478 16-18 454 Hispanic 218 Over 18 508 Native American 18 >75 Multi-racial/other 123 3. Briefly describe your service population. UAY serves youth and families, primarily teens and adolescents and their parents for counseling. More younger youth are served in youth development programs and the Teen Parent program also serves infants and toddlers. 4. How do you determine eligibility for services? Service requests for counseling and prevention are processed by staff on intake and forwarded to the service team based on the nature of the request for service. All youth are eligible regardless of income or other factors. 5. Are there fees for your services? Yes No X If yes, please describe your fee structure: 6. Do you provide services to areas outside of Johnson County? Area(s) served: Cedar, Iowa, Muscatine, and Washington counties Services Provided: All of those counties receive limited services for runaway and homeless youth and street outreach. Muscatine county, West Liberty receives substance abuse prevention and more extensive street outreach for Hispanic youth and families. Requests for victim services are accepted from those other counties, but coordinated with other VOCA funded agencies in other communities. Funding Sources: Runaway grants, substance abuse prevention grants, crime victim assistance grants UAY JCCOG request FY 04 4 Agency Name: United Action for Youth Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: UAY uses client satisfaction surveys for various services. Interviews by third party evaluators, peer reviewers, and funding sources are conducted with clients. UAY tracks referral sources and 372 referrals last year came from peers, indicating client satisfaction. From all these sources the indicators are that youth and parents are very satisfied with both counseling and youth development services. We also incorporate client feedback in design of services, involving youth in the design of several programs including street outreach and the youth center. (b) Community: UAY funding sources include meetings with community members during site visits and evaluations by third parties. UAY is also involved in several collaborative projects with other service partners during in which community satisfaction is assessed (such as Strengthening Families). We also solicit commtmity feedback to the board and at open houses sponsored by the agency and solicit external community feedback during staff evaluations. 2. Briefly summarize your findings: Client satisfaction has been very good for both counseling and youth development programs. This has been cited by the Department of Substance Abuse, the juvenile court, and the Administration for Children and Families peer review. We continue to get many referrals from youth and other parents. 3. What changes have been made in response to these findings? In renewing Street Outreach and Teen Parent programs we have incorporated feedback generated from both clients and the community. As examples we used client feedback to designate which locations of street outreach were most needed. We used feedback from teen parents to help determine how to deal with cuts in funding to determine lowering the age from 21 and under, to under 21 for when teen parents graduate from the program. We used client and community feedback to help determine location choices for the expanded youth center in the downtown area. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Peer/self 530 25% Family member 165 7% School 1221 58% Court/law enforcement 34 1% Social services 92 4% Other 50 2% 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Youth Homes Four Oaks assists youth and families. Neighborhood Centers of Johnson County assists youth and families. MECCA provides substance abuse counseling and prevention. Community Mental Health provides counseling to youth and parents. MYEP assists youth in pre-employment youth development programs. DVIP and RVAP provide victim services to families. Planned Parenthood and Emma Goldman collaborate on pregnancy prevention services with UAY. Big Brothers Big Sisters provide youth development and prevention services, as does UAY JCCOG request FY 04 5 Agency Name: United Action for Youth Four-H. Various scouts and Campfire also provide youth development services. There are many faith based youth groups at various churches, synagogues, and mosques as well as Youth for Christ. Area schools provide a wide range of after school youth development activities for youth. Iowa City, Coralville, and North Liberty provide recreation programs and other youth development programs for area youth. There are more but these are some of the main ones that UAY tries to stay informed about. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. UAY's primary focus is serving area teens with a wide range of both counseling and youth development services, as distinguished from groups that serve neighborhoods, or provide a primary type of service, such as substance abuse or mentoring. 7. Outside of referrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1. 1. Crime Prevention Youth Development With several other providers- this project provides youth development activities in 2. several places including the youth center and Pregnancy prevention community project rural locations and assistance to youth who might benefit from early intervention 3. 2. Substance Abuse prevention With area schools, Neighborhood Centers, Planned parenthood, Emma Goldman, Mercy hospital, and U of I Hospitals provides service to pregnant and parenting teens as well as prevention to junior high youth and parems 3. With MECCA and also with NCJC and area schools provide activities and skill building for youth and parents such as Strengthening Families UAY JCCOG request FY 04 6 Agency Name: United Action for Youth Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Space to conduct programs, especially the 1. The board relied on a building task force to Youth Center and Teen Parent Program, has develop ideas on how to improve space. A been limiting our programs proposal to purchase space from Iowa City was funded by CDBG and UAY is conducting a capital campaign for the next 3 years. 2. The state budget crisis threatens many 2. UAY is working with collaborative services for youth and families, especially agencies to maximize resources, including use the Teen Parent program, of case management with several agencies. We have developed contracts with Empowerment and Four Oaks/FaDSS to 3. Youth can use more opportunities to develop maintain home visits and continue to work their skills and demonstrate their abilities in the with Mercy Hospital to provide health community, services. We have developed additional fund support from foundations and are working on an additional federal grant to enhance services. 3. UAY became aware that the Federal Communications Commission was making low power frequency radio FM stations available. Working with youth and volunteers we submitted a request to develop a youth run radio station at the new youth center. The FCC has given initial approval to the project and we have begun planning to start the station in late 2003. Rockwell Collins staff and the Iowa City TV staff were key in helping us get the technical aspects of the project submitted. 3. In what way will the needs of your service population change in the next five years? We continue to look at how the population of youth is changing in Johnson County. There is much more diversity as well as people locating hem from other communities, both urban and rural. The economic realities of local state and federal budgets will impact what resources are available. 4. How do you plan to address these changes? We continue to have a diverse staff that can offer services in both English and Spanish. We network with other service providers in Johnson County to collaborate on projects that bring resources to UAY and our partners. We also network with providers in other communities, to use them as resources for clients, and to share "best practice" ideas. UAY staff were instrumental in organizing the Future Net network of providers who work with teen parents and the Missouri Iowa Nebraska Kansas Youth UAY JCCOG request FY 04 7 Agency Name: United Action for Youth Service network. We have developed a number of research eftbrts about the impact of some of our programs to help document the cost effectiveness of programs to justify funding source support, including cooperating with the U of Iowa, U of Nebraska, and the National Institute of Mental Health on research related to our youth programs. 5. Describe the evaluation methods you use to measure the success of your services? UAY participates in a variety of evaluations for its programs. Last year we completed a two day site visit by Health and Human Services for our Street Outreach and Runaway programs; a one day site visit by the Iowa Division of Substance Abuse for our Prevention programs; a site visit for the Crime Prevention project; and a site visit by the Attorney General's Victim's Assistance program. These visits included meetings with youth served by the program and review of outcomes projected in grants that fund our services. We also participate in other reviews with the Department of Education and DHS and the evaluation of FaDSS. With MECCA we are conducting an evaluation of the Strengthening Families project. We are a research site for a National Institute for Mental Health project studying runaway youth and our street outreach program. Some of the outcomes highlighted in these evaluations are: 6. What are the results of these evaluations (outcomes)? · There was a 25% reduction of discipline complaints and 15% reduction of truancy at South East junior high following the initiation of our school based program there · In the Teen Parent Program over 3 years, 92% of the teen moms completed high school or GED while they were in the program; 70% are not on FIP after completing the program; the second pregnancy rate was 3%, compared to the national average for teen parents of 22%, of the teen moms UAY saw on a pre-natal basis, there were zero low birth-weight deliveries this past year. · Over 150 youth at risk completed the "challenge by choice" ropes course, of over 50 delinquent youth less than 15% committed delinquent acts over the next year · Runaways handled by area law enforcement were reduced from 360 in 1998 down to 230 in 2000, (a 35% reduction) over the course ofUAY's 3 year Street Outreach program. Research by Washington University of runaway programs, including UAY's, indicated that the youth seen in the program were better able to return home, more likely to remain home after being a runaway, and reported less family conflict after participating in the counseling program offered as part of the Basic Center program. · Youth and families in UAY/MECCA substance abuse prevention programs are less likely to use drugs and alcohol than their peers. This is true also for youth in UAY's program for Spanish speaking families. 7. How do you plan to use the evaluation results to enhance/extend your services? We continue to use results to demonstrate our success to potential funding sources and to the general public. We have incorporated some of the research findings from projects we participated in to improve program design, such as linkages for our street outreach program. We improved our case documentation system based on valuable feedback we received during past site visit/peer reviews. We have used "science based/researched" program models in developing collaborative prevention efforts with MECCA. We will continue all of these efforts to enhance and extend our program services. 8. How do your programs/services impact the community? The Center for Youth Development and Policy Research conducted a financial analysis of youth development programs similar to UAY's in which they demonstrated a minimum $10 return for every $1 spent on the programs. During challenging times, it is important for youth to feel connected to the community, and UAY's outcomes demonstrate that our programs help do that. Teaching young parents effective parenting and early childhood development reduces future health costs to the county. UAY JCCOG request FY 04 8 Agency Name: United Action for Youth We provided an analysis to the county about how the crime prevention initiative was saving local tax dollars spent on detention. 9. How did the agency respond to the UWJC recommendations from last year? The comments from last year were very kind and had no suggested areas for UAY to work on. We continue to collaborate with several other providers. We continue to track many different outcomes for our services and cooperate on a number of research efforts. We are fortunate to retain an excellent staff and to have Don Carstensen become board president after three years of leadership from Casey Cook. Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and conunittee assignments. (Attach as Appendix A) 2. How often does your board meet? The board meets monthly, with additional meetings as needed and an annual retreat. 3. What is your average attendance at board meetings? 8-10 of the 13 or 14 members 4. How is the board involved in strategic planning and governance of the agency? The board has engaged in two broad strategic planning efforts in the past four years. The first to improve fundraising and the second to study UAY's space needs. In the latter the board also sought non- board community members to help in the process. Balancing these broad eflbrts the board at several meetings reviews specific programs like the Teen Parent Program or the AmeriCorps project, or the Youth Radio Station proposal to examine and recommend direction for programs. 5. What type of training/orientation do board members receive? Prior to serving, potential members interview with board members and staff; with an outline of duties and expectations. Once on the board the board member visits with the leadership staff at UAY for orientation in which programs and budget information is presented. Adult and youth members are also encouraged to attend other training sponsored by UAY such as regional youth meetings or the National Symposium for Youth. 6. Does your agency have written policies and procedures for financial management? Yes. If yes, date of last board approval ? __9/17/02 7. Have you filed the annual report with the Secretary of State? Yes. If yes, date filed? 3/22/01 this report is now done on a biennial basis 8. Have you filed the IRS form 990 for the most recent year? Yes. If yes, date filed? _11/13/01 If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes X__ No__ UAY JCCOG request FY 04 9 Agency Name: United Action for Youth If yes, Who completed the audit? Greenwood & Crim, Steve Kuhl. How much did the audit cost? $4,200 if material weaknesses are noted in the audit, what is your plan for addressing them? There were no material weaknesses. If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability X 1,000,000 b. employment practice liability X General Liability X 2,000,000 Umbrella Liability X 2,000,000 Professional Liability X 2,000,000 Property or Renters X 750,000 Vehicle X 1,000,000 Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Jim Swaim has been employed at UAY since 1973, Executive Director since June of 1974. He has a BGS from the University of Iowa and completed additional course work in Family Counseling, Social Work Administration and other specialized training from groups like the Institute for Cultural Affairs and National Youth Work Project at the University of Minnesota. He serves as a consulting grant reviewer for several state and federal agencies, past national chair for the National Symposium on Youth, delegate to the White House Conference on Families, past member of the Iowa Juvenile Justice Council and Commission on Volunteers. He is a current Iowa City Library trustee and current president of the Missouri Iowa nebraska Kansas Youth Service network. UAY JCCOG request FY 04 10 Agency Name: United Action for Youth 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health merit Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Director X X X $40,000-60,000 3 3 3 Program Coordinator X X X $30,000-38,000 4 4 4 Family Counselor/therapist X X X $30,000-38,000 2 2 2 Family Support Counselor X X X $24,000-36,000 4 4 5 Youth Counselor X X X $26,000-38,000 7 7 7.5 Program Specialist X X X $20,000-31,000 3 3.5 3.5 Child Development/child X X X $18,000-26,000 2 2 2 care Office Manager X X X $25,000-30,000 1 1 1 Secretary X X X $18,000-26,000 .75 .75 .75 Custodian X X X $18,000-26,000 .5 .5 1 AmeriCorps X X $9,000-9,800 5 5 5 TOTAL FTEs 32.25 32.75 34.75 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 31.5 4. How much was spent on staff development in the last fiscal year? __$8,290 5. How much is budgeted for staff development in this fiscal year? _$9,000_ 6. What training and support opportunities are offered to staff?. UAY sponsors attendance at conferences and training for all staff. We conduct monthly in-service training at ail-staff meetings with guest presentors. UAY sponsors CEUs for key staff and sponsor specialized training for staff such as ropes Course Certification, Parents as Teachers, as well as attendance at professional association meetings such as Certified Arts Therapists, Family Therapy annual meetings and the like. Special training for specific project is offered such as the Community Youth Development and Advancing Youth Development sponsored by the National Network. UAY JCCOG request FY 04 11 Agency Name: United Action for Youth 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 4% Yes No If no, brief explanation 9. Does your agency have personnel X Reviewed June of 02 policies? If yes, date board last reviewed? 10. Does your board annually evaluate X In some years this is done by the board chair, at least every the director's 3 years a comprehensive review with outside agency input performance? has been conducted. The last review was June of 02 11. Does your agency have job X Many job descriptions are approved as attached to specific descriptions for grants. The board has not conducted a comprehensive every position? review of all job descriptions. Job descriptions are If yes, date of last approved by the executive director or associate director board approval? 12. Is there an annual performance review for every X staff?. UAY JCCOG request FY 04 12 Agency: United Action for Youth Section 7: Financial Management ~,. Three Year Historical Balance Sheet As of your fiscalyear-end) FY02 FY03 FY04 , I FY02 FY03 FY04 Current Assets Current Liabilities Cash $44,441 $100,000 $135,000 Accounts Payable $205,519 $215,000 $218,000 Investments $0 $0 $0 Payroll Taxes Payable $3,970 $5,000 $5,000 Receivables < 90 days $92,565 $90,000 $100,000 Contracts Payable $0 $0 $0 Other $4,850 $4,000 $4,000 Mortgage Payable-6 months $6,000 $7,000 $133,000 Total Current Assets $141,856 $194,000 $239,000 Total Current Liabilities $215,489 $227,000 $356,000 r Other Assests = Other Liabilities Property $457,431 $832,000 $940,000 Mortgage Payable-Balance $97,673 15360,673 $221,673 Equipment $171,965 $192,000 $225,000 ~ Other less depreciation ($302,102) ($330,000)! ($360,000)i Total Other Liabliities $97,673 $360,673 $221,673 Receivables > 90 days Total Liabilities I $313,162 $587,673 $577,673 Other _ NetAssets i $155,988 $300,327 $466,327 Total Non-current Assets $327,294 $694,000 $805,000 TotalAssets $469,150 $888,000 $1,044,000 Liabilities & Net Assets $ ,150 $888,000 I $1,044,000 Agency: United Action for Youth FY 02 FY 03 FY 04 B. Income & Expenses Income Local Funding Sources Iowa City $65,000 $65,000 $68,250 Coralville $2,500 $2,750 $3,000 Johnson County $97,275 $97,275 $102,000 United Way - Allocation $62,683 $70,199 $7_7~000 _ - Designated Giving $5,982 $6,400 $7,200 Grants-Federal, State, Foundation $649,021 $693,634 $852,700 Net Sales of Service $212,358 $229,000 $233,000 Net Sales of Materials $332 $600 $600 Contributions/Fundraising (*Includes Cap. Camp.) $48,438 $165,000 $156,000 Investment Income $390 $600 $600 Other ............... $757 $1,20~0 $1,200 _ Total Income $1,144,736 $1,331,858 $1,501,550 Expenses Wages & Salaries $759,636 $832,750 $871,718 Benefits $174,208 $193,273 $202,691 Occupancy $44,691 $49,000 $72,000 increase is costs of operating new center Non-occupancy $144,300 $118,700 $168,100 decrease in 03 is reduced contracts to Program Supplies and Activities $40,366 $41,000 $44,000 other agencies $1,163,201 $1,234,723 $1,358,509 C. Fund Balance Revenue $1,144,736 $1,331,858 $1,501,550 Carryover Balance from previous year $55,598 $37,13~3 $39,268 Total Operating Budget $1,200,334 $1,368,991 $1,540,818 Less Total Expenses $1,163,201 $1,234,723 $1,358,509 Ending Fund Balance $37,133 $134,268 $182,309 Less Restricted Balance (explain) $95,000 $125,000 Restricted to new youth center Carryover Fund Balance i $37,133 $39,268 $57,309 'Building Bright Futures*' campaign Agency: United Action for Youth D. Bd/Donor/Funder Restricted Funds Designated for: FY 02 FY 03 FY 04 Health Benefit Account Health benefits $5,127 $5,200 $5,300 Building Bright Futures building fund/capital campaign $7,092 $95,000 ~ $125,000 (beth of these funds are restr_icted by UAY board action) Total Reatrioted Fuad$ $12~2t9 $'i00,200 $130,300 E. In Kind Support: Laat'(ear Thia Year Noxt Year Services/Volunteers 4200 hrs@$9, 550 hrs@$20, 100hrs@$50 $82,800 $89,800 $94,000 interns 4@$3000 AmeriCorps 5@$4800 Material ?oo~d.s Donated food,~music/rec equips: furniture . $18,000 $20,000 $24,000 Space, Utilities, etc class space, ropes course, bldg material $14,000 _~;84,000 $~18:D_00 Other: (Ptease footnote) Labor for the finish and remodeling (estimate) $60,000 $20,000 Tota~ll.l~_-_k_i_nd Suppo~ _ ~ $114,800 _$253,800 $15_6,000 F. Grants Description/Purpose Last Year This Year Next Year 3rime Victim Assistance assist child abuse victims & families $71,250 $74,100 $76,000 Runaway Youth/Street Outreach assist runa~wy_,_ homeless youth & families $--189,400 $200,000 $250,000 Substance abuse prevention ski~ls training, activities for youth &families $8~3,000 I $90,000 $120,000 Teen Parent assistance skills training, home visits, ch/care, counselin ~ $114,500 $226,000 Youth developmentJAmeriCorps skills training, activities, yth cntr,~recreation $129,000 $141,000 $134,000 Total Grants $598,050 $619,600 ~ $806,000 United Action for Youth c ..... ~,,~.~,E~,.~.Ap,~ .... o.,h..o~,,,,,~.~o UAYBoardofDirec~ors ] DONCARSTENS"N JANETSCHLAPKOHL Jim Swaim Ginny Naso ~Ew~ NANSEN CAT~ WE~NGEIST Executi~ D~re~or Ass~i~e Director o. Board since ~02 On Board sln~ 2~ Basic Center C~rdinator MERRY JAYNE HAWORTH, M.D. Teresa Ulin Business Dir~or CHUCK HIPPEE I . I I I Administrative Team Counseling Se~Mces Team Teen Parent Services Team Youth Services Team Kylie Buddin Jacey Freestone Diane Tonkyn, AAMFT, Kim Anderson, MSW Lynette Jacoby, LMSW Molly Gee, BAW Stu Mullins, BA Kylie Buddin Da a Manager CounseCedified ngAd CoordTherapiStnator Family/Youth Counselor Teen Parent Coordinator Teen Parent Counselor YoUthcoordinatorService Team Youth Center Staff I Gladis Chaisson, MSW Mark Jeneen, BA Dada Podz, BSW Jessica Thomson, BSW Sarah Hallas, BA Janie Jeffriee, CTRS U of I/Youth / Rural Outreach School-based Counselor Teen Parent Counselor Pregnancy Prevention GLBTQ&A Se~ces Volunteer Coordinator Recpt on ats , Counselor Counse or AMindy Tomash dmieistrative Assistant Amy Louis, MSEd Dorothy Scanian, MSW Terresa Maas, AA Pediatric Nurse Pract.& Erin Mullins, MA Grace Sinclair Street Outreach Youth/Family Counselor Childcare Coordinator Registered Nurse Solon Center Street Outreach Worker Coordinator Mercy Hospital Coetract Coordinator Staff Rick Spear, BA MSW/SSW Practicum U of I Work StudyI Arnedcorps Volunteers Kelly Vander Wedf SchooFbased Counselor Students Coud-referred Services Adventure Course LChdcare Staff J Coordinator MSW/SSW Practicum StudentsYouth & Adult Volunteers Section 1: Background Agency Name: Visiting Nurse Association of Johnson County Address: 2953 Sierra Court, Iowa City Phone: ?!9) 337f9~686 r~ ~ Director Name: Suellen Novotny Signatur~e~: Bd. Pres Name: Diane Huber Signature: /~/.~A~--~ Request Completed By: Suellen Novotny Date: Check Your Agency's Budget Year: 1/1 - 12/3 l_x_ 7/1-6/30 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $75,1375 $78,150 $80,495 3% Does not include designated giving or Special Needs Grants FY 02 FY 03 FY 04 City of Iowa City 0 0 0 0 Johnson County $117,600 $97,500 $100,425 3 % City of Coralville 0 0 0 0 What were local funds used for this year: United Wa ~ funds subsidize VNA's home care services for individuals without insurance to pay for the services. Johnson County funds pay for services in Health Promotion, Eldercare and Community Services. What will next year's local funds be used for? The same. United Way funds will be used to subsidize home care services for individuals without insurance. Johnson County funds will pay for Health Promotion, Eldercare and Community services. Agency Mission Statement: The Visiting Nurse Association's primary purpose is to provide quality health services without discrimination in the home and community setting. Services are provided within the constraints of the agency's resources to persons with limited means and are provided on a part-time, intermittent basis or on a full-time basis for special needs patients. The VNA works cooperatively with other organizations and services to meet individual and community needs. Summarize your programs and services for which you are requesting funding: A. The Visiting Nurse Association is requesting funding from United Wa~ for Skilled Home Care Services with which our professional and paraprofessional staff visit persons at there place of residence, to provide physician- directed health care to individuals with diagnosed health problems. United Way, private donations and State Grants help subsidize visits to those individuals without insurance. Agency Name __Visiting Nurse Association of Johnson County_ A. The Visitinq Nurse Association is requestin,q fundin.q from United Way for Skilled Home Care Services with which our professional and paraprofessional staff visit persons at there place of residence, to provide physician-directed health care to individuals with diagnosed health problems. United Way, private donations and State Grants help subsidize visits to those individuals without insurance. Skilled services include direct care, observation, and evaluation to improve the health of the individual. Services also include monitoring and evaluating patients who have the potential for complications and/or deterioration without appropriate supervision and intervention. Skilled care involves services provided by Nursing, Physical Therapy, Speech Pathology, Occupational Therapy, Medical Social Services, and Home Care Aides. Consultation services by a Dietitian and Pharmacist are also available. B. The Visitinq Nurse Association is requestinq fundin,q from Johnson County for Health Promotion, Eldercare and Community pro.qram& 1. Health Promotion: home visits are made to assist individuals and families in obtaining/maintaining an optimum level of health. Services include developing and maintaining appropriate coordination of community resources for the benefit of patients. Services are provided by Nursing, Medical Social Worker and Dietitian staff. The Health Promotion Program includes a Personal Emergency Response System called "Health Watch" offered to those whose safety in the home setting is in jeopardy. 2. EIdercare Program: this program represents a series of services offered to the well elderly at various sites throughout Johnson County. The goal of the service is to promote optimal health and independence to older persons. Services include direct care, screening, teaching, counseling, and referral. Services are offered at 11 sites in Johnson County. Special programs include the Foot Clinic, Therapeutic Massage, and Influenza Immunization Clinics. 3. Community Programs: these programs include direct health care, health consultation/ collaboration, screening / education provided at various community sites, promoting healthy life styles, early detection of health risk factors and prevention of health problems for Johnson County residents. This service includes providing influenza and pneumonia immunizations for the general public. The VNA algo provido~ frozen meal9 for tho individual~ confined to their home; the frozen meals serve as a supplement to improve their nutritional intake. List any accreditation and licensure your agency currently has. Explain. The Visiting Nurse Association is currently accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) through November 17, 2002. However, due to the increasing survey cost of JACHO, the VNA will not be continuing accreditation through this organization. The VNA is completing a Preliminary Evidence Report for the organization, Accreditation Commission for Health Care, Inc. (ACHC). VNA is planning for the ACHC to conduct an accreditation survey in late fall. A date has not been confirmed at this time. Also, a Medicare and Medicaid certified agency. 2 AGENCY: VISITING NURSE ASSOCIATION AGENCY HISTORY 1949 The Visiting Nurse Association was formally organized on July 13, 1949. 1959 The agency combined with the City Nursing Service. 1963 The Child Health Clinic was established as a service for indigent children. 1965 The VNA became Medicare certified; Nursing was the first service certified. 1974 The Eldercare Program was developed for well elderly at Congregate Meals and housing sites. 1981 Evening services were added, then 24 hour nursing emergency services. 1982 The billing and statistical systems were computerized. 1984 The VNA diversified and opened another nonprofit agency designed to maintain elderly at home; the agency was named CareResources. 1985 The Adult Day Program joined the VNA; private duty services were started and then discontinued due to a negative monetary effect on other services. 1987 The Child Health Clinic (the Loraine Frost Clinic) was transferred to the Johnson County Department of Public Health to compliment the WIC Program. 1988 In cooperation with the Health Department, the VNA started the Senior Health Program to serve those individuals not receiving regular medical evaluations. 1990 A formaJ Quality Assurance Program was started; a support group for families and caregivers of AIzheimer's disease was started by the Adult Day Program. 1992 The Adult Day Program was transferred to the Johnson County Department of Public Health and the Home Care Aide Program was transferred to the VNA. CareResources ceased operation and its employees joined the VNA. 1994 The VNA was awarded two flood grants for nursing and home care aide services; the agency participated in a new state program - The Family Investment Program. 1995 The VNA joined nine Iowa VNAs to develop a nonprofit corporation to provide statewide home health services through contractual arrangements with insurers. 1996 The agency contracted with insurance companies to conduct Activities of Daily Living assessments; the VNA was awarded the Iowa Breast and Cervical Cancer Early Detection Program Grant; twelve graduate students completed a two-semester project, developing a strategic direction for the VNA; the agency was awarded Accreditation with Commendation by the Joint Commission on Accreditation of Healthcare Organizations. 1997 The agency contracted with a company to complete paternity testing. 1998 A letter of intent was signed by the Board of Directors to affiliate with University of Iowa new program to offer a Personal Response System for the frail elderly, latch-key kids and others whose safety is in question. 1999 The VNA continued to work on the affiliation with University of Iowa Community Homecare; the agency moved into a new building, sharing space with UICH; the nurses began providing cardiac monitoring services. The VNA was reaocredited by the Joint Commission for Accreditation of Healthcare Organizations. 2000 To meet a need in the community, the VNA developed a frozen meal program to serve Medicaid Waiver clients. From an anonymous trust in New York City, the VNA received a grant for the Home Care Aide services. "CareResources" was reopened as a limited liability company, jointly owned by the VNA and U of I Community Homecare. Medicare changed its reimbursement system to a prospective payment system (PPS), effective October 1,2000. The financial impact of PPS on the VNA will not be known for several months. 2001 The VNA received a second grant from the anonymous trust in New York City for $15000: the purpose is to provide subsidy for patients who need "special" services but cannot pay the full cost of the service. The services will include Health Watch, frozen meals, medication dispenser and telemedicine home visits. The VNA started a weekly AGENCY: VISITING NURSE ASSOCIATION nursing service for Emergency Housing and added Eldercare services at Windmill Pointe. Private duty nursing and aide services were developed through a contractual relationship with UICH. Services are provided in Johnson County and within fifty-mile radius. 2002 The VNA received a third grant from the anonymous trust in New York City to continue providing subsidy for patients who need special services of Health Watch and frozen meals and can not pay full cost for these services. The VNA entered a contractual relationship with the VNAA for ~roviding Anthrax vaccinations to specified local employers and their staff. Agency Name __Visiting Nurse Association of Johnson County Section 2: Client Profile ~- . '-. - - - ~ 2000 2001 1. How many Johnson County 1 Unduplicated Count residents (Including lC & Coralville) 1850 877 did your agency serve? 2. How many Iowa City residents 2 Unduplicated Count did your agency serve? 507 591 3. How many Coralville residents 3 Unduplicated Count did your agency serve? 121 122 Age (use Gender Ethnicity (use agency's agency's breakdown) breakdown if needec~ 0-5 56 Female: 565 Indian/Alaska Native 6-17 21 Male 312 Asian 18-29 58 Black/African American 30-61 302 Hispanic/Latino 62-75 143 White/other >75 297 Unknown 3. Briefly describe your service population. The VNA serves the elderly, ill and disabled of Johnson County. VNA skilled professional services are physician- directed health services provided to individuals with diagnosed health problems who require the care of a nurse, therapist(s) and/or medical social worker. Those patients who have health insurance often find that their coverage is restrictive or does not provide coverage for their particular situation. Through United Way, State funds and donations the VNA is able to subsidize the skilled care of individuals who do not have insurance for these services. The VNA provides preventative services to the elderly, ill and disabled of Johnson County through the Health Promotion, Eldercare and Community programs, which promote health and well being. The VNA is able to subsidize these services to these individuals and families through local Johnson County funds. Johnson County's population of elderly and disabled is predicted to continue to grow, in part because of the very positive living conditions in the Iowa City/Coralville area, including the human service resources. As they age and become infirm, they will require more community services to stay at home. Increasing numbers of individuals are retiring to Assisted Living Facilities or multiple dwelling buildings from single-family dwellings. The VNA is diversifying its services to meet the needs of the elderly, ill and disabled, both in the community and 4 Agency Name __Visiting Nurse Association of Johnson County. homo settings, e.g. frezon meals, Health Watch (a personal response emergency system), MD2 (a medication compliance machine for dispensing medications), telemedicine for monitoring patients' in their home. Health insurance companies are increasingly restricting coverage of services which places a burden on patients and families to pay privately for health services. The VNA requests funding from local sources to subsidize services beyond what the patient can pay for those with no insurance or limited insurance. 4. How do you determine eligibility for services? The VNA provides health care on a part-time intermittent basis for the elderly, ill and disabled of Johnson County. Eligibility for skilled home care services is based on an admission criteria approved by the Professional Advisory Committee of the VNA Board of Directors. This criterion requires that a patient be under the supervision of a physician and that there are medical orders for skilled home care services. The patient must be assessed as safe at home during the hours that VNA would not be providing intermittent services and that the home care services do not duplicate other care; e.g., outpatient Cardiac rehab or therapy, assisted living services. Both the patient and family agree to the Plan of Care including services to be provided, frequency of visits and fee, if any. The patient must have an emergency plan in place in the event of a health or environmental emergency. The VNA does not have an eligibility requirement for Community services. Patients admitted for Health Promotion services in the home must be assessed as safe living in the home. Eldercare is a series of services offered to well elderly at various sites throughout Johnson County, which requires the elderly to have transportation available to attend the Eldercare programs. The VNA provides care to individuals regardless of race, religion, creed, sex, sexual orientation, ethnicity, disability, disease entity, age or ability to pay. 5. Are there fees for your services? Yes__X No If yes, please describe your fee structure: Skilled Home Care and Home Care Aide Services: Sliding fees are available for patients who are deemed to be ineligible for health insurance coverage. Sliding fees are based on income, liquid assets, dependents, and unusual circumstances. United Way funding, State grants and donations subsidize skilled services provided on sliding fee. Main payers for home care services are health insurance companies. Communitl/Services: Flat fees exist for Foot Clinic, Massage Therapy and Flu Clinics. Sliding fees are available for Health Watch and frozen meals. 6. Do you provide services to areas outside of Johnson County? Upon request the VNA will occasionally provide services outside of Johnson County, Agency Natne __Visiting Nurse Association of Johnson County. Area(s) served: 50-mile radius of dohnson County, including counties of Cedar, Iowa, [.inn, Muscatine, Washington and [.ouisa. Services Provided: Skilled Home Care/Private Home Care, Insurance Assessments and Health Watch. Funding Sources: Third-party reimbursement (Medicare, Medicaid, Insurance) for Skilled Home Care/Private Home Care. Private Insurance for Insurance Assessments and Private Pay for Health Watch/Private Home Care. Agency Name __Visiting Nurse Association of Johnson County. Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: patients are given a Patient Rights Protocol when admitted to Skilled Services, which addresses a grievance protocol. The VNA encourages patients and families to voice any concerns or complaints during the time of service. A Patient Satisfaction Survey is mailed randomly to patients. Any complaint rendered by a patient/family is documented on a complaint form and investigated by a Clinical Service Manager. Action is taken as indicated. A file is maintained on any complaint received and a report is prepared for the Professional Advisory Committee and then reported to the Board. The Complaint File is reviewed by accrediting bodies. (b) Community: The satisfaction of VNA services on a community level is measured by: Unsolicited Comments- complaints/compliments Fundraising success, unsolicited memorials and donations Attendance at Community and Eldercare sites Continued Referrals 2. Briefly summarize your findings: Cancelled or decreased services due to staffing issues or budget cuts are the main complaints received. Occasionally, a patient will request a change in a caregiver due to a personality conflict. A complaint form is completed, reviewed by the Management Staff and then reviewed with the appropriate staff person involved. Action is taken as indicated. 3. What changes have been made in response to these findings? Maintaining adequate staffing is critical to VNA's service provision. The VNA continues to have staffing issues despite the concerted efforts of the Human Resource Specialist to hire and maintain home care aides, nurses and therapists. 4. Who are your referral sources to your agency? Please list the main sources and estimate the ~ercentage of clients that are referred by each source. Soume of Referral % of clients referred Inpatient Patient Health Facility 42.97% 13.85% Physicians 11.41% Intra Agency 8.55% Self/Family 8.35% Government/Schools Agency Name __Visiting Nurse Association of Johnson County. 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? There are at least three other home health providers in Johnson County that provide skilled home care services to residents. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. The VNA is a community based non-profit organization with fifty three years experience in providing home health services. The VNA has an excellent reputation of quality services and receives support from state and local funds. The VNA's mission is to accept patients for intermittent services regardless of ability to pay. The VNA often admits patients that other home health providers refuse. 7. Outside of referrals list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1 .Elder Services 1. VNA participates in monthly Case Management meetings to review the safety and health status of the Frail and Elderly patients followed in Case Management. VNA collaborates with Elder Services in evaluating and providing service to Alzheimer patients and elderly patients who home health services. 2.HACAP and DHS 2.The VNA provides services to families at risk for safety and well being who are referred by HACAP and DHS. 3.Hillcrest 3. VNA provides health assessments, ongoing care and reed management to residents of Hillcrest. Agency Name .._Visiting Nurse Association of Johnson County. Section 4: Strateqic Planninq and Aqency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1. Staffing 1. Human Resource Manager is actively recruiting to offset 2 RN turnover positions. In addition to a 3% pay increase management is reviewing reimbursement incentive plans to reward higher levels of productivity on the part of nursing and billing staff. 2. Cash Flow 2. A financial consultant has been retained to review billing processes and program profitability. Ongoing education is provided to billing staff to ensure compliance with Medicare Prospective Payment regulations and billing procedures. 3. Patient referrals 3. A part time marketer will be hired to market new VNA business and to increase referrals from local hospitals and physician practices. 2. In what way will the needs of your service population change in the next five years? The elderly and disabled population of Johnson County is predicted to grow. The baby boomers are reaching retirement age and health issues are occurring. The disabled population continues to grow in part because of the excellent human service resources of Iowa City and Coralville. Many residents are experiencing decreased health insurance benefits due to insurance companies and employers limiting health coverage benefits. Some residents have become unemployed due to layoffs due employer downsizing. Hence, the population of uninsured or underinsured has increased during the past year. 3. How do you plan to address these changes? VNA diversified it's services last year to improve the home safety of patients through implementing a personal safety system (Health Watch) and an automated med dispensing machine (MD2). These services have been so successful in making residents safer in their 9 Agency Name _.Visiting Nurse Association of Johnson County_ homes that VNA is expanding these services further during the next year. VNA is diversifying it's services further through a Wise Woman Cardiovascular Study grant to provide education and cardiovascular assessment to Iow income women 42-62 years old. To meet the needs of the uninsured and underinsured VNA will be providing services to this increasing population through the United Way, Johnson County Health Department, State grants and private donations. VNA is hiring a marketer to evaluate community need and to market VNA services that meet the VNA mission in the community. 4. Describe the evaluation methods you use to measure the success of your services? Outcome Measurement of Performance Improvement Activities Benchmarking with prior months, years and with other agencies Medicare Certification Survey Accreditation Commission for Health Care Inc. Continued Referrals Fundraising success, unsolicited memorials, donations Unsolicited compliments/complaints Random patient Survey Questionnaires 5. What are the results of these evaluations (outcomes)? Section 4 Question 5 Attachment Patients have complained about reductions in hours of homemaking services that occurred due to state funding budget cuts. Aisc a waiting list develops for homemaking services on occasion due to lack of staff. There is never a waiting time for skilled services. It is a VNA standard that all skilled services will be initiated within 48 hours of a referral. 6. How do you plan to use the evaluation results to enhance/extend your services? The VNA Human Resource Manager is a highly motivated manager who is actively recruiting and interviewing potential HCA and RN staff. VNA advertises in local papers, professional publications, at local hospitals, and on the web. VNA's goal is to have no waiting time for any services due to a lack of staff. VNA is hiring a part time marketer to assist management in evaluating new opportunities in serving the residents of Johnson County and to generate more referrals: Historically the VNA depended on its quality reputation in the community for its referrals. With referrals decreasing during the past year it is evident that VNA must become more visible and active within the community. Goals of the next year are to develop more health services, to generate more referrals from local hospitals and physician practices and to become more active in fundraising activities (without competing with United Way). 7. How do your programs/services impact the community? The VNA home and community services provide health and physical services to the elderly, ill and disabled population of Johnson County regardless of an individual's ability to pay. VNA often provides service to individuals who were refused service by other home health agencies. VNA provides services that help maintain the elderly, ill and disabled in their homes, thus delaying or preventing institutionalization. These services include professional ]0 Section 4 Question 5 Attachment Program outcomes 1. Skilled Care Program Description: Visits are made to persons, at their place of residence, to provide physician-directed health care to individuals with diagnosed health problems. Services are reimbursed through Medicare, Medicaid, private insurance and private pay utilizing a sliding fee. United Way funding, State grants and private donations subsidize visits to those patients without insurance coverage. Goals: to provide curative, restorative and palliative home health care, assist individuals to stay in their home as long as possible, delaying or preventing institutionalization. Visits: Goal 02 Projected Skilled Nursing 13000 11333 Physical Therapy 2200 2006 Speech Therapy 175 62 Occupational Therapy 150 174 Medical Social Services 100 537 Home Care Aide 10500 10900 Outcome: Skilled nursing visits have decreased with Medicare patients due to increased case management. Medicare reimbursement is based on a 60 day basis rather than a per visit basis. A decrease in referrals has contributed also to the decreased skilled nursing visits. VNA is actively recruiting for two RN's; however, the current nursing shortage is impacting recruitment efforts. Also the Medicare requirements involving computerized charting and excessive documentation is a deterrent in attracting home health nursing staff. Decreasing referrals has also affected the Physical Therapy goal of seeing 2200 patients. Strategy in handling decreased referrals is to become more aggressive in marketing VNA services to local hospitals and physicians. VNA has not actively marketed its services to the community in the past. A part time marketer is budgeted for the next fiscal year. 2. Goals set for Health Promotion, Eldercare and Community services are met to date. Agency Name __Visiting Nurse Association of Johnson County. health care as ordered by a physician, but also include supportive services that help individuals maintain their independence, such as personal care assistance, errands and household maintenance. The mission of the VNA is to provide service regardless of ability to pay, thus serving the Iow income and underinsured or uninsured. The vision of the VNA is to find new ways to help individuals stay in their home, such as MD2 med dispensing machines that assist with med compliance, Health Watch which is a personal emergency system and frozen meals. 8. How did the agency respond to the UWJC recommendations from last year? The Citizen Review Panel did not provide specific recommendations to the VNA. Comments mirrored the VNA concerns regarding cash flow problems and adequate staffing. The VNA is addressing the cash flow problem by retaining a financial consultant to evaluate billing procedures and processes. This consultant will evaluate the efficiencies of the billing department as well as program profitability. VNA recruitment of quality nursing staff is a challenge during this time of a nursing shortage. The requirements of working with a laptop computer, complying with Medicare documentation requirements and VNA productivity guidelines presents additional challenges in recruiting and retaining nursing staff. 11 Agency Name ._Visiting Nurse Association of Johnson County_ Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly except for July and November 3. What is your average attendance at board meetings? The officers of the board and the finance committee attend all meetings. The remaining board members attend the monthly meeting on an average of 82% 4. How is the board involved in strategic planning and governance of the agency? The Board and Management developed a 2001 to 2004 Strategic Plan in a retreat in May 2001. The Board approved this Strategic Plan in June, 2001. This Strategic Plan is reviewed bi-annually by Management. 5. What type of training/orientation do board members receive? The Directors are provided a Manual containing By Laws, Articles of Incorporation, Director responsibilities, Committee responsibilities, funding sources, SWOT Analysis (Strengths, Weaknesses, Opportunities,Threats), and the Strategic Plan. New Directors meet with the Executive Director and are encouraged to make home visits with staff and to attend community clinics. Ongoing education occurs during committee meetings, board meetings and with handouts mailed with board packets. 6. Does your agency have written policies and procedures for financial management? yes If yes, date of last board approval? August 8, 2002 7. Have you filed the annual report with the Secretary of State? yes If yes, date filed? 01/10/01 Filed biennially. 8. Have you filed the IRS form 990 for the most recent year? yes If yes, date filed? 11/05/01 If no to questions 6, 7, or 8, give explanation. 9. Does your agency have a yearly audit? Yes x__ No If yes, Who completed the audit? Clifton Gunderson LLP How much did the audit cost? $5913 If material weaknesses are noted in the audit, what is your plan for addressing them? No material weaknesses noted 12 Agency Name __Visiting Nurse Association of Johnson County_ If you do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency Amount has Directors & Officers a. fiduciary liability (a) x (a) 1,000.000 b. employment practice liability(b) x (b) 2,000,000 General Liability x 1,000,000/2,000,000 Umbrella Liability x 1,000,000 Professional Liability x 1,000,000/3,000,000 Property or Renters x 100,000 Vehicle x 1,000,000 13 Agency Name __Visiting Nurse Association of Johnson County_ Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Suellen Novotny is the Executive Director. She is an RN with an undergraduate degree in business administration and a Masters in Health Care Administration. She has 10 years experience in home health. She has been with the VNA from January 1997 to present. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health merit Current Salary (FTEs) Position Leave Ins. Plan Range Last This Next Per Position Year Year Year Executive X , X X 49,942-72,350 1 1 1 Director Administrative X X X 35,358-38,127 1 1 1 Asst Clinical X X X 39,156-58,826 2 2 2 Services Mangers Team X X X 21,685-32,950 3 3 3 Assistants Intake X X X 25,359-38127 1 1 1 Coordinator Staff Nurses X X X 31,569-47,443 9.32 9.32 9.32 Home Care X X X 16,392-24,669 9 7 9 Aides Home Makers X X X 15,354-22,887 3 2 3 Physical X X X 44,968-67,427 2 2 2 Therapists Social Worker X X X 27,196-40,793 1 1 1 Senior HCA X X X 20,359-30,590 2 2 2 Occupational X X X 36,402-54,688 1 1 1 Therapy Community X X X 33,986-50,891 1 1 1 Prog. Co Auxiliary RN X X X 31,569-47,442 8 7 10 TOTAL 46.3 40.3 46.3 FTEs 14 Agency Name __Visiting Nurse Association of Johnson County. 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? All VNA employees serve Johnson County, hence 40.3 FTE are serving Johnson County at this time. Next year 46.3 FTE positions are budgeted and would be serving Johnson County. 4. How much was spent on staff development in the last fiscal year? $14,250.00 5. How much is budgeted for staff development in this fiscal year? $15,000.00 6. What training and support opportunities are offered to staff? ,, Continuing Education dollar support and time off for local classes offered. · Initiate training for Homemaker to become C.N.A. certified and become HCA's. · Weekly in-service education for the professional staff, and every 1st and 3rd week for the para-professional staff is offered as well. 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? The average % wage increase was 3%. Yes No If no, brief explanation 9. Does your agency have personnel policies? If yes, date board last reviewed? X 9/26/01 10. Does your board annually evaluate the director's X performance? 11. Does your agency have job descriptions for every position? X If yes, date of last board approval? 04/24/02 12. Is there an annual performance review for every staff? X 15 _ . _ iAgency: Visiting Nurse Association Section 7: Financial Management A. Three Year Historical Balance Sheet FY 99 FY 00 FY 01 current Asset~ -- Cash $46,532~ ($70,912 $139,114 I~nvestments $0 Receivables < 90 day~ _ __, $320,978 ~ $202,614 $567,881 _Other . $75,243[ $28,452 $0 Total Current Assets $442,753~ $234,591 $429,378 Other Assests Propert~ $0 $0 $0 E~ijpment $14§,838 $113,384 $107,282 less depreciation __ ($65,695 ($60,299 ($70,449 Receivables >~90 days $92,491 $278,947 $360,233 Other $0 $0 ' $0 Total Non-current Assets $172,634 $332,032 $397,066 TotalAss~ets $615,387 $566,623~ $826,444_~ FY 99 FY 00 FY 01 Current Liabilities ...... Accounts PaYable i ~ _ , $37,341 _ $86,654~$38~1,103~ ~ayroll Taxes Payable $0 $7,763 $15,997 Contracts Payable _ $62,67~9 $'151,088' $140,757! Mortgage Payable-6 m0nth~s $0 $0 $0 Total Current Liabilities ' $100,02~0 _ $245,505 $537,857 Other Liabilities Mortgage Payable-Balance $0 $0 $0 Other $120,991 $236,639 $473,197 Total Other Liabilities $120,991 $236,639 $473,197 Total Liabilities $221,011 $482,144 $1,011,054 NetASsets - $394,376 i~ $84,47~[ ($184,61~ Liabilities & Net Assets $615,387: $566,623 $826,-.-.-. Income & Expenses Ll°owC~ la ~;~d ' n g S °u r cas .... ;~! $0~ ~0~ - Designated Giving ! $11,049 I $8,413 = $8,413~ Grants-Federal, State, Foundation _ _ _ $275,6~01 I $~230,58~4 / $275,999 Net SaI~ of~ateriais ~ $~ ~ $~ $0 Contributions/Fundraising J $33,726 $26,500 $26,500 ~ Investment In~e ~ $23 ~ $0 $0 ~ ~cupancy , $83,318 1~79,500 I $82,300 .... Non-occupancY -- ~ ,1,44;; ~ ,1,668,863 ~,1,800,989 ~ Other ~ $0 I $0 I $0 C~ Fund Balance ~ ~ ~ Car~over Ba[ance from previous year / ($207,230) ($265,152) ($320,482)J To~lOperafingBudget i$2,789,352 152,993,366 $3,151,441 ~ Ending Fund Salan~ ~($265,15~ ($3~,482)~ ($305,328) Car~over Fund Balance I ($265,152)~ ($320,482)~ ($305,328)~ I Nurse Assoc~iatio n D. BdlDonorlFunder Restricted Funds D~ignated for: 2001 2002 N/A~ , $0 Total Restricted Funds . . $0 $0~ $0 [ E. In Kind Support: __ 200t 2002 2003 Services~'olunteers ~ $34,430 $35,463 Mata~rial Goods N/A $0 ~ace, Utilities, otc Senior Center - 792 square feet + $11,088 $11 310 i $11.536 [ Other: Student volunteers $14,388 i $15,168 , $15,623 Total In-~ind Support $60,876 $60,908 F. Grants Descflpttan/pur~ose 200t 2002 2003 JCHD - CSB Public heatth nursing & home c~re aides __$227,917 $177,224 $193,343 JCHD - BCC/Wise woman east, cervical and cardiac screenings $3,420 ~ $13,860 $t5 JCHD - Child health clinic Social worker screenin ~and intervention $5,580 $9,500 $9,785 JGHD - Children*s health outreach Recruiting and application assistance $0 $0 $26,88181~ JP Morgan/Chase Headh promotion and frozen meals $15,000 $15,000 $15,0000 ~ erita~[e Agency on Aging ~Alzheimer's ~esearch $9,028 $15,000 $1 Total Grants I $260~945 ~230~584 $275~999 VISITING NURSE ASSOCIATION of Johnson County Appendix A 2002 BOARD OF DIRECTORS (VNA Board Members may serve two three-year terms) OFFICERS & BOARD MEMBER COMMITTEES TERM ! END OCCUPATION MAILING ADDRESS PHONE KATHARINE BJORNDAL Nominations / Development Second 12/05 Retired / Administrative Assistant, U of I 2510 Bluffwood Circle, Iowa City 52245 338-2759 DR. ROBERT BROWN Finance / Professional Adv Fimt 12/03 Retired / Radiologist, U of I 351 Koser Ave, Iowa City 52246 338-7231 DONALD CANFIELD TREASURER Second 12/03 Retired / General Manager, Hy-Vee Food Stores 46 South High Circle Ddve NE, Iowa City 52240 338-3358 Executive / Finance / Development VIRGINIA CLEMONS SECRETARY First 12/03 Retired / Medical Technologist 518 Woodddge Ave, Iowa City 52245 338-6674 Executive / Human Resoume / Development CHRISTINE CONOVER Human Resource / Planning Second 12/03 Attomey/ Simmons, Perrine, Albdght 115 Third Street SE, Cedar Rapids 52401 887-1368 & Elwood PLC SUE DALLAM Human Resource/Development Second 12/04 Retired / Professor, College of Business, U of I 18 Valley View Knoll, iowa City 52240 338-9330 DR. ERiC EVANS Planning / Prclessional Adv First 12/02 Staff Physician / Student Health, U of I 1044 Weeber St, Iowa City 52246 353-5959 JOHN GROSS Planning / Nominations First 12/04 President / Technigraphics Inc. (Printing) Plaza Centre One, 125 S Dubuque, Iowa City 52240 354-5950 GORDON HINZ Finance / Planning First 12/02 Retired / Vice President, Hills Bank 2119 Leonard Circle, Iowa City 52246 338-5033 DIANE HUBER PRESIDENT Second 12/02 Asscciate Professor/College of Nursing, U of I 304 Olde Hickory Ridge Road, Corelville 52241 354-7010 Executive / Ex-officio Member of all Standing Committees MARION JOHNSON Planning / Professional Adv First 12/02 Retired / Professor, College of Nursing, U of I 2107 Norcor Avenue ~, Coralville 52241 351-3305 HYMAN JOSEPH Finance / Human Resource First 12/02 Professor / Economics, U of I 1152 Hunters Run, Iowa City 52246 335-0837 DEANN LEHMAN Humen Resoume/Development First 12/02 President / Enzlers Inc. (Gifts & Leather Goods) 902 Wylde Green Road, Iowa City 52246 337-2325 GAYLORD (Duke) McGRATH Nominations ! Development Second 12/04 Owner ] McGrath Financial Services 2307 E Washington, Iowa City 52245 337-9301 DENISE PRYBIL VICE PRESIDENT Second 12/02 Pharmacist / Hy-Vee Pharmacy 4830 Utah Ave SE, Iowa City 52240 354-7121 Executive / Nominations / Professional Adv ROBERT RASLEY Finance / Planning Second 12/04 Retired / Public Relations, U of I 820 Club House Road 4A, North Liberty 52317 665-9394 STEVEN ROE Finance / Human Resource First 12/04 Administrator / Oaknoll Retirement Residence 2127 Abbey Lane, Iowa City 52246 466-3006 KATHRYN TADE Nominations / Professional Adv First 12/03 Retired / Nurse 838 Bluffwood Ddve, Iowa City 52245 337-9122 PETER VANDERHOEF Finance / Nominations First 1 2/02 General Manager / Owner, Iowa Book & Supply 2403 Tudor Ddve, Iowa City 52245 337-4188 THOMAS VAUGHN Finance / Planning Second 12/03 Assistant Professor / Health Management, U of I 2058 Holiday Road, Corslville 52241 335-9846 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: / Executive Finance ~ " .......................... ' ~ Planning Prof Advisory ns Development Executi've Director Human Resource ~ nformatonSvstMOr i Financa Manaaer . i Human ResourCeSDec · OualitvManaaer :1 cinicatserVicesMClrS II Admnist~atiVeASsiStant ,.-.---,-.-'-.-', ....... ........... ......... _L-.' ...... " " · ............ I, ........................ .. .L ........................ ~. .I. ............ ~ I · -- -- · M R A.~ .~t~nt ·, B nn .c;n~.c. ~ ~t~ ,, RP.c. ret~rv/RRc. P.r~t nn .~t · ~ Professional Staff · ~ o Registered Nurses I ~. Licensed practical Nurses Physical Therapists I Speech Pathologists Occupational Therapist Medical Social Services Paraprofessional Staff Home Care Aides Homemakers Contract Prof Staff Registered Nurses Licensed Practical Nurses Speech Pathologists ....'""' Occupational Therapist i Contract Paraprof Staff ........ ~ ................................... i Home Care Aides .. Homemakers Intake Coordinator M Rdic.~l Rennrd.~ Team Assistants Community ProC Coord ] Legend - Dotted lines represent contracted positions from CareResources and UI Community Home Care ~O ~ * Managerial Positions, both VNA Staff and Contract Staff interact with the VNA Board in the Standing Committees ~ rganizational Chart - 9/0 Section 1: Background Agency Name: Youth Homes Address: 1916 Waterfront Dr. Phone: 319 337-4523 Director Name: Kelli Malone S ignat u~'~-~-~ Bd. Pres Name: Mark Danielson Signature: Request Completed By: Kelli Malone; Dave Davis Date: 9/27/02 Check Your Agency's Budget Year: 1/1-12/31 7/1-6/30 X 10/1-9/30 4/1/01- 4/1/02- 4/1/03- % of 3/31/02 3/31/03 3/31/04 Total Amount received from UWJC $20,500 $19,999 $20,599 1.24% Does not include designated ~ecial Needs Grants FY 02 FY 03 FY 04 City of Iowa City $0 $0 $2,000 0.12% Johnson County $68,400 $61,560 $63,407 3.78% City of Coralville $750 $825 $1,000 0.06% What were local funds used for this year: Local funds were used for local match for the Dept. of Economic Development grant, to cover PAL costs due to decreased grant dollars, day care certificates, and increased costs, help serve homeless teens in SCILS, to support provided services revenues do not cover in Family Services, and to provide emergency shelter and supervision for local youth. What will next year's local funds be used for? Funds will be used for similar purposes next year with the addition of using funds for Johnson County girls admitted to the Residential Center. Funds will help support costs not covered by the state per diem. Agency Mission Statement: Youth Homes provides family-based services that help children grow into competent, caring and responsible adults and encourages development of community attitudes and support systems to assure their success. To support our mission, Youth Homes provides short-term emergency shelter; long-term residential care for young women; structured independent living services; after school and summer programming; acute crisis intervention to prevent out-of-home placement of children; therapy, counseling, and skill development to keep children in their home; foster care; and special needs adoption. Summarize your programs and services for which you are requesting funding: Youth Emergency Shelter: Provides emergency and short-term residential care, counseling, and supervision to runaway and homeless children; to victims of abuse, neglect, or exploitation; and to Agency Name: Youth Homes, A Division of Four Oaks of Iowa children who have been removed from their homes because of emotional, behavioral, or family problems. Pursuing Adventures in Learning (PAL): Provides after school and summer programming for preadolescents and middle school children (ages 6-15) who are behaviorally disordered and not able to attend regular day care or summer programs. Structured Community Independent Living Services (SCILS): Provides housing, behavioral support, life skills, educational and employment support, financial assistance, and counseling to foster care and homeless youth ages 16-21. Family Services: Provides in-home counseling, therapy, and skill development, intensive assessment and therapy, special needs adoption, foster care, supervised visits, and diagnosis/evaluation services to children and families at-risk for child removal, for reintegration from out-of-home placement, or for assistance to alternative placements. Residential Treatment Center (RTC): Is a group foster home providing long-term residential treatment and therapeutic services to young women (ages 13-l 7) who are emotionally challenged and behaviorally disordered as a result of physical or sexual abuse, neglect, or other family problems (domestic violence, criminal behavior, substance abuse, lack of parental supervision/involvement, mental health issues). List any accreditation and licensure your agency currently has. Explain. Iowa Department of Inspection and Appeals This state licensing body conducts annual reviews. The purpose of this licensing review is to ensure compliance with state regulations regarding staff qualifications, personnel files, supervision, client records and facility structure and maintenance Residential services, foster care, adoption and independent living services are reviewed. The last review for residential services was concluded in 2001 with current re-licensing occurring in 9/02. Youth Homes is on full licensing status. Child placing services were last reviewed in 1999 with current re-licensing occurring in 9/02. Youth Homes is on full licensing status. Council on Accreditation for Families and Children Founded by the Child Welfare League of America, this national organization accredits private and public agencies that serve children and families. The purpose of this accreditation is to evaluate the agencies practices and procedures against national best practice standards in the following areas: staff training and supervision, personnel records, client records, service delivery, behavior management, risk management, cultural competency and business practices. All Youth Homes programs and services are COA accredited. The first accreditation review was conducted in July 1998, resulting in full accreditation status. Re-accreditation was conducted in August 2002, with Statement of Findings pending. Reviews are on-site, 6 days in length, and are conducted by 4 to 6 national peer reviewers. Reviews are scheduled every 3 years with the next review in 2005. The review standards for service delivery, Board of Directors, administrative organization, supervisory practices and qualifications, staff training, financial practices and policies, infrastructure organization and policies, quality improvement and policies. j ccoghs\fundingform.doc 2 Agency Name: Youth Homes, A Division of Four Oaks of Iowa Rehabilitative Treatment and Support Services (RTSS) This is a state regulatory body certifies the following services every 3 years: residential services, family-centered services, foster care, adoption and day treatment. On-going reviews/audits are conducted throughout the year. The next certification process will occur in July 2003. Youth Homes has full certification status. The purpose of these reviews are to ensure compliance with RTSS regulations regarding staff qualifications, training, client records, documentation practices and personnel files. Bureau of Purchased Services-Division of Fiscal Management (POS) This is a state governing body that conducts annual contract reviews. Services covered under this contract include independent living, adoption, and shelter services. The purpose of this audit is to review service delivery, monitor client files, review staff qualifications, inspect facilities and review agency policies and procedures. Contract renewal occurred in July 2002, with the full contract awarded. The next review will occur in July 2003. Magellan Behavioral Health- MBC of Iowa This private organization contracts with the State of Iowa to monitor outpatient mental health services. The purpose of the review is to monitor the appropriateness of clinical services, to ensure service delivery, and to assure documentation is consistent with standards set by H.C.F.A., Iowa Department of Human Services, Iowa Department of Public Health and with the MBC of Iowa contract. Audits are conducted annually. The last audit was conducted in 3/02 with continued service delivery status. j ccoghs\funding form. doc 3 Agency Name: Youth Homes, A Division of Four Oaks of Iowa Agency History On May 31, 2002, Youth Homes celebrated 30 years of providing services to children and families in Johnson County. Approximately 200 donors, staff, collaborators, families, youth, United Way agencies and staff, and members of local government came to celebrate Youth Homes 30 year commitment to this community. Creating an environment for success has been a thirty-year growing experience for Youth Homes. in December of 1972, the Youth Emergency Shelter opened its doors to six youth needing emergency housing. Today we serve over 600 children and families annually in the following programs: Shelter, Courtlinn Residential Center, PAL Day Program, Independent Living, and Family Services. It was the foresight and vision of the Johnson County League of Women Voters that helped establish the Youth Emergency Shelter in December 1972. The impetus behind the development of the Youth Shelter was concern that too many Johnson County delinquents were housed in the city jail and that homeless youth had only adult shelter alternatives. In 1976, the agency changed its name to Youth Homes, Inc., and began providing long-term care as well as the emergency shelter services. Beginning in 1987, the agency experienced rapid growth and new partnerships were formed with United Action for Youth, MYEP, Grant Wood AEA, and others. 1993 was a year of significant change for Youth Homes: the local Department of Human Services initiated a Decategorization Project and Youth Homes enthusiastically participated with other local agencies. In November of that year, the state initiated the conversion of some children's services to Medicaid funding, which required massive changes in staffing, programming, record keeping, and cost reporting for Family Services and the Residential Treatment program. In December, the 1916 Waterfront Drive property was purchased to meet growing community needs, to consolidate several programs to one location, and to improve program facilities. In 1995, national and state trends pushed the Youth Homes board and staffto prepare for success in a managed care environment. This meant establishing a partnership with another agency to share financial risk and create infrastructure efficiencies. After exploring a variety of partnerships, it was determined by the Youth Homes Board, to merge with the Cedar Rapids based Four Oaks. Youth Homes and Four Oaks legally merged on 1-1-97, creating a new agency Four Oaks Inc. of Iowa. With the merger, Youth Homes increased the types of services offered by adding special needs adoption, family foster care, family preservation, and FaDSS programming. In 2000, Shelter added an alternative school classroom that provides a structured educational environment for students who are suspended or expelled. In 2001, Family Services added private pay services for families who need supervised visits due to separation and divorce. The primary purpose of Youth Homes is the same today as it was 30 years ago: to assist children and families when they encounter problems they are unable to solve alone. Most of the families referred to Youth Homes are at high risk for one or more children being removed from the home (or running from home). Other children referred are already in out-of-home placements (residential treatment, foster care, shelter) and along with their families need help coming back together. Our goal is to help provide a healthier and safer community by providing children and families with a continuum of services and through local partnerships. j cc oghs\funding form.doc 4 Agency Name: Youth Homes, A Division of Four Oaks of Iowa Section 2: Client Profile · · ~ FY01 FY02 1. How many Johnson County residents (Including IC & 1 Unduplicated Count 230 229* Coralville) did your agency serve? 2. How many lowa City residents did your agency serve? 2 Unduplicated Count 142 104 3. How many Coralville residents did your agency serve'? 3 Unduplicated Count 29 18 Age (use agency's Gender Ethnicity (use agency's breakdown) breakdown if needed) 0-5 33 Female: 109 African American 59 6-17 196 Male 120 Native American 0 18-29 0 Asian 2 30-61 0 Hispanic 3 62-75 0 Caucasian/Non-Hispanic 126 >75 0 Multi-racial 39 *This reflects the # of clients referred/admitted, but the number of additional siblings, parents, and extended families served increases the number to 325. 3. Briefly describe your service population. Each of Youth Homes five programs serves a different service population: · Youth Emergency Shelter: Runaway and homeless youth, ages 11 - 17, needing temporary shelter, supervision, and counseling · Women's Residential Treatment: Young women, 12 -17 years of age, needing therapeutic group foster care due to psychological/psychiatric difficulties and delinquent behaviors · Independent Living: Homeless or aged-out of foster care youth, 16- 20 years of age, needing shelter, behavioral support, life skills, educational and employment support · Family Services serves children and families referred by DHS or Juvenile Court due to imminent out-of-home placement, reintegration from placement into their home, adjustment to foster care or adoption placement · PAL: Behavior and conduct disordered children, 6 - 15, who need after school care and summer programming. 4. How do you determine eligibility for services? We base eligibility on the assessments of Department of Human Services and Juvenile Court Services, program admission criteria (see #3 above), program capacity, and based on the most appropriate treatment and services. 5. Are there fees for your services? Yes X No__ If yes, please describe your fee structure: YES: 1 child in residence (direct) for 1 day = 1 unit ~ $83.69 RTC: 1 child in residence (direct) for 1 day = 1 unit ~ $63.51 FS: 1/2 hour direct service = 1 unit ~ $38.87 (therapy), $ 33.54 (skill devel.) SCILS: 1 hour direct service = 1 unit ~ $84.87 (scattered- Iowa City) PAL: 1/2 day of direct service = 1 unit ~ $28.04 j ccoghs\funding form.doc 5 Agency Name: Youth Homes, A Division of Four Oaks of Iowa 6. Do you provide services to areas outside of Johnson County? Yes Area(s) served: Eastern Iowa Services Provided: Residential Treatment, Emergency Shelter, Family-Centered Services, FaDSS, Independent Living, Adoption, Foster Care, Day Treatment, PMIC Funding Sources: State of Iowa Purchase of Service Contract, State and Federal Grants, County Cost Difference, Merit, Medicaid, Private Pay Section 3:Community Relations 1. How do you assess satisfaction with your services? (a) Client: We send satisfaction surveys to families 30 days from admission and at discharge. We give quarterly satisfaction surveys to youth in PAL, Shelter, RTC, and SCILS. (b) Community: We send DHS and Juvenile Court referring workers satisfaction surveys 30 days from admission and at discharge. 2. Briefly summarize your findings: 70% of parents are satisfied or very satisfied with service delivery and outcomes. 100% of referring workers felt "very satisfied" with the referral and service delivery process. 100% of referring workers reported being "very satisfied" with staff's knowledge concerning treatment and staff demonstrating respect to clients. 3. What changes have been made in response to these findings? Our parental return rate is still Iow and we are now making follow up calls to help with the return. Based on parental comments, we have developed cultural competency practice improvements through consultation work with the University of Iowa School of Social Work Director Salome Rahiem. 4. Who are your referral sources to your agency? Please list the main sources and estimate the percentage of clients that are referred by each source. Source of Referral % of clients referred Iowa Department of Human Services 65% Iowa Juvenile Court Services 34% Other 1% jccoghs\fundingform, doc 6 Agency Name: Youth Homes, A Division of Four Oaks of iowa I 5. What other agencies/organizations in Johnson County provide similar services to the same clientele as your agency? Families Inc. and Lutheran Social Services also provide in-home therapy and counseling services. Youth Homes' Emergency Shelter, Residential Treatment, PAL, and SCILS are unique services to Johnson County. 6. Describe what distinguishes your agency and/or its services from other agencies that provide similar services in Johnson County. Youth Homes provides a continuum of service provision. This means that the child or family who need additional services, such as residential treatment, foster care, assessment services, or temporary shelter for example, may continue with the same agency and case manager, therapist, or program staff. In addition, children and families may access Four Oaks resources such as day treatment, PMIC, sexual offender treatment, or foster care group homes. Our continuum of services also allows us to admit a higher level of difficult youth due to immediate access to these support services. 7. Outsideofreferrals, list up to 3 primary collaborations. Briefly describe the nature of each collaboration. Collaborations Briefly describe 1.United Action for Youth 1. Share staff and financial resources on programs for runaway and homeless youth: SafePlace and Street Outreach. 2.JTPA, HACAP, Neighborhood Centers, 2.Collaborate on the Johnson County DHS FaDSS program, a state grant funded welfare to work program. 3. Utilize PAL resources to assist the Iowa 3.Iowa City School District City schools with transportation of children before and after school. Section 4: Strategic Planning and Agency Effectiveness 1. Describe up to 3 challenges/opportunities your agency is currently facing and how your agency is addressing them. (e.g., staffing, finances, service delivery) Challenges/Opportunities Strategies 1.Challenge: State budget cuts 1. Sharing resources with local agencies ccoghs\funding form. doc Agency Name: Youth Homes, A Division of Four Oaks of Iowa (E.G. YH and UAY have applied for a $200,000 Independent Living grant); Reduced spending (E.G. part-time staff and capital expense reduction,); Stronger marketing (E.G. Increased emphasis on customer service and relationships with referral agencies); Partner with other state agencies (E.G. Collaborating with 10 Iowa agencies on a state grant brings approximately $40,000 into Johnson county for independent living services) 2.Challenge: Increased regulatory and 2.Developed a software system that monitors licensing documentation timely and accurate data and allows for specific retrieval and analysis of data; Providing increased training and supervision for staff 3.Opportunity: Implementing a Care 3.We are moving from development (2001) to Management System implementation {2002) of care management that will standardize case review and improve outcomes across the agency. 2. In what way will the needs of your service population change in the next five years? The Iowa state budget crisis is having a negative impact to the services that Youth Homes provides. We have had cuts in prevention programs, reductions in authorized service units, and an imposed waiting list for residential treatment placements. This waiting list is determined by case dates and not case needs. This means many youth who are most needing services are not being served or are being served in a lower than needed level of care. Subsequently, we are admitting more difficult youth and families at a time when services are limited. 3. How do you plan to address these changes? The Youth Homes Board has approved goals to 1) increase our communication and partnerships with the Iowa City schools through improved customer service and implementation of suspension services, 2) increase training and supervision for staff, and 3) increase program structure for the most behaviorally challenged youth. Prevention programs are increasing grant applications and looking to private businesses for financial support. In addition, we are working more closely with local DHS and JCS partners on a case by case basis to assure safety and the best possible outcome for youth and families. j ccoghs\funding form. doc 8 Agency Name: Youth Homes, A Division of Four Oaks of Iowa 4. Describe the evaluation methods you use to measure the success of your services? Youth Homes outcome measurement system is managed by the Quality Improvement department. The outcome measurement system evaluates client progress, service delivery, consumer demographics, and program/organizational effectiveness. Various evaluation tools and methods of monitoring are used to evaluate program effectiveness, risk management, desired outcomes, appropriateness of care and quality of care. Outcome measurement tools and methods include: a. Satisfaction surveys are conducted for workers and families at 30 days of service and at discharge. The information collected from these surveys are analyzed and reported to programs quarterly. If survey feedback warrants follow-up the quality improvement department conducts an internal review. b. CAFAS: The Child and Adolescent Functioning Assessment Scale is used within the agency to measure the level of client functioning at admit and discharge. Data from this tool is collected and analyzed at both the client and program level. Data is reviewed quarterly. c. Disposition surveys are conducted 12 months from the time of discharge. Outcome indicators are collected that identify the clients level of functioning, status of well-being, school and community involvement, safety and permanency. Data is analyzed and reported on quarterly. d. Outcome indicators are collected at the time of discharge. Indicators collected include: % of progress on treatment goals, the level of care being provided at discharge, discharge status (planned/unplanned). 5. What are the results of these evaluations (outcomes)? · 96% of served clients made progress on 50% or more of treatment goals · Of those clients, 80% obtained progress on 80% or more of their treatment goals · 94% of clients had a planned discharge (left planfully, not under emergency circumstances) · 83% were discharged into the same or lower level of care · CAFAS Data: ADMIT DISCHARGE No Dysfunction 0% 18% Minimum Dysfunction 18% 21% Mild Dysfunction 35% 29% Moderate Dysfunction 31% 22% Severe Dysfunction 16% 10% Our disposition surveys are very low in number as families are difficult to track at 12 months. We continue to seek solutions to collecting this data. 6. How do you plan to use the evaluation results to enhance/extend your services? Feedback and results from both internal and external review/evaluation processes are coordinated, analyzed and disseminated to appropriate individuals, programs, boards and committees. Agency level data is reviewed quarterly by administration and the board. Data concerning risk management, outcomes and service delivery is reviewed by service jccoghs\funding form. doc 9 Agency Name: Youth Homes, A Division of Four Oaks of Iowa and program leadership on a quarterly basis. Programs and services work in partnership with the QI department staff to identify areas for improvement or needing corrective action. For example, to increase the percentage of achieved treatment goals, we have developed a skill group intervention curriculum that will improve the delivery of skill groups. 7. How do your programs/services impact the community? We provide a safe, family-based, respectful living environment to 100% of youth served in our independent living program, shelter, and residential treatment programs. 100% of youth participating in independent living services are completing their education and are employed. In addition, we work with referral agencies to assure that youth have safe, permanent relationships and placement when they leave Youth Homes. Our PAL program provides after school and summer programming to elementary youth who, due to severe emotional and behavioral disorders, can not be in regular day care centers. We work closely with parents of PAL youth to ensure adequate child supervision, home and community safety, and improved school behavior. Our Family Services staff lower the risk of child removal and help children reintegrate back into their home and community. Youth Homes services help create a healthier community by helping children and families build stronger relationships with each other and in their community. 8. How did the agency respond to the UWJC recommendations from last year? 1) We currently have 6 Board members with 2 in the recruiting process. Our recruitment process was temporarily on hold as we planned and implemented our 30th anniversary events. Our desired number is 10-12 members. Our Community Board of Directors is unique to Four Oaks and is critical to the success of Youth Homes. In 2002, The Youth Homes Community Board members: planned and implemented Youth Homes 30th anniversary celebration; initiated 5 speaking engagements to local service organizations; partnered with a local church to raise $600; initiated a school supply drive and collected materials to equip every youth served; initiated 2 local radio speaking engagements; worked with Iowa City, a local church, United Way, a local contractor, and local union workers to redesign a dangerous playground at PAL. In addition, the Youth Homes board approved 2003 program and service goals that will assure the agency is focused on quality improvements, staff and client satisfaction, and on developing strategies for meeting current challenges. 2) We are now collecting increased numbers of satisfaction survey data from families, youth, and referring workers. We continue our goal to collect information on clients at 12 months from discharge. This is difficult as families often move and releases of information are terminated at discharge. While we have a large amount of agency data to review (customer service data, referral and admission data, training, personnel file compliance, etc) we are focusing on improving service delivery outcomes and responding to client and referring worker needs. jccoghs\fundingform, doc 10 Agency Name: Youth Homes, A Division of Four Oaks of Iowa Section 5: Board Governance 1. Please provide a board roster with names, town, occupation, term and end date, officers and committee assignments. (Attach as Appendix A) 2. How often does your board meet? Monthly 3. What is your average attendance at board meetings? For FY02, an average of seven plus leadership staff. 4. How is the board involved in strategic planning and governance of the agency? Two YH Board members are full members of the Four Oaks Board of Directors. One is the Treasurer of the Four Oaks Board and Chair of the Finance Ad Hoc Committee. Another is on the Four Oaks Public Policy Ad Hoc Committee. They assure that any strategic planning, annual goals or policy development is congruent with the goals and direction of Youth Homes and Johnson County. While Four Oaks establishes global goals, the Youth Homes Board uses those goals to develop/approve goals specific to Youth Homes and Johnson County. For example, if improve customer service is a global goal, the Youth Homes Board and staff may develop a goal to increase communication with the Iowa City schools and developing a school suspension service. In addition, the Youth Homes Board may decide to develop goals that are Johnson County specific. The Youth Homes Board approved 2003 fiscal year goals for all Youth Homes programs and services in July of 2002. The Board reviews goal progress quarterly and strategizes with staff to assure goal achievement. 5. What type of training/orientation do board members receive? They are first given a Board Packet that states Youth Homes' mission and purpose, describes all services and programs, includes a roster of current board members and leadership staff, describes the role of a community board and member, describes the benefits of board membership, and includes a 10 minute Four Oaks video tape. The Board President and Director have a meeting with the candidate to answer questions and review the Board Packet. The candidate is invited to a Board meeting to meet members and staff and observe the meeting process. Training is provided by the Director and/or Board President and includes review of annual goals, current goal status, current challenges and strategies. 6. Does your agency have written policies and procedures for financial management? If yes, date of last board approval? Yes, last approved in May 2002. 7. Have you filed the annual report with the Secretary of State? If yes, date filed? No 8. Have you filed the IRS form 990 for the most recent year? If yes, date filed? __No If no to questions 6, 7, or 8, give explanation. For #s 7 & 8: To be filed once the current audit is finalized in October '02. j c coghsSfunding form. doc 11 Agency Name: Youth Homes, A Division of Four Oaks of Iowa 9. Does your agency have a yearly audit? Yes X No__ If yes, Who completed the audit? Clifton Gunderson P.L.C. How much did the audit cost? $17,000 If material weaknesses are noted in the audit, what is your plan for addressing them? None Noted If yon do not have an audit, what is in place to assure accountability in the agency's financial management? 10. Insurance Coverage: (check what coverage your agency has) Insurance Check if agency has Amount Directors & Officers a. fiduciary liability* b. employment practice liability* General Liability X $1M/$3M Umbrella Liability Professional Liability X $1M/$3M Property or Renters X Replace-Cost Vehicle X $1 M *We are currently reviewing quotes for this liability insurance. Section 6:Personnel and Staff Development 1. State the length of employment of the Executive Director and his/her qualifications. Kelli Malone has been employed by Four Oaks for 17 years. She has her Masters degree from the University of Iowa in Counseling and Human Development with an emphasis in Marriage and Family Therapy. She has been in management and administration for 15 years and the Director of Youth Homes for 5 years. 2. Staff Salaries & Benefits Check if Applicable Retire- Full-Time Equivalent Paid Health ment Current Salary Range (FTEs) Position Leave Ins. Plan Per Position Last This Next Year Year Year Adminisn-ative X X X $42,500 - $65,000 0.90 0.80 0.80 Supervisors/Managers X X X $21,100 - $51,200 2.50 2.00 2.00 Therapists X X X $24,200 - $48,650 7.50 6.50 6.50 j ccoghs\fundingform, doc 12 Agency Name: Youth Homes, A Division of Four Oaks of Iowa Direct Care Staff X X X $17,400 - $36,800 16.00 16.20 16.20 Parttime X $15,120-$28,986 7.12 6.62 6.62 Night Counselors X X X $15,120 - $28,986 4.00 4.00 4.00 Other Staff X X X $15,120 - $28,986 2.67 2.01 2.01 TOTAL FTEs 40.69 38.13 38.13 3. If serving multiple counties, how many FTE's serve Johnson County (include administrative and direct service staff)? 3 8.13 4. How much ~vas spent on staffdevelopment in the last fiscal year? __$3,558 5. How much is budgeted for staffdevelopment in this fiscal year? $3,796 6. What training and support opportunities are offered to staff?. Staff are required to complete at minimum 24 hours of training their first year and 12 hours thereafter. Four Oaks provides the following mandatory training for all staff: Child Abuse Mandatory Reporter, Cultural Diversity, Infection Control, Mandt (physical restraining), Critical Expectations, CPR, First Aid, Medication Manager, Emergency Safety Intervention, and CAFAS (child functioning). We have also developed a Core Competency Curriculum including Youth Worker training, Community-Based training, Supervisor training, and New Employee Orientation. Each program is allocated staff development dollars to send staff to workshops, seminars, conferences, visiting like programs or facilities, consultants or providing in-service training. Every staff receives individual and team supervision. We also provide leadership opportunities including Leadership Team (monthly), Emerging Leaders Program (6 week course), and Team Leaders (structured supervisory experience). j ccoghs\fundingform.doc 13 Agency Name: Youth Homes, A Division of Four Oaks of Iowa 7. Please attach current organizational chart as Appendix B. 8. Comparing the last complete fiscal year to current fiscal year, what was the average % wage increase? 2% Yes No If no, brief explanation 9. Does your agency X have personnel policies? If yes, date board last reviewed? June 2002 10. Does your board X annually evaluate the director's performance? 11. Does your agency X have job descriptions for every position? If yes, date of last board approval? June 2002 12. Is there an annual X In 2002, we individually customized job descriptions for every performance employee and revised performance evaluations to directly tie to review for every each employee's job description. staff?. jccoghs\fundingform, doc 14 Agency: ~YOUTH HOMES, a_ Division of Four Oak__s A. Three Year Historical Balance Sheet ~ (As of your fiscal year-end) I .......... { 06/30~/00 06/30/01 06~30~02 Current Assets $221,497 $232,571 ! $244,200 Cash Investments $0 $0 $0 Receivables < 90 days~ __$.3__93,051 i~ $354,673 $40~7,626 Other $38,500 $28,000 $8,500 Total Current Assets $653,048 $615,244 $660,326 Other Assets Property $595,_605 $660,205 $657,235 Equipment $34,106 $32,006 $29,146 less depreciation net net net Receivables > 90 days $0 $0 $0 Other Total Non-current Assets $629,711 $692,211 $686,381 Total Assets $1,282,759 $1,307,455 $1,346,707 Current Liabilities Accounts Payable $128,895 $135,340 $142,107 Payroll Taxes Payable $42,583 $43,861 $45,177 Contracts Payable Mortgage Payable-6 months $10,876-- _ $11,009 $11,330 __ Total Current Liabilities $182,354 $190,210 $198,614 Other Liabilities Mortgage Payable-Balance $270,727 $249,819 $238,356 Other Total Other Liabilities _ $270,727 $249,8-19 $238,356 Total Liabilities $453,081 --$440,029 $436,970 Net Assets $82{)~678 $867,426 __$909,737 Liabilities & Net A~s~_s.~e~._s__ $~,-2-~2,759 $1,30-7,4_55 $1,3~6,--7_07 ..... Agency:~_ YOUTH HOMES, a Division of Four Oaks FY 2002 FY 2003 FY 2004 B. I~nc_ome & Expenses Income Local Funding Sources ~ $52,755 $40,000 $41_,_2_00_4 Iowa_Ci~ $o ___ $~o .... ~$~2,_o_0o_ Coralville $750 $825 $1,000 _ Johnson County ! $68,400 $~1,_5_60~ .... $63_,_4_0~ United Way - Allocation i $20.377 $20,145 $20,760 - Designated Giving $3,379 $2,146 $2.000 _G_['a?ts-Federal, State. Foundation $86.396 $84,591 $84.738 Net Sales of Service $1,660,642 $1,432.725 $1.405,567 Net Sales of Materials $0 $0 $0 Contrib u_t!_ons/Fu n draisin g $966 $900 $900 Investment Income $0 $0 $0 Oth~er__ $60,053 $54~,1__44~ _ $55,~7~6~8 Total Incomm_e_ ............. $1,~9_5~3~_18~ $1,697,036 $1,677,340 Expenses Wages ~_Sa~l?ries ! $1,041,634 $1,052,678 $1,084,258 Benefits $199,205 $212,408 $229,400 O~u~pancy $251,451 $259,259 $280,000! Non-occupancy ............... $2~66,215 $237,884 $253,911 Other $0 $0 $0 $1,758,505 $1,762,229 $1,847,569 C. Fund Balance Revenue $1,953,718 $1,697,036 $1,677,34~0 Carryover Balance from previous year $909,737 $804,950 $804,757 Total Operatin_g~B_ud~g~ ......... $2,863,455 $2,501,986 $2,482,097 Less TotalExpenses , $1,762,229 $1,847,569 _ Ending Fund Balance $1,104,950 ! $739,757 $634,5__28_ Less Restricted Balance (explain) $300,000 ($65,000) ($170,000) Carp/over Fund Balance $804,950 $804,757 $804,528 /¢ D. BdlDonorlFunder Restricted Funds ! Designated for: Last Yea_ This Year Next Year Board Restricted I Future Operating Expense not covered $300,000 $0 $0 ........ ~. due to decreases in State Fundincj Total Restricted Funds $300,000 $0 $0 E. In Kind Support: Last Year This Year Next Year Services/Volur~eers Material Goods Space, Utilities, etc APPENDIX A YOUTH HOMES COMMUNITY BOARD MEMBERS* Ruth Bonfi.qlio Mark Danielson Founding Board Member Iowa City Foster Parent, Retired Attorney Iowa City Community Board President Four Oaks Board Representative Public Policy Ad Hoc Committee Janice Baumback Ron WriRht Iowa City Coralville Clinical Social Worker, University Financial Consultant Of Iowa Child Psychiatry, Retired Four Oaks Board Treasurer Chair, Finance Ad Hoc Committee Wayne Johnson Bode Olakanmi, Ph.D Iowa City Iowa City Professor of Social Work, University Chemistry Research Associate Of Iowa, Retired Natalie Cronk (in recruitment process) Kathy Green Iowa City Coralville Attorney Grant Wood AEA Consultant APPENblX B YOUTH HOME5 TABLE OF ORGANTZATZON Community Board of birectors Administrative Director ,[ Program Manager Program Manager 5C];LS, Family Services, Shelter, Eesid~ntial Customer Service, Admissions Tn~tment, PAL Shelter [~esidential [ PAL 5C[LS Family 5tvs. Coordinator CoordinatorI Coordinator Coordinator Team Leader APPENDIX A I YOUTH HOMES COMMUNITY BOARD MEMBERS Ruth Bonfi.qlio Mark Danielson Founding Board Member Iowa City Foster Parent, Retired Attorney Iowa City Community Board President 1972-Present* Four Oaks Board Representative (1997) Public Policy Ad Hoc Committee 1993-Present* Janice Baumback Ron Wri.qht Iowa City Coralville Clinical Social Worker, University Financial Consultant Of Iowa Child Psychiatry, Retired Four Oaks Board Treasurer (1997) 2001-Present* Chair, Finance Ad Hoc Committee 1994-Present* Wayne Johnson Bode Olakanmi, Ph.D Iowa City Iowa City Professor of Social Work, University Chemistry Research Associate Of Iowa, Retired 2001-Present* 1973-1984* 1999-Present* Natalie Cronk (in recruitment process) Kathy Green Iowa City Coralville Attorney Grant Wood AEA Consultant 2002* 2001- Present* Denotes the years of Youth Homes Community Board membership. Commundy board membership is not limited to terms. Length of service is based on interest, time. and commitment_ APPENblX B YOUTH HOMES TABLE OF ORGANTZAT~ON Community Board of Directors Administrative Director Program Manager Program Manager SC~L5, F~mily 5~rvices, Shelter, P~esidential Customer Service, Admissions Tr~tment, PAL 5heifer Residential I PAL 5CIL5 Family 5rvs. Coordinator Coordinator J Coordinator Coordinator Team Leader MINUTES ~ IOWA CITY HUMAN RIGHTS COMMISSION EMMA HARVAT HALL 410 E. Washington St. October 15, 2002 MEMBERS PRESENT: Lisa Beckmann, Paul Retish, Lucia Page, Jan Warren, Charles Major, Rick Spooner MEMBERS ABSENT:Nick Klenske, Keri Neblett, Bob Peffer STAFF MEMBERS: Heather Shank 1. CALL TO ORDER: Meeting called to order at 7:08 p.m. 2. APPROVAL OF MINUTES: Beckmann asked for approval of minutes and/or changes in the minutes from the September meeting. Motion to approve minutes by Page and seconded by Warren. Motion: Minutes unanimously approved. 3. RECOMMENDATION TO COUNCIL: None 4. NEW BUSINESS: Homeless Task Force- see letter, review questions, provide input as to answers. Beckmann asked Shank if she was on the board. Shank stated she was actually on the focus task force and she asked whether the members had information about housing in Iowa City she could bring to the meeting to share. Beckmann will do some checking and get back with Shank. Warren brought up the subject about the DHP facilities and how they have a beautiful shelter and can only staff it three nights a week due to state budget cuts. Major talked to a man named "Brian" who works with the homeless. He tries to get them help and refers them to the various services available. Major will get back to Shank with Brian's last name. Major said the services they have in Davenport are a bigger operation than in Iowa City. Page suggested Shank call Steve Nasby and Steve Long in Planning and Zoning as they know a great deal about the homeless. Shank indicated she would also contact the Housing Inspection Services. Warren recalled an article in the Press Citizen that spoke of the police and the problems with the homeless and the challenges that they face in dealing with them. 5. OLD BUSINESS: Breakfast Evaluation: Shank reported that there were 191 people in attendance and 198 tickets were sold. Warren stated that the presenters were too lengthy. Page suggested that it might be best to have the presenter not be the person that nominated the winner. She added that it might be good to have someone else write the presentation on behalf of the person who nominated the winner. Shank stated that she thought that at times the focus seemed to be more about the presenter than the winner. Possible suggestions to shorten the length of the presentations included a timer, time card, press announcements setting forth a specific time frame for the breakfast, etc. Beckmann suggested getting the presenters together for a meeting right before the breakfast to reaffirm the time limit on their presentation might work. Warren suggested a five-minute limit for the presenters and then somehow let them know their time is up. Shank said that some people left early to get to work before all the presentations were done. Beckmann added that the Commission could set the breakfast for a specific ending time, which would be printed on the ticket. Warren reminded the Commission that it had added awards over the years, therefore it added more time to the entire event. Shank suggested to Beckmann that maybe the Commission could announce the five-minute limit at the beginning of the breakfast to all in attendance. Beckman indicated that if the Commission announced the speaker had three minutes left, nominators would go five. In the alternative, the Commission could announce when five minutes are up and then stop them. Beckmann would also like to see the breakfast start earlier. Warren would have liked to see the order of awards changed, placing the Lifetime Achievement award at the end but overall she thought the event was great. Retish said that he was unhappy with the price of the breakfast. He believed it was too high. He indicated that he thought coffee and doughnuts would be sufficient. Beckmann asked how much the IMU would charge the Commission for coffee and rolls. Retish asked Shank about the cost of the breakfast this year not including all of the other costs. Shank stated that the breakfast was $8.50. The rest of the money that makes up the cost of the ticket goes toward advertising, printing, plaques, etc. Retish said that he was not aware that the $15 cost was for anything but the price of the breakfast. Shank said if the Commission did go with just coffee and rolls the ticket price can go back to $10, as the cost is $5.50. Beckmann asked Shank if the Commission made a profit this year and Shank reported that she is still paying the bills. Check requests have been sent to accounting in the amount of $1800 to the Union, and $300 to the Gazette. She still has to pay for the plaques. Beckmann asked Shank if the cost of the breakfast included the room rental. She said yes. Beckmann wondered if the room cost would increase if we go to a cheaper breakfast. Shank said it's possible, but she said that the IMU is not supposed to charge for the room rental if the event is catered. Beckmann would like the final costs of the breakfast and any profit from the breakfast to be tabulated and brought to the next meeting so it can be discussed. Retish indicated that when the Commission charges $15 for a breakfast, it sends the message that it is looking for a specific group of people to attend. Warren pointed out that the breakfast attendees are the family and friends of the award winners and she does not see the $15 price as that much of a problem. Retish disagrees. He thinks the breakfast should be used more as a tool for educating the public as to what the Human Rights Commission is and what it can do. Retish said he would like to see new faces at the next breakfast. He pointed out that the $15 was a hurdle for persons who couldn't afford to attend and he said that maybe the Commission was presenting a certain image by charging $15.00, such as, "these folks in Human Rights are really catering to a very elite group." He doesn't want that image to be projected to the public and the Commission needs to make every effort to lower the price and to find a bigger room so more people can attend. Page suggested the possibility of a sliding scale fee. Shank indicated that she and her friends buy tickets for people who can't afford it. Retish asked if it was legal to write a grant to support the breakfast, possibility to the Stanley Foundation. Shank said that it might complicate things, such as the decision making process and who is in control of the breakfast. Beckmann suggested possibly sending out packets of tickets to businesses to sell. Beckmann further added that the public knows very little about the breakfast. She said that people had mentioned to her that they believed that $15.00 was too much to pay for a ticket. Beckmann agreed with Retish that the price is too high. She also suggested that the Commission work harder to invite people to the breakfast as opposed to just advertising. Warren asked the Commission what it believes to be the true purpose of the event. Warren also suggested having people at the breakfast fill out a short evaluation of it after the awards are given. It was determined that Shank will bring the accounting of the breakfast to the next meeting. Shank indicated that any money remaining in the breakfast account wourd remain in there. The account is separate from any other city accounts. After all of the bills are paid, any additional funds will go towards reserving the room for next year and for costs associated with the 2003 breakfast. Survey: Beckmann started the discussion by asking (1) what the Commission wanted to do with the survey data, (2) where the Commission wanted the survey to go next, and (3) how the Commission wanted to change the survey. It was agreed that people who filled out the survey were confused as to how to respond to question #1. Major agreed to prepare a spreadsheet setting forth the results of the survey. Spooner thought the survey was biased as the questions were set forth affirmatively and this he thought made people respond in a falsely positive way. Warren stated that the questions were staggered, positive and neutral to balance out the questions. Spooner stated that you couldn't make a true assessment of the data unless the questions are neutrally based. Page thought the "hotspot" was the question regarding tenants and landlords. Beckmann would like to see the survey go out to two groups a month starting with the Senior Center and UAY and Shank agreed to take it to them. There was a spelling error on # 1 3 changing the word tenants to tenets. It was also decided that the data would be put onto an Excel spreadsheet. Registration-Biversity Conference: Page went to the conference and enjoyed it very much. She brought back some materials that she gave to Shank to put in the packet for the next meeting. She stated that the highlight of the conference was the play that Graffiti Theatre put on about white privilege. New Protected Categories in SF: Shank included material in the packets that set forth guidelines for persons in San Francisco regarding the addition of weight and height to their Civil Rights Ordinance. The Commissioners found the material interesting. Shank spoke with an employee at the Commission in San Francisco and learned that a public hearing was held before the legislation was passed. The employee indicated she would send Shank more material, but it hasn't arrived yet. Beckmann asked if this is something the Commission should look into further. Warren said that it was a good idea and we should discuss it further and explore all aspects of it. All agreed. Out of date Commission web site-Geonet: Afon said he would fix the problem and direct persons to icgov.org/humanrights: Shank asked Warren to check on Geonet and see if Afon took the outdated information about the Commission off the website. 6. REPORT OF COMMISSIONERS: Retish no report Major talked about the Northern Ireland Parliament being dissolved and how Northern Ireland has returned to British control. He indicated that he remembered the last time Britain had control. He indicated that there were a lot of human rights abuses at that time. Warren expressed her sadness over the eleven immigrants that were found in the train car in Denison, iowa. She also mentioned the new restrictions for International students in the area of employment. The student's paperwork must be in perfect compliance with the law or they wilt be fired. Page stated that the library has a display for Human Rights Day, which is December 10th and suggested that anyone interested should check it out. She also spoke of an article in the Cedar Rapids Gazette about people apologizing for folks in their racial group who had committed an offense of some nature. She indicated that she found it ironic that white people do not do that, but if you're a member of a minority group then it's almost expected. Page discussed another article she read that was about a lesbian who was moving out of Iowa because she did not feel comfortable or safe to live here. Spooner no report. Beckmann no report 7. STATUS OF CASES: Shank indicated that they are just waiting for Peffer to finish reading a case. No additional cases are in legal at this time. Beckmann stated that she would be out of town from the 18th until the 25th. 8. ADJOURNMENT: Motion made by Warren to adjourn, seconded by Retish. Meeting adjourned at 8:42 p.m. MINUTES DRAFT IOWA CITY PUBLIC ART ADVISORY COMMITTEE THURSDAY, NOVEMBER 7, 2002 -- CIVIC CENTER LOBBY CONFERENCE ROOM ~ 11-21-02 Members Present: Emily Walsh, Sandra Hudson, Terry Trueblood, Rick Fosse Members Absent: Barbara Camillo, Betsy Klein, Chuck Felling Staff Present: Karin Franklin, Marcia Klingaman Others Present: None Call to order: Sandra Hudson called the meeting to order at 3:32PM. RECOMMENDATIONS TO COUNCIL That the Community Initiated Public Art Application Procedure and Form, as amended at the meeting, be adopted as part of the Procedural Rules of the Public Art Program by a vote of 4-0. That the Policy for Dedication of Public Art to Individuals, as amended to include reference to the gift policy, be adopted as part of the Procedural Rules of the Public Art Program by a vote of 4-0. Public discussion of any item not on the aqenda: Hudson noted that she was concerned that Klein has accumulated excessive absences. Franklin noted that her absence is excused today. Consideration of Minutes of October 3, 2002: MOTION: Rick Fosse moved that the minutes for October 3, 2002 be approved as submitted. Terry Trueblood seconded the motion. Motion passed, 4-0. Updates Neighborhood Art Project (Felling): Felling was absent but gave Klingaman his report in writing. Klingaman reported that the Neighborhood Art Video Subcommittee has met 3 times, reviewed, edited the interviews, and compiled a script of the comments. However, there are some comments that are still needed, particularly regarding "what do you consider a neighborhood?" They will interview some Neighborhood Association members. They had hoped to have the draft available in December, but more likely, it will be January. Klingaman commented that this project really concerns two videos: 1. Promotional Video 2. Charette Process Video Franklin reiterated her concern that if the public art money is not spent this year, the Committee might lose it. However, the fact that the project was for neighborhood art, an expressed Council priority, retention of the funds would be arguable. She noted also that neighborhood participation in the project requires more time. Weber Statue: Fosse and Hudson have visited the foundry. Fosse passed around pictures of the project in progress. Hudson said that she did not know Irving, so she would not know if it was a good likeness, but four Lions members that knew him said that it was a good representation. The only concern was with the glasses because the frames are only suggested to deter vandalism. The Lions seemed to accept this. Hudson noted some roughness on the model, but assumes that these will be smoothed out in the next stages. Overall, everyone was pleased. Franklin agreed that the model looks more like Irving with glasses on. She was worried that the assumption would be that a mistake had been made. Hudson suggested putting the glasses on, and if vandalism is a problem, they can be pared off with no net loss. Franklin will Iowa City Public Art Advisory Committee Minutes November 7, 2002 Page 2 speak with Steve Maxon about the glasses matter to make sure that the frames are being omitted because of vandalism concerns and not because of projected problems with their production. Review and Recommendation to Council on the Methodolocw/Procedure to Address Proposals to PAAC (Klin~aman) Klingaman read the purpose statement, selection criteria, and submittal requirements, with changes made from suggestions brought up at the last meeting. The purpose statements and selection criteria were informally approved. As for the submittal requirements, Hudson suggested artists be able to submit digital images by CD, zip disk, etc. in addition to slides and photographs. She also suggested that on the application there be a space for artists to note their e-mail address. Fosse asked that "medium" be added to the application. Need to clarify what is meant by site and project locations, making sure that redundancy is eliminated. It was clarified that installation costs could be better expressed under construction costs. Trueblood suggested that there be a footnote for other costs that are associated with construction/installation (site preparation, staff contribution, engineering & plumbing costs). MOTION: Rick Fosse moved that the Community Initiated Public Art Application Procedure & Form be approved with the amendments suggested at this meeting. Terry Trueblood seconded the motion. Motion passed 4-0. Review and Recommendation to Council of the Policy for Dedication of Public Art to Individuals (Franklin) Franklin reported that she had made the changes suggested at the last meeting; iR the second sentence, the second bullet is new. This will go into the PAAC document. MOTION: Emily Walsh moved that the Policy for Dedication of Public Art to Individuals be approved as amended. Rick Fosse seconded the motion. Discussion followed. The discussion centered on the problem of hypothetical persons wishing to donate money for a sculpture or other public art piece on the condition that it be dedicated to their lost loved one who may not meet the criteria for dedication as described in the policy. Trueblood, in particular, argued that it would be shortsighted to not accept a sculpture because the credentials did not "add up". Hudson commented that there are already memorials allowed in parks to allow grieving friends and family to express loving memories of the deceased; public art is not an appropriate vehicle for this expression. Franklin noted that they needed to distinguish what is the difference between "in memory of" and a dedication. Franklin noted that this policy covers extant public art and/or a proposed project. A gift or donated artwork may have donor stipulations that could fall under "in memory of", but not under a dedication. It was decided that the following bullet be added to the document: "This policy does not apply to gifts"--this would then reference rules applying to gifts. There was a friendly amendment to the last motion. It now reads: MOTION: Emily Walsh moved that the Policy for Dedication of Public Art to Individuals be approved with the addition of the bullet regarding gifts. Rick Fosse seconded the motion. Motion passed 4-0 as amended. Discussion of Relocation of Snelson Sculpture Franklin noted the Snelson has already been re-located once and the question being posed to the committee is whether it should be moved again. The reasons for moving it are: 1. Sculpture may be losing visibility in the trees 2. Only piece that has been vandalized; could be due to location Trueblood noted that the trail going past it would be lighted at night, which would help. Franklin commented that there has been a suggestion from the public to place the Snelson in front of the water plant. It was decided that Snelson would get more exposure at the present location. The committee agreed that rather than moving the sculpture, the trees should be trimmed and the anchors fixed more securely in the ground. Hudson suggested putting the sculpture on a schedule for re-configuration and asked that the artist be approached to submit plans for re-configurations. Iowa City Public Art Advisory Committee Minutes November 7, 2002 Page 3 Discussion of Proposal for Poetry on the Buses Klingaman commented that she has seen this done with success in various communities. She sees this as another form of public art and asked the committee if this should be an avenue that is pursued. The goal behind putting poetry on public buses would be that it would give both public art and local literary artists more exposure. Klingaman clarified that this project would be similar to, but separate from the federal "Poetry in Motion". This would be an on-going project, as the poetry would be rotated. Hudson thought it sounded fun and asked that a subcommittee be formed to look into the matter. Klingaman, Walsh, and Hudson will work on a proposal for the project, not its implementation. They will check with local writers' groups and transportation agencies. Committee Time/Other Business: There was a discussion regarding meeting dates for the next two months. It was decided that the next meeting will be on December 12, and the January meeting will be cancelled. Franklin announced that Hudson had received the "Larry Eckholt Award for Art Advocacy". The committee applauded her receipt of the award. Klingaman alerted the committee that an art proposal having to do with placing Zen sayings on local billboards might be given at the next meeting. Franklin noted that this is the last meeting for the current minutes-taker, Lindsay Eaves-Johnson. The committee thanked her for her service. Adiournment Sandra Hudson adjourned the meeting at 4:45PM. ***Next meeting will be December 12, and the January meeting is cancelled*** shared on citytnt/pcd/mlnutes/public arl/adl 1 07 02doc MiNUTES DRAFT IOWA CITY TELECOMMUNICATIONS COMMISSION [ 11-2~-02 MONDAY, OCTOBER 28, 2002 5:30 P.M. CITY CABLE TV OFFICE, 10 S. LINN ST.-TOWER PLACE PARKiNG FACILITY [[~'[ 3 MEMBERS PRESENT: Betty McKray, Jim Pusack, Cathy Weingeist, Kembrew McLeod MEMBERS ABSENT: Terry Smith STAFF PRESENT: Drew Shaffer, Mike Brau, Andy Matthews, Dale Helling OTHERS PRESENT: Rene Paine, Randy Brown, Jon Koebrick, Beth Fisher, Kameron Swinton, Brandon Pearlman RECOMMENDATIONS TO CITY COUNCIL None at this time. SUMMARY OF DISCUSSION Koebrick reported that beginning in November that the cable modem service and the cable TV service will be combined on subscriber bills. Letters have been sent out to those who subscriber to both cable TV and the cable modem service. In addition, phone calls are being made to those subscribers. About 75% of such subscribers have been contacted. PATV's annual membership meeting will be held November 21 at 6:30 at the PATV Pacility. A board member will be elected at that meeting. It is anticipated that the public comment on PATV's performance requirement in their contract can be conducted at thc meeting. Automated channel playback equipment has been ordered and is now arriving. It is hoped that the library channel system will be entirely digital within three years. Shaft'er rcported that Mediacom is challenging the City's recent basic tier rate order at the Federal Communications Commission. Koebrick said that Mediacom will reduce the basic tier rate to $13.91 and raise the expanded basic rate to compensate so that most subscribers (those that subscribe to the Family Package) will not see a difference in their rates. Shaffer reported that City staff and Mediacom inet recently to discuss possible methods of implementing a liquidated damages so that subscribers will receive a benefit. Mediacom will be presenting a proposal to the City in the near future. Koebrick provided answers to questions contained in a letter from the City regarding Triennial Review issues. .APPROVAL OF MINIUTES Pusack moved and Weingeist seconded a motion to approve the regular September 2002 meeting minutes. The motion passed unanimously. ANNOUNCEMENTS OF COMMISSIONERS McLeod said that he may be out of the country during the third year of his term and, if so, unable to serve out his term on the Commission. SHORT PUBLIC ANNOUNCEMENTS None. CONSUMER ISSUES Shaffer referred to the complaint report in the meeting packet. There were 24 complaints-4 about cable modem problems, 2 about wanting just the basic tier and a premium channel and the company telling him it was not possible, 4 about higher rates and fewer channels, 2 about not being able to get a cable buried, 2 about channels being taken off the basic tier, 2 about not being able to reach the company by phone, 1 about an unidentified woman claiming to be a Mediacom employee in an apartment complex basement with no identification or a call ahead., l about being charged to return digital equipment after a free trial period, 1 about charging in advance for service, I about a rate change in February without notice, 1 about who has to pay for replacement ora cable line, 1 about the lack of competition, 1 about the Mediacom web site not having current prices for Iowa City. Brown said Mediacom has a review process that alerts them when a node is over-used. At that point arrangements are made to split that node. Koebrick said that one complicating factor is that Iowa City is not typical of other systems in that it is a computer-rich environment in which users are more likely to be utilizing larger amounts of bandwidth. That combined with areas of rapid growth may lead to deficiencies in Mediacom's usual procurement procedures for equipment. Brown said that therc was a large up-swing in data use in some areas when the students returned to the University of Iowa. MEDIACOM REPORT Koebrick reported that beginning in November that the cable modem service and the cable TV service will be combined on subscriber bills. Letters have been sent out to those who subscriber to both cable TV and the cable modem service, in addition, phone calls are being made to those subscribers. About 75% of such subscribers have been contacted. There will be change in the billing cycle and charges will be pro rated for the interim period. Steps to accommodate the expected rise in subscriber inquiries about the change are being made. UNIVERSITY OF IOWA REPORT No representative was present. PATV REPORT Paine reported that PATV staff attended a regional trade show to learn about new equipment. PATV recently provided a tour for a visitor from Slovenia. PATV participated in the University of Iowa Homecoming Parade n support of the Iowa Shares program. The new season of series programs began on Oct. 7. PATV is part of a grant by the Iowa City Community School District Senior High Alternative Center to do interviews with members of the University of iowa's International Writing Program. PATV's newsletter will be out in November. PATV's annual membership meeting will be held November 21 at 6:30 at the PATV facility. A board member will be elected at that meeting. It is anticipated that the public comment on PATV's performance requirement in their contract can be conducted at the meeting. SENIOR CENTER REPORT No representative was present. ICCSD REPORT No representative was present. Pusack said that the charmel still suffers from a technical problem for those subscribing to the digital tier and asked about the pass-through fund allocation that was to purchase a time-base corrector to solve the problem. LEGAL REPORT Matthews said he had nothing new to report. LIBRARY REPORT Fisher reported that the PoPo Puppet Festival will be held Nov. 23 and will be taped for cablecast. There will be about 10-15 shoots in November. Automated channel playback equipment has been ordered and is now arriving. It is hoped that the library channel system will be entirely digital within three years. K1RKWOOD REPORT No representative was present. MEDIA UNIT Shaffer reported that Hardy was ill. Staff recently attended a regional trade show to learn more about new equipment. Staff have been receiving training on the use of digital equipment. CABLE TV ADMINISTRATOR REPORT Shaffer reported that Medicom is challenging the City's recent basic tier rate order at the Federal Communications Commission. Koebrick said that Mediacom will reduce the basic tier rate to $13.91 and raise the expanded basic rate to compensate so that most subscribers (those that subscribe to the Family Package) will not see a difference in their rates. Shaffer reported that City staffand Mediacom met recently to discuss possible methods of implementing a liquidated damages so that subscribers will receive a benefit. Mediacom will be presenting a proposal to the City in the near future. Shaffer said the annual report and the budget are being worked on. Shaffer will distribute a copy of the budget before the next Commission meeting. TRIENNIAL REVIEW Shaffer referred to a September 25, 2002 letter to Mediacom with questions regarding the Triennial Review. I. How many subscribers were affected by the loss of premium movie service and then received rebates or credits for loss of that premium movie service during the January through February, 2002 period? Koebrick said approximately 2,000 or 10-11% of all subscribers were in this category. Mediacom provided pro rated service credits. In addition, there were a number of individual accommodations made when a customer called to complain. 2. Does Mediacom keep a record of any complaints received from subscribers and if so, can the City receive a copy or inspect these? Koebrick said that complaint records are kept at the local office and are available to City officials at that location. A copy of the complaint file will be forwarded to Shaffer in the near future. Many complaints Mediacom receives are in the form of email from Shaffer. 3. How many cable TV outages over 18 hours in length occurred in 2002, how many subscribers were affected, and how many rebates were given as a result? Koebrick said that there were no instance of an outage of node size or larger for greater than 18 hours in 2002. Mediacom does not have a way of knowing how many individual outages occurred. Many individual credits were given, but the exact number is not known because the adjustment or credit may also be an accommodation for other complaints as well and the coding the customer service representatives use may not clearly indicate that it was for an outage. 4. How many cable modem outages over 18 hours in length occurred in 2002, how many subscribers were affected, and how many rebates were given as a result? Koebrick said there were no system-wide outages over 18 hours in 2002. On an individual basis there is no way to know if the service was down if the subscriber doesn't inform the company. Pusack said that the company doesn't appear to be offering pro rated rebates for outage of the cable TV service or the cable modem service unless the subscriber requests it. 5. Please provide documentation that the required drop audit as stipulated in the franchise Section VIii. E) has been completed. Koebrick said that the franchise requires that a drop audit be completed within two years of the rebuild. the rebuild was completed in 1998 when AT&T held the franchise. Drop maintenance is an on-going program for Mediacom. Mediacom would not have documentation of them doing a drop audit within 2 ycars after the rebuild because they did not have the franchise. However, when the question was put to AT&T and it was calculated that 8,313 drops had been replaced since January of 2000. Every time there is a service call of any kind the drop is checked. In the last six months 120 drops have been replaced. There is no way to go back to the period two years after the rebuild and arrive at a figure of the number of drops tested. Pusack said that his understanding is that the franchise holder was required to audit 95% of all drops within two years and that the franchise holder was in non- compliance at that time. Shaffer said that the concern is that because the system was built around 1980 and over a period of time there is a decline in the cable's usefulness so drops need to be replaced. The question is how much and how fast. Pusack said that the question is how reliable the plant is. Does it make sense to audit 95% of all taps? Perhaps a certain per cent should be checked every year or after a period of time determine how close the company is to testing all the drops through the usual course of examining drops when service calls are made. Koebrick said that from January of 2000 to March of 2001 over 8,000 drops were replaced. That together with the drops that were replaced during the rebuild demonstrate that a very large per cent of drops have been replaced. There are about 18,000 subscribers. In other franchises Mediacom has agreed to place messages on a local origination channel that informs subscribers that if there are any signal problems that Mediacom will come out and test the drop at no charge. That may be an option in Iowa City. Pusack said that a program of random checks might be a good method of monitoring drops. Weingeist said she likes the random check idea. Koebrick said that the entire system is checked once per quarter for signal leakage. Defective drops typically leak and many are identified during those checks. Brown said that each year the company budgets to replace 10% of all drops. Pusack asked Mediacom to make a proposal for alternative language regarding drop audits. (Comments from Kameron Swinton and Brandon Pearlman were heard at this point so that need not stay for the entire meeting. Minutes of their comments follow the enumerated points.) 6. How many households in Iowa City have satellite service? Koebrick said that the data they purchase indicates only if it is greater that 15, the level at which it is said there is effective competition. Iowa City is not at that level. 7. What changes have been made to the Iowa city cable TV system since the rebuild? Keobrick said that since the rebuild the system has been made 2 way interactive so that the cable modem service could be launched. The system was also modified so a return path from the digital boxes does not need a phone line. The plant has been extended in a lot of areas. 8. What is the state of the art in Mediacom's cable systems? Koebrick said that state of the art systems for Mediacom offer analog and digital programming, offer the cable modem service, and are two-way interactive. Testing is being done on other services such as video on demand, but no Mediacom system has services not offered in Iowa City. Pusack asked if there will be any channel additions. Koebrick said the digital tiers will likely expand. 9. Does Mediacom foresee any plans for expansion or upgrading during the remaining years of the present franchise in Iowa City? Koebrick said that Mediacom would consider an upgrade to add bandwidth for future uses but there is a balance that needs to be maintained, especially in light of the cable modem service. Doing an upgrade would disrupt those subscribers dramatically. Is that disruption worth the cost? Any additional bandwidth also comes at a cost and must be balanced against the new services that could be carried on the expanded bandwidth. Mediacom is looking to launch a business grade cable modem service that guarantees a certain level of bandwidth for an increased cost. 10. Does Mediacom foresee any pans to add or delete any channels during the remaining years of the present franchise in Iowa City? Koebrick said that Mediacom's plans will be dependant on the relationships and contracts they have with program providers. As long as a channel worthy of offering in the line-up at a reasonable rate that thcy can pass the costs on to subscribers and they will continue to subscribe, those channels will stay on the system, lfa program provider demands too high of payment, then they might not be carried. There are some channels, such as ESPN, in which the contract prohibits cable companies from offering the a la carte. If they were, operators could avoid the problem of high fees for a channel that from a marketing point of view must be offered on the system. Some channels simply can't be dropped because they are carried by direct broadcast satellites and have a viewership that would switch from cable if it was not carried. In addition, Mediacom, as a smaller operator, is unable to negotiate terms as favorable as larger operators like AT&T. (Brandon Pearlman read a prepared statement in which their difficulties with the cable modem service were presented. They subscribed to the cable modem service in August when they returned to school. Their apartment is just south of Burlington St. Beginning in September they began receiving very slow speeds and staying connected. A technician came out who swapped out modems and the problem apparently was fixed for about 6 hours. Within about the next 2 weeks eight different technicians attempted to fix their problems. The service appeared to be fixed when they left but the problcms kept re-emerging. Four calls were made to the voice mail of the supervisors in Des Moines before a return call was made claiming that there was a problem with too many users on that node. The supervisors claimed that the problems was with returning college students and that an order to purchase additional equipment had been made. During the next seven weeks he received numerous reasons why the problem had not been corrected. There still is no resolution to the problem. Mediacom is a large, profitable corporation with a monopoly in the local market. Subscribers that use the service less are less likely to complain if they have problems. Kameron Swinton said he is unable to use his cable modem to connect to University of Iowa servers to do classwork because it is so unstable. If the company tells you that the problem will be fixed by Friday but it is not, the company will not call you back to inform you. Phone technical support often will put you on hold for long periods of time and then do not have records of your previous calls and complaints.) Puscack asked how many nodes in Iowa City have over 20% subscription levels. Brown said that node serving Pearlman and Swinton if the only node that is over-utilized. Weingeist said the lack of communication with subscribers has lead to frustration by subscribers. Koebrick said that Mediacom is having some growing pains with the cable modem service. Phone center staff are being added. Brown said Mediacom is developing a method to be more proactive in identifying and correcting nodes that are being over-utilized. PATV CONTRACT Paine said that there is a performance review public comment requirement in PATV's contract and asked if it would be appropriate to conduct this during PATV's annual meeting. McKray said that as long as it was advertised that would be a good time to collect public comment. ADJOURNMENT Weingeist moved and Pusack seconded a motion to adjourn. The motion passed unanimously. Adjournment was at 7:35 p.m. Respectfully submitted, Wm. Drew Shaffer Cable TV Administrator