Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2004-229K
I � 1 D • V r 0 . 1 04wl La K Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2004 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street, Vero 32960 ("County" ) and Center for Emotional & Behavioral Health , ( Recipient) , of: a�ll?P9'� 119037 th Street Vero Beach Fr r Background Recitals A. The County has determined that it is in the public interest to promote healthy children in a healthy community. B . The County adopted Ordinance 99- 1 on January 19, 1999 ("Ordinance") and established the Children's Services Advisory Committee to promote healthy children in a healthy community and to provide a unified system of planning and delivery within which children's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose. D . The proposals submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee, has applied for a grant of money (" Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals The background recitals are true and correct and form a material part of this Contract. 2 . Purpose of Grant The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes") . 3 . Term The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2004/2005 ("Grant Period ") . The Grant Period commences on October 1 , 2004 and ends on September 30 , 2005 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Five Thousand Dollars ($5 , 000 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit " B " attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate. 5 . Additional Obligations of Recipient . 5 . 1 Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant. In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense, upon five ( 5 ) days prior written notice . 5 . 2 Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state, and local laws , rules, and regulations . 5 . 3 Quarterly Performance Reports . The Recipient shall submit Quarterly Performance Reports to the Human Services Department of the County within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 , and September 30 . 5 .4 Audit Requirements . If Recipient receives $25 , 000 or more in the aggregate from all Indian River County government funding sources, the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget . The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for a prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from it's independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate this Contract. 5 .4 . 2 The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 Insurance Requirements . Recipient shall , no later than September 21 , 20041 provide to the Indian River County Risk Management Division a certificate or certificates issued by an insurer or insurers authorized to conduct business in Florida that is rated not less than category A- : VII by A . M . Best, subject to approval by Indian River County' s risk manager, of the following types and amounts of insurance : - 2 - ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage, including coverage for premises/operations , products/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage, including coverage for owned autos and other vehicles , hired autos and other vehicles, non-owned autos and other vehicles ; and ( iii ) Workers' Compensation and Employer's Liability (current Florida statutory limit) 5 . 6 Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty ( 30 ) calendar days prior written notice having been given to the County. In addition , the County may request such other proofs and assurances as it may reasonably require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract . The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Workers ' Compensation insurance . The Recipient shall , upon ten ( 10 ) days' prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage, or causes of action which may arise from any misconduct , negligent act, or omissions of the Recipient , its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 Public Records , The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract. 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty ( 30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this Contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . — 3 — � M IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS lj . By: Caroline D . Gibnj Chairm a BCC Approved` Attest: J . K. BartIP%rk By. Deputy Clerk Approved : Jos;PN A . Baird County Administrator Ap ed f and legal uffi r6Wr Fell , Assistant Couut Atorney( RECIPIENT: By: Center or E otional & Behavioral Health 4 - t EXHIBIT A [Copy of complete proposal/application] - 1 - • • The Center for Emotional and Behavioral Health(gJR.MH — Parenting Education Group — IRC- CSAC PROGRAM COVER PAGE Organization Name : The Center for Emotional and Behavioral Health @ IRMH Executive Director: Dr. Raymond Dean, MD E-mail : raymond . dean a , irmh org Address : 1190 37th Street Telephone: 772-563 -4666 ext 1809 Vero Beach, FL 32960 Fax: 772-770-2025 < Program Director Mariamma Pyngolil RN E-mail : mariamma. yn olil Irmh org s , Address : 1190` 37' Street Telephone: 772-563 -4666 ext 1838 Vero Beach, FL 32960 Fax : 772-770-2025 . . 11 L p,. 4 ' Pieogram' Tttle: ` Parenting Education Group Priority Need Area Addressed Therapeutic, intervention and educational Parenting Education Group t program for parents of children and adolescents with emotional problems in Indian River County Brief Description of the Program: PH-610 Parenting Education : Programs that provide classes groups or other educational opportunities for parents who want to acquire the knowledge andskills to be effective in heir parentinl? role p = 10.680 Parenting Skills Development• Programs that teach • e . .+ . _. P. zs+, skills that _enabl6parents to dec.�apl construdively�and' consistently with a broad spectrum of child rearing . D„ • .ff " . .1" " e;4_1 , .�� -+iP,A44c'9z . 13Cw"�s ' ; .,:.mow ,` .� ;, •' ; g robleM's w6ich''ma � include' sl in ` nvaf -e school behavior and erformance - poor self-esteem` shyness: drug use: sexual promiscuity= and the whole range of negative acting out behaviors including whining, temper tantrums. disobedience insolence and destructiveness Some parenting skill development programs utilize a step-by-step approach for managing specific problems and may incorporate application at home of techniques that were discussed and practiced in the classroom setting. Other programs may offer participatofy family workshops which provide opportunities for parents and children to learn and practice methods for dealing with one another in the guidance of a trained facilitator. Most training programs teach the parent a particular way of talking and relating to their children that reinforces positive behaviors and communication and ' decrease negative behaviors while supportinu the development of a relationship that is built on fairness mutual caring and respect If Wr If rt` , +Ki.' r' 2 C a i . re, 1Ale '} . r '. y 3 k � � G • M � � � .jt .Y -. Tl SZ �'N q i D . ii 5ie r`i.. " ' §"`- •� "" C au.�xaa. ";f etlee The Center for Emotional and Behavioral Health®IRMH — Parenting Education Group — IRC- CSAC SUMMARY REPORT nter Information In The Black Cells Onl Amount Requested from Funder for 2004 /05 : $ 5 , 600 . 00 Total Proposed Program Budget for 2004 /05 : $ 9 , 127 . 96 It Percent of Total Program Budget : 61 . 3 %0 Current Program Funding (2003 /04 ) : . $ Dollar increase/ (decrease) in request : $ 5 , 600 Percent increase/( decrease) in request * * • # DIV /O ! UndupLcated . Number of Children to be served Individually : _ .�} Unduphcated: Number `of Adults to be served Individually : 42 Unduplic d um efto be served via Group settings : 8 T.. otaLProgram Cost� per_ Client : 182 . 56 I€reques increased 5% or more, briefly explain why: a = fir If these funds are being used to match another source, name the source and the $ amount: The Organization #s Board ofDireetors approvaatthis application o dot • J o) (o • (7 yr fK //�� � ,� �� t Y l okG.V _. a ys , y d f T � � Name of Ffesideat/Chait"of the Board SiSt t TL Signature t 3 d • d _ 1 vc'� y Name of Executive Du eetoi/CEO ' s X tr r. y t { JYSLv. T 1 51 Pf 9 vy y . i Xy"3'sya 1 y • ; • r It m n ty�'k'^ .p4 ' .a.: � e•. n . . . it 15 = 1 k y r � . - . . The Center for Emotional and Behavioral HealthngIRMH — Parenting Education Group — IRC- CSAC PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section . In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 t/z" X 11 " paper and number each page. These directions and the graphic boxes may be deleted if space is needed . ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) i 1 . Provide the mission statement and vision of your ,organization . oe 011 # = IndiadR>< "er Memorial Hospital strives to be the finest community based health care �organizat>ion anywhere. Our values are compassion, respect, and teamwork. Tiieenter for Emotional and Behavioral Health @ IRMH is committed to provide excellence in Mental Health Care to the individual and families while responding to the needs of the changing community. Our patients can expect quality care with dignity and professionalism through the collaborative efforts of the multidisciplinary team. We will continue to support the Quality First process while working together as a team. arent><ng; Education Groff is committed to impr`oving lives of children and their families who 'at6 challenged by psychiatric disorders and behavioral problems by teaching and promoting effe� iv* parenting skips. x ' " 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served . CEBH provides Mental Health services to children, adolescents and adults . In patient services are provided on a voluntary or involuntary basis to all three age groups. The facility also provides out-patient therapy for children/adolescents' and their families, EAP services, urine drug , screenddrug free workplace services, a summer camp (Camp Manatee Therapeutic Summer Camp) for ADHD children and Experiential (ROPES teambuilding) services to the community. .Parenting Education Group is an education and discussion group for parents of children with psychiatric disorders and/or behavioral problems . This group will be facilitated by a licensed therapist who has experience with this Lidentified group . r. � t ¢ .,' % •it . - 4 to Ny�� ' � ' ^ ; A � y y Yah Y �Y" .. A W11 Mie Center for Emotional and Behavioral Health(?)IRMH — Parenting Education Group — IRC- CSAC B . PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change ? b) Who has the need ? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need . Children diagnosed with psychiatric disorders or who have problematic behavioral problems do not always respond to conventional parenting approaches. Usually a more sophisticated parenting approach is required to better manage these children. These new parenting skills improve the behavior or the children and reduce the distress in the family. The Parenting Education Group provides this skill. This type of parenting group is lacking in Indian River County. <' Ac¢ cording to a national survey titled Speaking of Kids ( 1991b) reports that a majority of 1i4=` . . ,. .. American adults, regardless of age, race, marital; or parental status believe that it is harder to be a parent today than it used to be (88 percent) and that parents today often are uncertain about what . is the right thing to do in raising their children (86 percent)_ Therefore based on this I statistic, parent education groups would be an asset for the parents of Indian River County. Furthermore, an estimated 1245% of all children suffer mental disorders; approximately 10% have received treatment in the past. year (NatI- Iional Commission on Children, 1991x): - Nearly' 500, 000 Amencair children novi� live in" hospitals; detention facilities, and foster u' homes That number is expected to climb` to more than 840 000 by 1995 (House Select Committee 'if hild ren, Youtlian&F amilies 1989) n y u an �. �:. �m 2. a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program . Although there are other parenting groups in Indian River County, none offer the clinical expertise and education to parent children that have psychiatric and/or behavior problems, that we are aware Of. ! t > eY�z �" tit A _ ` ydt f vIA mmr F h w01 ' ¢ 1 r 1 ' f The Center for Emotional and Behavioral Health(t IRMH — Parenting Education Group — IRC- CSAC C. PROGRAM DESCRIPTION (Entire Section C, 1 – 6, not to exceed ttvo pages) 1 . List Priority Needs area addressed. Therapeutic, intervention and educational Parenting Education Group program for parents of children and adolescents with emotional problems in Indian River County. 2.1 Briefly describe program activities including location of services. The program helps the parent to identify their parenting style: easy going, rescuer, disciplinarian or consultant All of these styles are detrimental to the child except for the consultant—the style the parent will embrace after attending the group. The parents learn effective ways of providing choices, the difference between using thinking words versus fighting words. They- will learn how to avoid control battles with their children and the importance of giving the children age appropriate responsibility., The parents learn new skills and follow simple but powerful „models that caused the ' -child to become more skilled at making decision and behaving more appropriately. The educational component is provided via a lecture for 30 minutes followed by . 1 . discussion related to a specific problem parents maybe having with their children. The Parenting Education Group meets at the Center for Emotional and Behavioral Health , 3. Briefly desenDe now, your program '-addresses the stated need/problem. Describe how our ro follow l recognized "best practice", (see d am efinition on 'page X6 the Ins tructi6i6)and provide evidence that indicates ro osed `strate ies are ' + . , . P p g e effective with target population. The material for this Parenting Education Group is based on two of the most effective parenting modes available today. They are the Love and Logic method developed by Jim Fay and Foster W. Cline, MD and The Systematic Training for Effective Parenting ( STEP) model developed by Don Dinkmeyer and Gary McKay. Both of these models provide excellent, easy to understand techniques for parents that will reduce conflict with their child . The goal is to . promote parenting expertise in eacn' parent who attends this group. 1 . 14 . w i w ( a rr.l F. a c a r� ,. . yys ao+.i VSs' � k• Vic_ r a � ru* a"S Aw zy. �a,"� *'y {"^��� � '. T µ'{�. F �Ta yit.t� "°�y�` ".?i4' + �r1r fa, xc . t 5r r (a' ''9+'Try ' +• "�y� 6t l :'b'f`7� � Fx� . 'i: • •The Center ror Emotional and Behavioral Ilealth(MIRMH — Parenting Education Group — IRC- CSAC 4. List staffing needed for your program , including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet). One licensed therapist for 3 hours per week. This includes group preparation, advertising activities, outreach to promote the group and facilitating the weekly one hour Parenting Education Group. 5. How will the target population be made aware of the program ? Target population for the parenting education group will be made aware of the group by referrals from the Center for Emotional and Behavioral Health in-patient and outpatient therapists and > physicians. Flyers will be distributed in the community, via the Vero Beach Community Health Fair, distribution to Indian River County Schools via school specialists. The group will be advertised in the Indian River Memorial Hospital calendar published in the Vero Beach Press Journal, as well as on the web and the Hospital Newsletter, 6. How will the program be accessible to target population (i. e., location, transportation , hours of operation) .9 The Parenting Education Group is located at the Center for Emotional and Behavioral Health across the street from Indian River Memorial Hospital and easily accessible for US I or Indian River Blvd . The group will meet for one hour once a week in the evening. Parents must provide their own transportation to get to and from the group. Y i ` M i # d < n � • �� t : r r � � '.y.*�q"^'�'"�C^Ykcf? , Y"r' �."'° aS,ksa,r{4N• ..,C,tsy.� . .V �t a ✓ {' $ ` "€ i 2 •*1* '4. i e ca' C.r'k .n �Wc i `± ' 4 4 '• .. r ' 4t „ E h ''u' 7 „ {�. ivr�ar MY ' "Si• c°,¢ ,'�t' r .x a , . r _*4 ' + Y .,y `�f" q'nvl '".{ �.r '- ` '[,"?F��sj "f`r3','�• �: ,�;r�F E.�n .,:i�.`,,.. • • The Center for Emotional and Behavioral Health(MIRMH — Parenting Education Group — IRC- CSAC D . MEASURABLE OUTCOMES (Description of Intent) Use the Measurable Outcomes orm. This descri tion a e does not need to be included in the proeosal In order to show the impact that your program is having on the target population and the community, the funders are requiring measurable outcomes . Please review the examples and summaries below to insure your understanding of what is expected . OUTCOMES : Describes what you want to achieve with the target population. Indicates the results of the services you provide not the services you provide. Outcomes utilize action words w " Mk such as' maintain, increase, decrease, reduce, improve, raise and lower. ¢ T r �� � f{ iii w " t ;. .. ♦ o04? j f . ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the _ . *1 Tr , qi results stated in the outcomes. Activities utilize action words such as complete, establish, create, provte; ° operate, and develop . The activities should reflect the services described in the PROGRAM DESCRIPTION (C2). Use the following elements to develop your outcomes All elements must be included: . • ` Direction of change • Time frame • Area of change As measured by • Target population • Baseline: The number that you will. be • " Degree of thane measuring against Example 1 (Out ) • T'o deer"ease direction. come ( ' of change) number of unexcuse'd absences (area of change) of enrolled boys and girls (target population) by 750/o;`(degree of change) in one year (time frame) as reported by the 2003 School Board attendance records (as measured by). Baseline : 2003 School Board attendance records for ' enrolled boys and girls . Example 1 (Activity) : To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks . Example 2 (Outcome) , 75% (degree of change) of youth (target population) who have participated in the academic enrichment activities (as measured by) fox_ 6 months or more (time frame), will improve (direction of change) their scores in one or more subject area (area of change) . 25 % of participants in academic enrichment activities will maintain the initial level of performance assessed at entry. Baseline: Pre-test scores from the academic enrichment test . Example 2 (Activity) : , 1 ) Provide pre and post-test exercises on the Advanced Learning System software; 2) Participants will go through the one lesson per week and be graded for 10 weeks . IMPORTANT NOTE : Keep in mind when developing your PROGRAM OUTCOMES, that if funded , this will be what you are held accountable to accomplish. Also, the PROGRAM OUTCOMES should reflect -the information described in the PROGRAM NEED STATEMENT (B1 ) . All Program Need Statements should flow from the Mission & Vision. Measurable Outcomes should be based on and measure program needs . Activities are the tasks you do that are going to influence the outcome and impact the unacce table condition in your Program Need Statement •5 ' �'& F� t� � � Yi ti is � 1. Rte,, Maryt ' , � � t ?ffik L cJ ` F" t - , 9 5 ..♦ se� `Y' � \ .. .�,aY xc ¢ ��Rr �' N „ - i r 4 r � � Sb �aR"'sA � 'A'a�', Y , '� 1,',r• s,, '"�• rC h= s` ri i` }}� u'� s i' " 1 x s �'. i?:�rp'It�N�. ' ` " The Center for Emotional and Behavioral Health(y),,IRMH — Parenting Education Group — IRC- CSAC D . MEASURABLE OUTCOMES (Entire Section D not to exceed tivo pages) OUTCOMES ACTIVITIES Add all of the elementy or the Measurable Outcome (s) Add the tasks to nccont lish the Outcome p) I . To decrease the level of frustration 1 . Parent will complete an evaluation they feel toward their child(ren) by that asks them to rate their level of 80% as a result of the feedback frustration at session one and reports by the end of the six week session six . cycle. Baseline: Feedback report ` Y`Y 2. To increase the Level inpathy 2 . Parents will complete"an evaluation and respect they express toward to rate their level of empathy and their child by 80% byhe end of the respect they express, toward their six weeks . child(ren) before the first class and Baseline : Feedback reportagain affter ' six weeks , N i 3 . To use the new modelof 3 Parents willcomplete ands intervention t0 extinguiSfl evaluation to rate the frequency inappropriate betiavibis' by 80% at they use interventions from the the end of the six weeks , . . class to manage problematic documented on their evaluations . behavior of child(ren) . Baseline : Feedback report 4 . To increase appropriate behavior in 4 . Parents will complete an evaluation child by applying parenting to determine the frequency of techniques learned through out the appropriate behaviors their six week. The goal is at least 80% child(ren) displays before the first improvement of problematic class and after 6 weeks. , behaviors . Baseline: Feedback report , ,. i _ ' ss'4.h + , r s.`1 u !r X` a'• ;t ' r +rx. ; �v1' 9, +X ' - 11 b xr r c rx-• i abvh Ok' 't G+ q°M r4 R` v Y N 0 WT t i�L� JY3 # m . n . r t;, �a:� . �' r c"4y . .., , . $ . tq' .�`•' „ aSa . *-�. 'Fi . . .",.,5 .6r ° a �, . a ,¢ .'� ._ *The Center for Emotional and Behavioral Health(t),IRMH — Parenting Education Group — IRC. CSAC E. COLLABORATION (Entire Section E not to exceed one page) L List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters . Collaborative Agency Resources provided to the program Indian River Memorial Hospital and Provides physical plant for the Parenting Education Center for Emotional and Behavioral Group as well as consultation with psychiatric and Healthpsychological team members. Florida Irist> tute 'of Technology Doctoral Practicum students assist with development of kD%c tom:, - . .: . . . .::.*` t • .+Iq y.". F pre and post parent evaluation forms, and iesearch of disorders and treatment modalities V� 'I' _ _ Department of Children and Families Provide consultation and follow-through for continuum of care. Children of Society Provide consultation and follow-through for continuum Y �q R ' of care Xi6f �Indian County School District Provide consultation and follow-through for continuum of care t F F T• q 2 `4 ?d't y. ,% .Y=iiTf .' 11 I?i t [ e y 1K zt' NW ✓4 �k iG �. , W^ iq k ' . �q tr �aY 2 k i' '. b n• i "� 'N+C V A 45 a" 4 lmt /tt+`'` 1 '�S '-" ��` 11grsYt Y w r . . The Center for Emotional and Behavioral Health(#i IRMH - Parenting Education Group — IRC- CSAC Fe PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : 'What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 We will track the following demographics as provided by the parents via the registration form : • Age ❖ Gender .4 ; :• Ethnic Background r Family, income m ._ ❖ School attending 4 • Medications •:� Zip, code Center for Emotional and Behavioral Health outpatient therapistswill collaborate with community mental agencies and Student Support Specialist to identify potential parents who may " need these parenting classes to learn effective ways and strategies to parent a child with a - psychiatric disorder.11 ,;. . : a � . u . $y 2. MEASURES: What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What - tools or. )Items are you using as measures (grades, survey scores, attendance, absences, skill levels) for your program ? Are you getting baseline information from a source on your Collaboration List in Section E? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data? We will be taking attendance each week to count the number of participants . We will be distributing a pre and post evaluation for each six-week parenting class to measure parent effectiveness of strategies learned . This data then will be entered into a database for tracking purposes and to accurately measure goals and outcomes of our interventions and education. 3. REPORTING: What will you do with this information to show that change4ias occurred ? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program ? The pre and post evaluations will be entered into a data base and the outcomes will be charted and measured . We will keep all returned feedback evaluations for one year, to reference as needed . The results will guide curriculum and discussions in future groups � . tj It ~ The Center For Emotional and Behavioral Health(?IRMH - Parenting Education Group - IRC- CSAC f G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities, or cycles of events that will occur within the program year. New programs should include any start- up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections, Month/Period Activities August/September 1 . Marketing/develop and mail flyers notifying potential 2004 parents/participants, school professionals, and community mental health professionals of the first group session. Advertise in Vero Beach Press Journal"IRMH Educational Happenings", develop the Parenting Curriculum tailoring into the needs of these group members, Compile goals of parents and determine outcomes : October 2004 2 InitiaTgroup meeting begins; Give parents pre-test evaluation form, November 2004 Compile goals and chart , data, initial group curriculum based on parent' s need. Continue meeting for 6 weeks. November 2004 ' 3 Compile post test data evaluation information, compile outcomes OW o ') r , December 2004- Repeat above steps 1 -3 based on six week Parenting Education Group September 2005 interval . September 2004 Compile all data from each Parenting Education Group interval and Wrap up group information for grant information (employee paycheck, cancelled checks, finance department) . tl t�ryr+' 4W✓ , v�+. X- 4 Y;. ( `� iFy S ; x i 7 % t t s '� '",• l A 13 rr'�� n .2#1 _ �� X , r - .uiti n '�•„ ,� f � , �"., T:,Y r Kr � 1 ��Y Ai 3 " n.by 'nivkLr �:"41+}Fy 1 # r � �4 s#. p d ° Yr. f '"t'dr � S Vs "T1tif. W r 4 u w u � r ' 'rhe Center for Emotional and Behavioral Health(MIRMH — Parenting Education Group — IRC- CSAC H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location .. . .K.:�::iii:i':� v' :{.;r..:.}}v}:•iii'•} Current Fiscal Year ------------------- ' 0 : : - ` 4/0Location Budget 2003/04 oa Unduplicated Clients Unduplicated Clients Unduplicated Clients N Indian River County - 11 15 S: Indian River County: ` - 16 26 Indian River Co. Total - 27 41 Greater Stuart _ Hobe Sound Indiantown rc Jensen Beach Palm City Martin County Total Pori Pierce Port Saint Lucie : _ Osdil' uc>le Co Total _ r • l�, 1 Other Locations TOTAL SERVED - 28 42 Number of Unduplicated Clients bv A e : :::{iiia• :.. . :.:jy;iiiw:i :i•:Lv: i` R . }.\;:::iii i�::ii: ::$:$ y ii:;L: : ::iiv:::: ~'?::i:� :`•''`'��: i p Aa�;::: . . Current Fiscal Year. .%:}.:,�;...;::;;,,;; ;, ; ,;; , ,:. ..}a:;::. :;:::::•::::.:.:•:::.:...:•: Sic; ;:: •`:``:}::�+;{:::'t:2':r::: :; ;:::;: Location it > v Budget 2003/04 t0 . . . . . ::::::. . . . . . . . . . . . .. . . ::> . dividual Group " : IEv: dual>A < :div P _ .,: . ... € 0 to 4 - Pre- school 5 to 10 - (Elementary) 11 to 14 - Middle 15 to 18 - (High School Total Children 19 to 59 - Adults - - 28 7 42 8 60 + Seniors Total Adults - - 28 7 42 8 TOTAL SERVED - - 28 7 42 8 zz y 10 1 a. / moi . r int _ } : w3 c.� E � #. Le, y �. - : hr ��H, •WeLt+V • jt 2�t6SY ":r.+'�"`t Z i r z i a mob. � •' ? 'S « § " 7 � s`,�. .� . r ' " The Center for Emotional and Behavioral Health(rt)IRMH — Parenting Education Group — IRC- CSAC I. BUDGET FORMS - To open the Budget Forms, please double- click on the icon below. �} rt Y ,s • i f^ reIf �y li.P. .N f✓- dry .1' tir i _ r . ^' `"„ •sr •! � � i I �?7S � a it 'm t s , i � a k 1 �� �+ " '" .' ) 4t ay.. Y"" : '. t + f'tw + i )` ,9r A fASr r s4• , AFF IN S) riu ' A' T r!H ?rkf � ntti«• !� I if $ rt,a" m SU, � °. ^.. t �` ` Y rG e ' •. . J 1� e '�`.n x. � rt " � ' CEBHOIRMW Paredrg Edumfon Groep UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide detaifs to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be inked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : CEBH@IRMH/ Parenting Education Group FUNDER : IRC-CSAC CAUTIOIV • Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should Abe used for calculations 'and to write Infonti adore ophr, 01 5f ,! .:.Y.Y:r.y}); :;'•Y 'r}}:•�hY::Yr}.-},.:f--Y . . . . x:x . v.Y v::nY .. • .jp. x '�r•1 YY:v: At;:: } ,xi fv�li.,f .••r jr •Yr::. rrv;Yx.�ry}ytoo}Ji i}}}:S . . . . . . . . . .yfa. Y:P'-S'• •:G,r is yr;•: r ff. v/.. . { . .v f. :f.::.J+/. . . . . . . . : •. :�S ?Y->v:jri} : tiiri}ii'n-:.vv::f p:j f. v-:,:ry.: -: . . r . Y.PMC�*61t.E: . . . . . . . . . . . .. . . . . . ,_..,. .r,-•,,e, , o4J. . r}a. .. o .. .:. . . r: . . :nl�...x . r . . .tr :. . •' . • {.JY• � •:- "{` , }}��„, '{� }. . . . . . . . . . . . . :: . . . .. . . . :. . . -. . J'r . .. . . ... . +} �: .::iG::.;;{.;;4;:;Y::.. ; 'r{ ' ;a;;y ;Y::?%:r}:?'i:::• }::R} •}}':J;Y:• k• r:. ;G.-ff {f.. /:?if . .. .: n - ? : 1. ::yru . . {:: :: - • {Sx}xY:}r}:x!} < }? _:J}}.}•:_t}., . ?: . , :'s.t 1ii3�:Aiirlf:. t., .; .- ., .i.'vx/ k: . . ,. .Y . .:::. rri:• :}f.G Y,' -::Y.'f f: ..f : :rG x.Yr:.Y.Yr:::. . //. .r: :f. r.x-:Y m:. r .Y::- •:•f.•• ,-.-.�.•. • •.-.•.. . .- :: .:f. : ?n ?�+J��.j ;"4..,.. .../ > . :+} . } �r.{c . :f. n . •.r..+ .{:Y:r<Y:. fes. . .it .. G..x. r...rf. . -'t•.{T.vx{:} ,. rr .. . . .. : •!?r7:i/.I :r•- ., ::v :ry, }'•Y..;:.}.i,.w,: 4F.:J.�:1•-�-r'.�i.. •I. -. . : /R: .. Gv. ' '•$ t i}i. .vn.vn4 :n-.v: .::.v. r ..- . .. . f . .. .} v:• ::}•.•f n:�. . Y. . fvn :. :. f: {•: . G' Y vrr.}Y}.. .4r. 3,.... ., i�r:: . . .. . . v-. .}}. . N .v�r:t•. -lr /. •: r : ::r.±l.:vv rfn�r. n } :: .�+�� �j�{p�•`. . :-$:+�. {y�,�,} :. �: Jr < �., `" :'_ .. :-, . : r+G . ,C: 1•:.w . . - :: ,xSl� t r . r - . .. . . n 4:��r ��•� .v{vr.; . ..r •.vv:• t:n� ; :.,-::.Y. ...,-.Yr. rr.f . w: , .' . :.v.... . '..v r... . . . . . . . . . ..v . . . . . . . — icy 1r �• Q/ �=i:•-: K{.. � J�-r{::Sv}viii:. -:(• . f/.•�Y:nrr . .. :n :. . ..r . � . fT:::: •.J:frn .- . :. .}yyv : vr;T T=J;;,.rrr Y•�� : : ... . :fr. .. .. . r iry ....:. . . ..x . J R . .. ....-.t... rr•.Y . . . :. . -: . $ •}'}; ... - . .{v? :,iif-J•r.^G.Yr:'�'•r-: �y/{��""pp��.t,{4}:; :: ::.rn}:xr:,r.; :•:•:• •r.:ti:::::::. :}!.Y }-:. . m :��} { • . $: :{ �[ :. }. rY . . vdv d ..f.. .Y , � }.- n.: r.:•S�•S:•-'.J��.:..;.:.•.Gf.-:::::.Y. . . • •. :.r::::n}}•:::.};.?:fr :.n f>:. %{•;>;{?.: '� r . : : . .%� . . . . . . . . . .. .. . . .. J-•r}iti::-:. . :. r$:.� v . . . . f,Yvn: nom.:n.. :.. , -w •.vr:xvir-.:{}:$.: ..Y{•. S}htv:G:•: is{i}'r '•}}} ' ' ' ' 1 Children's Services CouncilSL Lucie ` 2 Children's Services Council-Martin f•�f {;rx 5 3 Advisory Committee4ndian River 5600.00 5,6W.00 15205.0 4 United WaySL Lucie County r r ' r4%r. iY •; 5 United Way-Martin County ��%%.;•:�;::?,• Y. . ... n:, 6 United Way4ndian River County 7 Department of Children & Families f• >.'•x z r ' SF J S` 8 County Funds 9y4 }yfer 9 Contributions-Cash �, . .• Program Fee$` '„- '"" 6t700,11M.00 ' t �x'11 Fund, Raising Events-Nets f{f A ` n a,FsCSry �a" a" = -�.� : " z ' +� a�m5 ' : 12 Sales to Public°* Net . x}f ' 4 , h • . � 13 Membership 14 Investment Income 15 Miscellaneous • 16 Legacies 8 Bequests 2 Doo 17 Funds from Other Sources 18 Reserve Funds Used for Operating 19 in4Vnd Donations - IRMH 39527.00 20 TOTAL REVENUES doesn'tinclude One 19 - y $516M.00 $5,600.00 $6,854,605.07 `e • L ' L. . .t}}:•:. . . YY'•Yii•:•}:•:-:Gn. . . . t ::. ' . •Y-:-y.:.Y.Y:.Y:.. .r:: •::::..:: • :v: •:: :.: :.,v.:::Y -:. :Yn ... . . . . . . . . . . . . . . . . . . . .. . . {ti SS- ?n.Y.} . : •.Y..v}: . ::. : n . .Y. t •r: r-•:::::::•::}}}Y.:}}y{;. .t....., ..5: n. . . . . . . . . . . i.. .•.T:f.%JY-:..f:�:•:.}•:.; : ..: . . l r: ... .::. /.....n•.,.::::r..:i.}:i•:S :• :•: :•:::: ?•i}}''::- -:::::r: - . . . .- :4:::rn:':`':•}:':v ?•. •: : -.Y v .tv •.Y !. . r. : ••:::.•:::•::::::..:v .. n. . : .Y.v:.:: . ... r. . . . .. . .. . . . . . ... .. .. .. . .. . . . .r. r .... :-.. . .v-:. . ..--r.::. v. . r. .,. . .Y .. .. . :�l. . . : . . . - t. ... . ... : v:.: . ; . . .. .}. . . : n.....:..:... ... :.,-:. iv... ..xr r .. . . . . . ... r .... . ::. :J:G;•.:Y:::::.:Y -. : }Y.{:Y:- '•::,-:? r:.. : : x.Y. - . . . -. . . . ,..: :rr:.Y:-.v. r .. .. . . .. y.:.: n..,.-.. .v.. .-. .. . . . .::::r.•.:Y:.Y: . . . . . . . .. . . . . . . .. . . r •::: -Y:•}:.:;:{{.;f.{GiiX :- ::. :r . •:. .r: v:.::.:. , }. . . . ::::::• -:::n::•:::f.•rf,.:.}}} r.:::.,-:.-:n:S ::-Y:�.:;.r.: .r..-.r. : .:: 'Y•:::: •:r . . . :-r: . .:::.:.Y::::.:Y.Y -.Y: . . . . . .. . .::. . . . . .. f. .n:::::}. .. ,. . . .rJ.} : } . ::w: .:Y.v: .: : . . .. . . . . .. .,.x. ..r-.. .. m. . ..- . : :•::n;..v...,:. f.:.,.-. :-.., .::v-:•r. .. .-.. .- . r zR7lK. TANG:. ` . . . Y:x.,:•:Y: . . .,..,. .: :.Y._:?•::-:.:nY::>: -. : .::tr.-:::::•.:Y::.::n.Y. :•:.: ::. ::..,•: . l7lt`�f3fiE ..:.. •:f:'::Y-:;;•:•::: .Y:. r::.Y:Y.::Y::.:Y:.};.Yf:. :. .. -. .: .:: -:::'•:.Y - . . r'' r-' is r: : . . . . .Y.Y:::. 3- . ... .. .t, .. . . :. n . :: ::•::: :. ?,. . . . .. . . . . . r. . . . .-.. f. . . .. . . . n.. . . . . . -:.::r•}. }}y�. .�TJltl�.l� . . � :.;Y::.: . . .. . . .: .:.: . . . �::::::•::::+.•J}::•;}:{4%:: ::`•J G:: �µ v -::: •::::::.. . . .:::. •rr.:::{:ti•:'.:4f•:Y1'•:: •:-.::}:.:•::n+•::•::.-.}:;.Y::•:.Y.v. :•. . ... . . ... .v:.i: �f•'r::::::. . ::. :v :: �.Y::: • '� :.v.. ...... .:...r. .:r.ri. - . .. : . . . . :....r. � •:J•YF:::•::-::. �µll •::f.::•�i• .}Y�i},}_.},:•i f'f.^::{ry :., .S;.vxvy:.Y::: v .,-ir ,Y . . . . r. . : ..v. :... ....... .3 :. :.. : :.. . . ..-. i:. Y{•J;.r.}:..v-n:3i r :r}}, •:: .. ,..t r. r. . . . .. .. --. .... . {: . . ,. . .r • . ../'::i{jj . .: . . ... . .. . . ... .. . :. . r. .. .4.:,. ,. . . . . . r. . .:n:YrY••f:{: Y:::•Y:.Y::nY} .::-: Y: . . •.Y}}nY . . ..nn . Y.Y- Y.Y . ,. ,-. . .. .. . ,:. . .. . . . . . . . :. . . . . . . . . . .- . . .. . . . . -. �- . . .. :.r.-.-. .. .-:. . - �.-::: .. . . . . . . . . . . . . .. .. . . . .. - ,Y - 21 Salaries - (must complete chart on next•page) :G: :}:?'{ : :}::t•JJ:•:}}:•: 2 999.36 3,551 ,44721 •Y}:'•} }';•YYY : }:}Y � - ' 2 F-:. .; /. : :n':•i :.5}::•}YYf{4:.} • S•::.,•.Yf•::f. - ,.., . . :. ::: Y . . . . .,YY 999.36 Y:^.::2x r. -. } ....n .. :. .. . 24::.,-.Y :: •.r. ....t:. : . ... . . . . . . . . .. ::••. . . . . .Y::. :•:i-S::'{v;}::9-r•Y':{•Y'-Y}:•}:{•JY'•}'.::J' }}}J': :.: ::.Y:::. :.::Y:::::. :::::.Y .: . . . . . . . . . . . . . . . tn. . .:nYn... . . . . . . .. . . . ..r.:.. s . :tt•.Y . ... . . . . . . . ... . . .. . . . . . .. :. ::: •::::::: ... .,r.Y::::::::::: -::::::::.: ::::: ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n{..--r'•":r "•:r:r::• •;,;.}4..{:•.Y:l.,-s� . .:n•Fir •::..�.:v.-.,,ry. .i�:.;nt .:J-:: •: -:•.. :.Y::::-Y.v,--:::{}{}?:.^:- .:. .. . . :.r. ... . . :v : . ...... . ... . . .. . -. -. ..» ::::::n•-:: - < .: : n .: v- �.J.•.Y•:.v-::vt . :. n,: . ./. . .J. f . Y . . ..... . .:rv..--v.iv.J:. . .. . . . . -- r.. .. . .. . . . . . .. . . ...:.:. . ..v-. . . ... ... . ...... - - - .. . .. I. f.•'f{r.}};...-. {i-}J: ::f:Y: :.:5-:i?{.}'i.YS J:r }.} 41 to ..t?:f:Y}:}i:v. .-. :, v� w.Y:r rex .. vv.:v.Y v: •I .:tiS:i. .G:. . . . is}:n.Ji}}ir•Y::.} :. . . . . . . . . : . ::}ti} :G::}Yh:Y:.,v; . ;, '-'SSG:•t{gvif%:{> rri{•x ,. . . .. . -. . : :.vv-. ;Y..Y.:Y.Y..-:::. r. -. ....v:•. .::::n.Y':•:+:. . . . . :. :.::. ' Sti{ `. :Yffj : - N..:::::. . . . . .. . . : .{.:::{-.v:::rr:-v.:.t-..,-.tom..-t. . -. . . . . . . . . . . . r.- . -.. .::Y:YYx .. . .-.: . . . -.t .. .::: Y• x:-:.::Y:•} r{•Y:::t•.::Y:-Y::--Y:-:-:Y:.:.rlr::{G::'i'i : �:i::i `;: :;- . . .. . . . . .. . . .: . . . 22 FICA Total salaries 'z 0.0765 229.45 2245 271 ,685.71 e icemen - Annualpension or qua i i :r<. ;> r• • 23 staff f d 83 144.27 144.27 170,624.61 Life/Health Ica en a - erm . . . .:}.Y::n:Y: :: 24 Disab. 487.40 487.4 5770110.17 Workers compensation - employees x 25 rate C.7 y 53.09 53.09 629860.62 ' on a nemp oy en - projected 26 employees x $7,000 x UCT-6 rate # , 14.40 14.40 176046.95 w4x � 7a Y F`'�� # ' ° ;atm. '% ' nor h +"• `%4 � � r P yya�+ 9 �{.=ka�' �y� fi r ��'�'^ �}• `�%`t� < � '' r� �- y, .if "a _ a •:� '= :'w�^ter \,;.y % ., {. . ' n 5 Y r: • ,t �� y r .. ... w . . r � -rp f .f 7. - ♦ �. ". � �"Y ':. . . t w n ^ •�� l. . ,"f F,.. • . S R 4 �'.0\r �� . M? . •,t , .� - a l �f �lil 4 til �¢ p s� pp � ( fit (� COO C C C C G G C G C C O C C O O G O C Ntneq Q � O Of 17 ' ++ r ' ` ' ' 0x. . . N: ., : . . : w4.y: .,+y`$}i}'ih�^}S{,}tii �•.'::• };?::} 7�1: Q � ` �g'.�dg.5 ' -, `-ox- Y y s x . .h44 : Y V' Y a• 5 �• s� i i ' q ':uY, z .:}`i �;„:•CFC: '•. {iT: : •s a J'l. �C ?,�;,y°" ., i"•, tet' "�' € �-i :. :. :. .. . . ::• ::,::.:•: •. ::{•: - .. ,• � iF.'}�,'Fti \22{2?:�i':St :Y}} : 7 L ., .;F. . .. . . c Qf • L • �y� � •}} , . M1 •x �J tiL: Y: ' N •r 4 .�R� : `iS'f:i::'•?S• 'Sf>: ipp : .'1} ....ovSY :.T:.:•SS: • F}r+.•.YCO} }e u �R7 �y t7 ��^{. • ':;a::::: :} (( >.�tiy{:`{{? }p.•:;{i{.•Sl:':F � ��' n � - t• pd _ [:}:Y.• :;:i ; S M•.4}•r 4 C . J. � N �a9 C F}}• S:� N a F: nmm ,,i}i}..��.. { F'ti ',•: : O , tir}: F} ,,gy�pp,, �} la}�' ” 4 x/':: _'•:F�{c.YF{:; <' r '�{},; .t.. qV;;tf; .: firs' th R LI*;<' W C iTPt{}}:i{Q?:a4 '�F:•:? >:''} .S. a+>;f:;: FFpiFi:{•':j? :;:;: :: .f7 k . .. C} f eyg. ? ^{^, 'r;^,'`@:{°;:•:.::: :}� v g g o g g G p C C p p o o p fn - A .> :.:; }: 'a:'•:•}w;:`•:aS '; {{�'"44\�tk+ . {:�: �:S}:, :^: S S O S a ^ i • { <, ,,; :; :; ai o o c 0 0 0 0 o 0 o 0 0 0 0 o 0 0 0 0 nPt r. "Y. ;41.1\ 4{:;L•''.' ji$•}}:•':} �5.,.;: t' aY.. . d' }:;�t•},}. ,y Ln '.}K,v:•::5: 61► ... hs:r+4' , i {v •. �l •f 1 •: 4 r- to ;<Yi:ii: ------- ;; 'Qf r r � •'•:{•}. '.}Y •.•.; •::.y:•;::.. p p ="SI' ...x�s} . . ',iot'. . W '>:•:ti'.;ti :$$:t:• ;• {. N k :LS}S�}. ::;5'+SLr.SSf}itiU :i • .? M O O fD -51 :;;zC::•: ^;>: �` :. Ct}{;• : M1Y: ri 00000000000000000do rn :. ., . x :. Y V) '� � �R`. �/�y/�j�)r � y4{;i{41l : l fF •l!'}}{: ., .; � � � F �}: •. a!n.. ''� 3 .5 r+ '.Z d;.. . 4• :`� , • ::{?,:,Y,. l ; :t� � T N ; . . .1Y:• , • .. . _ ' F ' r '' r• \h} yvS: .:Y; , � q "�C,S'�}, •. .: ; Sa: : � d .qa. ' :.•::.}}}:•e. .�;C:j�:: a3: - ;� r:,� f, ..`. a'- f '..' ��+} Y .J:gV,.;{}'ti°: Fi' ti}v.}• is >�4 q+y 'y,,"��-yy;��j. At L ti;Y1 }i ' %9A ,{, } +}:: •.ltiv,:}. .•} '<.wn•. S e .. . ::.{Y:f'}:. :r r p F _?• ' ''J:; LN'4'lh1J%y.V}JA',;5:',v,:;: S:{{. y C •• • �. . . �• � :`u' Y ?:,,' 't,T;ii�. is ; } 'r}}: '{• .,\ r. ' l tiL . } •: Y/• P u • 4 �Y ff$' 4 Mx X +r ' dr ls;r •{. . .$},: 1/, ' `x•.F}JF'• F:,'+ CI .•il .Y. .''a'p fi C Y W .35 �n . k ' a} y Y . I, � r i a a {{yy {::{F•{:?5;: . Lyt . .}}:• }*: r t> . >, -Z {S. ,`� '\. '••?^: hj a - .�.. {L ::}:}ii h . ; {O \5: {T, 't•: : :TY: 'Zi'',y t '`fi"; �Y s.A . . ? :F L a •?,: }Ni,:•:�„} •. :$: y ,n » . i. ;. 3 Y7;.`.: '1•x 1b' ; . ? '•}.v •. �. .c:�:? ':"i •} . xx. \ • M1� ,4}}• M1 ;ti ,, gar i $ '}�'"S{:4: ' {{: :FLt: � R - :: fl %� \ %q±ik ?`$5•• Tti r .} .7 1d:'�i;• �i .�h �;:�!:i}{3S } �j � O .2:<• a;"r.:yS{ f :. 3 _ Ldws .9' y`, . . .} : . >. . � ';L'. �. : 4 • ; ��•JF`41.} ;n`VW::; � O ` t' a �" ;" - :�,L••:}F:• :ivarr I IN oopooo00000000000000 e co rg co arn. r"-Co m O � M - z m wo rn 0 0 .01 > M It mi —1 owl c a CD 0 1 SC 0 M 0 C C) p m 0 I I a) 0 CD CC) m 1 972 - 0 I e ul 0 PU 0, 19 4MV I� CL -0 CD M 0 M (D 14 0 LAO . . . . . . . . . . . . . . 0 ez 0 CD rV, (D C) a 0 (D 0 :3 :3 69 0 < CL m ID X 3 0 A4 " 2 m m r, rIr 1 0 1 % 44 (a X r I I I (A A) Cal M M a) 1 0 US 0 I � IS "' § - � A o TI 13 (D 0 R =:I @ 0 I I m r 1 00 .67 m x (A cr. m 0 469 x C) -0 0 m (A PZ 0 Sp 0 0 v,7", 4n 13 0.1 1 1 It t 3 1 0 1 1 )c x AU (D 4 It I X ... . . . . . . . ... . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . ... .... . m .... . . . . . . . . . . . . %%,0:::: Ie .... ................. . . :.. ... .. ... ... I I . 4 lk . N X :m: 1 7,, ... I I I I I I I I I I I I ... Ye. . . X%N� 4;S�N�- .. .... ... ... ... ... ... ... �'44 ; e- X : Ln . . . . . . . . . . ........ . ... ... ... ..... .. ... ... ... ... . ... ... .. . . . . . . . . . . . . . . . . . . . . . . . 2 "%"% .. . . . . . .% .... . . . . . Ul lob . . . . . . . . . . ... ..... XX . . . . . . . . . . . . . . .X X X.. X:X�$ x moo ol r: q p vv:. •;: N t h O :{:is••x:: ^ ' ♦\:1v; . . \,• • In •.;Lnt '.•:<::; N N i}:iC 4: : r :•1 K•':iL'}v:{k.;.}vT f� k::{: . \h § h` f0 ?: h > .x;\;+ .;%::{vv 4:< .:•:}T::f : •Y: .. :,t : c -:r •+: yy ]: to i 'C " +.:v::r T+::: O N :{t};+.;:.; 'tiff;S:;:;:1•v.?,•:2 :rSt;: k: +• }; _ .. " `'•'fi `'%` : r (p ::{i•: ;.i};;:4{ Y2{3`L;;tijl.: . ; 3>S}+:{ •V' L}• .,; (9 ."•j �atiiv{•i: �— p::f, }:: N y}1,i: +4}i }k •i^:{n;h• x. ,t rr I IA . . vii k}Y}+,.}y..+,::• tk�:it:• vK \ + + , : M �'Ar. . x , � ' - L-er •: •}:•: +`ytititi�{:: vrv};}\:•:•'vi::n i3}i v :k r ,Si` •k, H d Yd :.3; •. Jr. s4e Jr O s:"� S E: p O ; O : O ti:9kk::?;:;•3:}.,t,•: C .T;•.,•>.1..� O k:}}• 4 �:'t{kkkY}} ca> Stiy,::.`.3+:•}: •xo}T:•}::' N r :•:•}i:•.`:.{S:v{}{; \�:h;}tiff;{: 1:$$ t . }. . f. . .: h t. rJ rZIV§r 1 ,0 rr . iir . . S x.s O tai.•{.ii{'+.ti:T}Tp};.;}:.,. N .:•:\:3;< ::•::Ti 17; moi'"`:+ asz. . • .l . n �p� .., Q. C.N. }::{•Y:}: h':K•}}u:'•n{ . Kxk•+ :: 4X5'• . :V•..e •M�: :•:}::v •};. '{•tir ♦; •+:L:+:tt� '•. +: :1.ti ;h1- ^tit.@= - O :i )'r: :ti::\:}.:ki: i •'it:v \M1v. iv{•y {: . ?{5 ! . K �< }, '4& _:3 ..y. ti:..,? .::: ?i:{ :♦\1} } nn3.iv${i �nv :{ Y 6 •:•!'. 'u • ...1i,+ ' : ;'' tiff}�^:;>}:;: f v •r:::: .:':j::t; ti::}v:3: j' ,k`•:`,S+.ti}n{{'i. .?v 1�1 `f\viv 4 . Ma v ".:" • y { {::}:;;.: yy% <ft}tK!Y :2::ii {b )ft - . _ 8: , : 1'i ::: {: .; v •.S?i}k} '`{i•`4n• •:{S•. vM1?tAd. 't-X? tt#; ,' • ^ ` „ ^.v\v ♦ t4s C n . . . . . }:{ :. . 1. . . . . . :::. . ::.:. ;.o:?'1k�i\ �}k :. \ 3�t iF' ii z - 'i • g" i..',' -i. A v{tikkT jyki :k•,ti , : ;; :%;'.,tv,L 3+.�: \ .yl"' :.L}y ; •}i., .}., v, +,. w•• k1v' 3 : 1 : � w .�.e b�. _. ' A CL ;itti{;:•,::kv: ^::.};;{• j2titi ..:.,yn`}}}n3iti 1•'•. }\, t . L {:ti.v v '+•:;ti: :; y: ?K{•..♦'\M1+' f i. C . .h 1 ra ..5 , `%�+ r,. +i� :r�; ",".e` t^tititi i:ii: \ 13 T.} k+rt ;, h,+ti ; :a Gy : .✓` `� 4, _i ' . xQ - p� ]? .�{}.}} ';4' O\\,n;{},:; 4 \i4,; •. 3 t .i ✓• , aX`X, k1s m` � a + °'' .} P y� 4 q s ,f b� k. m .Y:\ft ?+}::j•}}}: n }. x:}:u: ':•:} •.}}} ::. Y! ;. ,.S}: n. .. } •:\• KSv.v: r .vxw•+: {•] :S:m:t}:3; ::;;•. . :. . . rv :;. . • uir,•:.� . . . . � }!}:�:0 :;:; W., yv.: . . . . ... . .. .ti^., r.s M. �' ::::::::..... . . . . . . . . :::.::.}:3:• . . . . .v ^: i:r•:::::::::. x{' .:,. l;k• . . • r . :kV . . . Tr. Y}:... .:: .}::fiT,:; _ • .;t'y _ ':4 ?';. (.1 :.;.: . . . ..:u.: ♦:.:{n ..3::: ::. • •U.v; !:. :•. 4.t :u. . {{ • •, {Y.M1M1. . :. t .{ .::::{::: . v:. ':.v,• ; , :• . �e { , Y� f: •r:x+;•i+:::;: . , . . . •. .x }l . . . . . .YY}'•i •::: . . }. . . }k . .3.3..+ :}::: + : ¢: •.} l .: . . . . . •:3'?{•. . . . . . { .t :vi6*: ';F • ` 1• •Y:;:;}:::•::.�:{ .}:•:.}•:. . . . .�{.}; .�•::T::.t: ;. . • }:{: ::n•:::::: :n.+`} •n.::;}3 ,k}:?;}:<}?};. ;XnQ{Si: •}}}? ,Y . . . .. .. . p . k• , ?:yt k.,;..tk:]v: ` iti•:fS '}}}:: .:n�,.i !! }\�}: . •4+n+. L , :v!.{ . . k . : '4, ... " 'C .`�• 4107°,.. • 'ti•}}}'•�3:?• +•;• ' :...`}•: Y•`•Y}.} . . Yfiv:• : .2,`v;:•7 } '.�"`�zx 5.,.< r�� . y.. : . . . : •. k:<ti± ? t:{:;:n. ;Ay ' l ::,l,::,v;:3 :it j•,:•2i. . . .v r ..+63 . ;}:•:Gi;: : :;.2:;`.; . ; .} k:: :::: }K•:{ ,q{]$;•) tis:.'?3:k::: ')j}t^: :a;. ;;ni' -,. • itvvi {:}.:{ �:kkttia: ;: r3:; :•YkYR: !:.'!y,•'r:.S}}+i}.•;.1.3}: .3 .1.}h,`,\:rY:nv ::, v .}} . S �ti•.ivkki"v • t• nv.v :•:::: ::\ :•n• • •. •: tn3: •+. i • ' 3:• a •:}y{3;•:•.:i: ' . .:}.!: :? \ v:3.:3• •. 4 ; . }(?.:ti ., v+ pt { - , i~•s. {{•. . . n na . . . . i'ii}•::;:.}•:::::. :k]::titi�tti•.•::k: �'{{{•}}}:. :.i. l.;SkY . . . . . . ! T . . . . . . :rl. . . . :vt. .0 },., .;.}v:4' ::::. . . . . . . . . . . • •: . •}:::: . ::.Lv:::. .}:!:}:3:: ih .}! + {r v .n}:} , t :iiia}:!•}:•}:•} .: :.: . . . •;}rti:{ !: }:.3, {::T.;.\.:: ): . ,'k. ;; .S.{y. !Ra :ie: } ` C. .FYI: :,NJ ' '.'•'ht;:::;:iki? ';:.i.; . }. :. .;•;j;.;:r,;.,:a<:;: : :i.. .ln• v :ui.,•..R•. •.v }. v - t, ro + • Z t _ _ IrI .161 N $ 10 C Q Ol rrr K _LU rr er Cyt S co r c x U c c a Q %rrgq{.. o D yZxt avQy m a �� , a} LU = i E d r r �+ �+ x � a c E X. + � � • +'%.. 'tc. . ' {.7 w• � . V �r 7" �r ?� r4 `gyp a 'w 1 k u i + fitIr 1 .' ::x 7 a .;i•.ip i •A.. + �{ w.; k.. " ' L j},b s ' , ' ` i ,-, a UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME.CEBH IRMHI Parenting Education Group FY 01!03 FY 03/04 FY 04105 % INCREASE FYfL9130/2003 FYE 9/3012004 FYE�.9/3012005_ CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (c°L C-c°I. Bycot 6 REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0,00 #DIV/Ol 2 Children's Services Council-Martin 0.00 #DIV/01 3 AdvisoryCommittee-Indian River 20,000,00 24 445.00 152 605.07 524.28% S 4 United Wa t Lucie County0.00 #DN/0! 5 United Way-Martin County 0.00 #DN/01 6 United Wa -Indian River County0.00 #DN/Ol 7 Department of Children-& Families 0,00 #DN/O! e CountyFunds • , 0.00 #DNJ01 9 Contributions ash 0.00 #DN/OI 10 Program Fees 6 931 136.00 6 900 000,00 617001000,00 -2,90% 11 Fund Raisin Events-Net 0.00 #DN/O! 12 Sales to Public-Net , ;: � '•sia 0.00 #DIV/Ol 13 Membership Dues 0.00 #DN/O! ' 14 Investment Income 0,00 #DIV/01 15 Miscellaneous 0.00 #DN/Ol 1s Legacies & Bequests 21000.00 #DN/0! 17 Funds from Other Sources 0.00 #DNlO! 18 Reserve Funds Used for Operating 19 In-Kind Donations pact iw wed in iota) > 0.00 #DN/O! 000 #DIV/01 Y 20 TOTAL 69619136,00 619249445.00 6,854 605 07 4 .01 % " " - Y : t 1 f r }� ,,,t t,vr 1/t tt o• ::;:z;'.•::•:.::•::.,:{. :�. . . .. . . . . . r. . .. . . . .. . .... . . . . . . . .. . .... ... ..:. .. . .. . .. . :... .. . .. . .:.:=:•??�? iii w:•. ,�....•.•.:x.•.•.�::.•.•:fw:. :.:,tf'•:}:::iifil-:i ::{:4:iti-i:ff.: :iii•:nj_: :i ?�_: ii::i.,v`r!.{L :. ' EXPENDITURES • 21 Salaries =z 3 446,298.00 3A48,007,00 3551 447 21 3.00% ' 2 FICA .. . 240 .00 w ? 263 902.00 271 685.71 x�as . . * ~ 2.95% 23 Retirement , - . =: r : 165 766,93 165 849.14 170 824.61 3.00% 24 Life/liealth . F 560 023A3 560 301 .14 677110.17 3,00% 25 Workers Compensation 60 999,47 61 029.72 6286062 3.001/ 26 Florida Unemployment ` 16 542.23 16,550.43 17 046,95 3.00% 27 Travel-Daily 21389.00 21559.00 21635,77 3.00% 2e Travel/Conferences/Training 49,649.00 49 649.00 50,035.64 0.98% 29 Office Supplies 47,051 .00 48v249.001 48 249.00 0.00% 30 Telephone 42157.02 43 460.85 449805.OD 3.09% 31 Postage/Shipping19647.00 11638,00 11638,00 0.00% 32 Utilities 66182.00 6170000 66 636.00 8.00% 33 Occupancy (Building & Grounds 11135,899.00 119971200 1 ,121 909,12 0.20% 34 Printing & Publications 3145,00 333100 31464.24 4.001. 35 Subscrition/Dues/Membershi s 19706.00 152400 11524.530 0.00% 36 Insurance 390 200.00 355 200.00 360 000.00 1 .35°k 37 E ui ment:Rental & Maintenance 81614.00 9 650.00 965000 0.00% 38 Advertising 4 996.00 51000.00 6000.00 0.00% 39 Equipment Purchases:Ca ital Expense 13115.00 1755700 1755700 0,00% 40 Professional Fees (Legal, Consulting) 303 850.00 303 850.00 303 653.00 -0.06%41 Books/Educational Materials 24,349,00 28 657,00 28,657.00 0.00% 42 Food & Nutrition 1179636.00 110,880.00 112 720.00 1 .66% 43 Administrative Costs 551 ,085.00 559,351 ,28 567,617.55 1 .48% 44 Audit Expense 0,00 0.00 0.00 #DN/O! 45 Specific Assistance to Individuals 0.00 0.00 0.00 #DIV/O! 46 Other/Miscellaneous 800.00 800.00 19575.00 96.88% 47 Other/Eontract 739,421 .00740 000.00 740 000.00 0.00% 46 TOTAL 7 993,676.09 7 978,307.56 8,138,301 .59 2,01 % . . . . 49 REVENUES OVER/ UNDER EXPENDITURES 41042,640.09 49053,862.56 -1 ,283,696.52 21 .81 % r • x• w~"'trrf4i ^ •{ Zv` '•) .c � 'k }� a •F ;"u` c¢R ez «+ ti• . x �' ° k' vn �.+ F:": . .''a y'v"3`t. � : jt ° �• i + 2' 1 Na - � , . t - '-�`^' r S , r d , , . .•�-• t,, � � e h x s� siXA }y CESH MM" Pffft*V Edwelan Cn p UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME:CEBH IRMH/ Parenting Education Group FY 02103 FY 03104 FY 04105 % INCREASE FYE 9/30%1003 FYE 9/30/2004 FYE 9/30/2005 CURRENT VS. NEXT FY BUDGET A g C D ACTUAL TOTAL PROPOSED IcoL C.coL eycoL e REVENUES BUDGETED BUDGETED 1 Children's Services CouncilSt Lucie 0.00 #DIV/O! 2 Children's Services Council-Martin 0.00 #DIV/O! a Advisory Committee-Indian River 61600,00 #DN/O! 4 United Wa St Lucie County0.00 #DN/0l 5 United Way-Martin County0.00 #DN/0! % . United Way-Indian River County0.00 #DN/0! 7 Department of Children & Families 0.00 #DN/O! . 8 County Funds 0.00 #DN/0! 9 Contributions-Cash 0.00 #DN/Of 10 Program Fees 0.00 #DN/0! 'ii Fund Raising Events-Net �% 000 #DIVfOf . � Sales'toPulaliafVet 0.00 #DNJO! 13 Membership Dues 0.00 #DIV/O! 14 Investment Income - 0.00 #DN/01 15 Miscellaneous 0.00 #DN/O! N x`16 Legacies b nests 0.00 #DN/O! 17 Funds from Other Sources 0.00 #DIV/O! 1s Reserve Funds Used for Operating EE 0.00 #DNJO! 19 In-Kind Donations p&* bwks&dinlotal 39527.00 #DN/0l 20 0.00 = . M 0.00 51600.00 #DN/01 EXPENDITURES a 21 Sala k : 2,999.36 ' *DN/O! . , �� ..t: �2 FICA _ = '' . - . ' . " " ;, ~ ' • . 229A5 #=101 �z.23 Retirement"'= ' . 14427 #DIV/O! 24 Lifefi-leWtIvOrL - U7AO #DIV/01 25 Workers Compensation 53.09 #DIV/O! 2s Florida Unemployment 14.40 #DIV/01 27 Travel-Daily0.00 #DN/0! 2e TravellConferenceslTrainin 0.00 #DN/01 29 Office Supplies 200.00 #DIV/O! 3o Telephone 100.00 #DNIO! 31 PostaWShipping50.00 flt)IV101 32 Utilities 250.00 #DN/01 33 Occupancy (Building & Grounds 21600.00 #DIV/011 34 Printing & Publications 50.00 #DN/OI 35 Subscription/Dues/Members hips 100.00 #DN/O! . 36 Insurance , �,, 750.00 #DN10! 37 E ui ment:Rental & Maintenance 0.00 #DN/01 3, 38 Advertising i t„ , 0.00 #DN/01 39 E uI ment Purchases:Ca ital Expense 0.00 #DIV/O! - 40 Professional Fees (Legal, Consulting) 0.00 4#DIVIOI 41 Books/Educational Materials 200.00 #DIV10l 42 Food & Nutrition 0.00 ' #DIV/0t 43 Administrative Costs 1 ,000.00 #DIV/01 44 Audit Expense 0.00 #DIVIO! 45 Specific Assistance to Individuals 0.00 #DIV/01 46 Other/Miscellaneous 0.00 #DIVIO! 47 Other/Contract 0.00 #DIV/0! " - 46 TOTAL 0.00 0.00 91127.96 . #Dfvioi 49 REVENUES OVER/ UNDER EXPENDITURES 0.0010.00 -3$527.961 #DIV/O1 r . y Z t ' �, �. W -rte Y`.{a3 ` , � s "� a `. ' ` • *+a'' . .S e � .e Sr« 1V k . ) ax'I of �1 -0 r n e •: • ' XF w [ ° ' r '• . a +4 i �' � IR � � � i , M1 p `r«��• %9 I , 0.llr a ' ." F... r ..W.x < 4F ?h'�•}'e i n �g yy f , a CEBH@IRMW Parenting Education Group UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : CEBH@IRMH/ Parenting Education Group FUNDER : IRC - CSAC A B c FY 04/05 FY 04/05 % OF TOTAL FUNDER TOTAL VS. > _ PROGRAMI SPECIFIC FUNDER REQUEST Xf k4 ' s xxMrk' '' BUDGET BUDGET (col. B/col. A - R EXPENDITURE I IPA, 21 Salaries : ' `r`y 36 2,999 299936 100000% 22 22945 . . : ; 229.45 n ° 11 PP , /o " 100.00 23 Retirement V ; 144927 " 144.27 100.00% 24 Life/Health „ 487.40 . , ; 487AO 100.00% ' • `, Fe, 25 Workers Compensation 53.09 53 .09 100:00 /° , , - . 2s Florida Unemployment 14.40 14.40 100.00% I If } 27 Travel-0aia�.0 �� If O.DO p 28 TraveVConferenceslTrainin '.� � 0.00 0.00 #DNIOt ' 29 Office Su lies" ` jyfr�fl,ry 200 200.00 100, 000% , 3o TeleAiionIt ,� lie 100.00 100.00 100000% µ 31 Postage/Shipping " 50.00 50.00 100.00% 32 Utilities 250.00 500 .00 200.00% 33 Occupancy Building & Grounds ) 27500.00 822.04 32.88% 34 Printing & Publications 50.00 0 .00 0.00% 35 Subscription/Dues/Memberships 100.00 0.00 0.00% 36 Insurance ' 750.00 0.00 . 0.00% ` 37 E ul ment: Rental Maintenance "y ,4 0.00 0.00 #DN/01 4 : , p ; 3s Advertlsln 0.00 0 .00 #DN/01 39 E ui merit Purchases : Ca ital Expense 0.00 0.00 #DN/O ! . . Elm 40 Professional Fees Legal, Consuftfng 0 .00 0.00 #DN/0 ! 41 Books/Educational Materials 200 .00 0 .00 0.00% 42 Food & Nutrition 0.00 0.00 #DN/O ! 43 Administrative Costs 17000.00 0.00 0.00% 44 Audit Expense 0 .00 0 .00 #DN/01 45 S ecific Assistance to Individuals 0 .00 0.00 #DIV/01 46 Other/Miscellaneous 0.00 0 .00 #DN/Ol 47 Other/Contract 0.00 0 .00 #DN/OF . 48 TOTAL r x�VI,, ; 1 .w _ p, $ 9,127.96 $ 51600 00x61 .35% 1 . If �� � "1" E4 A 11 by t'}�� , ',- e$s ,x,� "� �a d :§e s '� �P. '�� }�'i.' +�},K�# ., �x w ��� '' ' �a, , �` +. .&- vr. ✓ a�. �'� {Ir�yn i 1 � {y �' w 0$/14/2004 E Pd• .. E E �, Via ' ,�� E� q ruxx r 4 YS S ' d r a s. : a • CEBH@R6kV Pww" EdwWion Group UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: CEBH@IRMH/ Parenting Education Group FUNDER: IRC - CSAC :' .. .. . . . . . .vZ.Y: n.v -.iai.•:.:nvn:i:`.i.;v. %%0R. . r#D[V/01 /01 /O! /0! 10, /0! vv...aa.::.::::.J.•:•i:-:::itii:i?i•:i?ii}ti{?ii:;•:xL:;.{i:nuv�.,��i:.{}$-::ti.;:^v•:r:•in:...i}vi.vJ;;.i.?};-?..v;:}:p.y;:;:r^{:ni4v.v.v:.`,.�v-. . . . : �. .. .. i. .1F.H. . . .f.'1. .i.:.7.{.I..' .i }. :. ...::�.i,i:.:}.:;i.vi`av•`.i?i:i.v^.^v:ivii}.:i:$•:i;?>i,;;?i:'r.ivi% .:..::.i>.::;:.vi:.}v:-v».;:;i.v::v::.:.,v;,:: :. .i•...'-,.:;.�..'.i:.n'vy:.:'t.nv.:`:;`:.::- : #avrol - #mvi0! #DN/O! �" #Dlvro! r� a _ #Drv/o1 �: #D1vro! #DIVroJ� rt ream , k`' : #Dlvro! I " #DIV/O1us3 K, w �. ' b os_ ,q •M.1i'� � rr;F : - x �r tea ,..:�x . x s J #DIV/01 #Dlvro! #DIVro! #on/101 . » '. r n i h #DIVro! y.. , 3 3 ;,. #DIVro r '& e '1` x .,+y, n`t s .'` � ��I'n"tk �' " „3;11$x�'kF'I• • fi #olvrol �� �' aln"! 3` Yr�.,y,yr 9 '�U•&'.I +��lk-'" �* ,. > .,£ �-,meq ��,t "b' tN '. #aero! #Gv10 #Dlvro! #DIVio1 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/0! #DN/0! #Dlvro! #DIV101 r #DIV/01 . #DN/0! '. t J y.,- s �: 1� �a r +�+' r "k •c', a � t '� 1 .. �� i. -• k �" ; �. '4s k t } y� �" �lha '�Tv + +.:? � IT, - ,tj `�? -, 'e ';' z. ' . x�' �'A. ' 1 , }M ' �hy�V 0$�l�/MM" Wk "4 `n( �.nt ' �' '�". ,•wyt- i .:5 e�tS. ,S w�� Z pI , d'' r r ,� "Y•q" ;£ ,. N ' ` dna, i "�q'a-yw-� xrrr'� S7, [ ax f J � mi C` y CESHOW""Prefft Educe°°n Group UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECOC BUDGET ' AGENCY/PROGRAM NAME: Center for Emotional & Behaviorial Health[ Parenting Class FUNDER: IRC - CSAC . ... lNtiw•' :4:i;:Y' ' .;{•,. .\•ui\•. .. .. .. .•.•{<i4Y141. .wv.:;j?ti.:.....:iyti. ....:{}u.:•:;•:•:<:;ti.:;•?:.:•:4li:J'•:v«;•:J.ri•} : .v . . .. •:4Y•14 4A;V M4 F4 �• • `4,2;4C'.2L4.`4444.XaG:•.4 #f:3� :.4>.x. o . 4,.: :.,.444 .• 4 4 .4. < 4•: 4444 a,:::::`; :x;::;4,-d.:s:.;•::.;4.;.r;;r•::.44;44•:.4.f.';'.;`y:' ., . . . . . .. . :. :..::.:: . . :. .. ... .:: :::.:.:::�-:•.::::•::,,...;,,,,a;:4.4,..4:::. :. 41��lF3N:'!.'•t >fi>.4it2 : . . .,, eW Salaries R vestin funds to cover more than 150 of P ram Costs FICA R uestin funds to cover more than 15911 of P ram Costs Retirement R uestin funds to cover more than 15° of ram Costs LifeMeatth K29uestinq funds to cover more than 15% of Program Costs Workers Compensation R i funds to cover more than 15% of Program Costs Florida Unem to enY- R uesting funds to cover more than 15% of Program Costs Office Sup Reg uesti funds to cover more than 15% of P ram Costs Tel hone '•r i _ " • , R "questing funds to cover more than 15% of ram Costs e Postagelshipping4?=3? ?t, �_ >. - Requesting funds to cover more than 15°/d of Program Costs Utilitiesltr. kw ama _ x - . .: : R funds to cover more than l56 of ram Costs Occu n (Building b Grounds) Ing funds to cover more than 15% of Program Costs #DIV/0! #DIV10I #DN10I #DIV/01 .;�z. ^� :vxrt #DIVIM #DN/0! " #DIV/ot & " #DI1//Ot tb � ' �4 +�iR.'fis�Y"�.� 'r � - �� �°. 1 : rr, .^zt�-': ���,3 ,s. r �yf•� , r #Dn/rot If 41 Ik �µ; A f al L .51 .4 91, <+ y r i s z If 91, 19 Ij 91 1 a r \ q {{ g \ �Cky �Irw- ' 'i'Se'Sr�v+ " �P .ty'� ti 'v' `- w �Y 'ACS" #p''� 4'fi �rtt?: � r4 ` . R '� � j A 4 •yw F:. `�,?r • y s .� * y^ '�� "3:T.., vow' y1Ah��' ri• T t+e � ns sy ' ' � 4 }( s A y14 119 31 v w e [ 1 1 e „1� r ry . a _ tr EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on February 19, 2002] " D . Nonprofit Agency Responsibilities After Award of Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example, no expenditures prior to October 1St may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year end ( September 30th) must be submitted on a timely basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year . This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expenses by type . These summaries should be broken down into salaries , benefits , supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a . Travel expenses for travel outside the County including but not limited to; mileage reimbursement, hotel rooms , meals , meal allowances, per Diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c . Any expenses not associated with the provision of the program for which the County has awarded funding . d . Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " - 1 - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices : Any notice , request, demand , consent , approval or other communication required or permitted by this Contract shall be given or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service; or mailed by registered or certified mail ( postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston-Carlson , Director Indian River County Human Services 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Mariamma Pyngolil , RN , Program Director Center for Emotional & Behavioral Health 1190371h Street Vero Beach , Florida 32960 2 . Venue; Choice of Law: The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida , only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties , shall be Indian River County, Florida for claims brought in state court , and the Southern District of Florida for those claims justifiable in federal court. 3 . Entirety of Agreement: This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability: In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other term and provision of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent, this Contract is deemed severable . 5 . Captions and Interpretations : Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless the context indicates otherwise, words importing the singular number include the plural number, and vice versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision , and control . 7 . Assignment . This Contract may not be assigned by the Recipient without the prior written consent of the County. - 1 - ACORD„ CERTIFICATIt OF LIABILITY INSURANCE OPID E DATE (MWDDNYYY) INDIA - 1 11 04 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Florida Hospital Assoc Ins Svc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1675 Terrell Mill Rd . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marietta GA 30067 Phone : 800 - 476 - 7601 Fax * 770w850 - 0988 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Admiral Insurance Co . INSURER O: American Autnnobils Ins . Co . Indian River Memorial Hospital Greg Morgan INSURER C: 1000 36tH Street INSURER D: Vero Beach FL 32960 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRE TYPE OF INSURANCE POLICYPOLICYNUMBER DATE 62 DATE IMIND LIMITS GENERAL LIABILITY f EACH OCCURRENCE $ $ 5 F 0 0 0 1 0 0 0 X X COMMERCIAL GENERAL LIABILITY CAPTIVE SIR 10 / 01 / 04 10 / 01 / 05 PREMISEBKhfrence i X CLAIMS MADE OCCUR MED EXP (Any one person) s PERSONAL d AoV INJURY $ $ 5 , 0 0 0 , 0 0 0 GENERAL AGGREGATE $ $ 1510001000 GENIL AGGREGATED 1 APPLIES PER PRODUCTS - COMP/OP AGG S $ 5 f 0 0 0 0 0 O 0 POLICY JECT LOC AVYOMOsILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) s $ 2 , 000 , 000 ALL OWNED AUTOS BODILY INJURY B X SCHEDULED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 (Per person) $ B X HIRED AUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 BODILY INJURY B X NON-OWNEDAUTOS MZA80833367 10 / 12 / 04 10 / 12 / 05 (Per accident) s PROPERTY DAMAGE s (Per accident) GARAGE LIABILITY AUTO ONLY . EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S E(CESSIUMBRELLA LIABILITY EACH OCCURRENCE $ $ 2 0 , 0 0 0 , 0 0 0 A OCCUR KICLAIMSMADE CRL - FLm10013 - 1002 - 03 10 / 12 / 04 11 / 01/ 05 AGGREGATE $ $ 20 , 000 , 000 Excess s DEDUCTIBLE Above SIR s RETENTION s $ 5M/ $ 15M $ WORKERS COMPENSATION AND EMPLOYER34 LIABILITY TORY LIMITS 1 ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT S OFFICERN GL48ER EXCLUDED? K yes, describe under E.L. DISEASE - EA EMPLOYE S SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holder is added as Additional Insured with respect to their interest in contract with the Named Insured . CERTIFICATE HOLDER CANCELLATION INDIANC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Indian River County IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1840 25th Street REPRE TATInS. _ Vero Beach FL 32960 AUT IZEDREPRE TA VE ACORD 25 (2001 /08) © ACORD CORPORATION 1988 u r M ACORD,,, CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MMOD/YYYY) INDIA - 1 11 / 04 / 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF IN FORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Florida Hospital Assoc Ins Svc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1675 Terrell Hill Rd . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Marietta GA 30067 Phone : 800 - 476 - 7601 Fax : 770 - 850 - 0988 INSURERS AFFORDING COVERAGE N= # INSURED INSURER A: Continental casualty Company INSURER B: Indian River Memorial Hospital Greg Morgan INSURER C: 1000 36th Street INSURER 11, Vero Beach FL 32960 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICY DATE MM/FE TIVE POLICY EXPIRATION D DATE MMI LIMITS GENERAL LIABILITY EACH OCCURRENCE f COMMERCIAL GENERAL LIABILITY VAMPREMISES Ea oceurence $ CLAIMS MADE OCCUR MED EXP (Any one person) S PERSONAL a ADV INJURY f GENERAL AGGREGATE f GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG f 1 "1POLICY Z'c LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) f HIRED AUTOS BODILY INJURY f NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE f (Peraoddent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC f AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABLITY EACH OCCURRENCE f OCCUR CLAIMS MADE AGGREGATE f S DEDUCTIBLE f RETENTION s f WORKERS COMPENSATION AND X TORY LIMITS ER _ A EMPLOYERS' LIABILITY yq- 7 2 8 5 8 8 4 3 8 01 / 01 / 04 ANY PROPRIETORIPARTNER/EXECUTNE 01 / 01/ 05 E.L. EACH ACCIDENT f $ 1 or0 0 0 f 0 0 0 If yyeeFss#C�be E�CLUDEDT E.L. DISEASE • EA EMPLO $ $ 1F0001000 SPECIALPROVISIONS below E.L, DISEASE • POLICY LIMIT S $ 1 , 000 , 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Proof of coverage for above Named Insured , CERTIFICATE HOLDER CANCELLATION INDIANC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO So SHALL Indian River County IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1840 25th Street REPRE TATIV.ES. Vero Beach FL 32960 AUT IZEDMPRE TA VE ACORD 25 (2001 /08) _ © ACORD CORPORATION 1988 Internal Revenue Service District Director Department of the Treasury [)ate: 'WR 2 6 1985 Employer Identification Number. 59- 2496294 Accounting period Ending: September 30 Form 990 Required: ® Yes I] No Indian River Memorial Hospital , Inc . 1000 36th Street Person to contact: Vero Beach , FL 32960 Brenda Wilcox/cdt Contact Telephone Number. (404) 221 - 4516 File Folder Number : 580062333 Dear Applicant ; Based on information supplied '. and in your application for recognition assuming Your operations will be as stated from Federal • income tax under sare ection 501of • eXePtion , we have determined ( c ) ( 3 ) -of the Internal Revenue uCode . exempt We have further determined that cau meaning of section 509 ( a ) of the Codeare of a private foundation within the section 170 (b) ( 1 ) (A) (iii) 6 509 (a) ( u , You are an organization described in If your sources of support , or -changes Please let us know so we canyconsider our othe � effect cof the changeter , or On d of operation exempt status and foundation status . Also , you should inform us of l changes in Your name or address . Your As of January 1 , 19849 You are liable for _ Contributions Act ( social security taxes )s ) onremunerat ones undeofthe$ 100ederal or moreInsurance yo pay each of your employees during a calendar Imposed under the Federal Unemployment year . You are not liable for thetaxay to P Yment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Code Federal excise taxes . If uesYou are not about excise , ey exempt from other Federal taxes You have any questions about excise , employment , or other Please let us know . Donors may deduct contributions to ` Bequests , legacies , devises , transfers You as provided in section 170 of the Code . or deductible for Federal estate and gift , gifts gifts to you or for your use are Purposes if provisions of sections 2055 , 2106 , and 2522pofthe sCodethey meet the applicable The box checked in the heading of this letter shows whether you must file Form 9909 Return of Organization Exempt from Income Tax , If Yes is checked required to file Form 990 only if your You are than gross receipts each year are normally more $ 25 , 000 . If a return is required , it must be filed by the 15th day of the fifth month after the end of your annual accountin $ 10 a day , up to a maximum of $ 5 , 000 , when agretriod . The law imposes a penalty of I is reasonable cause for the delay . urn is filed late , unless there i IV 040, JP iuu arc 11u (. 1 • c14u11 'eu to ille reaera .L income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code . If you are subject to this tax , you must file an income tax return on Form 990-T , Exempt Organization Business Income Tax Return . In this letter , we are not determining whether any of your present or proposed activities are unrelated trade or business as defined in section 513 of the Code . You need an employer identification number even if you have no employees . If an employer identification number was not entered on your application , a number will be assigned to you and you will ' be advised of it . Please use that number on all returns you file and in all correspondence with the Internal Revenue Service . Because this letter could help resolve any . questions about your exempt status . and foundation status , you should keep it in your permanent records . If you have any questions , please contact the person whose name and telephone number are shown in the heading of this letter . Sincerely yours , District ector CC ** Edward J : Hopkins William J . Stewart Letter 947 ( DO) (Rev. 10-83)