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HomeMy WebLinkAboutCommunity Health Center - Natural Medicine Co /bl eb't t.(;v1,1 LkU® 1 ( `- k4woJ Rating Tool for 2009/2010 Funding Applications IJOJt! SECTION 1: Mary Ann: Pass/Fail: If all answers are yes, the application goes forward. If any answer no, the application review stops. Yee o 2 Submitted before deadline? ❑ All questions answered on City supplemental application? in [9-6ommon Application Checklist—all items "yes"? e;),( -- O I( COMMON APPLICATION CHECKLIST Yes� No_ Cover pages 1i Agency Information and Questions 1-7. I © Question 8 Organizational Experience (2.page maximum) 2 ]-Question 9 Need for Your Program (2:page maximum) prQuestion 10 Proposed Program/Service (6 page maxinigm)'Question 11 Long Range Plan (1_page maximum) • L�J L i Question 12 Budget (2 page maximum) Data Tables 77:,„2-lueessttiiconn � Question 13 Number of Individuals/Households Served 14a-cPerformance MeasuresandAverage Cost of Service 15 Demographics (from all funding sources) I Li Question 16 Program Staff �0" P-Question 17`'Program Revenue& Expense Budgets E LJ Question 18 Subcontracts Required Documents ❑ Proof of non-profit status L( ❑Organizational Chart L1 D Agency%Organization.Mission Statement" [ ❑ Board resolution authorizing submittal of the application (may be submitted up to 60 'f','days after application). lir ❑ 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.): Pr-❑ Board Meeting Minutes of last three board meetings of governing board and local board as applicable a'❑Annual Budget 2'❑ Fi cial Audit Cover Letter ❑ Financial Audit Management Letter 10 Financial Statement la ❑ Verification of Non-Discrimination Policy ®rP_I Program Intake Form E ■ Sliding Fee Scale PAS 7 / FAIL - 1i " ool p. 1 Draft of 4/15/08 H:\HS 08\09-10 Funding cycle\Rating TooI414financeupdate.doc 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 performance 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'? No Score Rating Tool p. 3 Draft of 4/15/08 H:\ILIS 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;in:#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;y-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 pp*-;. ❑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 a CI No O 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 Dreft of 4/15/08 HAIL'S 08\09-10 Funding cycle\Rating TooI414financeupdate.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,as`to 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 Renton:residents access.the program? (score 0-3) Does the:proposed outreach fit Renton or show knowledge of Renton?- is (score 0-3) Were the language arid cultural needs of the clients addressed?`: (score 0-3) Does the a enc ro ose to;have subcontractors or partners? 9 .Y P. p Are services accessible through the organization or 2) the subcontractors/partners? (Circle one) d :Long Range Plan— (score 0-3) Is a long-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 TooI414financeupdate.doc