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Home My WebLink AboutEastside Baby Corner Food & Supplies for low income Children CO A- .F004L4._stdve\fie co,,, Rating Tool for 2009/2010 Funding Applications '`•' �) SECTION 7. Mary Ann: Pass/Fail: If all answers are yes, the application goes forward. If any answer no, the application review stops. Yes o §_ubmitted before deadline? ❑ 1-TAllgiiestions answered on City supplemental application? ❑ ommon Application Checklist—all items "yes"? COMMON APPLICATION CHECKLIST Yes No Cover pages ❑ Agency Information and Questions 1-7. PI ❑ Question 8 Organizational Experience (2 page maximum) 171,_ ❑ Question 9 Need for Your Program (2 page maximum),:;:. Er ❑ Question 10 Proposed Program/Service (6 page maximum). ❑ Question 11 Long Range Plan (1'page maximum) a ❑ Question 12 Budget (2 page maximum) Data Tables [�,�El Question 13 Number of Individuals/Households Served ❑ Question 14a-c Performance Measures and Average Cost of Service. Fr ❑ Question 15 Demographics(from all funding sources) \\ (�❑ Question 16 Program Staff W❑ Question 17_ Program Revenue;.&.Expense.Budgets [ ❑ Question 18 Subcontracts , Required Documents [ ❑ Proof of non-profit status ❑ Qrganizational Chart 111r, 1 A' ency/Organization Mission Statement ❑ Board resolution:authorizing submittal of the application (may be submitted up to 60 'days after application). LI,.. ❑ List of the currentgoverning board and local board, if applicable, (include name, position/title, City residence, length of time on the Board, and expiration of terms. to any vacancies:) ; ❑ Board Meeting Minutes of last three board meetings of governing board and local >I o d as applicable' Er❑ Annual Budget ❑ [Financial Audit Cover Letter Vl� 111- magp,ial Audit Management Letter Il /61,_ ."`Et:....1US..inaneial Statement ��❑ Verification of Non-Discrimination Policy ❑ 2115-rogram Intake Form P'1 kit, ❑ tiding Fee Scale p f PASS / FAIL NI 0 rrti, (iW 5 ° " 190eU'"d- 111 I nt,L4 J 1 Rating Tool b 0 ( J'11 -+I o n c-� Ci ( A — t�5 Gc.r�6i" Dr ft of 4/15/08t H:\HS 08\09-10 Funding cycle\Rating Tool414financeupdate.doc„, 1 SECTION 2. Karen & Dianne: All pre-applications Passed No Score Rating Tool p. 2 Draft of 4/15/08 H:\HS 08\09-10 Funding cycle\Rating TooI414financeupdate.doc SECTION 3. Dianne: For informational purposes this year: Agency's Past Performance Past Funding History for last two funding cycles 2005-2008 (Circle CDBG or GF) Amount Allocated: 2005-2006 CDBG / GF 2007-2008 CDBG /GF Yes No ❑ ❑ Were quarterly reports on time in `07? ❑ ❑ Was first quarter report in '08 submitted on time? ❑ ❑ Did agency meet 100% of all the performative measures in 2007? If not— which ones did they not meet? ❑ ❑ Did agency submit an annual outcome report, on time for `07? ❑ ❑ Was a monitoring visit done? If yes, were there any findings? Yes _ No ❑ ❑ Did agency staff respond to staff requests for information,in a timely manner? (looking for a pattern, not one-time occurrences).in 2007? ❑ ❑ Did agency staff attend the City of Renton contract workshop in 07? ❑ ❑ Did agency staff attend:the"Joint City funding workshop in 2008? ❑ ❑ Was there key staff turnover in 2007? If so, what position(s) and how many? N N. Score Rating Tool p. 3 Draft of 4/15/08 H:\HS 08\09-10 Funding cycle\Rating TooI414financeupdate.doc SECTION 4. Staff check (Mary Ann and Dianne): make sure numbers in tables match. Score based on the number of boxes checked "Yes" Yes No ❑ ❑ #5 Total project costs need to match the totals on #17. ❑ ❑ #6 Total City funds requested for 2008 and requested for 2009 must match numbers given in table #17. ❑ ❑ Last column of#6 must match first column of#14C. ❑ ❑ Average cost of service per client for Renton its"=#12C must match same in #14C ❑ ❑ Last column of#13 must match middle;column:of#14C. ❑ ❑ In #13 - column two percentages must add to 100% " ❑ ❑ In #13 - if agency selected individuals or households, should be answered the same in question #15. ❑ ❑ #13 1st column numbers must match numbers on the top of#15. ❑ ❑ Three columns in #17 .p' 19 (Revenue Source) add correctly? ❑ ❑ Three columns in #17 p:,20'(Program Expense) add correctly? SCORE: / 10 Rating Tool p. 4 Draft of 4/15/08 H:\HS 08\09-10 Funding cycle\Rating TooI414financeupdate.doc SECTION 5. Finance Subcommittee of Human Services Advisory Committee: Scores financial health of the agency Originally the thought was that this would be pass/not pass. However, it does not get to the financial health of the organization. 1. Level of Financial Statements without"going concern" noted in Auditor Cover Letter ['CPA Audited 3 points ❑CPA Other/reviewed 2 points ['Internally prepared 1 point 2. Program Budget A) Is there a change of over 20% in the total program budget line on Table 17 Revenue Source between 2007 Actual and 2008 Budgeted? ['Yes ❑No If yes, has this been adequately explained in question 12 B, "Changes to budget"? ['Yes 0 Points ❑No -2 Points B) On Question 17, are the totals for program budget Revenue or Expenses off by more than $100? ❑Yes -3 points ❑No 0 points 3. Balance Sheet Strength Does the program/agency.have a positive total net asset figure on the balance sheet? ❑Yes .1 point' ❑No. 0 points 4. Balance Sheet''Liquidity.,. Is the current ratio at least 1.10 on the Program /Agency Balance Sheet? (Current assets divided by current liabilities = current ratio). ❑.Yes 2 points ❑ No 0 points 5. Diversified Funding Program has a mixture of funding sources for 2007 as shown in Question 17, revenue source. ❑ At least 1 each City, Other Government Funds and Private Sources 3 points ❑ Has funding from at least two of the three types listed above. 2 points ❑Only City funding sources, but receives funding from more than one city. 1 point SCORE: / 9 Rating Tool p. 5 Draft of 4/15/08 H:\HS 08\09-10 Funding cycle\Rating Tool414financeupdate.doc 6. Human Services Advisory Committee: Scores quality of the application 0-3 a. Organizational Experience (score 0-3) Agency has track record of providing service (score 0-3) Staff has applicable/related experience in working with proposed program and/or training (score 0-3) Was there an explanation ?Op how the Board stays informed and connected:.about needs in South King County? b. Is the need in the City supported by data? (score 0 —3) Is the data specific to Renton or to`South King County? (score 0 — 3) Is there a quantifiable need? c. How easily can Rentonkresidents access:fhe"program? (score 0-3) Does the proposed outreachfit Renton or show knowledge of Renton? :‘ (score 0-3) Were the language and cultural needs of the clients 'addressed?;' (score 0-3) Does the agency,propose to have subcontractors or partners? Are services accessible through 1) the organization or 2) the subcontractors/partners? (Circle one) d:: Long"r"Range Plan - (score 0-3) Is a'Ionq-range plan described, versus a strategic plan? (score 0-3)- Does the plan,list multiple funding sources for future funding?°:: (score 0-3) Was evaluation of services mentioned in the plan? SCORE: / 33 Total Score: / 52 Rating Tool p. 6 " Draft of 4/15/08 H:\HS 08\09-10 Funding cycle\Rating Tool414financeupdate.doc fly Wednesday, April 30, 2008 4p,0 lyCJ Karen Bergsvik: Thank you for the opportunity to apply for to the Human Service Program funding. We are a small organization and so do not have some of the structure that larger organizations have. In regards to the check list: • We are in the process of engaging an advisory board but for now we manage daily operational activities. • We do not have the resources for a financial audit or the cash flow to make one feasible. • We do not discriminate against either client or volunteer. We fulfill all requests with the inventory available and everyone is welcome to contribute to our organization. • We do not use an Intake Form. • We do not have a Sliding Fee Scale or charge for any part of our services. As an organization, we feel we support Renton's Results, Strategies and Activities in the following ways: Result#2: By providing clothing, food, books, and school and healthcare supplies for children at risk due to economics or displacement of living conditions it allows our most voiceless population to have their basic necessities met. Result#8, Strategy A: Our services often prevent families from becoming homeless because they can focus their limited budget on paying for their housing versus food and clothing for their children. It allows case management and services to supplement their client's resources and thus have their clients become more self-sufficient. Result#9: Our services are directly accessed by the neediest of the Renton residents because of the distribution by social service agencies who are intimately involved with their circumstances. Our goods are transported directly to the client. Thank you for your support, Eastside Baby Corner 19. APPLICATION CHECKLIST Applic tions missing one or more of the following components or not following these directions may not be revi wed. Sign and submit the application checklist with your application. Conte itS (Your application should contain each of these items in this order.) ❑ IAPPlication Cover Pages.The top three pages of your application must be a completed copy of the Agency Information and Questions 1-7. Application Narrative: ❑ Question 8 Organizational Experience(�page maximum) ❑ Question 9 Need for Your Program(2 paie maximum) ❑ Question 10 Proposed Program/Service(6 page maximum) El Question 11 Long Range Plan(1 page maximum) El Question 12 Budget(2 page maximum) Da a Tables E Question 13 Number of Individuals/Households Served ❑ Question 14a-c Performance Measures and Average Cost of Service ❑ Question 15 Demographics(from all funding sources) ❑ Question 16 Program Staff ❑ Question 17 Program Revenue&Expense Budgets ❑ Question 18 Subcontracts E fequired documentation. Supply one copy of the following required documents with the signed original application. See Part II: City Specific Supplemental Information to determine whether additional copies of the application and required documentation need to be submitted. ❑ Question 19 Required Documentation, including: • Proof of non-profit status • Organizational Chart • Agency/Organization Mission Statement • Board resolution authorizing submittal of the application(may be submitted up to 60 days after application). • List of the current governing board and local board, if applicable, (include name,position/title, city residence, length of time on the Board, and expiration of terms. Note any vacancies.) • Board Meeting Minutes of last three board meetings of governing board and local board as applicable • Annual Budget • Financial Audit Cover Letter • Financial Audit Management Letter • Financial Statement • Verification of Non-Discrimination Policy • Program Intake Form • Sliding Fee Scale ❑Application Check List. (Signed below.) Name: a►�,,, 0 _�/.V L5 ❑City Specific Supplemental Information.Required in Part II for applicable City onl . Position: Phone #: 4.25 S 310 ' bU E-mail: d el vt c.(S Cl9 i X • eizmi Signature of Person Completing Checklist DO NOT SUBMIT ANY OTHER MATERIALS WITH THIS APPLICATION Make sure that you carefully check Part II of this application to see what additional attachments each city requires. Page 22 Application Cover Pages (Agency Information and Questions 1 - 7) Agency Information Agen iy Name: Eastside Baby Corner Applicant Name and Address: Agency Director: P.O. Box 712 Karen Ridlon - President Issaquah, WA 98027 Name and Title 425 865-0234 (Area Code)Telephone baDycorn@gte.net 425 865-9935 E-!nail address(if available) (Area Code) Fax Number Required signatures: By signing below,you certify that the information in this application is accurate to the best of your knowledge and that you have read the application, certifications,and appendixes. (SI99NATURES MUST BE IN BLUE INK) Signature of Agqncy Board President/Date �i nature of Agency Director/Date (aye r) Kt dl Iovi I ev-6&- 1_i vt do Printed Name of Agency Board President Printed Name of Agency Director Program Information 1. Prlogram Name Food & Supplies For Low-Income Children Contact Person (available to answer specific questions on this application) Karen Ridlon 425 865-0234 Name (Area Code)Telephone I ddress(if different than above) abycorn@gte.net 425 865-9935 E-mail address(if available) (Area Code)Fax Number 2. PS ogram is New for our agency ElAn Ongoing Program X 3. BII ief Description of Program (One sentence) Collection, acquisition & distribution of basic and necessary Children's items which includes cllothing, formula, diapers, car seats, sundry essentials, furniture, and cribs to low-income children. 4. Where are services provided? (If different from agency location) 1510 Maple St I saquah, WA 98027 Page 1 5. Total Program Cost: fctual 2007: $4,188,459 Proposed 2009: $ 5,049, 362 Projected 2008: $ 4,590,330 6. 'Total City Funds Requested for this Program: City Awarded 2008 Requested 2009* General CDBG Total Requested** Fund Auburn 0 0 0 Federal 0 0 0 Way Kent 0 0 0 Benton 0 0 $30,000 City Awarded 2008 Requested 2009* General Fund General Fund Burien 0 0 Covington 0 0 De Moines 0 0 Enumclaw 0 0 S4aTac 0 0 Tukwila 0 0 *Cities on a two year funding cycle will renew 2009 awards to 2010 based upon performance and availability of funds. See Part II for city specific information. **Include your total request for Auburn, Federal Way Kent and Renton. The source of funding will be determined by staff. Page 2 7. Agency Contact Sheet Provide the following information for the agency and for the program requesting funds. Age cy Contacts General Agency Name: Eastside Baby Corner Address: P.O. Box 712 City/State/Zip: Issaquah, WA 98027 Phone/Fax: 425 865-0234 Agency Web Address: babycorn@gte.com Executive Director Name: Karen Ridlon Title: President Direct Phone: 425 865-0234 E-Mail: babycorn@gte.net Devel pment Director Name: Dana Roberts (or Grant Writer) Title: Grant Writer Direct Phone: 425 865-0234 E-Mail: babycorn@gte.net Finance/Accountant Name: Teresa Lindo (person preparing invoices) Title: Vice President Direct Phone: 425 865-0234 E-Mail: babycorn@gte.net Program Contact (Stuff contact for contracting, reporting and program implementation.) Program Name: Eastside Baby Corner Staff Name: Karen Ridlon Title: President Direct Phone: 425 865-0234 E-Mail: babycorn@gte.net Page 3 Application Narrative Section (Questions 8 - 12) The maximum number of pages is listed after each major section. You are not required to submit the maximum number of pages for each section, but you may not exceed this limit. 8. ORGANIZATIONAL EXPERIENCE (2 page maximum) In this section you should provide enough information about your agency/organization for thg reviewer to determine whether you will be able to successfully implement the program you propose. A. Ex erience. Provide a short description of the programs and services you provide, including the length of time your agency has delivered these services and your expedience working with the proposal's target population. If this is a new service or program, please explain how your agency is qualified to deliver the program to the target population. Eastside Baby Corner, a 501(c)(3) nonprofit organization, was started in 1990 with a mission to collect all items used by children from birth to age twel a and distribute them to service providers who work with families in nee . We act as a distribution center supplying basic items through donations and wholesale purchase to over 100 shelters, food banks, public health nurses, social workers, and others. We operate with extremely low overiead and refurbished many donated gently used items. In 2007, we gave away approximately $5.2 million in goods using less than $200,000 in cash donations. Items donated and purchased by Eastside Baby Corner are never sold and are given away free of charge to families in need. B. Operational Structure. Discuss how your agency is operationally organized and the roles, responsibilities and expertise of management and staff. Include (as an attachment to Question 19) an organizational chart, which indicates how the proposed program fits in to your organizational structure. Explain how your governing board stays connected and informed about the needs in the South King County cities to which you are applying. The governing board is the legally responsible entity that makes policy decisions on behalf of the organization (usually has error and omissions insurance on its members). Explain the functions of the governing board and indicate how often it meets. Discuss how diversity is reflected among the governing board membership (i.e. age, service, consumers, disability, gender, race/ethnicity, geography). Our relationship with the social workers who are in direct contact with the children and families in need allows us to be intimately connected and informed. Page 4 Our board meets approximately once a year or as often as determined by the need of the organization. We are a small "grass roots" organization who was formed wanting to make a contribution to children and have tried to maintain our focus on our services. If the governing board is not local, you may also have a local advisory council/committee that makes recommendations to the governing board and/or is more connected to the local community. If there is a local advisory council/committee in addition to the governing board, discuss their function and decision making authority and their relationship to the governing board, as well as how diversity is reflected. 9. NEED FOR YOUR PROGRAM (2 page maximum) This section should describe the specific problem faced by the population you are serving or intend to serve. A. Problem Statement. Describe the problem faced by your target population that will be addressed by your proposed program including any research or data that supports the need and/or gap in services. Do not describe how your program will address this problem. I Children are a voiceless and "invisible" population whose needs get forgotten or ignored in poor, distressed and underprivileged families. The demands for our services has been established by the constant and ever growing demand from the community and state social service agencies that use our services. B.Target Population. Identify and describe the population to be served by your program - both demographically and geographically. Our target population is the children in poor, distressed and underprivileged families. Shelters, food banks, public health nurses, and social workers identify and service these children, ages of 0-12 years. We do not turn away any agency in need due to their geographic location. 10. PROPOSED PROGRAM/SERVICE (See page maximums to each part of this Question below.) This section should describe the program/service proposed for funding, with specific information on what you expect to accomplish and the major activities for achieving the proposed outcomes. Best practices may be cited. A. Program Description. (2 page maximum) Describe what you want to do and how you will do it. Be sure to include: (1) the type of services to be provided; (2) methods (including locations) you will use to serve your target population; (3) what outreach you will use to reach your target population; (4) how your program addresses the Problem Statement in 9.A.; (5) how the program addresses the language and/or cultural needs of clients; (6) if you are making significant changes to your program or agency in 2009-10, explain these changes and the rationale; and (7) detail how this program will work with other programs and/or agencies. Page 5 1) Recycle and procure food, clothes, sundry essentials, and safety items needed by families with children between the ages of 0-12 years old. 2) Maintain a warehouse where donations of gently used items can be refurbished and where items can be purchased and delivered. Provide an ordering system for social workers so they can obtain and distribute to their cliental the necessary food, clothing and safety items for their at risk children. 3) Social workers have identified our target population and through our online ordering system express their needs. 4) Our program provides an organized method to recycle and obtain necessary items for a child's care and well-being. 5) We provide books in Spanish and English and holiday and cultural items that are donated to our facility. 6) NA 7) Our program has become invaluable and indispensable to the social workers in our community. It lessens the financial and organizational burden of our government and these agencies to provide these goods. Quesion 18 must be completed whether or not you are subcontracting on this program. If your application contains subcontracts to other agencies/organizations, these must be itemized in your proposed budget. If you will not be subcontracting any part of the program, indicate not applicable for Question 18. B. Performance Measures and Outcomes. (1 page maximum) List the performance measures which are the outputs from your program (e.g. the number of home delivered meals) followed by the related outcome(s) of your program (e.g. increased ability of clients to obtain nutritious food) and the indicator used to measure the outcome (e.g. percent of survey respondents reporting that receiving home delivered meals makes it easier to get enough to eat). These performance measures, outcomes, and indicators will be used to develop the contra.ct if the program is funded. i. Performance measures are the units of service produced by the program such as number of hours of counseling, number of home visits, number of meals served, training hours, etc. (Reported in Question 14.) ii. Outcomes of the program/service. Program outcomes are the intended effects of the program on a particular problem, and measures what changes have been made in the lives of individuals, families, organizations, or the community as a result of the program. Outcomes are generally very broad and are not often directly measurable. (See Part II: City Specific Supplemental Information to determine whether a city is requiring additional information on city specific results or has specific strategies your program should be addressing.) Page 6 iii. Indicators are used to measure progress toward the outcome by stating outcomes in specific and observable terms. I. We measure our success by being able to meet every single request made by our agencies and service providers. II. O r intended affect is to have a community of children and families who have the basic necessities to raise a healthy child. Our goal is that a parent does not have to choose to either feed their child or pay the rent; who does not have to chose child safety by buying a car seat or paying the electric bill. Ill. Our specific and measurable outcome to of our progress would be to have the orders by social agencies diminish because children are no longer at risk, families are no longer in need, and government agencies have the funding to provide for all of their community necessities. The following is an example of how your performance measure, outcome, and indicator information should be organized. Every performance measure must have at least one outcome and indicator. Some performance measures may have more than one outcome and some outcomes may have multiple indicators depending on the program. Your response to this question should match the performance measures provided in response to Question 14. EXAMPLE: Performance Measure: Number of home delivered meals. Outcome: Increase the ability of clients to obtain nutritious food. Indicator: At least 90% of survey respondents report that receiving home delivered meals makes it easier to get enough to eat. Performance Measure: Number of case management hours provided. Outcome: Increase in individual/family self sufficiency. Indicator: 95% of clients will set service plan goals to increase/maintain self- sufficiency. C. S -ffing Plan & Evaluation. (1 page maximum) i. Staffing Plan. Explain your staffing plan for this program as a whole. How many FTEs will work on this program? What will they do? What are their credentials? 0 - We have been able to keep our overhead to a minimum because we are run entirely by volunteer staff. Our FTE is probably close to 20 people. Page 7 ii. Evaluation. Describe how the program will be monitored and evaluated to determine whether program/service outcomes have been met. Describe the board and client involvement in the evaluation process. Include how the evaluation will be used to improve client services. We received immediate feedback from the requests made by our social service providers. Our goal is to meet every request for essential items. D. Differences in Service Delivery by City. (2 page maximum) Explain any differences in service delivery for this program among the cities that you are submitting this application to for funding. Explain any differences in the average cost of service per clients relative to funds requested by city as shown in the last column of Question 14c. We o not discriminate by location or city- our goal is to provide for any and all children and families in need. 11 . LONG RANGE PLAN (1 page maximum) In this section you should describe your long range plans for this program. Discuss your plans for future service delivery, collaboration, and other sources of continued funding for the program. What funding sources do you anticipate this program will have in the next three to five years? Our long range plan is to have the funding to provide for the increasing needs of families and community. We will need to establish a permanent location and have been investigating options that will not impact our limited current annual budget. 12. BUDGET(2 page maximum) The budget section of your application pertains to the information provided in Question 17 of,your application. A. Budget Request Narrative. In this section of the application narrative, provide a short paragraph explaining how your requested funds in Question 17 will be used. The requested funds will be used to purchase diapers, formula, bottles, baby food, cribs, car seats, safety supplies, toiletries, hardware to refurbished donate baby goods, and high chairs. B. Changes to Budget. Explain any significant changes between 2008, 2009 and 2010 expenses or revenues as noted in Question 17. Are there any known or anticipated changes to the program's 2008 Budget since adopted? Any hange in expenses would be due to the increased cost of goods and fuel for deliveries. C. Cost per Service Unit(s). You should provide an estimate of your cost per service unit provided by the program you propose. Explain how your cost per service unit was Page 8 determined. These should be based on the total cost of the program and the total number of clients served, not just the funds requested. You have the option of providing a cost per service unit for each separate service provided within the program. Cost Per Service Unit: $ 185.00 Explanation of how determined: We fulfilled 22,630 orders at a cost of$4,187,030. Data Table Requirements (Questions 13 - 18) The following documents contain all the data tables you are required to submit with your application. If you are submitting an application to continue an existing program, complete the following data tables with information pertaining only to this application. If you are submitting an application to fund a new program for your agency or forming a new agency, organization or a team of agencies and you do not have client data which is specific to your proposed program, fill out the data tables with information pertaining to what you predict your program will accomplish(projected). Explain in the applicable questions in the narrative for your program and how the numbers for each data table were determined. 13. NUMBER OF INDIVIDUALS / HOUSEHOLDS SERVED (DATA TABLE) Provide the number of individuals or households your program serves. The columns should be an unduplicated count of clients served from all funding sources as indicated. For example, someone may have attended a group meeting in March 2007 and then received direct, personal service in October 2007. Such a person should only be counted once when they first received services in 2007. If the group meeting was for one program at your agency, and the direct personal service was offered through another program at your agency, you can count this individual once for each program. Do not double-count a person who received the same type of service more than once. For example, a woman who received a physical exam in January and a mammogram in Marc i would only be counted once if both medical services are part of the same program. All clients should be counted as an unduplicated user the first time they receive services in a calendar year. A client who received services from the same program on 12/31/07 and 01/02/08 would be an unduplicated user for the 01/02/08 visit. The final column represents the unduplicated number of clients that will be served with the funds requested by city in this application. You will be required to serve that number of clients if fully funded. For example, your program has a total of 900 unduplicated clients served in a city. If you are requesting $10,000 to provide services to 90 unduplicated clients with the funds requested with (the remaining 810 clients to be served with another funding source), 90 would be shown in the last column for this city. Page 9 Agency: Program: 13. NUMBER Of INDIVIDUALS/HOUSEHOLDS SERVED BY PROGRAM Individuals? or Households? (Check which applies and use for reporting all demographics.) Unduplicated *Unduplicated Number of all Clients Served Clients by Served with All Funding Sources Funds Requested 2007 % of 2007 column 1 2008 2009 2009 (Actual) clients (Anticipated) (Projected) (City Requested served by Funding Only) City _ Auburn 122 .5 134 147 Burien 10 0 11 12 Covinjton 0 0 0 0 Des Moines 29 0 31 34 Enumclaw 12 0 13 14 I Federal Way 89 .5 98 108 Kent 346 2 381 419 Rentoln 1760 8 1936 2129 30,000 SeaTalc 14 0 15 16 Seattle 363 2 399 439 Tukwila 148 1 163 179 Other 19737 87 21710 23882 100% Total 22630 (This column 24891 27379 must total 100%) Page 10 Agency: Program: 14. Performance Measures & Average Cost of Service (Data Tables) This information will be used by each City to develop 2009-10 contracts with funded agencies. 14a. Your Performance Measures should reflect numbers based on the funding you are requesting from each City. 14b. In the space provided, define at least one (1) and no more than three (3) performance measures the program will report with a brief explanation. Do not use Unduplicated Clients/Households as a performance measure. Provide the estimated number of clients/ households served by city your program plans to provide in the corresponding column for each of the performance measures listed. Estimate the number of units to be provided for each measure annually. Provide accurate and realistic estimates. These estimates will be the basis of your contract if funded. 14c. Complete the table with the city funds requested in Question 6 and the unduplicated clients served with funds requested by City listed in the last column of •Question 13. Explain any differences between the average cost of service per client between cities in Question 10.D. of your application. Exam le of Completed Data Tables 14a: 14a. Service with 2009 Requested Funds Proposed Performance Measures as listed below. A) Meals B) Case Mgmt Hrs C) Delivered Auburn 7,000 75 Buries 5,000 50 Data Table 14b. Performance Measure.2009 Proposed (City Requested Funding.Only) Title: Brief explanation: A) Meals delivered One meal delivered counts as 1 service unit. B) Case management Will include intake, assessment, planning, advocacy and hours evaluation of results. Page 11 14. Performance Measures (Data Table) Agency: tastside baby for Children In Need 14a. Service with 2009 Requested Funds Proposed Performance Measures as defined below. A) Clothing & Diapers B) Safety Items C) Food Auburn Burien Covington Des Mloines Enumclaw Federal Way Kent $16,500 $7,500 $6,000 Renton SeaT+ Seattle Tukwila 14b. Performance Measures 2009 Proposed with funds requested City Funding Only Title: Brief explanation: Provide necessary clothing and disposable diapers for A) Clothing & Diapers low income infants and children. Provide car seats, safety gates, and cribs for low income B) Safety Items children Provide formula & bottles and baby food for low income C) Food children Page 12 Agency: 14 ' erformance Measures (Data Table), ContProgram: 14c. Average Cost of Service Unduplicated Clients Served with.Funds Average Cost of Requested 2009 Requested 2009 Service per Client (Same as last column of (Same as last column of Column 1 divided by Column Question 6) Question 13) 2 Example: $5,000 45 $111.11 Auburn Buries Covington Des Moines Enumclaw Federal I Way Kent Rento� $30,000 1936 $16 SeaTac Seattle Tukwila Page 13 Complete Question 15 with 2007 Actual numbers reported in columAgemKtuestion 13. 15. Demographics (from all funding sources) (Data Table),rogram: c o ca Client E c rn co Ti o a)71 A -J Residence _a '� '5 cn .c E Cr) >+ c c CS a Y H c 0 a) o c ca Q m c) c E w U. 5 Y Y c°n' ui H I— Unduplicated (check one), c CO C1) CO e, [El Individuals . � C,2 0 CAM m g3 0 Households N Served in 2007* i Page 14 Mousenoia income Level 30r of Median or Below 50r of Median or Below 80r of Median or Below Above 80%of Median Unknown 122 10 0 29 12 89 346 1760 14 363 148 2893 TOTAL 122 10 0 29 12 89 346 1760 14 363 148 2893 Gendier , Male Female TOTAL Age 0-4years 5-12years 13-17years _ 18-34years 35-54 years 55-74 years 75+years Unknown TOTAL Ethnicity Asian Black/African American Hispanic/Latino(a) Native American/Alaskan Pacific Islander White/Caucasian Other I Multi-Ethnic TOTAL 122 10 0 29 12 89 346 1760 14 363 148 2893 Female Headed Household DisatiIing Condition Limited English Speaking * Check Individual or Household, which should be the same as checked in Question 13. Unduplicated means count each client only once per calendar year. This should match the number served by City in the Actual 2007co1 umn of Question 13. The "total" column will be different from Question 13 since the "other" column is not included due to space limitations. Page 15 16. PROGRAM STAFF (DATA TABLE) In this data table, record the number of full-time equivalent (FTE) paid staff and volunteers for this program. FTE means a 40-hour week throughout the entire year. For example, if you enter "5" in the box for Number of Volunteer FTEs, this would mean that you have, on average, five volunteers assisting your program at all times (assuming a 40-hour week). If you know only the total number of hours contributed by all volunteers for this program, simply divide that number by 2,080 to find the total FTE number. For example: 5,000 volunteer hours over the course of a year, divided by 2,080 equals 2.4 FTEs. 2007 2008 2009 (Actual) (Budgeted) (Projected ) Total Number of Staff(FTEs) 0 1 2 Number of Volunteer (FTEs) 30 1100 1210 Actual Number of Volunteers 4000 4400 4840 17. ROGRAM REVENUE & EXPENSE BUDGETS (DATA TABLE) Program Budget: All columns should include total program operating revenue and expenses. Complete the following data tables with figures indicating the source of program operating funds for 2007 (actual), 2008 (budgeted) and 2009 (projected). Budget amounts should match funding requested (Question 14c) and Question 5. Include an explanation of any significant differences between the revenues and expenses by year in Question 12B of your application. Page 16 Agency: 17. PROGRAM REVENUE BUDGET (DATA TABLE) Program: Revenue Source 2007 2008 2009 (Actual) (Budgeted) (Projected/ Requested) City Funding (General Fund & CDBG) • Auburn 0 0 0 • Burien 0 0 0 • Covington 0 0 0 • Des Moines 0 0 0 • Enumclaw 0 0 0 • Federal Way 0 0 0 • Kent 0 0 0 • Renton 0 0 30,000. • SeaTac 0 0 0 • Seattle 0 0 0 • Tukwila 0 0 0 •1 Other (Specify) East & North 32,280 King County Human Services 35,508 39,059 Funders •11 Other (Specify) Oth+r Government Funds . • Ding County 0 0 0 • Washington State 0 0 0 • Federal Government (Specify) 0 0 0 • Other (Specify) 0 0 0 Private Sources • United Way (grants & designated 13,959 15,355 16,891 • Poundations and Corporations 89,968 98,965 108,861 • Contributions (e.g., Events, 95,022 104,524 114,977 • Program Service Fees (User Fees) 0 0 0 • Other (Specify) In-Kind Donation 4,020,170 4,422,187 4,864,406 TOTAL PROGRAM BUDGET Page 17 17. PROGRAM EXPENSE BUDGET, CONT. Agency: (DATA TABLE) Program: Expenses 2007 2008 2009 (Actual) (Budgeted) (Projected) Personnel Costs • Salaries 0 30000.00 60000.00 • Benefits 0 0 0 • Other 0 0 0 i • Dotal Personnel 0 0 0 Operating and Supplies • Office / Program Supplies 2158 • Rent and Utilities 74,396 • Repair and Maintenance 1330 • Insurance 1792 • Postage and Shipping 913 • Printing and Advertising 659 • Telephone 1825 • Equipment 0 • Conference/Travel/Training/Mileage 158 • dues and Fees 395 i • Professional Fees / Contracts 23,299 • Direct Asst. to Individuals 4,020,567 • Administrative Costs 60,814 • Other (specify) Taxes 153 TOTAL PROGRAM EXPENSES 4,188,459 Net Profit(Loss) 62,939 (revenue—expenses) = Page 18 Agency: 1 8. ?UBCONTRACTS (DATA TABLE) Program: List all the agencies you will be subcontracting with for this program. Provide the agency name in the first column, a description of the contract/service in the second colu n, and the contract amount in the third column. Do not list agencies you coordinate with on a referral only basis. Indicate not applicable if you do not subcontract for any part of this program. Subccintracting Agency Specific Subcontracted Activities Contract in the Operation of Your Program Amount none Page 19 19. APPLICATION CHECKLIST Applications missing one or more of the following components or not following these directions may not be reviewed. Sign and submit the application checklist with your application. Contents (Your application should contain each of these items in this order.) ❑ Application Cover Pages.The top three pages of your application must be a completed copy of the Agency Information and Questions 1-7. Application Narrative: ❑ Question 8 Organizational Experience (2 page maximum) ❑ Question 9 Need for Your Program (2 page maximum) ❑ Question 10 Proposed Program/Service (6 page maximum) ❑ Question 11 Long Range Plan (1 page maximum) ❑ Question 12 Budget(2 page maximum) Data Tables ❑ Question 13 Number of Individuals/Households Served ❑ Question 14a-c Performance Measures and Average Cost of Service ❑ Question 15 Demographics (from all funding sources) ❑ Question 16 Program Staff ❑ Question 17 Program Revenue & Expense Budgets ❑ Question 18 Subcontracts ❑ Required documentation. Supply one copy of the following required documents with the signed original application. See Part II: City Specific Supplemental In formation to determine whether additional copies of the application and required documentation need to be submitted. ❑ Question 19 Required Documentation, including: ■ Proof of non-profit status ■ Organizational Chart ■ Agency/Organization Mission Statement ■ Board resolution authorizing submittal of the application (may be submitted up to 60 days after application). ■ List of the current governing board and local board, if applicable, (include name, position/title, city residence, length of time on the Board, and expiration of terms. Note any vacancies.) ■ Board Meeting Minutes of last three board meetings of governing board and local board as applicable ■ Annual Budget ■ Financial Audit Cover Letter ■ Financial Audit Management Letter ■ Financial Statement ■ Verification of Non-Discrimination Policy ■ Program Intake Form ■ Sliding Fee Scale ❑Application Check List. (Signed below.) ❑City Specific Supplemental Information. Required in Name: Part II for applicable City only. Position: Phone #: Signature of Person Completing Checklist Page 20 DO NOT SUBMIT ANY OTHER MATERIALS WITH THIS APPLICATION Make sure that you carefully check Part//of this application to see what additional attachments each city requires. Page 21 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. O. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number: Dat SEP 2 8 2000 91-1617032 DLN: 600265049 EASTSIDE BABY CORNER Contact Person: P 0 BOX 712 JOHN J KOESTER ID# 31364 ISSAQUAH, WA 98027-0712 Contact Telephone Number: • (877) 829-5500 Our Letter Dated: February, 1994 Addendum Applies: No Dea Applicant: This modifies our letter of the above date in which we stated that you would be treated as an organization that is not a private foundation until the expiration of your advance ruling period. Your exempt status under section 501 (a) of the Internal Revenue Code as an organization described in section 501 (c) (3) is still in effect. Based on the information you submitted, we have determined that you are not a private foundation within the meaning of section 509 (a) of the Code because you are an organization of the type described in section 509 (a) (1) and 170 (b) (1) (A) (vi) . Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lose) your section 509 (a) (1) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the part of the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you woulld no longer be classified as a section 509 (a) (1) organization. You are required to make your annual information return, Form 990 or Form 990-EZ, available for public inspection for three years after the later of the due date of the return or the date the return is filed. You are also required to make available for public inspection your exemption application, any supporting documents, and your exemption letter. Copies of these documents are also required to be provided to any individual upon written or in person request without charge other than reasonable fees for copying and postage. You may fulfill this requirement by placing these documents on the Internet. Penalties may be imposed for failure to comply with these requp.rements. Additional information is available in Publication 557, Tax-Exempt Status for Your Organization, or you may call our toll free number shown above. If we have indicated in the heading of this letter that an addendum applies, the addendum enclosed is an integral part of this letter. Letter 1050 (DO/CG) Mission Statement of Eastside Baby Corner Our mission is: ➢ to relieve the poor, distressed and underprivileged by providing for children in need of food, clothes, and sundry essentials. ➢ to lessen the burdens of the government by acting as a public charity. Eastside Baby Corner P. O. Box 712 Issaquah, WA 98027 Telephone: 425-865-0234 Fax: 425-865-9935 babycornCa�gte.net www.babycorner.org Tax ID # 91-1617032 Board Members 2008 President Karen Ridlon babycorn@gte.net 18 years 18713 SE 43rd St. 425-643-7838 Issaquah, WA 98027 425-865-9935 (fax) Vice President Teresa Lindo babycorn@gte.net 7 years 2519 239th Ave SE 425-392-7398 Sammamish, WA 98075 425-391-0704 (fax) Vice President Karen Rubin babycorn@gte.net 5 years 4517 Somerset PI SE Bellevue, WA 98006 425-746-8158 Vice President Edie Herb babycorn@gte.net 2 'ear 2026 201st Ave SE Sammamish, WA 98075 425-391-9609 Eastside Baby Corner, Inc. Statement of Financial Income and Expense 2007 Actual 2008 Budgeted 2009 Projected Ordinary Income/Expense Income 1 Donations-Unrestricted $140,684 $154,752 $170,227 Donations-In Kind 4,020,125 4,422,138 4,864,352 Donations-Temp Restricted 90,590 99,649 109,614 Total Income $4,251,399 $4,676,539 $5,144,193 Expense 1 Inventory, Beginning 392,299 414,553 456,008 1 Merchandise in kind 3,875,043 4,262,547 4,688,802 Baby Food 3,401 3,741 4,115 Baby Furniture 1,063 1,169 1,286 Baby Supplies 3,830 4,213 4,634 Carseats 36,309 39,940 43,934 Child Supplies 6,607 7,268 7,995 Clothes 17,534 19,288 21,217 Cribs , Mattresses, Bedding 11,956 13,152 14,467 Diaper wipes&ointment 1,884 2,072 2,279 Diapers 58,530 64,382 70,820 Formula 26,665 29,332 32,265 Fundraising 1,601 1,761 1,937 Overhead, Mgt&General 86,848 95,532 105,085 Overhead, Program Related 79,443 87,388 96,127 Z Inventory, Ending -414,553 -456,008 -501,609 Total Expense $4,188,459 $4,590,330 $5,049,362 Net Ordinary Income $62,939 $86,209 $94,831 Other Income/Expense Other Income 1,914 2,105 2,316 Net Other Income 1,914 2,105 2,316 Net Income $64,853 $88,314 $97,147