Loading...
HomeMy WebLinkAboutCommunity Health Center - Primary Medical r Co tif,witA Cliff . r 1 ey I fitiA(. Rating Tool for 2009/2010 Funding Applications SECTION 1. Mary Ann: Pass/Fail: If all answers are yes, the application goes forward. If any answer no, the application review stops. grI o Submitted before deadline? f ❑All questions answered on City supplemental application? []'Common Application Checklist—all items "yes"? )1u.A0 IL, . fCOMMON APPLICATION CHECKLIST Yes No Cover pages � Agency Information and Questions 1-7. I�1 LI Question 8 Organizational Experience (2 page maximum) E-1-11 Question 9 Need for Your Program (2 page maximum) ' ❑i''❑ Question 10 Proposed Program/Service (6 page maximum)., ❑ Question 11 Long Range Plan (1 page maximum) I''"❑ Question 12 Budget (2 page maximum) Data Tables 0 ,❑ Question 13 Number of Individuals/Households Served ❑y'.., El Question 14a-c Performance Measures and Average Cost of Service 0 ..❑ Question 15 Demographics.(from all funding sources) ® � El Question 16 Program Staff ; ; E ,❑ Question 17 :Program Revenue'& Expense Budgets ❑ Question 18 Subcontracts Required Documents R��.� Proof of non-profit status LJ ID Organizational Chart ®''❑Agency/Organization Mission Statement' E❑ Board resolution;authorizing submittal'of the application (may be submitted up to 60 days after application). Er ❑ 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 anylvacancies:) R❑ Board Meeting Minutes of last three board meetings of governing board and local board as applicable' lje0 Annual Budget ' © ❑ Financial Audit Cover Letter ❑ Financial Audit Management Letter yi ta,_, Er ❑ Financial Statement �❑ Verification of Non-Discrimination Policy ® n Program Intake Form [i❑ Sliding Fee Scale PASS FAIL R. ing p. 1 Draft of 4/15/08 H:\I1IS 08\09-10 Funding cycle\Rating Tool414financeupdate.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 Raing Tool p. 3 Drift 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 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#1,5. ❑ ❑ Three columns in #17, 11.19 ,(Revenue Source) add correctly? ❑ ❑ Three columns in #17.p;;20 (P,rogram Expense) add correctly? SCORE: / 10 Rating Tool p. 4 Draft of 4/15/08 H:\HS 08\09-10 Funding cycle\Rating Tool414financeupdate.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? " DYes 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 0points 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 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 Rentonsresidents access,the program? (score 0-3) Does the proposed outreach.fit Renton or show knowledge of Renton?----` (score 0-3) Were the language and cultural`needs of the clients addressed? (score 0-3) Does the agencyproposeto have subcontractors or partners? Are services accessible through 1) 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 Tool414financeupdate.doc