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2003-253D
CHILDREN'S SERVICES ADVISORY COMMITTEE C/O Human Services 184025 1Street Vero Beach , Florida 32960-3394 Phone: 561 -567-8000 (Ext. 467 or 524) Fax: 978-1798 E-Mail : Jcarlson(&bcc. co. indian-river.fl . us MmastersonC@bcc. co. indian-river.fl . us To : Beth Jordan From : Joyce Johnston-Carlson Date : October 16 , 2003 Re : Grant Contracts 2003 - 04 The attached is a Children ' s Service Advisory Committee Grant Contract for : Exchange Club CASTLE Please review the insurance certificate and verify that it is adequate by signing on the line below. Contact me if you have any questions . Thank you. Ao , Beth Jordan Date 10/ 16/03 f ' 2003 CLERK TO THE BOARD Please Note : Transportation is NOT necessary to operate this program . Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County") and Exchange Club Castle ("Recipient") ; of : (Address ) Exchange Club Castle P . O . Box 12908 Fort Pierce , Florida 34979 Valued Visits Program 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 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Fifteen Thousand Dollars ($ 15 , 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 its 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 23 , 2003 , 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 - 2 - 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 : ( 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. 3 - 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 . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER ZTD OUNTY COMMISSI RS By: nne , a Attest : J . K . Barton , Clerk By : OA&*1 Deputy Clerk Approved : a mes Chandler, C unty Administrator App r as to form and legal suffici is . Felr, Ass ist§ilrCount orney RECIPIENT : Exchange Club Castle P . O . Box 12908 Fort Pierce , Florida 34979 B . Name Title 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - 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 1 " 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 1h Street Vero Beach , Florida 32960-3365 Recipient : Theresa Garbarino -May Exchange Club Castle P . O . Box 12908 Fort Pierce , Florida 34979 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 - 1 - 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. - 2 - MAY-27-2003 09 : 26 HARBOR INSURANCE AGENCY P 772 460 2315 Pa02/05 ACOIID., CERTIFICATE OF LIABILITY INSURANCE Ex°cam 1 05 /27 / 03 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PROWJCFA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR HARBOR INSURANCE AGENCY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Z Colonial Road , Suite 100 Z . t Pierce FL 34950 = 5309 NAIC # Phoue : 772 - 461 - 6040 Fax : 7 '12 - 460 - 2315 INSURERS AFFORDING COVERAGE INSURED 11 IMF. INSURER A: Philadel him IndemnityInsCo The 8xchange Club CO2ter INSURER B: Twin Ci Fire Snsurance Co fohdhAbusevDHAion of INSUROR c: Exchange club 2INSURER DPperce FL 34979 wsuRERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE PEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIR> MENT TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR POLICMAY IES, THEINAGGREGATE L ANC 6NOWN�BY THE HAVE POOEEN REDUCED RI ED HEREIN I SECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH 1TS POLICY NUMBER DA Mro DA E MM/D 1111 1 LIMITS rLTR NSR TYPE OFINSURANCE EACH OCCURRENCE $ 1 000 000 GENERAL LIABILITY g X COMMERCIALOENSRALLIAB{LTTY gHpg044130 03 / 26 / 03 03 / 26 / 04 PREMISES Eaoccurenee $ 100r000 CLAIMS MADE OCCUR MED EXP (My ane oo'°°") S 5 O O O PERSONAL & ADV INJURY S 1 r 00 0 0 00 A X Sexual /Moj estatio GENERAL AGGREGATE $ Z 1 000 1 000 PRODUCTS • COMPIOP AOG S Z 0 0 0 0 0 0 GEN•L AGGREGATE LIMIT APPLIES PER: POLICY JELoc Y COMBINED SINGLE LIMIT AUTOMOBILE LIABILITS (Eo xdeenq ANY AUTO ALL OWNED AUTOS BODILY INJURY y (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S (Pe( eccidam) NON-OWNED AUTOS PROPERTY DAMAGE y (Peracdden0 AUTO ONLY • EA ACCIDENT S GARAGE LIABILITY OTHER THAN EA ACC f ANY AUTO AUTO ONLY: AOG i EACH OCCURRENCE S _ EXCESW MBRELLA LIABILITY AGGREGATE $ OCCUR CLAIMS MADE S 6 DEDUCTIBLE i RETENTION S WORKERS COMPENSATION AND TORY LIMITS x ER� 9 EMPLOYERW LIABILITY21WEDII9 5 6 7 12 / 03 / 02 12 / 01 / 03 E.L. EACH ACCIDENT $ 500 000 ANY yYICRROPRIEMBFOWRPARTNER�ECUT� E.L. DISEASE - EAEMPLO i 5500 000 _ Uxes dasAL Ounder VInK)NSbdaw EL DISEASE • POLICY LIMIT $ x500 000 OTHER A Professional Lieb PHFX044130 03 / 26 / 03 03 / 26 / 04 Occurrenc $ 110001000 Aggregate $ 2 000 000 DES CW FTION OF OPERATIONS ! LOCATIONS / VE}NCLCS I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONG Company A : Bmployee Dishonesty , Policy #PAPx019440 , 03 / 26 / 02 - 03 / 26 / 03 , $ 100 , 000 Blanket . Certificate holder is an additional insured for general liability with respects to Value Visits . CERTIFICATE HOLDER CANCELLATION INDIA- 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP1 TIO ' DATE THEREOF, THE ISSUING INSURER WILL ENOEAVOR TO MAIL O OAY3 WRITTEN Indian River County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, OUT FAILURE To DD So SHALL Co=mi a s ionera IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR 1640 25th Street E ENTATIVEB. Vero Beach FL 32960 A A RIz NTA Cindv me a r l ACORD ACORD 2I5 (2001 !08) ® RpORATt 3N 198 Internal Revenue Service Department of the Treasury District Director ' MAR 0 11984 Person to Contact : Ann Price / lch Telephone Number : ( 404 ) 221 - 4516 Refer Reply to : Exchange Club Center for the Prevention of Child Abuse E0 : 7201 : AP of the Treasure Coast , Inc . 2414 Nebraska Avenue Employee Identification Number : Fort Pierce , FL 33450 59 - 2094472 File Folder Number : 580014494 Dear Sir or Madam : Date of Exemption: February 3 , 1981 Internal Revenue Code Section : 501 (c) (3) Gentlemen : Thank you for submitting the information shown below . We have made it a part of your file . The changes indicated do not adversely affect your exempt status and the exemption letter issued to you continues in effect . Please let us know about any future change in the character , Purpose , method of operation , name or address of your organization . This is a requirement for retaining your exempt status . Thank you for your cooperation . Sincerely yours , Distc Directo Item Changed From To Name SCAN America of the Treasure Shown Above Coast Inc . 275 Peachtree Street, N . E . , Atlanta , GA 30043 �2tter 976 (DO ) ( 7 -771 Internal Revenue Service Department of the Treasury District Director Dater Employer Identification Number. LG JAN 2 91982 59 - 2094472 Accounting Period Ending: September 30 Foundation Status Classification : 509 ( a ) ( 1 ) & 170 ( b ) ( 1 ) ( A ) ( � ) r> Scan America of the Treasure Advance Ruling Period Ends: Coast , Inc : September 30 , 1983 2414 Nebraska Avenue Person to Contact: Fort pierce , Florida 33450 Y . Burleson/ eb Contact Telephone Number: ( 9o4 ) 791 - 2636 FFN : 580014494 Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have deitermined you are exempt from Federal income tax under section 501 ( c ) ( 3 ) of the Internal Revenue Code . Because you are a newly created organization , we are not now making a final determination of your foundation status under section 509 ( a ) of the Code . However , we have determined that you can reasonably be expected to be a publicly supported organization described in section 170 ( b ) ( 1 ) ( A ) ( vi ) & 509 ( a ) ( 1 ) . Accordingly , you will ' be treated as a publicly supported organization , and not as a private foundation , during an advance ruling period . This advance ruling period begins on the date of your inception and ends on the date shown above . Within 90 days after the end of your advance ruling period , you must submit to us information needed to determine whether you have met the - requirements of the applicable support test during the advance ruling period . If you establish that you have been a publicly supported organization , you will be classified as a section 509 ( a ) ( 1 ) or 509 ( a ) ( 2 ) organization as long as you continue to meet the requirements of the applicable support test . If you do not meet the public support requirements during the advance ruling period , you will be classified as a private foundation for future periods . Also , if you are classified as a private foundation , you will be treated as a private foundation from the date of your inception for purposes of sections 507 ( d ) ., and 4940 . Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period . If you submit the required information within the 90 days , grantors and donors may continue to rely on the advance determination until the Service makes a final determination of your foundation status . However , if notice that you will no longer be treated as a section 509 ( a ) ( 1 ) organization is published in the Internal Revenue Bulletin , grantors and donors may not rely on this determination after the date of such publication . Also , a grantor or donor may not rely on this determination if he or She was in part responsible for , or was aware of , the act or failure to act that resulted in your loss of section 509 ( a ) ( 1 ) status , or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section 509 ( a ) ( 1 ) organization . 275 Peachtree Street, N . E . , Atianta , GA 30043 (over) Letter 1045 ( DO) (6-77) If your sources of support , or your purposes , character , or method of operation change , please let us know so we - can consider the effect of the change on your exempt status and foundation status . Also , you should inform us of all changes in your name or address . Generally , you arenot liable for social security ( FICA ) taxes unless you file a waiver of exemption certificate as provided in the Federal ' Insurance Contributions Act . If you have paid FICA taxes without filing the waiver , you should call us . you are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Organizations that are .not private foundations are not subject to the excise taxes under Chapter 42 of the Code . However , you are not automatically exempt from other Federal excise taxes . If you have any questions about excise , employment , or other Federal taxes , please let us know . Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055 , 2106 , and 2522 of the Code . You are required to file Form 990 , Return of Organization Exempt from Income Tax , only if your gross receipts each year are normally more than $ 10 , 000 . If a return is required , it must be filed by the 15th day of the fifth month after the end of your annual accounting period . The law imposes a penalty of $ 10 a day , up to a maximum of $5 , 000 , when a return is filed late , unless there is reasonable cause for the delay . You are not required to file Federal 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 . 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 , l7lst. C Uirecto /1* cc : Eugene J . O ' Neill Letter 1045 ( DO) (6-77) BOARD OF COUNTY COMMISSIONERS 1840 25th Street, Vero Beach, Florida 32960-3365 Telephone: (772) 567-8000 Q �IORIOp' October 8 , 2003 Ms . Theresa Garbarino-May, Executive Director Exchange Club CASTLE P . O . Box 12908 Fort Pierce FL 34979 Dear Ms . Garbarino-May : We have reviewed your application for funding through the Children ' s Services Advisory Committee, and ask that you provide to the County a certificate of insurance with a 30 -day cancellation notification for all except nonpayment of premium . All other aspects of your insurance, as evidenced by the certificate of insurance, are acceptable and we wish you well with your program . We look forward to hearing from you . If you have questions , please contact me at 567- 8000 , extension 287 . Sincerely, Beth Jordan Risk Manager Cc : Joseph A . Baird , Assistant County Administrator Joyce Johnston-Carlson , Human Services Director Marian Fell , Assistant County Attorney 16 / 14 / 2003 09 : 12 FAX 772 46B5//6�013 �+ EXCHANGE CLUB CASTLE 1 j 002 ARD OCOUNTY C0041MISSIONERS 1840 25Th Street, Vero Beach, ,Fi!or2da 32960-3565 Telephone: (772) 567.8000 October 8 , 2003 Ms . Theresa Garbarino-May, Executive Director Exchange Club CASTLE P .O. Box 12908 Fort Pierce FL 34979 .Dear Ms . Gsrbarino-May : We have reviewed your application for funding through the Children ' s Services Advisory Committee, and ask that you provide to the County a certificate of insurance with a 30 -day cancellation notification for all except nonpayment of premium . All other aspects of your insurance, as evidenced by the certificate of insurance, are acceptable and we wish you well with your program . We look forward to hearing from you . If you have questions , please contact me at 567 - 3000, extension 287 . Sincerely, �J! J Beth Jordan Risk Manager Cc : Joseph A . Baird, Assisturt County Administrator Joyce Johnston -Carlson, human Services Director Marian Fell , Assistant County Attorney 10 14 / 2003 09 : 42 FAX 772 4656011 EXCHANGE CLUB CASTLE 2003 DCT-1.3-2003 11 : 12 HARBIR INSURFNCE AGENCY 7'72 460 2315 P102/03 F r'aRD� CERTIFICATE OF LIABILITY INSURANCE pp � °"TOimporr" HRM? 1 1d 13 03 THIS CERTM TE I5189UEC AS A MATTER OF INFORiEA14 oN R =S'OZti1I+TC8 A0ZWy ONLYAND CONFERS NO WHTS UPON THE CERTIFICA"1'E pIOLDER. THIS CERTIFICATEDOES NOT AMEND, ELTENo OR ealeia� al head , quite 100 ALTER TKECOVERAGE AFFORDED 13YTHE P'f1mESMMLO1N. Fort Pierce n 34959 - 5309 >'hosce : 779 - 463 - 6090 711ir772 - 460 - 2315 INSURERS APPORb1NGMVIiRAtaE NAIC9 INSURED TheE�CCh�go L,1 Ce ta>: M18URERA Phil&"! Ius xndeij #, U -- fChi d 1:48 or t revent an 09 IN8uR6R ®I Twin Fire Insurance Co a DX 1 908 Pt Pierce FL 34979 COVERAGES THE POUGES OF INELMNCJ U.1'PF.D BOLOW KAVII NVEN ISSUW TD TME INSURED NAMED ABOVE FOR THE POLICY P@RI06 W WCATEC, NOTVJITW3TANCIING ANY AI=OUNiEMENT, T&.RAI OR CONDITION oFaMv CONTRACTCR OTHEK DOCUMENT WITH RESPECT TO wHiCM TMi& CERTFICATE MAY BR LABi lm OR MAY PERTAIN. THE INS RANCEAPFORMSYTHEPOUCICBCOSCRIBRpHEREINiBSUL=rTOALLTMETfnJtMFW(CLUSIONSANDCONDITIONSOF $UCH PQLr.W, AQ0AEGA7E LIMITS SHOWN MAY HAVE BEEN REDWo p 8Y PAID CLAIMS, 6TR NSR TVP@ OFINEURU01 P41.iQY NUMBER ---� QATS " Ip 6E11ERAL EAC" OCCURRENrD 1 000 Opp 1L 7L X Q EnCIALf d ALLIAB PH79044130 03 / 26 /03 03 ,/' 35 / 1) 4 p aacaaenee sic add CLAIMSMADE 3( OCCUR MPMt" (ARyOftlPerrwl) tg+ Opp A Se7Gu /ka]_ e9tatia PER50NAL & ADV1NJURY i 1 000 000 G&4RRALAt3gNBrsATE A 2 8pp 000 GEN'L AGf.REf311TE LMAR APPLIsad PER, PRODUCTS - COMPopp AGG1621000 0 0 0 POWOY LOG f wTOMQSILE UAMLITV ANY SAI D Imo] SINGLE UMIT i ALL OVNG D AUTOS +� SCHEDUIJSD AUT03 BODILY i W URY HItEDAUTOB (Parr Po W) Nps AKIRIEDAUTOS U7'oB BODILY INJURY (pwa w"o PROPERTY DAMAGE -- (pwarbeenl) & GARAGE LIAMLny aNYAUro AUTO ONLY • FA ACCIDENT i arHEI� TWIN EA ACO 6 AUTO ONLY: ABG & E�ICESSNMBRELLA LIAlILITI' OCCUR CLAIMS MADE EACH OGOIitWFJICE i �� AGGREGATE i I DEDUCTIBLE p t WORKERS COMPRA&TION AMID = $ y 2111bDu9567 7 LYI VAMP LIM X 3 Z / CJS / 02 1Z / 0 �./ 03 LL FACHAr4AOENP Z35000000 ONSbofgw F.L. DISGA58 - EAEi+IPLo i 500 000 DTaER ��� E1 DI&EASE . POLICYL a 50p p00 Profeaaional Liab S+ 1C044130 03 ( 26 / 03 03 /26 / 04 palaurxend L 000 , 000 DESCRlP710N OF DPE LK1CATi0N2 / VElOGL66 f FJCCursiDii6 ADDED �r ENWIREMENr t a r� to 2 d 0 0 Company A : Employee Dishoreoty , Poliex FpapX01944C , �03 /26 / 0342 /26 / 04 , $ 1000000 .blanket , CertL9tQate holder Le an additional insured for goneral l3abi13ty 'with re9pectp to Value Visite , } 10 Daya notica for can wp4vzmeut of premium . CER1"IFIGATQ HOLbER CANCEW1TIoN ZMIA. 2 8NOULD ANY OFTHE MOVEDESCRIBEDPOI,ICMAMgCAN , NVORK THEO,MATION Indian Rivera Cougaty DAT& THEREOF, THE wsur401Ns1MFtW LI. ENAEAvoR To MAL go * � DAYS WN"p , CoaBmia n ionere1 NOTICE TO THE CERMC,AYe IIC"gR MAMI9c to TKE LEFT, eUr FAQ TQ DD SO aHALL 1640 26th Stromt ,`0�11 I3 I Q �SJ�, MPD&E No CBLAGII,TIONORLIQOFANYKINDLIPCWTREir URgR, iYzAGEMTSOR Vero Eeach FL 32960C� lam' RE 21MTATKL � � R ACOR.D 26 (2001/001 � Lr� V A 0 CORPO TION 1886 C3 6 v 10 / 14 / 2003 03 . 43 FAX 772 4656013 EXCHANGE CLLR CASTLE Z004 ❑CT-13-2003 1112 HARBOR INSURANCE AGCY 772 460 2315 P . a73/03 • 4 IMPORTANT SANT If the certM=a holder is an ADDITIONAL INSURED . the palloy(ies) must be endorsed , A statement on this certificate does not confer rights to the certlfloate holder In lieu of such endorsement(s), tf SUISROGATION IS WAIVED, subject to the terms and cond1dons of the policy, cartafn policies may require ari endorsement. A statement on this certlticate does nOt WrIfer rights to the ,certificate holder in lieu of such erdorvement(s). DISCLAIMER The Cert&ate of Insurance on the reverse side of this form does not epnstltute a contract betweon the Issuing Insurer(s), authorized representative or producer, and the certificate holder, nor does ii affin natively or negatively amend , extend or after the coverage affarded by the policies llstad thereon . ?"he infarmanon a ntained in this rrawmission 0 client prfvileged and confidential, or conside"d confidential under sxatelfdcral slatuleP ar regulalloria, tt zs ln*wd*d Only for the use of the indEYidual or 0.41* named above. If the reader of AisMCOMMSS09 I i s Strict t wended revolent, yOu a re h ereby h o �gd rhat a xy d i=sr Sikafi x, d tstrihudoq O r c opy of this ly prphibited. If',you received this mersage in error, please immediately notify us by the teleyrha�rc and return the original rnmsage 1k7 us at 09'r address via the Cfnlred States postal T60MCN, Thank you. TOTAL P . 03 10 ! 14 / 2003 09 : 41 FAX 772 4656013 EXCHANGE CLUB CASTLE zool Exchange Club C ASM, ,.hild Abuse Services, Training and Life Enrichment 8525 S .W. Midway Road Fort Fierce, FL 34981 PnO . Box 12908 Fort Fierce, FL 34979 Ph . 7724654011 Fx, 772465 .6013 A DATE . lt) 1 . TQ • �� h COMPANY, rill. FROM • RE : � � < .Q � ter*Rr NO . PACES INCLUDING COVER , WIN MissionqStatemank _-- �---- The Mission of the CASTLE Is to improve the uality of family life. prevent child abuse and neglect by providing community education, support and resources for parents in need of assistance. Pro raI low ms cf he CASTF�� Safe Famidles - in home parent aducation and suppartive oaunseiing Positive Parenting - Parent education in regard to raising children in a healthy home environment Families First . An education course for adults who are engaging in dissolution of marriage High Hopes For Kids — A course designed to help children Cope wlth the changes brought on by divorce Healthy Families _ in home parent education for families with newborn children Valued Visits — Benefits individuals who are under court mandated visitation restrlctions Co-Parenting — A program designed to teach divorced parents how to focus on positive behaviors and Interactions with exspouses and children Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children ' s Services Advisory Committee RFP: # 5054 PROGRAM COVER PAGE Organization Name : Exchange Club CASTLE Executive Director: Theresa Garbarino-May_ Email : tgarbarino-may@exchangecastle . org Address : P.O . Box 12908 Fort Pierce , FL 34979 Telephone : 772-465 -6011 Fax : 772-465 -6013 Program Director: Marie Bradt Email : mbradt@exchangecastle . org_ Address : 1906 12th Court , Vero Beach , FL 32960 Telephone : 772-567 - 5700 Fax : 772-567-7133 Program Title : Valued Visits Priority Need Area Addressed: Parental Support and Education . Brief Description of the Program : According to the Taxonomy of Human Services , Valued Visits is identified as a Parent Visitation Monitoring Program PH600 . Valued Visits provides supervised visitation while a child and parent re-build their relationship in a setting that is safe , has clear boundaries , and offers skill building training. In cases of domestic violence, children are prevented from witnessing disputes between parents as Valued Visits ensures that parents do not come in contact with each other during the exchange of the child for visits . Amount Requested from Funder for 2003 /04 : $ 15 , 000 Total Proposed Program Budget for 2003 /04 : $ 81 , 350 Percent of Total Program Budget : 18 . 4 % Current Funding ( 2002 /03 ) : $ 109000 Dollar increase/( decrease ) in request : $ 5 , 000 Percent increase/( decrease ) in request : 50 . 0 % Unduplicated Number of Children to be served Individually : 50 Unduplicated Number of Adults to be served Individually : 60 Unduplicated Number to be served via Group settings : - Total Program Cost per Client : 739 . 55 Will these funds be used to match another source ? yes If yes , name the source : League , foundations , donations Amount : $ 669350 . 00 The Organization 's Board of Directors has approved this =, a Sndatela 1/2Li� 1 ;' Al Fort Name of President/Chair of the Board Si nature eo-op 0e40001 _Theresa-Garbarino-May Name of Executive Director/CEO Si ature 3 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children's Services Advisory Committee RFP: #5054 PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. The mission of the Exchange Club CASTLE is to improve the quality of family life while preventing child abuse and neglect, by providing community education , support and resources for families in need of assistance . The CASTLE envisions a community where each child is allowed to grow to his or her full potential , free from abuse and neglect, and families have access to the supports they need to create healthy living and learning environments for children . 2. Provide a brief summary of your organization including areas of expertise, accomplishments and population served. The CASTLE began in 1981 , and now serves as the model for a national network of child abuse prevention centers that span 107 locations in 27 states . With an involved, active Board of Directors , and an Executive Director, Theresa Garbarino-May, who is beginning her 171i year at the helm of the agency, the CASTLE is known for its steady leadership and quality programs . The CASTLE was fortunate enough to receive both national and state recognition last year. Nationally, the United States House of Representatives recognized the CASTLE as a "true American success story" for serving as a national model in the fight against child abuse . In Florida, the State Senate awarded Ms . Garbarino-May the Florida Senate Medallion of Excellence for her outstanding service to the children of the Treasure Coast . This year, the CASTLE has been recognized as a leader in the area of supervised visitation by being awarded a $300 ,000 federal grant to expand services to victims of family violence . The CASTLE was one of only three providers in Florida to receive this funding . Finally, the CASTLE was in the running as one of the "Best Places to Work" in a local study done jointly by the Chamber of Commerce, the Human Resources Association , and the Workforce Development Board. The CASTLE was described as "very competitive" with other top organizations in the area. The CASTLE offers an array of services designed to prevent child abuse , and cultivate the parent-child relationship . Our core program Safe Families , offers long term, home based, parenting skills development . Other programs offered by the CASTLE include : Families First, a training seminar for divorcing parents ; High Hopes for Kids , offering support to children whose parents have divorced ; Positive Parenting, a support group for parents facing difficulties raising their children ; Healthy Families, providing home based services to pregnant women and newborns ; Valued Visits , a supervised visitation center, and our newest program , Co-Parenting, a support group aimed at helping divorced parents reduce conflict surrounding shared custody. CASTLE services utilize best practices , and a continuous quality improvement model . The population served is : families who are at risk for abusing or neglecting their children ; families who have had a reported incident of abuse or neglect, but who , with support and education , can eliminate further episodes of abuse ; families with children 0- 18 ; and families who live within Indian River County. This year' s demographics indicate that 46 % of enrolled families are single mothers or fathers , 69 % have completed high school , 82 % have incomes under $25 ,000, and 63 % are White, 20 % are Hispanic and 14 % are Black. 4 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children' s Services Advisory Committee RFP: # 5054 Be 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. What: The unacceptable condition requiring change is contact between a parent and child that puts the child at risk. The child is at risk for abuse, at risk of witnessing domestic violence between parents , and at risk of being used in a manipulative manner by estranged parents . Following Florida law , visitation rights are often ordered between a parent and child, even if the parent poses a risk to that child, or has hurt that child in the past . It is unacceptable that these visits take place in the community, without supervision , placing the child, the ex - spouse , and the general community in jeopardy. Who : Children who are at risk of abuse, or are from homes where domestic violence is present. Where : Last year, parents were served in all parts of Indian River County . Provide Data : In Indian River County, in 2001 -2002 , there were over 100 children who came under the supervision of the Department of children and families . There were a total of 555 domestic violence crimes . There were over 1 , 100 abuse reports . These children are eligible for Valued Visits , should visiting a parent pose a risk. Valued Visits has operated at capacity since shortly after opening in October 2000 . There is no waiting list due to a strong corps of volunteers , who help the program expand its capacity as the need arises . 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. There are no other supervised visitation centers in Indian River County . Before Valued Visits opened, supervised visit occurred in the offices of Department of Children and Family caseworkers , the homes of relatives , at fast food restaurants , or in police station lobbies . Visits in these locations were often poorly supervised, and inadequately secure . Research shows that the majority of visits scheduled under these conditions were cancelled and did not occur as scheduled, which does not allow the parent/child relationship to mend . 5 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children ' s Services Advisory Committee RFP: # 5054 C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Parental support and education 2. Briefly describe program activities including location of services. The purpose of Valued Visits is to provide a location for visiting parents to meet with their children in a safe , supervised manner. The participants in the program are referred by family courts due to contentious divorces or domestic violence, or by the Department of Children and Families because of the risk of child abuse or neglect . All referred families are screened for the appropriateness of Valued Visits , and given a date for a program orientation . Both the parents or caretakers must complete orientation . Following successful completion of orientation , families are given a visitation schedule. The hour and date agreed upon for the family will be consistent on a weekly basis , until such time as visita are no longer needed. The visits occur in a recreation room type setting, to enhance the programs attractiveness to children , and to ensure a comfortable setting that encourages a positive , interactive visit. Age appropriate games and activities are provided for children from ages 0- 18 . The policies and procedures of Valued Visits follow the guidelines recommended by the Florida Clearinghouse on Supervised Visitation , and the Minimum Standards for Supervised Visitation programs issued by the Florida Supreme Court . Valued Visits is open for visits on Thursday evenings from 5 : 30 to 8 : 30pm, on Saturdays , from 8 : 30 to 1 : 30pm, and on Sunday from 1 : 00pm to 5 : 00pm each week. The services offered at Valued Visits include : Monitored Exchange — Supervised exchange of children between the residential and non- residential parent. Supervised Visitation — Supervised visits between a non-residential parent and an child . The visit is observed at all times by a monitor. The visit occurs on-site , at Valued Visits , and follows strict guidelines as to what can be said and done during the visit. Unless rules are violated, the monitor does not interact with the parent or child. Therapeutic Supervision — Supervised visits between the non-residential parent an a child. In this case , the visit monitor is a licensed mental health counselor, and takes an a active role in the visit , working with the parent and child to improve the relationship . Parenting Classes — Non-residential parent will be offered parent education classes before and after each visit. Services are provided at 683 27th Avenue SW, Vero Beach , FL. This is the site of the Boys and Girls Club . Through a collaborative partnership , Valued Visits uses the site during off hours . 6 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children ' s Services Advisory Committee RFP: # 5054 3. Briefly describe how your program intends to address the stated need/problem, Include reference to any studies or evidence that indicate proposed strategies are effective with target population. The stated need or problem is unsupervised visits or contact between a child and a parent who puts that child at risk. Valued Visits addresses this need by offering a safe, enriched setting in which to supervise this contact. Valued Visits also fosters boundary and limit setting, holds parents accountable for their behavior, and enrolls non-residential parent in a parenting education class . In some case , therapeutic intervention is offered when ordered by the court. Evidence that that supervised visitation works comes from in-house statistics : there have been no instances of abuse , or witnessing of domestic violence by a child since the programs inception , during visits by families , and external statistics : • Only 17 % of families using supervised visitation centers missed their appointments , compared with 71 % of families who use Department of Children and Families caseworkers to supervise visits . • Families using visitation centers were likely to have 10 or more visits , about 3 times more than if caseworkers supervised visits . • 50% of children who had regular family visits were in foster care for less than one year, while only 10 % of children who had infrequent visits were in foster care for less than one year. • Children who use visitation centers have their court cases resolved sooner than children who use caseworkers to supervise family visits . 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 program manager (50 % of time) Required credentials/experience : BA/5 years Three visit monitors ( 100% of time) Required credentials/experience : High School/ 1 yr. One secretary (25 % of time) Required credentials/experience : High School/ 1 yr. 5. How will the target population be made aware of the program? All families using Valued Visits are court ordered to do so . Families are made aware of the program through the judge presiding at their court appearance, or in dependency cases , through their DCF caseworker. Program enrollment begins when a family provides a copy of the court order to the CASTLE . 6. How will the program be accessible to target population (i.e. location, transportation, hours of operation) ? Valued Visits is open in the evenings and on weekends , ensuring accessibility to working families . The program is located on a main thoroughfare in Vero Beach , at a well -known site (The Boys and Girls Club) . Enrolled families provide their own transportation . 7 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children ' s Services Advisory Committee RFP: # 5054 D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . Ensure that visits occurring at Valued Visits 1 . Provide each adult participant in the are successful , in that the visit will not be program with orientation training prior to the terminated for a rules violation (i . e. abuse, first visit, and monitor each adult participant at inappropriate touch , spousal alienation , etc . ) all times during the scheduled visit. for 95 % of the visits occurring at the program , as measured by case notes , and significant event reports . Baseline is 100 % . 2 . Ensure the learning of parenting skills in 2 . Non-residential parents will be offered non-residential parents for 90 % of enrolled parenting education classes while on site at parents , as measured by competency based Valued Visits . After each class , the parent questions (a post test) after each parenting will be given questions to answer that deal class session , during enrollment in Valued directly with that session ' s topic . The Visits . Baseline to be determined as this is a parenting instructor will review all questions new goal . answered incorrectly with the enrolled parents , until competency is achieved. 3 . 85 % of custodial parents will express 3 . Administer a satisfaction survey to satisfaction with the program services as custodial parents . The survey will emphasize measured by the results of a satisfaction survey enrollment procedures , safety, and changes in given prior to the end of services . Baseline to their child ' s behavior as a result of attending be determined as a new survey is being Valued Visits . developed. 4 . Maintain at 20 % the number of families 4 . Interviews , in person or by phone , will be who receive follow-up contact to ensure that conducted regarding the success of any any service linkages provided were successful , linkages with other services made by visitation as measured by a follow up survey delivered center staff. within 90 days of the service linkage . Baseline : 20 % families received follow-up surveys . 8 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children' s Services Advisory Committee RFP: # 5054 E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources 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 Core Funding for the program, assistance in securing Junior League of Indian River foundation funding , volunteers for the program, serve on advisory board . Boys and Girls Club of Indian River Provide location for the program at below market rental County rate . Indian River County Sheriff' s Provide security to Valued Visits , during all operating Department hours . Services will be donated as long as feasible . Department of Children and Families Cooperation on dependency cases , access to caseworkers , sharingof information . 19t Judicial Circuit Use of Valued Visits for court ordered supervised visitation , support of program 9 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children ' s Services Advisory Committee RFP: # 5054 F. 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 Age, gender, ethnicity , marital status , and address are collected upon intake . Eligibility for the program requires that a judge has deemed that contact between a child and a non-residential parent poses a risk of harm to that child. Intake and eligibility are further assessed during the intake and orientation sessions required by Valued Visits . 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 ? Outcome 1 (successful visits) is measured by visit monitor notes and significant event reports which track the number of visits terminated for a rules violation . Visit monitor notes are reviewed weekly ; significant events are reviewed immediately, and again quarterly at the Risk Management committee meeting. Outcome 2 (learning_parenting skills) is measured with competency-based tests (post-tests) given after each parenting class . Participants must get all answers correct, or remediation is done by the group facilitator. Tests are collected after every parenting class . Outcome 3 (satisfaction survey) is measured with a survey that is administered prior to the case closing. Results are collated quarterly and reported to the Service Delivery committee. Outcome 4 (follow-up contact) is performed with families who have been give a service linkage contact. Contact is made by phone if the family is no longer enrolled in the program , and in person , if the family is still enrolled. Results are tabulated quarterly, and reported to the service delivery committee . 3. REPORTING: What will you do with this information to show that change has 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? Information collected is reported to funders on a regular bases , through monthly, quarterly or semi -annual reports . Staff , board members , employees and other stakeholders are made aware of results through the CASTLE Continuous Quality Improvement process , and feedback at all - team and board meetings . The community is made aware of results through an annual report . 10 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children ' s Services Advisory Committee RFP: # 5054 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 10/ 1 /2003 — 9/30/2004 Valued Visits is a continuing program and will be fully staffed and in full operation at the start the contract year. Regarding the program operation : 1 . A court order is received for supervised visitation . 2 . The family is given 10 days to contact the CASTLE, and set up orientation . 3 . Each parent receives orientation , reviewing the rules and guidelines for participation in the program (orientations are done on separate nights for each parent) . Orientations are scheduled every week. 4 . Visits begin and continue until there is no longer a risk of harm to the child. 5 . Prior to and after each visit, the visiting parent participates in parent education classes . 11 Info Loo (,0 16C .d .d Q N in [ M CO 000 tncuy 64 PC .w N w ` a V1 �n w •« as C �O ON 00 It M N N PC U bOno U b W � > E" ...i r� M O\ U U , aPC PC , qtt 00 ;m. W P b u w Q uZa oPs + H 0 0 0 Exchange Club CASTLE -Valued Visits RFP #5054 UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program, From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms, AGENCY/PROGRAM NAME : Exchange Club CASTLE - Valued Visists -- Indian River County FUNDER ; Children 's Services Advisory Committee 1 CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should j : be used for calculations and to write information only, ; r} ` ;+°g�✓"P r' e 5 r` SY> „ ' r T.< ,�� a3 IAt{ '+,� qa - P✓ x.� z% .K s�- x ° et cY3�srprxr � � 1bil�lli %` t7�1d J ` eC a � anp y gal `` .�k ? '�� . ,, ,. s��.��ppS �dyy.�F3. � 2' y 1 Children's Services Council-St. Lucie 174 ,300.00 2 Children's Services Council-Martin . ,=g 137 ,437. 00 3 Children's Services Council-Okeechobee 4 Advisory Committee-Indian River a ; at k^ 15,000 .00 15,000.00 609021 .00 5 United Wa •St. Lucie County 62,250.00 6 United Way-Martin County : � � " °,} 3 381300 . 00 7 United Way-Okeechobee Count F x < 8 United Way-Indian River County l;10io� 128,700 .00 9 Department of Children & Families ; r ; •, >,_; 3519182.00 10 County Funds , 11 Contributions-Cash ` , "� ' 30,000. 00 86 ,252 .00 12 Program Fees fr, � . ;; 1 ,500. 00 60 ,000. 00 13 Fund Raisin Events-Net 9 31000.00 137,000.00 14 Sales to Public - Net FRS 15 Membership Dues ` . ? , 16 Investment Income 11 ,000 .00 17 Miscellaneous 21000.00 18 Legacies & Bequests r 19 Funds from Other Sources `,' '" w 31 ,850.00 560 ,573 . 00 20a Reserve Funds Used for Operating vM' H F 64 ,750.00 20b In-Kind Donations (Not Included In total) 21 TOTAL REVENUES (doesn't x Z'e 4�+ include line20b) � .., 'Na .F ' $81 ,350 . 00 $ 15 , 000. 00 $ 1 ,873 ,765. 00 {r AI 3 - ; r rss�,- ✓u rs t r "#'ars- >a F y " `�v §ks' `" „ , fw;� ?',;. � se.=.F,:� .'�Y hc� � ✓.� ' � as ' A,„ ,� � ty e< n.. , `i ,. , vararo " d talPro rar» i � Fundei �Sp ltf� �, 7otalA` e c 3 �`.1a *` mei * � f': 22 Salaries - (must complete chart on next page) 39,089.00 119337.00 1 , 123 ,888 .00 V, ' r K ` $q 'xYx ,$ ?ry 1�5 x "� � i�-+<.� �1� $a �k� ��'.} 'a'�ga'" �anx -:. � x�2 ,.S Fd' �, � ^ F�` 9 �T ��"� ��� § " »'• '�j�'.� � '^?'�,yn�. , �_^:.'.s �`� � ; 23 FICA - Total salaries x 0 . 0765 3 ,437.00 867.31 90,908.00 e Yemen - Annual pension for qualified 41000 etull 24 staff 4 ;erne a playee 544 .00 220.00 40,000.00 Life/Health - e Ica enta ort-term 6. M 25 Disab. 170,8$tmd 11469. 00 1 ,071 .00 599888. 00 Workers Compensation - # employees x eL a g 26 rate 1100 683 . 00 129.69 14 ,260. 00 on a Unemployment - JW projected 27 employees x $7,000 x UCT-6 rate 0.00 0.00 89000. 00 5/21 /03 13 Exchange Club CASTLE -Valued Visits RFP #5054 le ei wl�a uq +y"eE - "iGrosaAnnualr��nro�yosea a,11 MIA .K d n s "S° ' vq w 5x`r - .€ 4 Vit#, ;`- � x a x?l! "w4dR,'. ' '« v'':" ,^ xn r p zs,.,r _..' .a,.. '"Ile a ... .S`. . s.�s '^ ,, rae .�.sara?a aXB'C'. f,VB'�ilif" tOr/",�10 �7'"f5 , toms: 'Ot)0.00 ? rt, . ,s ` ` o wsw a '<' ,law-n .x' S %�'� E " " O 1O,bbtlb0 . , , r 00• a . . = �'» 4 0.00 #DIV/0! 0.00 #DIV/0! M BRADT, VISITATION PRGM COORD 36, 756.00 17,675.00 81837.00 24 .04% BYRON , VISITATION MONITOR 5,568.00 0 .00 0. 00 0.00% MCCASKILL, VISITATION MONITOR 5, 792.00 0.00 0.00 0 .000/0 WINGATE , VISITATION MONITOR 5,792.00 59792 .00 0.00 0. 000/c SULLIVAN , VISTIATION MONITOR 5, 792.00 0. 00 0.00 0 .00% BROWN-GARCIA, VISTIATION MONITOR 5,354.00 0 .00 0.00 0. 00% GENTEN , VISITATION MONITOR 5, 354. 00 5 ,354 . 00 0.00 0 .00% RIOS , VISITATION MONITOR 51354.00 5,354.00 0.00 0. 00% NEW, SECRETARY 19,656. 00 41914 .00 2 ,500.00 12.72% 0 .00 #DIV/0! 0. 00 #DIV/0! 0 .00 #DIV/01 0 .00 #DIV/0 ! 0.00 #DIV/0! 0.00 #DIV/01 0.00 #DIV/0 ! 0. 00 #DIV/0! 0.001 #DIV/0! Remaining Positions throughout the agency 1 ,028,470.00 Total Salaries $ 1 , 123 , 888. 001 $39,089.00 $ 11 ,337.00 1 . 010/0 �. ��y/ T xr ,eire y / &Y' h " rya 4r t K a �t ., ' ' .. INE / � r' �'r a P< el " , .�'7w� z. 1 ,„ x g , ,s f a...- ✓z a / �a5 .�b`.w�r , ,a » { vrsfrr f' w+ x• a rr 2. a ^, ^i ,✓, a a ell /,-,'. • Y1{/Y _� ."f v z ,., 5` r¢r�y r" , v� .z 3'f f a NH ri axe q1z g4 E r v $ , under .0 . ,z, ^ ¢a'� kI r E & . R ra 1 .`7 p soon y orlrer tJne ty me at "}y/�ea t�` �� �' ''.: GQ f r v x tt, F t'A .�j , ,.. _. ~� . ff=< w 8t � " , : � �:. , � Coin/ nsom ensue e /f "n yd ` /` z flu ^ A rsY 5Y; ,. I • /� Fr� w ra�.Ex ati M rf � �j xn.yd u�r r ;r.' a.: 2t k e t Y 2" - rpzviq ,n,/ �M`a ]apel'/.�40h ,. l ,Ile .4, r" .,n n„z, 0 0 .00 0.00 0.0 0 0.00 0. 00 0.00 M BRADT, VISITATION PRGM COORD 8,837.00 676.06 220.00 765.00 126 .94 1 ,788,p BYRON , VISITATION MONITOR 0. 00 0. 00 0.00 MCCASKILL, VISITATION MONITOR 0. 00 0. 00 0 .0 WINGATE , VISITATION MONITOR 0.00 0. 00 0.00 SULLIVAN , VISTIATION MONITOR 0 .00 0. 00 0 .0 BROWN -GARCIA, VISTIATION MONITOR 0.00 0 . 00 0.00 GENTEN , VISITATION MONITOR 0 .00 0.00 0.0 RIOS , VISITATION MONITOR 0. 001 0.001 0.0 NEW, SECRETARY 2,500.00 191 .25 306.00 2.75 1 500.0 0 0 .00 0.00 0. 00 0 0. 00 0 . 00 0 .0 0 0.00 0. 00 0.00 0 0.00 0.00 0.00 0 0. 00 0 . 00 0. 0 0 0.001 0. 00 0 . 00 0 0 . 001 0.00 0.00 0 0.001 0 . 00 0. 0 0 0.001 0.00 0. 00 Total Funder Request Fringe Benefits $ 11 ,337.001 $867 . 311 $220 . 001 $ 1 ,071 .001 $ 129.691 $0. 00 $2 ,288. 00 1,�x' i �sr ate' / . s r$ mnU, s . « �, < -? ,z� k � < { % „� � ' E : {� . +a _• �/J � � � �. *�z�`,' � n� - t✓,.�,>f, , ' y' '� + �� � ee 9 ee ..., o�,r .. � os�y/ f�'"o 1 .oryrnyy �unrl� rS :eciti ,n ,.. �t ` `� t c 4'. » R : � k C ^P' �) J. 'r3�u t �r �a. " h r�,.��]/y < - pr •. r'� a� , •�,�`• R sMr ✓/. 5ur'. � 5�� �.zw." '<', ri�..' w , : h .5- S ��S.,A1��ETAfI� _�4"� � ��v� CI�� `4nx : F � sAmw :a` : � r�,,- �� DWt7y Q.�3 au" a ri 'h`x j��j/�/��/ ��' ^�x'.,. 14 Exchange Club CASTLE -Valued Visits RFP #5054 28 Travel•Dail Y g� �I W 1 1 v200.00 0.0( 42,460.00 # of Staff x average # of miles/wk x 50 wks x , A >e "� �1 el ��� " �ell , � � $ = Estimated Dail Travel/Miles a Reimb �" U fi Y 9 $50/Mo' Average @ $.29/mile 2FTE .• n � 29 Travel/Conferences/Trainingq ' " %I1 ,000 00 0.0c 25,000 00 • National Conference (cost per staff) y � "Feej ZZ Fie • Training/Seminar (cost per staff) � > "ll 11 1% l " ,+ 4 = f e F a • Other Trainings (cost of travel , lodging , Cor>fieence, CORE ' r 41 � Fee le,1, °� registration , food )) �. �. .. 'oiessional &<Com' 'etenc "Traintng� �,:. r lee Ile 30 Office Supplies � 4 250.00 0.00 20t500.00 Office supplies month) average x 12 y xIF 3 � PP (monthly 9 months = estimated cost of office supplies PP Avg $75 per;{nanth Pens, paper &IF e%I w "eel III, z IF based on present history. a a „;.. . � , er Ir genera' Fsu lieslej 19, fr 31 Telephone 600. 00 0.00 29j96.00 # Phone lines x average cost per month x " 9 P 3 s 12 months = local phone cost ell r � ` Average long distance calls x 12 months $75', er month for local servic6, $20 or Estimated cost of long distance , , es'ch:counselot for"66II phone; pbgers, F :s 32 Postage/Shippinglee I µ 300.00 0.00 9j125.00 • Quarterly Mailing of Newsletter 99 _ �fi a • Special events , etc. General COYf8sp011denCe, CheCkS, bulk = �� , • Bulk mailings - appeals � . , „ , ` irieilings _ , .,ti .e Ie , ' =' gym . ew , Ile 33 UtilitiesIlez" 600.00 0. 00 11 ,724 00 • Electricity ($ x 12 months) s • Water/Sewer ($ x 12 months) _ , � k z W rer ' lee rle I • Garbage ($ x 12 months) „ '; . . �, el ',a ., 'r ' . , t , .. A r el,wZe , i Ce :F 34 Occupancy (Building & Grounds) _ 3,600 00 19200.00 83 984 00 • Mortgage/Rent ($ x 12 months) i� ? i 44 qr s }' 3r Fill eel • Janitorial ($ x 12 months) , & _ " s , x R Mont! dent, Nlarl]tenance, 8e ) u dingy 3 • Grounds Maint. ($ x 12 months) s Y g5 r F y�, elocatton of fi ce Space"= • Real Estate Taxes " � rr w : :" .Mand=.EXpeY�se . ... ; ��� IF j ` .,� ., Feel , ." :9l - �ee , 35 Printing & Publications �' a' g 250.00 0.00 22 ,600 .00 Quarterly Newsletter ($ x 4) �� r _ � ' s " °�le > ;B "Ile v Letterheads, Envelopes , etasle xFell Fe� r x s Fundraising materials ' " �" a Celteriead brouchures, newsletter, IF ei wll z �� � - IX Other eel IBtC ' r . . . s.. ,rk . . 4>eel 1 , i 91 r 36 Subscription/Dues/Memberships _ . , . 100.00 0.00 1 4 ,000. 00 • DuesA A � Il } - 04, - G le • Subscriptions to Newspapers/magazines, ey - , F§ ` etc. K . �n' .4 Y 4Y ✓ A f t2 F q 1 37 Insurance, " �f > r 1 ,000 00 100.00 13 ,450 00 • Directors/Officers Liab. rz� ". 1eel ( " °p r/,. °L, a k' r' Asx' z,91 Z '.ke • Commercial/General Insurance r ' , 3 " I v r w • Bond Ins. � t.� lel fr ' Auto Insurance � � �.. 0 ar x ,.'. `_ ` � . . r�. s'm k', = 4 r > , "I leeffi , i1 i l , h •y ,�' . � •... 38 Equipment: Rental & Maintenance 500 .00 500 00 0 00 36,005 00 • Copier lease ($ x 12 months) E y 9 h ei � a x C A %y k,, A F - �. .xE el I • ell Meter lease ($ x 12 months) �k " d e, a 3 - le • Copier Maintenance $ x 12 months • Computer Maintenance ( $ x 12 months) � " x « � � • Other , A ,� ,\ a ar let 39 Advertising 600. 00 0.00 61650.00 • Newspaper ads t- ` ^T x eg A • Fundraising ads/promotions ' r, Ilei a , F� r. ¢ ` "� t' 3'd4 d� K Y ; 5 • Other vacancies F' ( ) 15Z n x h '- qw +_ s ' 40 Equipment Purchases : Capital Expense ¢� 0.00 0. 00 689160. 00 k • Computer/monitor (# x $) �� �� � Fee I ell 19 ell • Laser Printer � ' 41 Professional Fees (Legal, Consulting) 9 ( 9 9) k 500 00 15,000. 00 • Legal advice ( estimated #hrs x $) Mel " • Consultant fees �Fe " n Fk IF ' b . ., i _ 9 eeli Y l . . A M Me y Other COnf uterConsultanf^ ' "lee' e, ell y 5/21 /03 15 Exchange Club CASTLE -Valued Visits RFP #5054 42 Books/Educational Materials 0.0( 0.00 309290. 00 • Books/videos '48. ., M , < < „ � k� r, tx . Y Materials w� fi� x , , • f r ° e0ai1111r 43 Food & Nutrition Meals ( # meals x clients x 5days x 50 wks) � �� 6 �u _ 0 00 �• � z Snacks v �, e � � z s € � � p : WIN ill 20 44 Administrative Costs ° 90603 . 00 0.001 47,750.00 10% of actual program budget forte " executive management, accounting, tl SW M bookkeeping, personnelAl F 45 Audit Expense 125.00 75.001 59500.00 Independent Audit Review 46 Specific Assistance to Individuals ' , �_� $ 0. 001 0.001 71020.00 • , � }Medical assistancexs u 114 au�• Meals/Food yse �rtYk L' & T�rr ' � Fr 3�i `h £ a sz zri • Rent Assistance fi H� ��� s �IN � • Other b - 'v ` F3'4 '.«. M 7s � 'ka .y zL e � y. f( " a � ",, �' � �r » c � a4at" „s < s s tJ '.. verb •r; - ',+ ° .FxS' `x'F„�y; .Fx 47 Other/Miscellaneous300 00 0.0( 5t375.00 • Background check/drug test • 4 sT i +n l H YRz`” -H�9. h �5f�'#v�•'�vl^�(G Other d >a e fN . , z 6 \# t z , �, .. r—"" ; 3. , •a. .�-s,i.< _ ", �: � :�wz,.u.. .r�?a &` ,vt',� ` �'a , 32s ".,.� ,.. . , _ '. . -',@` - : °r, sz ?. a. . i..': 48 Other/Contract +a _ ` 15,600.00 53 ,032.00 a Sub-contract or program services a. S � Gt�artls �raptst , , X .... � 49 TOTAL EXPENSESWN ` .. $81 ,350 .00 $ 15,000.00 $ 19873 ,765.00 5/21/03 16 Exchm" Ck b CASTLE - V/u°° VMin RFP M5054 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Exchange Club CASTLE -- Valued Visits -- Indian River County FY 01/02 FY 02103 FY 03/04 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C<a. Sycol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 146 201 .00 162 900.00 174 300. 00 7.00% 2 Children's Services Council-Martin 85,446,001 100j375.00 137 437.00 36.92% 3 Children's Services Council-Okeechobee 0.00 0.00 0.00 #DIV/01 4 Advisory Committee-Indian River 37 251 .00 4500000 60o021 .00 33.38% 5 United Wa St. Lucie County 57 211 .00 58 000.00 6225000 7.33% 6 United Way-Martin County 41 974.00 38 300.00 38 300.00 0.00% 7 United Way-Okeechobee County 2j500,00 2 500.00 0. 00 0100.00% 8 United Way-Indian River County 113 333.00 96 000.00 128 700.00 34.06% 9 Department of Children & Families 235 343.00 276 641 .00 351 182.00 26.95% 10 County Funds 0.00 0.00 #DIV/01 11 Contributions-Cash 44 781 .00 86 252.00 86 252.00 0. 00% 12 Program Fees 48 746.00 6000000 60 000.00 0.00% 13 Fund Ralsina Events-Net 130 540.00 183 999.00 137 000.00 -25.54% 14 Sales to Public-Net 0.00 #DIV/01 15 Membership Dues 0. 00 #DIV/01 16 Investment Income 79362,00 6 000.00 11 000.00 83.33% 17 Miscellaneous 31969.00 2 000.00 200000 0.00% 18 Legacies & Bequests 0.00 #DIV/01 19 Funds from Other Sources 725 266.00 550 686.00 560 573.00 1 .80% 20a Reserve Funds Used for Operating 64 750.00 64 750.00 0.00% 20b In-Kind Donations (Not Included In total) 99000.00 0.00 #DIY/01 21 TOTAL 1 688 923.00 173340300 1 873 765.00 8. 10% MOW EXPENDITURES 22 Salaries 991 105.00 107107400 1 123 888. 00 4.93% 23 FICA 74t854.00 80s264.00 90 908.00 13.26% 24 Retirement 40 000.00 40 000.00 40 000.00 0.00% 25 Life/Health 45186.00 38 413.00 59 888.00 55.91 % 26 Workers Compensation 10 697.00 M 12 590.00 14t260, 00 13.26% 27 Florida Unemployment 12 440.00 = 81000.001 87000.000 0.00% 28 TraveWally 33 501 .00 43 730.00 42p460.00 -2.90% 29 Travel/Conferences/Train Ing 31220.00 14 439.00 25 000. 00 73. 14% 30 Office Supplies 24 514.00 2034300 20 500. 00 0.77% 31 Telephone 26,319.001 21 996.00 29196.00 32.737 32 Postage/Shipping5 515.00 9100.00 9 125. 00 0.27% 33 Utilities 13 626.00 10 368.00 17 724.00 13.08% 34 Occupancy (Building & Grounds 52 773.00 68j300.00 83 984,00 22.96% 35 Printing & Publications 8v751 .00 2260000 22 600.00 0.00% 36 Subscription/Dues/Memberships 3J99.00 230500 400000 73. 54% 37 Insurance 12 237.00 885000 1345000 51 .98% 38 Equipment: Rental & Maintenance 19 511 .00 18 095.00 36 005.00 98.98% 39 Advertising 8p274.00 665000 6*650.001 0.00% 40 Equipment Purchases:Ca ital Expense 31909.001 53 160.00 68 160.00 28.22% 41 Professional Fees (Legal, Consulting) 866.00 15 500.00 15 000.00 -3.23% 42 Books/Educational Materials 10 564.00 3019000 30 290.00 0.33% 43 Food & Nutrition 0.00 #DIV/01 44 Administrative Costs 28 704.00 4720100 47 750.00 1 . 16% 45 Audit Expense 17 010.00 550000 5 500.00 0. 00% 46 Specific Assistance to Individuals 10 274.00 71020.00 71020.00 0.00% 47 Other/Miscellaneous 6p450.00 45790. 0 5,375.00 17.38% 48 Other/Contract 76 502.00 73 136.00 53 032.00 -27.49% 49 TOTAL 1540001 00 1 733 403. 00 1 ,873 765.00 8. 10% 50 REVENUES OVER/ UNDER EXPENDITURES 1489922.001 ' 0.001 0.00 #DIV/01 \ WNW 17 ExchwW Cwe CAME - v.ww vmu RFP #5054 UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Exchange Club CASTLE - Valued Visits Indian River Count FY 01/02 FY 02/03 FY 03/04 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Ccol. Bycod. IS REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 Children's Services Council-Okeechobee 0.00 #DIV/o! 4 Advisory Committee-Indian River 91750,001 10 000.00 15 000.00 50.00% 5 United Way-St. Lucie County 0.00 #DIV/01 6 United Way-Martin County 0.00 #DIV/Ol 7 United Way-Okeechobee County0.00 N#DIV/O! 8 United Way-Indian River County28 508.00 0.00 9 Department of Children & Families 15 000.00 1500000 0.00 10 CountyFunds 0.00 11 Contributions-Cash 13 960.00 30 000.00 30 000.00 0.00% 12 Program Fees 12500, 001 w 19500,001 0.00% 13 Fund Raising Events-Net 3 000.00 300000 0.00% 14 Sales to Public-Net 0.00 #DIV/01 15 Membership Dues 0.00 #DIV/01 16 Investment Income 450. 00 0.00 -100.00% 17 Miscellaneous 400.00 0.00 #DIV/01 18 Legacies & Bequests 0.00 #DIV/01 19 Funds from Other Sources 22 500.00 15 000.00 31y850,00 112.33% 20a Reserve Funds Used for Operating 0.00 #DMO! 20b In-Kind Donations (Not included in total) 0.00 #DIV/01 21 TOTAL 90118.00 74 950.00 81350 DO 8.54% EXPENDITURES 22 Salaries 53l474.00 45 582.00 39 089.00 -14.24% 23 FICA 4 58O.00 39480.00 1437.00 -1 .24% 24 Retirement 19870.00 500.00 544.00 8.80% 25 Life/Health 19469.00 146900 0.00% 26 Workers Compensation 544.00 683.00 25.55% 27 Florida Unemployment 0.00 #DIV/O! 2a Travel-Dail 754.00 75.00 11200.00 1500.00% 29 Travel/ConferencesffrainIn 19000.00 #DIV/01 30 Office Supplies 1 ,200.00 250.00 250.00 0. 00% 31 Telephone 810.00 300.00 600.00 100.00% 32 Postage/Shipping 180.00 100.00 300.00 200.00% 33 Utilities 29250.00 600.00 #DIV/O! 34 Occupancy (Building & Grounds 71200,00 62000.00 3600. 00 -40.00% 35 Printing & Publications 250.00 #DIV/01 36 Subscription/Dues/Memberships 100.00 #DIV/01 37 Insurance 750.00 200.00 1000.00 400.00% 38 E ui ment: Rental & Maintenance 1 ,200.001 500.00 #DIV/O! 39 Advertising 200.00 600.00 200.00% 40 Equipment Purchases:Ca ital Expense 0.00 #DIV/O! 41 Professional Fees (Legal, Consulting) 11000.00 500.00 #DIV/01 42 Books/Educational Materials 880.00 0.00 #DIV/01 43 Food & Nutrition 750.00 0.00 #DIV/O! 44 Administrative Costs 93603.00 #DIV/O! 45 Audit Expense 125.00 125.00 0.00% 46 Specific Assistance to Individuals 0.00 #DIV/O! 47 Other/Miscellaneous 225.00 300.00 33.33% 48 Other/Contract 13 220.00 15 900.00 15 600.00 11 .89% 48 TOTAL 90 118.00 74 950.00 811350: 00 8. 54% 50 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.001 0.001 #DIV/Ol WIM3 18 Exchange Club CASTLE - Valued Visits RFP #5054 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Exchange Club CASTLE = Valued Visits Indian River County FUNDER : Children 's Services Advisory Com A B C FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS, PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 22 Salaries 39 ,089 .00 119337. 00 29 . 00 % 23 FICA 3 ,437.00 867. 31 25 .23% 24 Retirement 544.00 220 .00 40 .44% 25 Life/Health 11469 .00 1 ,071 . 00 72 . 91 % 26 Workers Compensation 683 .00 129. 69 18 . 99% 27 Florida Unemployment 0 . 00 0 . 00 #DIV/01 28 Travel-Dail 1 ,200 . 00 0 . 00 0 . 00 % 29 Travel/Conferences/Training 11000 .00 0 . 00 0 . 00 % 30 Office Supplies 250 .00 0 . 00 0 . 00% 31 Telephone 600 .00 0 . 00 0 . 00% 32 Postage/Shipping 300 .00 0 . 00 0 .00% 33 Utilities 600 . 00 0 .00 0 . 00 % 34 Occupancy (Building & Grounds 3 , 600 . 00 1 ,200 .00 33 . 33% 35 Printing & Publications 250 .00 0 . 00 0 . 00% 36 Subscription/Dues/Memberships 100 .00 0 . 00 0 .00% 37 Insurance 11000 .00 100 . 00 10 . 00% 38 Equipment : Rental & Maintenance 500 .00 0 .00 0 . 00% 39 Advertising 600 . 00 0 . 00 0 .00% 40 Equipment Purchases : Capital Expense 0 . 00 0 . 00 #DIV/01 41 Professional Fees (Legal , Consulting) 500 . 00 0 . 00 0 .00% 42 Books/Educational Materials 0 . 00 0 . 00 #DIV/Ol 43 Food & Nutrition 0 .00 0 . 00 #DIV/0l 44 Administrative Costs 9 ,603 . 00 0 . 00 0 . 00 % 45 Audit Expense 125 . 00 75. 00 60 . 00% 46 Specific Assistance to Individuals 0 .00 0 . 00 #DIV/Ol 47 Other/Miscellaneous 300 . 00 0 . 00 0. 00% 48 Other/Contract 15 , 600 . 00 0 . 00 0 . 00 % 49 TOTAL $819350 .00 $ 150000 . 00 $0 . 18 621/03 19 ME Ent pdm cASnA - VM VWb UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Exchange Club CASTLE - Valued Visits Indian River County FUNDER: Children's Services Advisory Committee .. #DN/01 #DIV/Of #DN/01 Advisory Commllteeandlan River Re uestin Actual Cost for Program Su ervisor in Indian River County #DIV/OI #DIV/01 #DN/01 #DIV/OI #DN/01 #DN/DI #DIV/01 #DIV/0 ;DIV/01 Funds from Other Sources Foundations and Sheriffs Department Match #DIV/Of #DIV/Of Workers Compensation Additional Premium direcily related to increase in salaries. #DIV/01 Travel-0ail #DIV/01 Telephone Postaae/ShiDoina Additional Postage due to increase costs, additional requirements for accrediation, and Information sent to community. #DN/01 #DIV/01 #DIV/01 Insurance Additional Insurance cost related to additional liability requirements #DIV/01 Advertisina Advertising for program and outreach #DN/01 #DN/01 #DIV/01 #DIV/01 #DIV/01 #DN/OI Other/Miscellaneous Miscellaneous costs to cover increase cost of background checks. UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME : FUNDER: Salaries EHGA Retirement Life/Health Workers Com en ation #DN/01 Occu ancv (BuIldino & Grounds #DIV/01 #DN/01 #DIV/OI Au it Expense #DIV/01 saoa 20 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children' s Services Advisory Committee RFP: # 5054 ORGANIZATION: Exchange Club CASTLE PROGRAM: Valued Visits TABLE OF CONTENTS Please "X " the parts of the grant application to indicate they are included. Also, please put the page number where the information can be located. X Section of the Proposal Pa e # X TABLE OF CONTENTS (Check list) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 X COVER PAGE (with signatures) . 3 A . ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . , , " I $ * , , , I I 111 , , 4 X 2 . Summary of expertise , accomplishments , and population served . . . . . . . . . . . 4 Be PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C . PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 4 . Staffing . . . , , & @ * @00 , @ # @ 0 0 * 9 . . . . . . . . . . . 463 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . , 1 " , 00001 , 10 1 0 61 , 18 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 F. PROGRAM EVALUATION (two pages maximum) X 1 . Demographics . . . . . . * , III . . . . . . . 11 # 011 , 110 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . 11 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 1 Organization: Exchange Club CASTLE Program: Valued Visits Funder: Children ' s Services Advisory Committee RFP: # 5054 I. BUDGET FORMS X 1 . Budget Narrative Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 X 3 . Total Program Budget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 X 4. Funder Specific Budget. X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 X 6 . Explanation for Variances — Funder Specific Budget . . . 0004111110 * 11110000 * 996820 J. FUNDER SPECIFIC/ADDITIONAL SHEETS X K. APPENDIX , 2 CHILDREN'S SERVICES ADVISORY COMMITTEE C/O Human Services 18Street Vero Beachh ,, Floridaori 32960-3394 Phone: 561 -567-8000 (Ext. 467 or 524) Fax: 978-1798 E-Mail : Jcarlsonabcc. co . indian-river.fl. us Mmastersonabcc. co . indian-river.fl . us To : Beth Jordan From : Joyce Johnston-Carlson Date : October 16 , 2003 Re : Grant Contracts 2003 -04 The attached is a Children ' s Service Advisory Committee Grant Contract for : Exchange Club CASTLE Please review the insurance certificate and verify that it is adequate by signing on the line below. Contact me if you have any questions . Thank you . ,�j Beth Jordan Date 10/ 16/03 i/ OUT ? 4 2003 CLERK TO THE BOARD Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County") and Exchange Club Castle (" Recipient") ; of : (Address) Exchange Club Castle P . O . Box 12908 Fort Pierce , Florida 34979 Safe Families Program 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 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Five Thousand Dollars ($35 , 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 its 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 23 , 2003 , 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 - 2 - 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 : ( 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. - 3 - 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 . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVE OUNTY BOA D OF COUNTY COMMISSI ERS By: neth R . MacKdSmrman Attest : J . K . Barton , Clerk By: t4/ . e Deputy Clerk dN Approve ames Chandler, County Administrator rov as to form and le uffici y Mari4v sistant County &6 ffy RECIPIENT : Exchange Club Castle P . O . Box 12908 Fort Pierce , Florida 34979 By. Name Title 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - 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 301h) 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 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : Theresa Garbarino -May Exchange Club Castle P . O . Box 12908 Fort Pierce , Florida 34979 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 - 1 - 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. - 2 - MAY-27-2003 09 26 HARBOR INSURANCE AGENCY 772 460 2315 P . 02/5 OP ID ,� OA RD„ CERTIFICATE OF LIABILITY INSURANCE EXCHA^ x 05 2� 03 THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE UARBOR INSURANCE AO S HOLDER. THIS CER11FICATE DOES NOT AMEND, EXTEND OR Z Colonial Road , Suite 2 00 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2 t Pierce FL 34950 = 5309 MAIC # Phone : 772 - 461 - 6040 Fax : 712 - 460 - 2315 INSURERS AFFORDING COVERAGE INSURER A: Philmdalhi a Inde InsCO IIIIII IN8URE0 The Exchange Club Center INSURER B• Twin CLtv Fire insurance Co fothe Prevention of Chfld Abuse DBA WWRER Co. Exchange Club CluVU0 C . A . S . T . L . S . INSURER D. PO Ft Pi erce FL 34979 wsURER E. COVERAGES ENAMED � � POLICY � 9tN THE POLICIES OFINTCEOMOW HAVE PEEN ENISSUED RESPECT O WHICH THIS MAY BE ISSUED OR ANY LIIERM CONDITIONORO R DOCUMENT WITH MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. DccLUSIONs AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, f61 uMITS rA 1CDDTNSR TYPE OF INSURANCE POLICY NUMBER DA E MID DA E MILD EACHDCCURRENCE $ lI. 000 OOO GENSRALLIAs�uTY i 100 000 x X COMMERCIALOENfiRALLV181LRY PHPKD4413o 03 / 26 / 03 03 / 26 / 04 M DMIEXP(A� one pe�t i5 000 CI plMg ){ApEFOCCUR PERSONAL & ADV INJURY $ 1 , 000 000 X $ AXt1Sl /MOIAs �at3c GENERAL AGGREGATE S 2 OOO OOO PRODUCTs - COMP/OPAOG s2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY P� Loc AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea iuleent) ANY AUTO BODILY INJURY ALL OWNED AUTOS y (Per persons SCHEDULED AUTOS BODILY INJURY s HIRED AUTOS (Per ecctdenl) NON.OWNED AUTOS PROPERTY DAMAGE 3 I (Per acddent) AUTO ONLY , EA ACCIDENT I GARAGE LIABILITY EA ACC S OTHERTHAN ANY AUTO AUTO OWLS^. A0G i EACH OCCURRENCE S — EXCESSIUMBRELLA LIABILITY AGGREGATE s OCCUR CLAIMS MADE i i DEDUCTIBLE _ RETENTION S TORY LIMITS X ER� WORKERS COMPENSATION AND B 1:MPLOY� LIABILtTY 21WBDU9567 12 / 01 / 02 12 / 01 / 03 E.L EACH ACCIDENT $ 500 — oFF CRROPRW OR EXCLUDED? E.L DISEASE - EA EMPLO 6 5 0 0 0 0 0 Oyes desa�eaER EL. DISEASE - POLICY LIMIT $ 500 000 SPECIAL PROVISIONS tmiaw OTHER000 , 000 A Professional Liab PHp1C044130 03 / 26 / 03 03 / 26 / 04 Occurrenc $ 1 , p, re ate $2 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PR6V9 0NS COmgany A : Rmployee Dishonesty , Policy #PHP1t019440 , 03 / 26 / 02 - 03 / 26 / 0 $ 100 , 000 Blanket . Certificate holder is an additional insured for general liability with respects to value Visits . CERTIFICATE HOLDER CANCELLATION INDIA - 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAM DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To MAIL 10 DAYS WRITTEN Indian River County NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, DUT FAILURE TO DO 30 SHALL Commissioners IMPOSE NO OBLIQATION OR LIABILITY OF ANY IOND UPON THE INSURER. ITS AGENTS OR 1640 25th Street Ef SAT, Vero Beach FL 32960 A RIZ NTAlCindv Mc a _ �► ® gCORD RPORATION 198 ACORD 25 (2001108) Internal Revenue Service Department of the Treasury District Director MAR 0 11984 Person to Contact : Ann Price / lch Telephone Number : ( 404 ) 221 - 4516 Refer Reply to : D Exchange Club Center for the Prevention of Child Abuse E0 : 7201 : AP of the Treasure Coast , Inc . 2414 Nebraska Avenue Employee Identification Number : Fort Pierce , FL 33450 59 - 2094472 File Folder Number : 580014494 _ Dear Sir or Madam : Date of Exemption : February 3 , 1981 Internal Revenue Code Section : 501 (c) (3) Gentlemen : Thank you for submitting the information shown below . We have made it a part of your file . The changes indicated do not adversely affect your exempt status and the exemption letter issued to you continues in effect . Please let us know about any future change in the character , purpose , method of operation , name or address of your organization . This is a requirement for retaining your exempt status . Thank you for your cooperation . Sincerely yours , r Distc Directo Item Changed From To Name SCAN America of the Treasure Shown Above Coast Inc . 275 Peachtree Street, N . E . , Atlanta , GA 30043 Letter 976 (DO ' ( 7 -771 i Internal Revenue Service Department of the Treasury District Director Date: 'Employer Identification Number. LG JAN 2 91982 59 - 2094472 Accounting Period Ending: September 30 Foundation Status Classification : 509 ( a ) ( 1 ) & 170 ( b ) ( 1 ) ( A ) ( vi ) r> Scan America of the Treasure Advance Ruling Period Ends: Coast , Inc . September 30 , 1983 2414 Nebraska Avenue Person to Contact. Fort pierce , Florida 33450 Y . Burleson/ eb Contact Telephone Number: ( 904 ) 791 - 2636 FFN : 580014494 Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from Federal income tax under section 501 ( c ) ( 3 ) of the Internal Revenue Code . Because you are a newly created organization , we are not now making a final determination of your foundation status under section 509 ( a ) of the Code . However , we have determined that you can reasonably be expected to be a publicly supported Drganization described in section 170 ( b ) ( 1 ) ( A ) ( vi ) & 509 ( a ) ( 1 ) . Accordingly , you will be treated as a publicly supported organization , and not as a private foundation , during an advance ruling period . This advance ruling period begins on the date of your inception and ends on the date shown above . Within 90 days after the end of your advance ruling period , you must submit to us information needed to determine whether you have met the . requirements of the applicable support test during the advance ruling period . If you establish that you have been a publicly supported organization , you will be classified as a section 509 ( a ) ( 1 ) or 509 ( a ) ( 2 ) organization as long as you continue to meet the requirements of the applicable support test . If you do not meet the public support requirements during the advance ruling period , you will be classified as a private foundation for future periods . Also , if you are classified as a private foundation , you will be treated as a private foundation from the date of your inception for purposes of sections 507 ( d ) and 4940 . Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period . If you submit the required information within the 90 days , grantors and donors may continue to rely on the advance determination until the Service makes a final determination of your foundation status . However , if notice that you will no longer be treated as a section 509 ( a ) ( 1 ) organization is published in the Internal Revenue Bulletin , grantors and donors may not rely on this determination after the date of such publication . Also , a grantor or donor may not rely on this determination if he or "3he was in part responsible for , or was aware of , the act or failure to act that resulted in your loss of section 509 ( x ) ( 1 ) status , or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section 509 ( a ) ( 1 ) organization . 275 Peachtree Street, N . E. , Atlanta , GA 30043 (over) Letter 1045 ( DO) (6-77) If your sources of support , or your purposes , character , or method of operation change , please let us know so we . can consider the effect of the change on your exempt status and ,foundation status . Also , you should inform us of all changes in your name or address . Generally , you arenot liable for social security ( FICA ) taxes unless you file a waiver of exemption certificate as provided in the Federal Insurance Contributions Act . If you have paid FICA taxes without filing the waiver , you should call us . You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Organizations that are . not private foundations are not subject to the excise taxes under Chapter 42 of the Code . However , you are not automatically exempt from other Federal excise taxes . If you have any questions about excise , employment , or other Federal taxes , please let us know . Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055 , 2106 , and 2522 of the Code . You are required to file Form 990 , Return . of Organization Exempt from Income Tax , only if your gross receipts each year , are normally more than $ 10 , 000 . If a return is required , it must be filed by the 15th day of the fifth month after the end of your annual accounting period . The law imposes a penalty of $ 10 a day , up to a maximum of $5 , 000 , when a return is filed late , unless there is reasonable cause for the delay . You are not required to file Federal 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 . 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 , ) Is t. c Uirecto /1* cc : Eugene J . O ' Neill Letter 1045 ( DO ) (6-77) Please Note : Transportation is NOT necessary to operate this program . Organization: Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 PROGRAM COVER PAGE Organization Name : Exchange Club CASTLE Executive Director: Theresa Garbarino-May Email : tgarbarino-may@exchangecastle . org Address : P . O . Box 12908 Fort Pierce, FL 34979 Telephone : 772-465 -6011 Fax : 772-465 -6013 Program Director: Ruth Orenstein Email : rorenstein@exchangecastle . org Address : 1906 12th Court , Vero Beach , FL 32960 Telephone : 772- 567-5700 Fax : 772-567 -7133 Program Title : Safe Families Priority Need Area Addressed: Parental Support and Education : Safe families develops individualized parenting programs for families at risk of abusingor r ne lg_ecting their children , and provides parenting support appropriate to the ages of the children in the family. Brief Description of the Program : According to the Taxonomy of Human Services , Safe Families is a Parenting Skills Development program #PH-610 . 680 . This definition applies if the revision "In -Home or Home Based" is added. Safe Families offers home based parent education and support designed to prevent child abuse and neglect and help families remain intact. Through long term (up to one year) , intensive (at least weekly) , visits from an in -home counselor, families learn to reduce risk factors associated with abuse and neglect, and increase the protective factors associated with non - abusive , caring families . Amount Requested from Funder for 2003 /04 : $ 509000 Total Proposed Program Budget for 2003 /04 : $ 234 , 125 Percent of Total Program Budget : 21 . 3 % Current Funding ( 2002 /03 ) : $ 35 , 000 Dollar increase /( decrease ) in request : $ 157000 Percent increase/( decrease ) in request : 43 . 0 % Unduplicated Number of Children to be served Individually : 207 Unduplicated Number of Adults to be served Individually : 117 Unduplicated Number to be served via Group settings : - Total Program Cost per Client : 723 . 00 Will these funds be used to match another source ? yes If yes , name the source : CASTLE/UW /DCF Amount : $ 184 , 125 *Cost per family = $2,601 The Organization 's Board of Directors has approved this application onjdate . 1/2 3T Al Fort Name of President/Chair of the Board Sig lure > ° Theresa Garbarino-May - r�4 r,1, Name of Executive Director/CEO Signature . - 3 Organization : Exchange Club CASTLE Program: Safe Families Funder: Children ' s Services Advisory Committee RFP: #5054 PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. The mission of the Exchange Club CASTLE is to improve the quality of family life while preventing child abuse and neglect, by providing community education , support and resources for families in need of assistance . The CASTLE envisions a community where each child is allowed to grow to his or her full potential , free from abuse and neglect, and families have access to the supports they need to create healthy living and learning environments for children . 2. Provide a brief summary of your organization including areas of expertise, accomplishments and population served. The CASTLE began in 1981 , and now serves as the model for a national network of child abuse prevention centers that span 107 locations in 27 states . With an involved, active Board of Directors , and an Executive Director, Theresa Garbarino-May, who is beginning her 17th year at the helm of the agency, the CASTLE is known for its steady leadership and quality programs . The CASTLE was fortunate enough to receive both national and state recognition last year. Nationally, the United States House of Representatives recognized the CASTLE as a "true American success story" for serving as a national model in the fight against child abuse . In Florida, the State Senate awarded Ms . Garbarino-May the Florida Senate Medallion of Excellence for her outstanding service to the children of the Treasure Coast . This year, the CASTLE has been recognized as a leader in the area of supervised visitation by being awarded a $ 300 ,000 federal grant to expand services to victims of family violence . The CASTLE was one of only three providers in Florida to receive this funding. Finally, the CASTLE was in the running as one of the "Best Places to Work" in a local study done jointly by the Chamber of Commerce , the Human Resources Association , and the Workforce Development Board. The CASTLE was described as "very competitive" with other top organizations in the area . The CASTLE offers an array of services designed to prevent child abuse , and cultivate the parent-child relationship . Our core program Safe Families , offers long term, home based, parenting skills development . Other programs offered by the CASTLE include : Families First, a training seminar for divorcing parents ; High Hopes for Kids , offering support to children whose parents have divorced; Positive Parenting, a support group for parents facing difficulties raising their children ; Healthy Families , providing home based services to pregnant women and newborns ; Valued Visits , a supervised visitation center, and our newest program, Co-Parenting, a support group aimed at helping divorced parents reduce conflict surrounding shared custody. CASTLE services utilize best practices , and a continuous quality improvement model . The population served is : families who are at risk for abusing or neglecting their children ; families who have had a reported incident of abuse or neglect, but who , with support and education , can eliminate further episodes of abuse ; families with children 0- 18 ; and families who live within Indian River County . This year ' s demographics indicate that 46 % of enrolled families are single mothers or fathers , 69 % have completed high school , 82 % have incomes under $25 ,000 , and 63 % are White, 20% are Hispanic and 14% are Black. 4 Organization: Exchange Club CASTLE Program: Safe Families Funder: Children ' s Services Advisory Committee RFP: #5054 Be 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. What: The unacceptable condition requiring change is child abuse and neglect . Child abuse and neglect has well -documented, long term, harmful effects on children , including permanent physical injuries , chronic low self esteem, developmental delays , difficulty in forming attachments and relationships , mental illness , aggressive behavior, and a cycle wherein an abused child is much more likely to , in turn , abuse his or her own children ! Who : Parents who pose a risk to their children , because of identifiable risk factors such as poverty, a lack of parenting knowledge and skills , or a parent ' s own history of abuse or addiction . Where : Last year, parents were served in all parts of Indian River County. Provide Data : The overwhelming majority of families that abuse or neglect their children can , with the proper support , learn to parent in a manner that is non abusive (research shows that home based parent education is the most effective way to prevent abuse and neglect") . This allows the family to remain intact and avoid the trauma of an out of home placement for the child. Research indicates that 96-98 % of families who engage in home-based parent education programs such as Safe Families , do not re-abuse their children . This reduces by almost two- thirds , the number of children who face further abuse at the hands of their caretakers . "' Keeping a family intact eliminates the need for a foster care placement, where a child is three times more likely to be abused in state care as compared to remaining with parents . '" Locally, Indian River County had over 1 , 100 abuse reports filed in 2001 -2002 . The rate of abuse in Indian River County is 17 children per 1 ,000 , which is lower than the state rate of abuse (20 children per 1 ,000) but higher than the national average ( 12 children per thousand) . " In conclusion , the data show that 1 ) home based parent education prevents abuse , 2) home based parent education helps children stay out of foster care (where they are more likely to be abused) , 3 ) Indian River County is doing better than the state at protecting its children , but worse when compared to national statistics , 4) with more home based parent education , Indian River County can make a significant impact in reducing the number of children abused . 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. There are no similar programs serving the population targeted for Safe Families . The other child abuse prevention programs in the county are Healthy Families and Family Builders and both serve different populations . The collaboration among these three programs creates a seamless system of caring for abused and neglected children . All age levels of children and all levels of risk to children are covered without duplication or overlap of services (see chart in appendix) . Despite this seamless system, the target population for Safe Families is underserved . This is evidenced by the fact that there is program space for only 65 families and yet 374 children had confirmed abuse . To date , the Safe Families program has received twice as many referrals as can be served this year. 5 Organization : Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Parental support and education . 2. Briefly describe program activities including location of services . 1 . Upon receiving a referral , a counselor visits the family, and assesses the need for home- based parent education (Safe Families) . This is accomplished through interview , observation , and completion of an initial needs assessment. To avoid duplication or overlap with other service providers , a review is done of all services being offered to the family . When necessary, and with consent, other service providers are contacted in order to coordinate services to the family. If eligible for Safe Families , the family will begin a program of regular visits , and a family plan , including specific goals , will be developed. The family is an active participant in this process , collaborating on the initial plan for services . 2 . Once a family plan is developed , the counselor makes weekly visits to address the family plan goals . Weekly visits take place for up to one year, with the visits taking place in the family 's home, thus increasing the counselor' s ability to assess the safety of the children , and evaluate improvements made by the family. Parents remain active participants during the weekly visits , teaming with their counselor to initiate improved parenting techniques . 3 . During the weekly visits , counselors use a multifaceted approach to teaching , including utilizing parenting videos , working through parenting programs , creating behavior management plans , and establishing family meetings , or other formalized methods to improve family communication . Information is discussed and input is sought from the parent, to ensure understanding of the material presented. 4 . All weekly visits are geared toward reducing risk factors (characteristics that increase the likelihood that abuse will occur) , and increasing protective factors (characteristics that decrease the likelihood that abuse will occur) . Safe Families has identified the following risk and protective factors that form the basis of each counselor' s work with a family : Risk Factors: Lack of parenting knowledge/skills; Parent 's past history of abuse; Parent 's history of drug or alcohol abuse, or mental health issues; Poverty/financial stress; Teen and young parent; Social isolation. Protective Factors: Housing stability; Delay of subsequent pregnancy; Enrollment in childcare and health care; Livable wage employment,% Involvement in child 's school. 5 . Families are tracked for one year after exit from Safe Families to determine if abuse or re- abuse has occurred. 3. Briefly describe how your program intends to address the stated need/problem. Include reference to any studies or evidence that indicate proposed strategies are effective with target population. The stated need or problem is child abuse and neglect . Safe Families addresses child abuse and neglect by offering long term, home based, parent education and support to build on the parent ' s knowledge of child development, positive discipline , communication , behavior modification , and nurturing and bonding . The family ' s relationship with their counselor is a critical element to the success of the program . Over the course of the program, the counselor guides , supports , coaches and teaches the parent to create a nurturing, healthy environment for their children . Initially, risk factors are identified , and addressed, and then protective factors are built upon , so that the family can remain stable and abuse free long after they graduate from Safe Families . 6 Organization: Exchange Club CASTLE Program: Safe Families Funder: Children ' s Services Advisory Committee RFP: #5054 There is a wide body of research that demonstrates the effectiveness of the long term, home- based model of preventing child abuse and neglect . The most recent research shows that : "Parenting programs of 90 days or more tend to produce significantly more positive parenting behaviors than programs less than 90 days in length . (The Impact of Gender, Race , Income, and Education on Parenting Attitudes , July 2001 , Stephen J Bavolek, Ph . D . ) "Home visiting programs show documented positive outcomes including reduced rates of child abuse and neglect, and improvement in maternal life course . " (Home Visiting , National Committee to Prevent Child Abuse , December 1995 ) . "Parent education and training have been linked to positive changes in parent-child interactions , an increase in parent self-efficacy, and a reduction in reported child behavior problems . " (A cost-effectiveness evaluation of parent training, Journal of Child and Family Studies , December, 1996 ) . 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). Safe Families Supervisor — 15 hours/wk —Required credentials/exp . — BA/2yrs . sup . exp . Safe Families counselors (3 . 0 FTE) - 40 hours/wk — Req . credentials/experience — BA/2 years Secretary — 30 hours/wk — Required credentials/experience — 1 - year experience . Human Resources -4 hrs/wk-Re wired credentials/experience — 2 yrs . HR experience . 5. How will the target population be made aware of the program? Families are made aware of the program through the following methods : Referrals from agencies , schools , parents and the Department of Children and Families . The CASTLE participates in local outreach efforts and information sharing events . The CASTLE participates in National Child Abuse Prevention Month . The CASTLE affiliates with many local businesses through fund raising and service clubs . The CASTLE ' s speaker' s bureau does informational talks and trainings . The CASTLE is a First Stop site . The CASTLE collaborates with several highly visible programs on the Treasure Coast . 6. How will the program be accessible to target population (i.e. location, transportation, hours of operation) ? Families are visited in their homes , with no required visits to the CASTLE administrative offices . To enroll in the program, all a parent must do is call the office . An intake screening is done over the phone . If the family seems appropriate for Safe Families , a home visit is scheduled within the next 48 hours . A more in-depth screening is done during the home visit to further ensure the appropriateness of Safe Families . Referrals from other service providers , churches or schools are accepted by fax or by mail . The same intake procedures follow the receipt of a faxed or mailed referral . The administrative offices are opened from 8 : 00am - 5 : 00pm . Home visits are scheduled weekdays , and weekday evenings . 7 Organization: Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 D. FY 03-04 MEASURABLE OUTCOMES (Entire Section D not to exceed two ages) FY 03-04 OUTCOMES ACTIVITIES Add all the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . Reduce the risk factors associated with child 1 . Provide information and education abuse for families in the Safe Families program regarding identified risk factors , during home by at least one , during enrollment in the visits , so that major risk factors are reduced or program and /or at the conclusion of the eliminated. program, for 90 % of families who have been enrolled at least 3 months , as measured by a risk assessment tool (see appendix ) . No more than 10 % of families who have been enrolled for 3 months or more will show no (zero) risk factor reduction . 2001 /2002 baseline : 99 % of families reduced at least one risk factor. 1 % showed no risk factor reduction . 2 . Maintain the reduction in risk factors (by at 2 . Complete the risk assessment tool one year least one) for a period of one year, for families after enrollment in Safe Families ends , with who have successfully completed the program, families who completed the program as measured by a risk assessment tool (see successfully. This will be done by phone appendix) in 80 % of families . No more than survey, with at least 20 % of families who 20% of families who have successfully completed successfully. completed the program will fail to maintain a risk factor reduction . 2001 -2002 baseline 91 % of families maintained a risk factor reduction . 9 % of families failed to maintain a risk factor reduction . 3 . Increase the protective factors associated 3 . Provide information and education with a reduction in the risk of child abuse for regarding identified protective factors , during families in the Safe Families program by at home visits , so that major protective factors are least one , during enrollment in the program increased and/or improved upon . and /or at the conclusion of the program, for 88 % of families who have been enrolled for at least 3 months , as measured by a protective factor assessment tool (see appendix) . No more than 12% of families who have been enrolled for at least 3 months will fail to increase at least one protective factor. 2001 -2002 baseline 97 % of families increased at least one protective factor. 3 % of families failed to increase at least one protective factor. 8 Organization : Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 FY 03 -04 OUTCOMES ACTIVITIES Add all the elements or your Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 4 . Maintain the increase in protective factors 4 . Complete the protective factor assessment (by at least one) for a period of one year, for tool one year after enrollment in Safe Families families who have successfully completed the ends , with families who completed the program , as measured by a protective factor program successfully . This will be done by assessment tool (see appendix) in 85 % of phone survey, with at least 20 % of families families . No more than 15 % of families who who completed successfully. have successfully completed the program will fail to maintain an increase in at least one protective factor. 2001 -2002 baseline : 99 % of families maintained an increase in at least one protective factor. I % of families failed to maintain an increase in at least one protective factor. 5 . Maintain at 94 % , the number of families 5a. Provide information and education who complete the Safe Families program that regarding identified risk and protective factors , will have no confirmed reports or re-reports of during home visits , so that parents develop the abuse for up to one year after completing skills necessary to eliminate abuse/neglect as a services as measured by the state data base on risk in their home . abuse. No more than 6 % of the families who complete the Safe Families program will have 5b . The Department of Children and Families a confirmed report or re-report of abuse for up will compare the names of enrolled families to one year after completing services . 2001 - against those reported for abuse/neglect to the 2002 baseline : 94% of families had no reports state abuse hotline , and provide the program or re-reports of abuse . 6 % had a report or re- with this information . report of abuse. 6 . Maintain at 90 % the number of families 6 . The AAPI test will be administered at the who , after successfully completing the Safe initiation of and at the conclusion of services . Families program, show improvement on the Scores will be compared to determine whether AAPI test, as measured by comparing their improvement has been made . pre-test score to their post-test score . No more than 10% of families who , after successfully completing the program, will have no increase in a post test score . 2001 -2002 baseline : 100 % of families who successfully completed the program improved on their post test AAPI scores . 9 Organization : Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources 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 United For Families CASTLE staff to participate on leadership council ; CASTLE staff to remain on board of directors of UFF; assist in planning and implementation of CBC contract ; jointly advocate for adequate funding . Children ' s Home Society Participate in weekly staffing meetings ; share relevant case information when necessary to assist families ; ensure that there is no dual enrollment through intake/assessment process and information sharing . Healthy Families — Indian River CASTLE continues to manage the program operations County of Healthy Families , IRC ; remain on the advisory board; share relevant case information when necessary to assist families ; ensure that there is no dual enrollment through intake/assessment process and information sharing ; participate jointly in advocacy efforts to support child abuse prevention programs , Department of Children and Participate in weekly staffing meetings ; share relevant Families case information when necessary to assist families ; ensure that there is no dual enrollment through intake/assessment process and information sharing . Hibiscus Children ' s Center Participate in weekly staffing meetings ; share relevant case information when necessary to assist families ; ensure that there is no dual enrollment through intake/assessment process and information sharing . 10 Organization: Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 F. 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 Age, gender, ethnicity, marital status , and address are collected upon intake . Eligibility for the program requires that children ages 0- 18 must be living in the home . Families must exhibit at least one risk factor on a child abuse risk factor checklist to be enrolled. Families who pose an imminent risk of harm to their children are referred to another program . Intake and eligibility information are assessed during an Initial Needs Assessment , which takes place during the first home visit. 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 ? Outcome 1 (to reduce risk factors associated with abuse) : is measured by a risk assessment tool that lists the risk factors identified at intake (see appendix ) . Identified risk factors become the focus of intervention until they are resolved. Risk is assessed at least quarterly . Outcome 2 (to maintain the reduction in risk factors) : is measured by a follow-up phone survey done one year after completion of the program , with families who complete the program successfully. Outcome 3 (to increase protective factors associated with a lower risk of child abuse) : is measured by a protective factor assessment tool that lists the protective factors identified at intake, and subsequently (see appendix) . Identified protective factors are a focus of intervention once risk factors have been reduced. Protective factors are assessed at least quarterly. Outcome 4 (to maintain the increase in protective factors ) : is measured by a follow-up phone survey done one year after completion of the program , with families who complete the program successfully. Outcome 5 (no re-reports of abuse) : is measured by the state database on abuse . Families enrolled in Safe Families for three months or more are checked to see if there have been any subsequent reports to the child abuse hotline . This check is done quarterly . Outcome 6 (improve on post test score) : is measured by the AAPI (Adult Adolescent Parenting Inventory) , which is a nationally accepted standardized test that measures parent attitudes and beliefs . Low scores are associated with an increased risk of abuse ; high scores are associated with a lower risk of abuse . The test is administered during intake , and prior to closure . Other data collected include satisfaction surveys from all clients , and completion of family plan goals , for each family. 11 Organization: Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 3. REPORTING : What will you do with this information to show that change has 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? Information collected is used to measure the progress of enrolled families , and to help determine the length and content of the intervention . Families are aware of their progress on the AAPI, risk/protective factor checklist, and family plan goals . Client satisfaction surveys are analyzed through the CASTLE ' s CQI process , in the Service Delivery committee . Recommendations for program improvements come from this committee . Results from collected information are reported to funders on a regular basis through monthly, quarterly or semi-annual reports . Staff, Board members , and other stakeholders are made aware of results through the CQI process , and feedback at all -team and Board meetings . The community is made aware of results through an annual report . G. TIMETABLE (section G not to exceed one page) Safe Families is a continuing program and will be fully staffed and in full operation at the start of the contract year. Regarding the program operation : 1 . Referred families are contacted within 48 hours . 2 . Referred families are assessed within 14 days . 3 . A family plan is developed within 30 days . 4 . Weekly visits take place for up to one year. 2 . Monthly and quarterly progress reports track client progress . 3 . Post testing and protective/risk factor assessments take place near the end of services . 4 . Follow-up is done within one year of closure . Regarding the hiring of an additional counselor: 1 . Advertise, interview and screen candidates mid August through mid September. 2 . Offer the position to one candidate in mid September. 3 . Hire the new counselor on October 1 , 2003 . 12 a o � n o o 0 0 ° o C cooLA We 0 NEW R r p .. et .� .. b O a CD CD C A W; n nCD C4 G:• Z1 to ol CD Mole 0 CD 0 cL IQ c CC0 CL CD D i °o o 0 o y y O O a C7 CD tzwe OWN fD m � oiln ;k ONNOMEN II C 0 0 CD a � co =D c oo w > ►� co 00 �l W N ON Q\ Iu- O O �o 00 F Cn "PEN C C f7 PI � 1 , a A• I .F.� , > : y. s p n owC� �� p F« N � � � � ►- a\ � v �-• � rn w w p ►-3 00 0 m a c o. r pol .. O Qr00 00 rA 00 w owe l_1 '� A• O N O CA 000 wrp `�" o • . A y ee .O rr W r� roth o. O A rA a CD CN .? a\ N w C c tn P O G O vii to O J w O O\ IC 1 y »3X+'e Fg N ►rtMEN ed .�. I-- 'wn•' � _ ri �, e �.i vim, A 141kou to O� N Vl w V1 �p O ' per N CJI t1i Cll O Cn C!t ? ap ! w, d A WMMwooW c, aa Ul) 1 I I I 1 1tOwe W V Ch \o LA \ o ul P&, . "x 4�A O O O OLA Exchange Club CASTLE -Safe Families Indian River County RFP #5054 UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : Exchange Club CASTLE - Safe Families Indian River County FUN DER : Children 's Services Advisory Committee I CAUTION Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should be used for calculations and to write information only. � Ire > s r oir� .„ i yr 'w, GftAy:SREAB'k`t1ft c " ' a - ., , Jett,�� eite EVEl11UES AOEr+cYw omy PrOp�sed To>�al Program Funder Specific 7o�taiA�er , ency F � tsttoworr Budget rALOULAVOW �. Budge# Bud' °t xa ,... yt, ,:�m g. 1 Children's Services Council-St. Lucie 1,r 1749300.00 2 Children's Services Council -Martin 137,437 . 00 3 Children's Services Council-Okeechobee 4 Advisory Committee-Indian River 50 ,000.00 50 ,000.00 609021 . 00 5 United Way-St. Lucie County 62,250. 00 6 United Way-Martin County38,300. 00 7 United Way-Okeechobee County 8 United Way-Indian River County - " 100 ,000 . 00 128,700.00 9 Department of Children & Families ""X 60 , 000.00 351 , 182. 00 10 County Funds ��d . 11 Contributions-Cash =' :' 7,000 . 00 869252 . 00 12 Program Fees ; ,• Q t 60,000. 00 13 Fund Raising Events-Net 7,238. 00 137 ,000 . 00 14 Sales to Public - Net 15 Membership Dues 16 Investment Income 111000 . 00 17 Miscellaneous : ' '! � _ � ' 21000. 00 18 Legacies & Bequests 19 Funds from Other Sources �„ � . - "' ' 91887 . 00 560 ,573. 00 20a Reserve Funds Used for Operating % : , x 64,750 . 00 20b In -Kind Donations (Not included in total) 21 TOTAL REVENUES (doesn't le " ler rrl ' include line 20b)_: "p $234 , 125.00 $502000. 00 $ 1 ,8739765 . 00 4 `3 dmf+ �r Sys x q `�e 5 .� ' tt, � � r /EXPENDIURES b :AYAFoR 1?roposad Total Piogram iFura►eraSpecrfic � Total Agency », ca rre" AGENCY t)SEONi:�* Y . Fffitt/;CALCU4ATloN3J �, rg 1. „t t w Kb 3 �A2 r .; �� . ,. : � ,,$t►dgat ; ; udgef Bud et 22 Salaries - (must complete chart on next page) 1209181 . 00 349077. 00 191239888. 00 ? s tr tell 9L 3 `` `fin` r }.*°,d' q 's,' P. Sala t % �` = 3 s J`i 3' �a y`. i x. . _ .2 , e . �. „. . '.: .. , t` ,, . .< . ' ='fix .,a ., c` $ �' , 5 ,-�`. �� 4+. K e x 23 FICA - Total salaries x 0. 0765 -7:65% 9 , 569.77 2 ,606 . 92 90 ,908. 00 Retirement - Annual pension for qua I Ie r, 1 $1000 perfull 24 staff time employee 5,500 . 00 1 ,500 .00 40 ,000. 00 Life/Health - Medical/Dental/Short-term ere ere 25 Disab. $ 170.88/mo 8 , 745. 23 30076. 00 59 , 888 .00 Workers Compensation - # employees x leer er 26 rate ter 11 A2/$100 889 .00 490. 081 149260. 00 Florida Unemployment - # projected 27 employees x $7,000 x UCT-6 rate 0 . 00 0 .00 81000. 00 5/23/03 14 Exchange Club CASTLE -Safe Families Indian River County RFP #5054 el, t` fs •` ! 'S ,$F" 4. �' c. �el Few, r A a x s �� {e { \�1.t�: 7 W /$_ lY ➢,y / :, if . � .. . .� W 5 �. . ' Jib s, frr�,' w„yy1 L �� f4 ! 3Y } § y Gross Annual F r ° Grass Annuaf ' , P�D$!TION Po►flonf Salary ren lrapbsed % eef Funder Spilitak Budget , S lard F posltfon �itief7o afrsl�vK` - rAll, on Y7 F zell t +rogram sf F Y� Jz Re ue re ,; , °`k } L rxi , , C 4„ �. e $ 'an"S<' W T? ;a' ?w s ` a "^ ,x„ - , . .. 5 . : la - '' Eiramp/e. . ExeciiUve bfiecfor( 4Q "hrs' 3 70,000 00 , �W � ' . . 10,OOO.QQ,; 5,000.00 714°a „ .4 x R Orienstein, Program Supervisor/15 hrs 38,984. 00 15,594.00 0.00% New, Counselor/40 hrs 28, 115.00 28, 115. 00 14 ,057.00 50 .00% A Tovar-Dillaha , Counselor/40 hrs 32,214 .00 32214 . 00 10 ,738 .00 33 . 33% F Sudbrock, Counselor/40 hrs 279846.00 27,846 . 00 99282.00 33 . 33% New, Secretary/40 hrs 19 ,656.00 149742 . 00 0. 00% K Rains, Human Resources/ 4 hrs 14 , 196. 00 1 ,670. 00 0. 00% #DIV/0! #DIV/0! #DIV/0! #DIV/0 ! EEE#DIV/O !0. 00 0 ! 0. 00 #DIV/0 ! 0.00 #DIV/0! 0.00 #DIV/0! 0 . 00 #DIV/0 ! 0.00 #DIV/O! 0.00 #DIV/0 ! 0 . 00 #DIV/01 0.001 #DIV/0! Remaining positions throughout the agency 962,877 .00 Total Salaries I $ 1 , 123v888.001 $ 120 , 181 . 00 $34vO77.001 3 . 03 % FRINGE B NEFI S aETA1V% W, A f s n i rtr �I, lr }gym t .� ,,;. rk xn Wbw:. x �. . i �e 3 3�' s '� a ;, §, "`�fY?, , � pecHICNAU'Ll e r l'rinder y B .: x s " k _ v t ° Penslort YI/orker s Ur emp oyr e d otal Frfnges under; % Specific FICA 7.55 ° Heafth Ins. Colum» C only, f On line 22461 7 , „ §ll Campensr� nt Dampens. specific !t fi a 3 '�` s a e �' £ 'yUfe " 6.,y,. v f W x s Pos/ to t titlelTotalHrsl�rlr u ; r .. _�� Sad $ a . . z 7 c el .."rl4. s" 'r f. Farample Case"lN nagerJ hrs_ r'> ,.� , � , " -- 5090,000 382.50 '- _rr :200;00 $00,60 _. 00.00 . , . 200:00 p " �f _ . _ . . ,.,'1,58x.50' R Orienstein , Program Supervisor/15 hrs 0.00 0 . 00 0. 00 0. 00 0 . 00 New, Counselor/40 hrs 14 ,057. 00 1 ,075 .36 834.00 19530.00 202 .42 3,641 .7 A Tovar-Dillaha , Counselor/40 hrs 10,738.00 821 .46 333 . 00 773 . 00 154.00 2 ,081 .4 F Sudbrock, Counselor/40 hrs 95282 .00 710 . 10 333 .00 773. 00 133.66 1 , 949. 76 New, Secretary/40 hrs 0 .00 0.00 0. 001 0. 00 0 . 00 K Rains , Human Resources/ 4 hrs 0 .00 0. 00 0. 00 0.00 0 . 00 0 0.00 0 . 00 0. 00 0 0. 00 0.00 0 . 00 0 0 .00 0. 00 0 .0 0 0 .00 0 . 00 0. 0 0 0 . 00 0.00 0 . 00 0 0 .00 0.00 0. 0 0 0.00 0 .00 0 . 00 0 0.00 0.00 0 . 00 0 0 . 00 0. 00 0. 00 0 0 .00 0 . 00 1 0 . 00 0 0 .00 0 .00 0. 0 Q 0.00 0 .00 0. 00 Q 0. 00 0.00 0 . 00 0 0 .00 0.00 10 .00 Total Funder Request Fringe Benefits $34 ,077 .001 $29606 . 92 $ 1 ,500 .00 $31076 . 00 $490.081 $0 .00 $7 ,673 . 00 [ s f K lee u EXPENDI "U2ES Y orsilYensFoa', 9 Prop�setl 1 otal Prograirr FuntlerSpeCific Total Agiency "n�`3Y` r '' ,AdBtVCY USE CNLV 70 ..x 3 sr + " a p . et 15 Exchange Club CASTLE -Safe Families Indian River County RFP #5054 28 Travel-Daily 5,595. 00 0 .00 429460.00 # of Staff x average # of miles/wk x 50 wks x f rI If $ 15542/Mo per Counselor Average d ; $ = Estimated Daily Travel/Mileage Reimb $ 29/mite A... , "; q3,. . V 29 Travel/Conferences/Training 7 ,350. 00 0.00 25,000.00 3 • National Conference (cost per staff) "K / If • Training/Seminar (cost per staff) If If % R • Other Trainin s cost of travel , lodging , 9 ( National Conference . CORE registration , food) Porfessional & Competency Raining` . , 30 Office Supplies 21500 .00 0 .00 20,500.00 Office supplies (monthly average x 12 ` rrf ' rrrrx months = estimated Cost of office supplies AV;g $75 per month--_ Pens, paper & t - based on present history. eneral sup hes - 31 Telephone f 11500.00 0.00 29, 196 .00 # Phone lines x average cost per month x 12 months = local phone cost �A Average long distance calls x 12 months = , $75 per month for local service; $20r Estimated cost of long distance each xounselor for cellphone, _pagers ,pg 32 Postage/Shipping /sM 1 ,500 . 00 0.00 99125 .00 • Quarterly Mailing of Newsletter f ' / y w e rIf f fir • Special events , etc. � General correspondence, checksIf; ulk I • Bulk mailings - appeals :,, N, -. - mailings 11 33 Utilities 6 ,000 . 00 0 .00 11 724. 00 • Electricity ($ x 12 months) / f • Water/Sewer ($ x 12 months) � � • Garbage ($ x 12 months) s , ." ,'_ 34 Occupancy (Building & Grounds) If §� 163000. 00 71330.00 831984 . 00 • Mortgage/Rent ($ x 12 months) W " • Janitorial ($ x 12 months) TI If Monthly Rent, Maintenance & Building • Grounds Maint. ($ x 12 months) " e� �, " Expense, Relocattort df c6,Space y, • Real Estate TaxesIffi " % ', and Expenseff ,. �. . 35 Printing & Publications 21500 .00 0 .00 22 ,600.00 Quarterly Newsletter ($ x 4) • Letterheads, Envelopes , etc. �, If • Fundraising materials € d Other Letterhead ,,brouchures, newsie#ter, • , etc: _ . . y: . . 36 Subscription/Dues/Memberships ;, g fr � 750.00 0 .00 4,000 .00 , 'gfe Duesff V , sk Subscriptions to Newspapers/magazines , �" sIf ee IV, etc. If �„ 37 Insurance „ w 1120 .00 500. 00 13 ,450 . 00 Directors/Officers Liab. § If I Commercial/General Insurance If R . If I Bond Ins . xle, n Auto Insurances<� � , q p ` 3 7 , 500. 00 0. 00 36 ,005. 00 38 E ui ment : Rental & Maintenance �3 • Copier lease ($ x 12 months) xr . Y,Y • Meter lease ($ x 12 months) s5 " If I Nl ' Copier Maintenance ($ x 12 months) Copier afntenance, Computer & Computer Maintenance ( $ x 12 months) Network Maintenance, Postage,- Other P. MachineKu� :Main"tenance 8, r Lease , " 39 Advertisin °� ` 9 21216. 00 0 .00 69650 .00 Newspaper ads If I Fundraising ads/promotions Other (vacancies) 40 Equipment Purchases : Capital Expense 27000.00 0. 00 68, 160 . 00 Computer/monitor (# x $) Laser Printer Computer Equipment/Network', 41 Professional Fees (Legal , Consulting) u3 0 . 00 151000. 00 Legal advice ( estimated #hrs x $) Consultant fees I If If Other 5/23/03 16 Exchange Club CASTLE -Safe Families Indian River County RFP #5054 42 Books/Educational Materials ,: ' g r 350. 00 0.0( 309290.00 • Books/videos ` r "%�y a nffi • Materials ($ x staff) ;, �' x . .: ` � _ �� i 43 Food & Nutrition 0.0 ll • Meals ( # meals x clients x 5days x 50 wks) h3 � � r � �� r ! � z f� ' ' ' a .�.�' .. f� . x3ia � Y3s7 � • Snacks ti x , 44 Administrative Costs 22, 919 00 0.0( 479750 . 00 F r a h rt Y � 10 /o of actual program budget for executive management, accounting, f11 � bookkeeping, personnela 45 Audit Expense 2t750. 00 420 00 51500.00 Independent Audit Review , : ; > depend�i7t audit;°°& Retirement t a; , p 3✓.r. t 5 M w: 46 Specific Assistance to Individuals °�; 2 ,500.00 0.00 7,020 .00 • a y Medical assistance � x , • Meals/Food • Rent Assistance � • Other ` ��' .. ..�. .,.:'�.`.. . . '` ;.��aaL � ,,, a• x ,. eU! ,4`vh' ! r, � .6�.!¢,>>:= i .a: +� °� 'a s. ' �` 'az r 47 Other/Miscellaneous �3 ' "' s 190. 00 0. 00 5,375.00 L , • Background check/drug test • Other 48 Other/Contract 3r000. 00 53,032.00 Sub-contract for program servicesry , � `� . , � N i _� , -77 74 77, -- _ 49 TOTAL EXPENSES +„ g p ' $234 , 125.00 $509000.00 $ 19873 ,765.00 5/23/03 17 E=hwW CWb CAME - Safe FwWWo Ir4w RNw Ce Ty RFP #5054 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Exchange Club CASTLE -- Safe Families Martin Count FY 01/02 FY 02/03 FY 03/04 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A Bammmm� C D ACTUAL TOTAL PROPOSED (ed. C•col. B)/col. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 146 201 .00 162 900.00 174 300.00 7.00% man,2 Children 's Services Council-Martin 85 446.00 100 375.00 137 437. 00 36.92% mmmm3 Children 's Services Council-Okeechobee 0.00 0.00 0.00 #DIV/01 4 Advisory Committee-Indian River 37 251 .00 45 000.00 60 021 .00 33.38% 5 United Way-St. Lucie County 57v211 .00 58 000.00 6225000 7.33% mama 6 United Way-Martin County 41 974.00 38 300.00 38 300. 00 0.00% 7 United Way-Okeechobee County 2 500.00 21500.00 0.00 -100.00% mmmmmmmmmmm e United Way-Indian River County 113 333.00 96 000.00 128j700.00 34.06% mmmm 9 Department of Children & Families 235 343. 00276 641 .00 351 182.00 26.95% to County Funds 0.00 0. 00 #DIV/01 11 Contributions-Cash 44 781 .00 86 252.00 86 252.00 0.00% 12 Pro ram Fees 48l746.00 60 000.00 60000=00 0.00% mmmm 13 Fund Raising Events-Net 130 540.00 183 999. 00 137 000. 00 -25. 54% 14 Sales to Public-Net 0.00 #DIV/01 15 Membership Dues 0. 00 #DIV/01 16 Investment Income 7t362.00 61000.00 11 000.00 83.33% 17 Miscellaneous 39969. 00 21000.00 29000.00 0.00% min 18 Legacies & Bequests mm 0.00 #DIV/0! 1s Funds from Other Sources 725 266.00 550 686.00 560 573.00 1 .80% 2oa Reserve Funds Used for Operating 64 750.00 64 750.00 0.00% 2013 In-Kind Donations (Not Included In total) 99000.00 0.00 #DIV/01 21 TOTAL 168892300 1 733 403.00 198739765,00 8 . 10% EXPENDITURES 22 Salaries 991 105.00 11071 ,074.00 1 123 888.00 4.93% 23 FICA 74 854.00 80 264.00 90$908. 00 13.26% 24 Retirement 40 000.00 40 000.00 40j000.00 0.00% Mamma25 Life/Health 45186.00 38 413I Mama .00 5988800 55.91 % mmmmommmm 26 Workers Compensation 10 697.00 12 590. 00 14 260. 00 13.26% 27 Florida Unemployment 12 440.00 82000.00 $7000.00 0.00% 28 Travel -Daily 33 501 .00 43 730.00 42 460.00 -2.90% 29 Travel/Conferences/Training 39220. 00 14 439.00 25 000. 00 73. 14% 30 Office Supplies 24 514.00 20 343.00 20 500. 00 0.77% mam 31 Telephone mamma 26 319.00 21 996.00 mm 29196.00 32.73% 32 Postage/Shipping 5j515,00 9100. 00 95125.00 0.27% Immmmmm33 Utilities 13 626. 00 10 368. 00 11 724.00 13.08% 34 Occupancy (Building & Grounds 52 773.0068 300.00 83 984. 00 22.96% 35 Printing & Publications 8t751 .00 22 600.00 2260000 0. 00% 36 Subscri tion/Dues/Membershi s 3199.00 22305.00 4000. 00 73.54% mama,37 Insurance 12 237.00 81850.00 13V450.00 51 .98% mama, Immm 38 Equipment: Rental & Maintenance 19 511 . 00 18 095.00 36 005.00 98.98% mm, mmmm 39 Advertising 81274.00 69650.00 6650.00 0.00% 4o Equipment Purchases: Capital Expense 3p909.00 53 160.00 68 160. 00 28.22% ma,41 Professional Fees (Legal, Consulting) 866.00 15 500.00 15 000.00 -3.23% 42 Books/Educational Materials 10 564.00 30 190.00 30 290.00 0.33% mamma 43 Food & Nutrition 0. 00 #DIV/01 mamp 44 Administrative Costs 28 704.00 47 201 .00 47 750.00 1 . 16% 45 Audit Expense 17 010.00 51500.00 59500.00 0.00% 46 Specific Assistance to Individuals 10 274. 00 79020. 00 71020.00 0.00% 47 Other/Miscellaneous 61450.00 41579. 00 52375. 00 17.387. 48 Other/Contract mmmmm 76 502.001 mama 73 136.00 53 032. 00 -27.49% 49 TOTAL 1 540 001 . 00 1 733 403.00 1 ,873 765.00 8. 10% 5o REVENUES OVER/ UNDER EXPENDITURES 148,922.001 0.001 0. 00 #DIV/01 Emma 18 Exchags Club CASTLE • Sds Fwn i" Inchm Riva County RFP #5054 UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : Exchange Club CASTLE -- Safe Families Indian River Count FY 01/02 FY 02/03 FY 03/04 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. CGcoi. BNcof. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/Ot 2 Children's Services Council-Martin 0. 00 #DIV/0! 3 Children 's Services Council-Okeechobee 0.00 #DIV/O! 4 Advisory Committee-Indian River 27t673.23 35 000. 00 50 000.00 42.86% 5 United Way-St. Lucie County 0.00 #DIV/O! 6 United Way-Martin County 0.00 #DIV/Ol 7 United Way-Okeechobee County 0.00 #DIV/O! 8 United Way-Indian River County 80 000. 01 80 000. 00 100 000.00 25. 00% 9 Department of Children & Families 25 000.00 60 000.00 140.00% to County Funds 0.00 #DIV/0! 11 Contributions-Cash 3 75O.00 50000,00 79000. 00 40.00% 12 Program Fees 39200.00 0.00 -100.00% 13 Fund Raising Events-Net 5 200. 00 20 000.00 71238. 00 -63.81 % 14 Sales to Public-Net 0.00 #DIWOI 15 Membership Dues 0.00 #DIV/Ol 16 Investment Income 0. 00 #DIWOI 17 Miscellaneous 0.00 #DIV/01 16 Legacies & Bequests 0. 00 #DIV/01 19 Funds from Other Sources 4,858.661 9 887. 00 103.49% 20a Reserve Funds Used for Operating 0. 00 #DIV/01 20b In -Kind Donations (Not included In total) 0.00 #DIWOI 21 TOTAL 116 623.24 173 058.66 234 125.00 35.29% EXPENDITURES 22 Salaries 71 990. 69 105 046.00 120 181 . 00 14.41 % 23 FICA 79668. 54 87036.02 91569.77 19.09% 24 Retirement 21210.73 87436.09 5 500.00 -34.80% 25 Life/Health 6p220,36 69560,00 81745.23 33.31 % 26 Workers Compensation 954. 18 11260.551 889. 00 -29.48% 27 Florida Unemployment 0.00 #DIWOI 28 Travel-Daily 31898,46 61500.00 51595.00 -13.92% 29 Travel/Conferences/Training 172.00 19000.00 71350.00 635.00% 30 Office Supplies 3184.80 3,000.00 20500. 00 -16.67% 31 Telephone 1 274. 13 39000. 00 11500.00 050.00% 32 Postage/Shipping 11860.00 11000.00 11500. 00 50.00% 33 Utilities 19200.00 21000.00 61000.00 200.00% 34 Occupancy (Building & Grounds 27575.00 91000.00 16 000.00 77.78% 35 Printing & Publications 21400.00 21600.00 29500.00 -3.85% 36 Subscription/Dues/Memberships 250.00 50.00 750. 00 1400.00% 37 Insurance 720. 00 1400.00 2120.00 51 .43% 38 Equipment: Rental & Maintenance 11362.86 1 500.00 7$500.001 400.00% 39 Advertising 19949.34 100. 00 2 216.00 2116.00% 40 Equipment Purchases: Capital Expense 281 .49 2 000.00 #DIV/01 41 Professional Fees (Legal , Consulting) 30.00 0.00 #DIWOI 42 Books/Educational Materials 233.57 250. 00 350.00 40.00% 43 Food & Nutrition 0. 00 #DIV/01 44 Administrative Costs 22 919.00 #DIV/01 45 Audit Expense 550.00 715.00 2t750.00 284. 62% 46 Specific Assistance to Individuals 867.05 19500.00 2500.00 66.67% 47 Other/Miscellaneous 307.82 105.00 190. 00 80.970/. 48 Other/Contract 4,462.221 10 000.00 33000.00 -70.00% 49 TOTAL 116p623.24 ! 173 058. 66 234 125.00 35.29% 5o REVENUES OVER/ UNDER EXPENDITURES 0.00 0.00 0.001 #DIV/01 �' ' 19 Exchange Club CASTLE - Safe Families Indian River County RFP #5054 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Exchange Club CASTLE - Safe Families Indian River County FUNDER : Children 's Services Advisory Com A B C FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS . PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col . B/col . A) EXPENDITURES 22 Salaries 120 , 181 . 00 34,077 . 00 28 . 35% 23 FICA 9 ,569 . 77 2 ,606 . 92 27 .24% 24 Retirement 57500 .00 11500 . 00 27 .27% 25 Life/Health 8 ,745 .23 39076 .00 35 . 17% 26 Workers Compensation 889 .00 490 . 08 55. 13% 27 Florida Unemployment 0 .00 0 .00 #DIV/01 28 Travel =Daily 5,595 . 00 0 . 00 0 .00 % 29 Travel/Conferences/Training 7 ,350 .00 0 . 00 0 . 00% 30 Office Supplies 2 ,500 . 00 0 .00 0 . 00 % 31 Telephone 1 ,500 . 00 0 . 00 0 .00 % 32 Postage/Shipping 11500 .00 0 . 00 0 . 00% 33 Utilities 61000 . 00 0 . 00 0 . 00 % 34 Occupancy ( Building & Grounds 16 ,000 . 00 79330 . 00 45 . 81 % 35 Printing & Publications 29500 .00 0 . 00 0 . 00 % 36 Subscription/Dues/Memberships 750 . 00 0 . 00 0 . 00 % 37 Insurance 2 , 120 . 00 500 . 00 23 . 58 % 38 Equipment : Rental & Maintenance 7 , 500 . 00 0 .00 0 . 00 % 39 Advertising 29216.00 0 . 00 0 . 00% 40 Equipment Purchases : Capital Expense 21000 . 00 0 .00 0 . 00 % 41 Professional Fees ( Legal , Consulting) 0 .00 0 . 00 #DIV/O ! 42 Books/Educational Materials 350 . 00 0 . 00 0 . 00 % 43 Food & Nutrition 0 . 00 0 . 00 #DIV/0 ! 44 Administrative Costs 22 , 919 . 00 0 . 00 0 . 00 % 45 Audit Expense 2 ,750 . 00 420 . 00 15 .27% 46 Specific Assistance to Individuals 2 ,500 .00 0 . 00 0 . 00% 47 Other/Miscellaneous 190 . 00 0 . 00 0 . 00 % 48 Other/Contract 3, 000 . 00 0 . 00 0 .00% 49 TOTAL $234, 125 . 00 IE $ 50 , 000 . 00 $0 .21 5/23/03 20 E=hChoc nE - 90% F� Intima RY Wary UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: Exchange Club CASTLE - Safe Families Indian River County FUNDER: Children's Services Advisory Committee FWA F #DNI01 #DN/01 D /01 Ws Committee-Indian River Additional staff for Safe Families ram in IRC, resultingin expansion of ram and additonal families served. #DIV/01 #DN/01 #DIV/01 United a an Ian River Countv Additional staff for Safe Families program in IRC, resulting in expansion of program and additonal families served. Degartment of Children & Families Additional staff for Safe Families program in IRC, resulting in expansion of program and additonal families served. #DIV/01 Contributions-Cash Additional cash contributions due to more exposure in the community and therefore more donations we receive. #DN 01 #DN/01 #DN/01 #DN/01 #DN/Of Funds from Other Sources ADN/01 #DIV/01 Additional Staff Member for Indian River County due to expanding r ram. FICA Additional taxes relates directly to additional salary expense. L Mealth Additional Life/Health costs due to additional staff member added. #DN/01 TraveUConferencesrrrainina Additional Training costs due to Accredidation/COA requirements and additional staff member. Postame/ShlDoina Additional Postage due to increase costs, additional requirements for accrediation, and information sent to community. OccuDancv lBuIldina & Grounds Additional Occupancy costs due to space needed for additional staff and program needs. SubscriDtion/Dues/Membershlos Additional Memberships to Organizations for new staff members, newspaper subscription for Indian River County Office, COA Insurance Additional Insurance cost related to additional staff members added and additional liability requirements E I ment:Rentai & Maintenance Additional Equipment Maintenance for older equipment currently in use and network maintenance Adverfisina Advertising for new personnel being added to program, program advertising, and outreach ADN/0f To provide for additional computers, desks, chairs, file cabinets for new personnel and program expansion ADIV/Of Book /Educatlonal Materials Replacement of Training materials #DN/01 ADIV/0f Administrative 10 - 14% Audit Exciense Due to additional audit requirements and standards 19MAssistance o Individuals Assistance to individuals based on program expansion and communityneeds Other/Miscellaneous Miscellaneous costs to cover Increase cost of background checks. UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: FUNDER: Salaries Additional Staff Member for Indian River County due to expanding ram. EHQA Additional taxes relates directly to additional salary expense. Retirement LMe/Health Additional Life/Health costs due to additional staff member added. Workers om nsation A N/01 Additional Training costs due to Accredidation/COA requirements and additional staff member. Additional Postage due to Increase costs, additional requirements for accrediation, and information sent to community, Occuvancv lBuildina & Grounds Additional Occupancy costs due to space needed for additional staff and program needs. Additional Memberships to Organizations for new staff members, newspaper subscription for Indian River County Office, COA Insurance Additional Insurance cost related to additional staff members added and additional liability requirements Additional Equipment Maintenance for older equipment curentl in use and network maintenance Advertising for new personnel being added to program To provide for additional computers, desks, chairs, file cabinets for new personnel and program expansion #DN/01 Replacement of Training matedals #DN/01 Percents a of Administrative 10 - 14% actual Audit Expense Due to additional audit requirements and standards Assistance to individuals based on program expansion and community needs Miscellaneous costs to cover increase cost of background checks. erz� 21 APPENDIX 22 HOME-BASED ABUSE AGE RANGE (for admission) PREVENTION PROGRAMS RPrenatal Teens Risk Levels . Primary 1 Pregnancy Birth-14 days Birth48 yrs (Early prevention. No abuse has occurred but family shows risk factors) � Primary Healthy Healthy CASTLE (Safe Families Families Families) Secondary *I,M, S *I,M, S *I,M, S ,O (Potential for abuse or actual abuse exists. ` Secondary Healthy Healthy CASTLE (Safe Family is early in the abuse cycle) is Families Families Families) Tertiary V *I,M, S *I,M,S *I,M, S ,O (Multiple abusive incidents Tertiary CASTLE Family Family have occurred. Potential for continued e (Safe Families) Builders Builders abuse is high, up to and including need to ' *I,M, S ,O *I,M,S , O * I,M,S ,O remove children from the home) *I= Indian River County, M= Martin County, S= St. Lucie County, 0= Okeechobee County Definitions : 1 . Healthy Families : Weekly home-based visits for parenting skills development. Families served for up to 5 years . Healthy Families excludes families with current Department of Children & Family involvement. Accepts community referrals only. 2. Exchange Club CASTLE (Safe Families) : Weekly home-based visits for parenting skills development. Families served for up to 1 year. Accepts community and Department of Children & Family referrals . 3. Family Builders (Children ' s Home Society and Hibiscus Children Center) : Short-term, intensive home-based intervention for 3 months. Accepts Department of Children & Family referrals only. Saved in Userl.SecretaryiWougCorres & Grant\Home-Based Abuse Prev Pro 23 d� own Client: Counselor: Open: County: Close: Supervisor: FAMILY RISKIPROTECTIVE FACTOR ASSESSMENT Instructions: When a risk/protective factor is assessed, place a checkmark in the box if the factor needs to be addressed. Upon completion (a risk factor that is no longer a risk, or a protective factor that has been enhanced) write, "completed" in the appropriate box. RISK FACTOR INITIAL 3 MONTH 6 MONTH CLOSING 1 YEAR ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT FOLLOW UP DATE: DATE: DATE: DATE: DATE: 1. Lack of parenting knowledge/skills 2. Parent 's past History of abuse 3. Parent 's history of substance abuse/mental health issues 4. Poverty or financial stress 5. Teen or young parent 6. Social isolation 7. Other PROTECTIVE INITIAL 3 MONTH 6 MONTH CLOSING 1 YEAR FACTOR ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT FOLLOW UP DATE: DATE: DATE : DATE: DATE : 1 . Housing stability 2. Delay of subsequent pregnancy 3. Enrollment in childcare 4. Enrollment in healthcare 5. Livable wage employment 6. Involvement in child's school 7. Other COUNSELOR SIGNATURE: Word/Share/Safe Families Forms/Family Risk Prot Factor 24 Organization: Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 References ' US Department of Health and Human Services : The Administration for Children and Families , Prevention Pays : The Costs of Not Preventing Child Abuse and Neglect, April 1999 . " US Department of Health and Human Services : The Administration for Children and Families, Child Maltreatment. 2000 . "' CPS Child Watch, Child Abuse Statistics , January 6, 2003 " Department of Children and Families, Investigation Reports Received, December 2002 . " Florida Abuse Hotline Information System, Child Protective Investigations Report Type for Reports Received ; Fiscal Year 2001 -2002 . 25 Organization: Exchange Club CASTLE Program: Safe Families Funder: Children' s Services Advisory Committee RFP: #5054 ORGANIZATION: Exchange Club CASTLE PROGRAM : Safe Families TABLE OF CONTENTS Please "X " the parts of the grant application to indicate they are included. Also, please put the page number where the information can be located. X I Section of the Proposal Pa e # X TABLE OF CONTENTS (Check list) 1 X COVER PAGE (with signatures) . 3 A . ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments , and population served , . 4 B . PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . 6 X 2 . Description of program activities . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . 6 X4 . Staffing . , . , * o , # 4 , 0 & @ # @ * a 0 * 0 0 @ . . . . . . . I I I 1 0 0 0 0 1 1 1 1 1 1 1 1 1 0 1 1 0 a @to a 0 0 & 0 a 0 0 0 0 0 0 0 , 0 . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 G. TIMETABLE (one page maximum) 12 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 X 2 . Projections by Age Group13 1 Organization: Exchange Club CASTLE Program: Safe Families Funder: Children ' s Services Advisory Committee RFP: #5054 I. BUDGET FORMS X 1 . Budget Narrative Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Total Agency Budget . . . . . . . . . . . . . , . . . . . . . . . . . . . 18 X 3 . Total Program Budget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X 4 . Funder Specific Budget. . 20 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X 6 . Explanation for Variances — Funder Specific Budget , . 21 J. FUNDER SPECIFIC/ADDITIONAL SHEETS XK. APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2 LZ XICINaddv NOT FOR PROFIT AGENCY CERTIFICATION The County of Indian River requires , as a matter of policy, that any Consultant or firm receiving a contract or award resulting from the Request for Qualifications issued by the County of Indian River, Florida , shall make certification as below . Receipt of such certification , under oath , shall be a prerequisite to the award of contract and payment thereof. I (we ) hereby certify that if the contract is awarded to me , our firm , partnership , or corporation , that no members of the elected governing body of Indian River County, nor any professional management, administrative official or employee of the County, nor members of his or her immediate family, including spouse , parents , or children , nor any person representing or purporting to represent any member or members of the elected governing body or other official , has solicited , has received or has been promised , directly or indirectly, any financial benefit, including but not limited to a fee , commission , finder's fee , political contribution , goods or services in return for favorable review of any Proposal submitted in response to the Request for Qualifications or in return for execution of a contract for performance or provision of services for which Proposals are herein sought. The undersigned certifies that he/she is a principal or officer of the firm applying for consideration and is authorized to make the above acknowledgments and certifications for and on behalf of the applicant . The undersigned certifies that the Applicant has not been convicted of a public entity crime within the past 36 months , as set forth in Section 287 . 133 , Florida Statutes . Failure to sign this form will result in disqualification. Handwritten Signature of Authorized Principal (s ) : DATE : 05-22-03 NAME : Theresa Garbarino-May TITLE : Executive Director NAME OF FIRM/PARTNERSHIP/CORPORATION : Exchange Club CASTLE FOR AND ON BEHALF OF THE APPLICANT: Sworn to and subscribed to me , a Notary Public, this qday of , 2003 . gYr 44(a il 0��,0000 Theresa Garbarino-May, Executive irector (SEAL) (TYPE NAME & TITLE) 05-22-03 X 22 Indian River Board of County Commissioners 1840 25" Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and Exchange Club CASTLE (Agency/ Individual are in the process of negotiation of a contract for Safe Families/Valued Visits , Indian River County is authorized to make an investigation of the Agency/Individual regarding its experience and qualifications . The Agency/Individual authorized the release of all relevant information concerning prior services furnished , contracts and background information of the Agency/Individual . The Agency/ Individual authorizes any individual or organization that is in possession of relevant factual contract and background information , to release such data to Indian River County in response of the County' s request . When an individual employee of the Agency signs Authorization for Release of Information , such individual authorizes the County to obtain relevant background information concerning such employee ' s criminal record , if any, and such other information that may be relevant to employee ' s good character and work experience . Authorization is given here by the Agency/ Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law . Name Agency/ Individual Exchange Club CASTLE Print name Name Employee Providing authorization Theresa Garbarino- May Pint a - � ,. Signature ( in blue ink) Date 05-22-03 XI 23 SWORN STATEMENT UNDER SECTION 105 . 08, INDIAN RIVER COUNTY CODE , ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS , 1 . This sworn statement is submitted with RFP No . 5054 for Safe FamiliesNalued Visits 2 . This sworn statement is submitted by : Exchange Club CASTLE ( Name of entity submitting Statement) whose business address is : _P . O . Box 12908 , Fort Pierce , FL 34979 and ( if applicable) its Federal Employer Identification Number ( FEIN ) is 59 -2094472 ( If the entity has no FEIN , include the Social Security Number of the individual signing this sworn statement 3 . My name is Theresa Garbarino- May ( Please print name of individual signing) and my relationship to the entity named above is Executive Director 4 . 1 understand that an "affiliate" as defined in Section 105 . 08 , Indian River County Code , means : The term "affiliate" includes those officers , directors , executives , partners , shareholders , employees , members , and agents who are active in the management of the entity . XII 24 5 . I understand that the relationship with a County Commissioner or County employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt , first cousin , nephew , niece , husband , wife , father- in - law, mother- in - law, daughter- in - law , son - in - law, brother- in - law , sister- in - law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild . 6 . Based on information and belief , the statement which I have marked below is true in relation to the entity submitting this sworn statement . [ Please indicate which statement applies . ] _X_ Neither the entity submitting this sworn statement , nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity, have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . The entity submitting this sworn statement , or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee : Name of Affiliate Name of County Commissioner Relationship or entity or employee XIII 25 j signature ) 3 (date ) STATE OF Florida COUNTY OF Indian River The foregoing instrument was acknowledged before me this 22nd day of May , 20 03 , by Theresa Garbarino- May , who is personally ide�nown to me> r who has produced as ion . NOTARY PUJ3LIC SIGN : PRINT : 71`� lo> ,el Al State of Florida at Large My Commission Expires : (Seal ) Jtiy pV� KATHLEEN N . DONOVAN Notary Public - State of Florida MyCommissslon Expires Oct 23, 2006 Commmission # DD156676 Bonded By National Notary Assn. XIV 26 @@see 7il< CASTUE BOARD LIST 2003 Name Phone, Fax & e-mail Company Name Phone, Fax & e-mail Company Al Fort Wk: 772460-7011 Harbor Federal Bank Dr. Robert Wk: 7724654545 Robert D. Gehrig, DMD, President (Ex. Board) Fax: 772-060-7001 P. 0. Box 249 Fax: 772-465-5869 PA Resident of IRC Fort@HGehriarborfederal . corn Fort Pierce, FL 34954 g rdgehrig0bellsouth net 1405 S. 2P St. Suite B H: 772-231 -4418 Secretary: Flo Governing Board H: 772465-1806 Fort Pierce, FL 34947 No preference Resident of SLC No preference Grisel or Lynne Michael Dillman Wk: 772-878,M Morgan Stanley Joseph DeRoss = 772465o3500 Fee, Kobelgard & 15t VP (Ex. Board) Fax 772-873-6920 1555 NW St. Lucie West Governing Board Fax: 7721468-8461 DeRoss Michael. dillman0morgans Blvd. Suite 101 RIP14(@bellsouth . net 401 -A S. Indian River Dr. Resident of SLC tanley .com Port St. Lucie, FI 34986 Resident of SLC H: 7724654777 Fort Pierce, FL 34950 H:7721468-3296 Secretary Jan No preference Secretary: Maria Prefers fax James Wk: 772m 340-3500 St. Lucie West Develop. Sheriff Ken Wk: 772462-3200 Sheriff of St Lucie Fax: 772-340-3718 Corp. Fax: 772489-5851 County Anderson , Past Mascara ianderson@corecommuniti 1850 Fountainview Blvd. kenimasftnetscape. net 4700 W. Midway Rd. President (Ex. Board) es.com #201 Governing Board Nextel: 772-201 -4352 Fort Pierce, FL 34981 Resident of M.C. H: 772-692-0629 Port St, Lucie, FL 34986 Resident of SLC Fax info Secretary: Dorothy No preference Secretary: Jean Gerry Hoeffner Wk: 772467-9212 Personnel Dynamics Robert Wk: 772486-0777 COASTABLE 2"d Vice President Fax: 772467-6768 2601 Lary Hammock Ln. Fax: 772-597-6665 Robert Schweiger GPHoeffnerOaol.com Fort Pierce, FL 34981 Schweiger robs(c�onearrow. net 9732 SW Santa Monica (Ex. Board) Resident of SLC H: 772467-6768 SELF Governing Board H: 772-597-6664 Dr. Prefers e-mail Resident of M.C. Prefers e-mail Palm City, FL 34990 James Hartley WK: 772461-8833 Dibartolomeo, Mc Bee, Jeanette Tilley Wk: 772-8734404 QVC Fax: 772-461 -8872 Hartle & Barnes Fax: 772-8734399 300 NW Peacock Blvd. Treasurer (Ex. y Governing Board Board) ihartleY0dmhbcpa .com 2222 Colonial Rd. #200 Resident of SLC jblley@gvc,com Port St. Lucie, FL 34986 Resident of SLC H: 772-340-0846 R. Pierce, FI, 34950 H: 772-879-6785 Anthony WK: 772-2344066 Donadio & Associates Joanne Baker WK: 772462-1489 SLC Clerk of the Circuit Fax: 772-2343987 y Governing Board Donadio 2125 Winward Way Fax: 772.462-1963 Court H: 772-067-6153 oanneb co.st4ucie.fl.us 2300 Virginia Avenue Governing Board donadloarch0eadhiink.ne Vero Resident of SLC H: 772398-9568 Ft. Pierce, FL. 34950 Resident of IRC t Vero Beach , Fl . 32963 , Michelle Wk: 772-873-6525 Port St. Lucie Police McMurtry Fax: 772-871 -5066 Department mmcmurtry@cityofpsl.com 121 SW Port St. Lucie Governing Board H: 772-064-5014 Boulevard Resident of SLC Port St, Lucie, FL 34984 EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . FINANCIAL STATEMENTS For the Fiscal Year Ended September 30, 2002 EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . FINANCIAL STATEMENTS For the Fiscal Year Ended September 30, 2002 TABLE OF CONTENTS Page Independent Auditors' Report 3 Statement of Assets, Liabilities and Net Assets - Cash Basis 4- 5 Statement of Support and Revenue, Expenses and Changes in Net Assets - Cash Basis 6 Statement of Change in Cash - Cash Basis 7 Statement of Functional Expenses - Cash Basis g Notes to Financial Statements 945 W Gaines, CPA J . W. Gaines & Associates , Chartered )• David S. McGuire , CPA Independent Auditors' Report Judy Hemberger, CPA Samuel R. Peterkin, Jr. ( 19364995) To the Board of Directors Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc . Fort Pierce, Florida We have audited the accompanying statement of assets, liabilities and net assets - cash ' basis of Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc. (a nonprofit organization) , as of September 30, 2002, and the related statement of support and revenue, expenses, and changes in net assets - cash basis , change in cash - cash basis, and functional expenses - cash basis, for the year then ended. These financial statements are the responsibility of the Center's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis , evidence supporting the amounts and disclosures in the financial statements . An audit also includes assessing the accounting principles used and -significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. As described in Note 1 , the financial statements have been prepared on the cash basis, which is a comprehensive basis of accounting other than generally accepted accounting principles . In our opinion, the financial statements referred to above present fairly, in all material respects, the assets, liabilities and net assets of Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc . as of September 30 , 2002, and its support and revenues, and expenses and changes in net assets and cash flows for the year then ended, on the basis of accounting described in Note 1 . J Gaines & Associates , Chartered Certified ubic Accountants January 7, 2003 -3 - CERTIFIED PUBLIC ACCOUNTANTS 1905 SOUTH 25TH STREET, SUITE 202 , FORT PIERCE, FLORIDA 34947 . 7724614155 FAX 772- 466-7974 MEMBER PRIVATE COMPANIES PRACTICE AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . STATEMENT OF ASSETS, LIABILITIES AND NET ASSETS - CASH BASIS September 30, 2002 ASSETS Current Assets Cash $ 165 , 093 Mortgage receivable - current 1 ,494 Investments 67, 371 Total Current Assets 2334958 Fixed Assets Land 106,250 Building 356 846 Vehicles 31656 Furniture and equipment 102 , 085 568 , 837 Less , accumulated depreciation ( 137,085) Total Fixed Assets 4314752 Other Assets Cash - Board Designated ?40 000 Investment in United for Families ✓25 ,000 Mortgage receivable, less current 42, 326 Deposits 689 Timeshare, less accumulated amortization of $404 1734 Total Other Assets 3104749 TOTAL ASSETS $ 976.459 See Notes to Financial Statements -4- EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . STATEMENT OF ASSETS, LIABILITIES AND NET ASSETS - CASH BASIS (CONTINUED) September 30, 2002 LIABILITIES AND NET ASSETS Current Liabilities Payroll deduction payable $ 12816 Net Assets Unrestricted 9744643 TOTAL LIABILITIES AND NET ASSETS L 76 .4 9 See Notes to Financial Statements -5- EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . STATEMENT OF SUPPORT AND REVENUE, EXPENSES AND CHARGES IN NET ASSETS -CASH BASIS For the Year Ended September 30, 2002 Temporarily Unrestricted Restricted Total Support and Revenue Support Grants and Donations $ 168 ,359 $ 598 , 348 766, 707 Revenue Florida Department of Children and Families 1852010 185, 010 Divorce groups 422336 42, 336 Counseling 661170 661 , 170 Fundraising income (net of $ 10, 879 in expenses) 15, 958 15y958 High hopes 22955 2,955 Other income 5 , 961 52961 Positive parenting 3 455 3 ,455 Interest income 7,362 73362 Unrealized loss on investment ( 482) ( 482) Loss on sale of investments ( 476) ( 476) Loss on asset disposal 1 033 1 033 Total Revenue _ 922 .216 9224216 Net Assets REleased From Restrictions Satisfaction of usage restriction 662 ,496 ( 662 , 4961 Total Support and Revenue 1 , 753 , 071 ( 644148,) 1 , 688 ,923 Expenses Program Services Family counsling volunteer program 946, 831 946, 831 Auxiliary services 19L888 191 , 888 Community education and awareness 1874485 187,485 Total Program Services 12.326.1204 1 , 326,204 Supporting Services General and administrative 213 . 797 213 , 797 Total Expenses 1 , 5404001 14540, 001 Change in Net Assets 213 , 070 ( 64, 148) 148 , 922 Net Assets-October 1 , 2001 7619573 64, 148 825 , 721 Net Assets- September 30, 2002 $ 9744 $ S 9744641 See Notes to Financial Statements -6- EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC. STATEMENT OF CHANGE IN CASH - CASH BASIS For the Year Ended September 30, 2002 Cash Flows From Operating Activities Change in net assets $ 148 , 922 Adjustments to reconcile change in net assets to net cash provided by operating activities : Depreciation and amortization 28 ,706 Loss on equipment disposal 1 ,033 Unrealized loss on investments 482 Loss on sale of investments 476 Increase in payroll deductions payable 133 Total Adjustments 30, 830 Net Cash Provided by Operating Activities 179, 752 Cash Flows From Investing Activities Purchases of property and equipment ( 5 ,464) Proceeds from principal payments on mortgage receivable 15828 Sale of long-term certificate of deposit 203000 Proceeds from sale of assets 50 Investment in United for Families ( 25 , 000) Purchases of investments ( 49,2201 Net Cash Used by Investing Activities ( 571806) Cash Flow From Financing Activities Payment of mortgage payable ( 43 , 0521 Net Increase in Cash 78 , 894 Cash, October 1 , 2001 3264199 Cash, September 30, 2002 $ 405 . 093 Supplemental Information Cash paid for interest 2 .222 See Notes to Financial Statements -7- EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . STATEMENT OF FUNCTIONAL EXPENSES - CASH BASIS For the Year Ended September 30, 2002 Program Services Support Services Family Community Counseling Education Total Volunteer Auxiliary and Program General and Total Program Services Awareness Services Administrative Ex enses Salaries and wages $ 6735951 $ 128 , 844 $ 795288 $ 8829083 $ 109,022 $ 9913105 Fringe benefits 65 ,200 122465 7,671 853,336 103547 95, 883 Payroll taxes 592360 112348 69984 77,692 93,602 87,294 Contract labor 61 ,202 61 ,202 15 ,304 76,503 Travel and conferences 273541 5 , 508 33 ,049 3 ,672 363721 Office. rent 21 ,692 51,423 27, 115 9,039 36, 154 Depreciation and amortization 123,918 4$ 06 21871 20,095 82611 28 ,706 Supplies 112369 21P842 5685 19, 896 .8 ,527 282423 Communication 17, 108 52264 222372 3 ,948 269320 00 Equipment rental 75804 15951 32902 13 ,657 53, 853 199510 Professional services 12701 1 ,701 19701 5 , 103 11 , 907 179010 Repair and maintenance 62479 21160 12440 10, 079 42318 142397 Utilities 6, 813 22725 13363 102901 21725 139626 Insurance 63119 29447 19224 91790 22447 12,237 Educational materials 4,226 39169 32169 10,564 109564 Client expense 10,273 105273 102273 Printing 4,375 27188 2, 188 8 ,751 8 ,751 Advertising 4, 137 1 ,655 5 , 792 2,482 89274 Postage 22757 12103 12103 42963 551 5 , 514 Background investigations 17495 13451 11451 4,397 47397 Dues and subscriptions 32199 33199 Interest 12000 333 222 13555 667 22222 Other expenses 513 513 513 1 , 539 513 2, 052 Fees and licenses 866 866 Total Expenses 46. 83 S 191 . 888 187.485 x . 326.204 $ 213 . 797 L1.14p. pp1 See Notes to Financial Statements EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . NOTES TO FINANCIAL STATEMENTS September 30, 2002 Note 1 - Significant Accounting Policies Organization The Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc. (the Center), was incorporated February 3 , 1981 , in the State of Florida for the purpose of prevention and detection of child abuse . It is affiliated with the National Exchange Club Foundation for the Prevention of Child Abuse, Inc . , and is supported primarily by grants and donations . The Center is exempt from federal income taxes under the provisions of Internal Revenue Code 501 (c)(3 ) . The Organization has also been classified as an entity that is not a private foundation within the meaning of Section 509(a) and qualifies for deductible contributions as provided in Section 170(b)( 1 )(A)(vi) . Accounting Policies Significant accounting policies of the Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc . are as follows : A. Basis of Accounting The accompanying financial statements have been prepared on the basis of cash receipts and disbursements . Consequently, certain revenues are recognized when received rather than when earned, and certain expenses and the related liabilities are recognized when paid rather than when the obligation is incurred. B . Cash Equivalents Cash equivalents consist of short-term, highly liquid investments which are readily convertible into cash within ninety (90) days of purchase. C . Investments Investments are recorded at the quoted market value in the Statement of Assets, Liabilities and Net Assets. Unrealized gains and losses are reflected in the Statement of Support and Revenue, Expenses and Changes in Net Assets - Cash Basis . -9- EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC. NOTES TO FINANCIAL STATEMENTS (Continued) September 30, 2002 Note 1 - Significant Accounting Policies (Continued) D . Fixed Assets Fixed assets are stated at cost or fair market value at the date of donation for fixed assets in excess of $ 500 . Depreciation is computed on the straight-Iine basis over the estimated useful life of the assets which ranges from five to ten years for equipment, 30 years for buildings, and the life of the lease for leasehold improvements . E . Contributions In accordance wit SFAS NO . 116, Accounting for Contributions Received and Contributions Made, contributions received are recorded as unrestricted, temporarily restricted, or permanently restricted support depending on the existence and/or nature of any donor restrictions. F. Temporarily Restricted Assets Temporarily restricted assets are established to account for the activity of the Center's state funded programs, local agency grants, and donations with donor imposed restrictions . The Center's temporarily restricted assets are reclassified to unrestricted net assets when the purpose for the restriction is accomplished. G. Financial Statement Presentation The financial statements are presented in accordance with Statement of Financial Accounting Standards (SFAS) No . 117, Financial Statements of Not for-Profit Organizations. Under SFAS No . 117, the Organization is required to report information regarding its financial position and activities according to three classes of net assets : unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets. H. Functional Allocation of Expenses The costs of providing the various programs and other activities have been summarized on a functional bases in the statement of activities . Accordingly, certain costs have been allocated among the programs and supporting services benefited. - 10- EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . NOTES TO FINANCIAL STATEMENTS September 30, 2002 Note 1 - Significant Accounting Policies (Continued) I. Estimates The preparation of financial statements on the cash basis requires management to make estimates and assumptions that affect certain reported amounts and disclosures . Accordingly actual results could differ from those estimates . J . Advertising Advertising costs are expensed as incurred. Advertising expense was $4,375 for the year ended September 30 , 2002 . Note 2 - Cash Cash as reported on the statement of assets, liabilities, and net assets - cash basis, includes the following : Checking $ 118 ,483 Money market 2, 021 Savings 284,364 Petty cash 225 Total cash $405 ,093 Less : Cash (Board Designated) $ 240 , 000 Total cash in current assets 1 f 5 . 093 The $240 , 000 of cash classified Board designated is reserved for future projects and the hiring of new personnel, and thus is not classified as a current asset. The Board maintained this amount in the savings account and therefore it is recognized as cash for cash flow purposes . At September 30, 2002, the Organization had $402, 847 on deposit at one bank, of which $ 302, 847 was not insured by the Federal Deposit Insurance Corporation. - 11 - EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . NOTES TO FINANCIAL STATEMENTS (Continued) September 30, 2002 Note 3 - Fixed Assets An analysis of the fixed assets accounts for the year are as follows : Balance Balance October September 1 , 2001 Additions Deletions 30, 2002 Land $ 1062250 $ $ $ 1062250 Building 356, 846 356, 846 Furniture and equipment 105 ,484 5 ,464 8 , 863 102, 085 Vehicles 20A75 3 , 656 20,475 3 . 656 Total Cost 5895055 9, 120 299338 5682837 Less accumulated depreciation 133 , 109 28 , 575 244599 137,085 Net 4 4 ( 19.4551 — 4 . 7391 -$ 431352 Note 4 - Investment in Timeshare The Organization has the rights to a timeshare unit. The estimated fair market value of the unit at the time of donation was $ 3 , 138 . At September 30 , 2002 , the accumulated amortization on this unit was $404 . The rights to this unit expire in 2022 . Note 5 - Mortgage Receivable The Organization has received a second mortgage note receivable as a donation. The mortgage receivable is collateralized by real estate and bears interest at 8 percent. Principal and interest payments are $413 per month. The mortgage matures in December 2017 . Future payments under this mortgage are estimated as follows : Year Ending September 30, 2002 $ 1 ,494 2003 1 ,618 2004 1 , 752 2005 1 , 809 2006 2, 055 Thereafter 35 , 092 43 0 At September 30, 2002, this mortgage was five months in arrears . Subsequent to year-end the mortgage has become current. 42- EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . NOTES TO FINANCIAL STATEMENTS (Continued) September 30, 2002 Note 6 - Marketable Equity Securities The following is a summary of investment securities classified as available for sale. Gross Fair Unrealized Cost Value Gain/(Loss) Common Stock $ 1557 $ 15154 $ ( 403) Preferred Stock 461184 465351 167 Mutual fixnds 51000 2,673 (21327) Fixed Income 174114 17, 193 79 Total $ 9. 855LUxL71 S ( 264841 Note 7 - United for Families The Organization invested $25, 000 in United for Families, a Florida non-profit organization. The center is considered a limited participant in the organization. 43 - EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . NOTES TO FINANCIAL STATEMENTS (Continued) September 30, 2002 Note 8 - Grants and Donations The Center's grant funding is received on a cost reimbursement basis . The Center's funding from grants and donations for the fiscal year was from the following : Temporarily Unrestricted Restricted Total Donations 44,780 442780 St. Lucie County Children's Services Council 146,202 146,202 Martin County Children's Services Council 69,201 692201 Local Exchange Club 1143579 114, 579 Florida Department of Children and Families 50,334 509334 United Way - Indian River County 113 ,332 1139332 United Way - St. Lucie County 57,212 572212 United Way - Martin County 41 ,975 41 ,975 Board of County Commissioners - Indian River County 37,251 37,251 In-kind donations 9, 000 92000 Hospice of Martin County and St. Lucie County 16,245 16 ,245 Florida Office of Attorney General 103417 10,417 Jr. League of Indian River County 53 ,679 53 ,679 United Way - Okeechobee 2. 500 2, 500 Total 168 $ 598 .348 $ 766 . 707 All of the Center's funding for cost reimbursement was expended during the fiscal year. The organization also received a grant of $ 185 , 010 for counseling services from the Department of Children and Families. - 14- EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST, INC . NOTES TO FINANCIAL STATEMENTS (Continued) September 30, 2002 Note 9 - Temporarily Restricted Net Assets Net assets were released from donor or grant restrictions by incurring expenses satisfying the restricted purpose by donors or grantees as follows : Purpose restrictions Family counseling volunteer program $ 4072303 Auxiliary service 822547 Community education and awareness 80,626 General and administrative 92, 020 Total $ 662 .496 Note 10 - In-Kind Donations The estimated fair market value of the in-kind donation for rental expenses included in the financial statements for the year ended September 30 , 2002, is $9, 000 . Note 11 - Unrestricted Net Assets At year end unrestricted net assets were as follows : Unrestricted $7349643 Board designated 240, 000 Total unrestricted net assets $ 974, 643 Note 12 - Contributions Held for Others During the year, the organization acted as the fiscal agent for a $ 14, 596 local grant. The organization did not have any variance power over this grant. Because of the lack of variance power, this grant is not recognized in the statement of activity as required by SFAC No . 136 Transfers of Assets to a Not for-Profit Organization or Charitable Trust that Raises or Holds Contributions for Others. - 15 - J . W. Gaines & Associates , Chartered J w Gaines, CPA David S. McGuire, CPA Judy Hemberger, CPA January 7, 2003 Samuel R. Peterkin, Jr. ( 19364995 ) Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc . P . O. Box 12908 Fort Pierce, Florida 34979-2908 In planning and performing our audit of the financial statements of the Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc. for the year ended June 30, 2002, we considered the Organization's internal control structure to plan our auditing procedures for the purpose of expressing our opinion on the financial statements and not to provide assurance on internal control structure. However, during our audit, we noted certain matters involving the internal control structure and other operational matters that are presented for your consideration. This letter does not affect our report dated January 7, 2002 on the financial statements of the Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc. We will review the status of these comments during our next audit engagement. Our comments and recommendations, all of which have been discussed with appropriate members of management, are intended to improve the internal control structure or result in other operating efficiencies. We will be pleased to discuss these comments in further detail at your convenience, to perform any additional study of these matters, or to assist you in implementing the recommendations. Our comments are summarized as follows : 1 . Internal Control The size of the Organization's accounting and administrator staff preclude, certain internal controls that would be preferred if the office staff were large enough to provide optimum segregation of duties. This situation dictates that the Board of Directors remain included in the financial affairs of the Organization to provide oversight and assist with the independent review function. Investments During the course of our audit, we noted the Organization had purchased a mortgage backed security. Because of the potential volatility of this investment type, we recommend that the board closely monitor this investment. CERTIFIED PUBLIC ACCOUNTANTS 1905 SOUTH 25TH STREET, SUITE 202, FORT PIERCE, FLORIDA 34947 7714614155 FAX 772-466-7974 MFMBFR PRTVATF. C:nMPANIF_S PRACTICE AMFRICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS Page 2 Exchange Club Center for the Prevention of Child Abuse of the Treasure Coast, Inc. January 7, 2003 General Ledger The general ledger provided to us at year-end did not agree with the general ledger or to the grant confirmation we received from major funding sources. We understand that these differences were the result of the auditors being provided an unadjusted trial balance. In the future, we recommend that the Organization insure that the auditors are provided the "final' trial balance. We have already discussed the observations and recommendations above during the course of our audit field work, therefore, we realize in some cases corrective action may have already been implemented. We would like to express our thanks to you and your staff for the cooperation we received during the course of our examination. If you have any questions regarding our engagement or desire further information, please contact us. I Gaines & Associates, Chartered ertified Public Accountants too Child Abuse Services , Training & Life Enrichment CA February 3 , 2003 J .W. Gaines & Assoc, Chartered Certified Public Accountants 1905 S . 25" Street Ste , 202 Fort Pierce , FL 34947 Dear Sirs : On behalf of the Exchange Club CASTLE Board of Directors and the staff, we would like to thank you for your very detailed and professional audit of the CASTLE's financial transactions for the year 2001 -2002 . As recommended , the CASTLE board is aware of and accepts the responsibility of oversight in financial affairs of the organization , as an independent review function . The board of directors concur with your recommendation to monitor the investments. It is currently done through regular financefinvestment meetings . The CASTLE staff and board will insure that a final trial balance is provided to the auditor. We will also work to enhance the communication with you so that these issues can be dealt with in a timely manner. It is also noted that upon discovery, these documents did agree with the CASTLE's November financial statements offered to the board of directors . We appreciate your time and expertise once again . Sincerely, , � L/ Theresa GarbarinoWay Executive Director TGM : pcm EXCHANGE CLUB CASTLE Mailing Address: P.O. Box 12908 • Fort Pierce, FL 34979 Office: 3525 SW Midway Road • Fart Pierce, FL 34981 Voice: 561 .465 .6011 • Fax: 561 .465 . 601. 3 • Email: tgarbarino- may. exchangecastle . org SDunsored in part by Exchange Clubs, DCF, United Way of Indian River. Martin , St. Luce and Okeechobee Counties, Return of Organization Exempt From Income Tax 0Iv_ 1545_W47 Form 990 Under section 501 (c), 527, or 4947( x)( 1 ) of the Internal Revenue Code (except black lung 2001 benefit trust or private foundation) Department of the Treasury Open t0 Public Internal Revenue Service ► The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection, . . .. ... . .. .. A For the 2001 calendar year, or tax year period beginning OCT le 2001 and ending SEP 30r 2002 B chem it please C Name of organization D Employer identification number applicable: uselRs XCHANGE CLUB CENTER FOR THE PREVENTION OAddress label or change print or F CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 F chaanngee °0 Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number Initial reeturn Specific 0 BOX 12908 ( 561 ) 465 - 6011 aFinal lnsuuc- return tions. City or town, state or country, and ZIP + 4 F Accounting method: ® cash LjAccruaf Ore urnd� T . PIERCE FL 34979 0 o' i Op p'd'i 9tIOn • Section 501 (c)(3) organizations and 4947(a)( 1 ) nonexempt charitable trusts H and I are not applicable to section 527 organizations. must attach a completed Schedule A (Form 990 or 990-EZ). H(a) Is this a group return for affiliates? 0 Yes ® No G Web site: ►N A H(b ) If 'Yes,* enter number of affiliates ► r7I H(c) Are all affiliates included? N/ A u Yes No J Organization type (chedo* one) ► ® 501 (c) ( 3 ) 44 Qnsertno.) 0 4947(a)( 1 ) or 0 527 (If 'No; attach a list) K Check here ► 0 if the organization's gross receipts are normally not more than $25,000. The H(d) Is this a separate return filed by an or- organization need not file a return with the IRS; but if the organization received a Form 990 Package oanization covered b a group ruling? C] Yes ® No in the mail, it should file a return without financial data. Some states require a complete return . I Enter 4-di it GEN M Check ► 0 if the organization is not required to attach L Gross receipts: Add lines 6b, 8b, 9b, and 10b to line 12 ► 1 721 367 . Sch. B (Form 990, 990-EZ, or 990-PF). Pai t 'f Revenue, Expenses, and Changes in Net Assets or Fund Balances 1 Contributions, gifts, grants, and similar amounts received: a Direct public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . to 168o3599 , . b Indirect public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b 284 , 943 * c Government contributions (grants) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c 498 , 415o d Total (add lines 1a through 1c) (cash $ 942 , 717 . noncash $ 910000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Id t d 951 717 . 2 Program service revenue including government fees and contracts (from Part VII, line 93) • • • • . 2 7 0 9 916 . 3 Membership dues and assessments „ • , . • . . I . . . . . . • . . 4 Interest on savings and temporary cash investments • . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 7 , 3629 5 Dividends and interest from securities 0 . 00 , 0 • • „ • 0000 , . . . • • • • • 0 • • 00 , 0 6 a Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 . . 04 . . . . . . . . . 6a b Less: rental expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . 000 . 6b c Net rental income or (loss) (subtract line 6b from line 6a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6c C 7 Other investment income (describe ► 7 71 d 8 a Gross amount from sale of assets other A Securities B Other rx than inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 , 524o as 1 50 . b Less, cost or other basis and sales expenses . . . . . . . . . 2 0 0 0 0 . 8b 1 Y 083 e c Gain or (loss) (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . < 476 . 8c 1 n83 g ( ) ( ( ) O) STMT . . . . ed < 1 509d Net sin or toss combine line 8c, columns A and B • . _ . . . . . . . _ • . . . . . . . . _. . . . . . . . . . . . . . . . . . . .9 Special events and activities (attach schedule) a Gross revenue (not including $ 0 . of contributions reported on line 1a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a b Less: direct expenses other than fundraising expenses . . . . . . . . . . . . • 9b 10 o 8 79 . c Net income or (loss) from special events (subtract line 9b from line 9a) . . . . . . . . . . . .SEE $ TA`1 'EMENT • • • 3, • , • 9c 15 , 958 * 10 a Gross sales of inventory, less returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t0a b Less: cost of goods sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . 10b c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) • 10c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Other revenue from Part VII, line 103 . • . • . • „• • . • 12 Total revenue add lines I dr 2t 149 5t 6cs 7s 8d 9c 10c and 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . 1 . 0 . . . . . . . . . . . . 12 1 , 689r405 * 13 Program services (from line 44, column (B)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . I . . . . . . . . • 13 1 s 3 2 6 , 2 0 4 . 14 Management and general (from rine 44, column (C)) • . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . 797 * . . . . . . . . 14 213 , 7 9 7 . 15 Fundraising (from line 44, column (D)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16 Payments to affiliates (attach schedule) . . . . . I . . . . . . . . . . . . . . . . . . . . 17 Total expenses add lines 16 and 44 column A 17 1 5 4 0 0 01 . 18 Excess or (deficit) for the year (subtract line 17 from line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 149 , 4049 Z y 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 . . . . . . . . . 8 2 5 , 721 * 20 Other changes in net assets or fund balances (attach explanation) . . SEE . . .ST.P�TEMENT • . . 4 . . . 20 < 482 * > . . 21 Net assets or fund balances at end of year combine lines 18, 19, and 20 . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000 0 21 9 7 4 6 4 3 . 01.0"3oz LHA For Paperwork Reduction Act Notice, see the separate Instructional Form 990 (2001 ) Form 990 (zoos EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094d72 Page Part 11. statement of All organizations must complete column (A). Columns (B), (C), and (D) are required for section 501 (c)(3) and Functional Expenses 4 organizations and section 4947 a 1 nonexem t charitable trusts but optional for others. Do not include amounts reported on line (B) Program (C) Management 6b, 8b, 9b, fob, or 16 of Part 1. (A) Total services and aeneral (D) Fundraising 22 Grants and allocations (attach schedule) cash $ noncash $ 22 23 Specific assistance to individuals (attach schedule) 23 24 Benefits paid to or for members (attach schedule) 24 25 Compensation of officers, directors, etc. . . . . . . . . . 25 12 5 8 4 0 . 5 4 112 . 71 , 728 * 00 26 Other salaries and wages . . . . . . . . . 26 865 , 265 * 827 971 . 3 7 2 9 4 . 27 Pension plan contributions 27 28 Other employee benefits , . 0 . . . . 0 . . . . . . . . . 0 . . . . . . . . 0 . . . . . . 28 95 , 883 * 85 336 . 10 5 4 7 . 29 Payroll taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000 . . . . . . . . . . . . 29 8 7- P 294 . 77 692 . 9r602 * 30 Professional fundraising fees 30 31 Accounting fees 0000 . . . 31 32 Legal fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 33 Supplies . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 28r423 * 19 , 8969 8 , 527o 34 Telephone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 26 , 320a 22 3720 3 9 4 8 . 35 Postage and shipping . , . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . 351 5 , 514 * 4P963 * 5 51 . 36 Occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136136 , 154 * 2 7 ff115 . 9 , 0390 37 Equipment rental and maintenance . . . . . . . . . . . . . . . . . . 371 19 510 . 13 1 657 . 5 8 5 3 . 38 Printing and publications 381 8 , 751m 8 r 7 51 . 39 Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 40 Conferences, conventions, and meetings . . . . . . . . . . . . 40 41 Interest . . . 41 2 , 222o 1 f 555 9 667 . 42 Depreciation, depletion, etc. (attach schedule) . . . 42 28s70691 20 , 0959 8 611 . 43 Other expenses not covered above (itemize): a 43a b 143bl C 143cl d 43d e SEE STATEMENT 5 43e 210 119 . 162 689 . 47r430 * 44 Total functional expenses (add lines 22 through 43) Organizations completing columns (9}(DI carry these 0 totals to lines 13-15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 1 5 4 0 0 01 . 1 3 2 6 2 0 4 . 213 , 797 * Joint Costs. Check ► 0 if you are following SOP 98-2. Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? _ . . . . . . . . . 0000 ► ED Yes ® No If `Yes; enter (i) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program services $ ; Ull the amount allocated to Management and general $ and 00 the amount allocated to Fundraisin Part"Ill' Statement of Program Service Accomplishments What is the organization's primary exempt purpose? Poo- TO TO PREVENT CHILD ABUSE ON THE TREASURE COAST a Pro ram Service All organizations must describe their exempt purpose achievements in a clewand concise manner. State the number of clients served, publications Issued, etc. Discuss Expenses achievements that are not measurable. (Section so1(cx3) and (4) organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and (Regorged ford 49473) and allocations to others.) (ts butorgo and 4gor tithe trusts; but optional for others.) a THIS ORGANIZATION ' S FUNCTION IS THE DETECTION AND PREVEN — TION OF CHILD ABUSE AND NEGLECT THROUGH COUNSELING COMMUN— ITY AWARENESS AND EDUCATION . IT IS FUNDED PRIMARILY BY GRANTS AND DONATIONS — Grants and allocations 530 704 . 1 , 326r2040 b Grants and allocations C Grants and allocations d Grants and allocations e Other program services attach schedule Grants and allocations $ f Total of Program Service Expenses (should equal line 44, column (B), Program services) ► 1 , 326 ,, 204 * "2.1 002 2 Form 990 (2001 ) Form 990 20p1 EXCHANGE CLUB CENTER FOR THE PREVENTION ( ) OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 Page Patt: 1V Balance Sheets Note: Where required, attached schedules and amounts within the description column (A) (B) should be for end-of-year amounts only. Beginning of year End of year 145 Cash - non-interest-bearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 6 2 0 0 . 45 53 , 9659 46 Savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 , 0009 46 351 128 . 47 a Accounts receivable . . . . . . . . . . . . . . . . . . . . 47a b Less: allowance for doubtful accounts . . . . . . . . . . . . . . . . . 476 47c 48 a Pledges receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48a b Less: allowance for doubtful accounts . . . .. . . . . . . . . . . . . . 48b 48c 49 Grants receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Receivables from officers, directors, trustees, andkey employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 H 51 a Other notes and loans receivable , 0 , , 0 , , , , , , , , , 0 , , 0 _ _ 4 3 8 2 0 . a b Less: allowance for doubtful accounts „ , , , , , , , , , , , , , , , , 516 45 , 648 * 51c .43 820 * 52 Inventories for sale or use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 53 Prepaid expenses and deferred charges , , , , , , , , , , , , , , , , , , „ , I . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . 53 54 Investments - securities STMT , , , C , 0000 . , pop, 0 Cost ® FMV 19 , 1089 54 67 371 . 55 a Investments - land, buildings, and equipment: basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . 55a b Less: accumulated depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . 55b 55c 56 Investments - other . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 57 a Land, buildings, and equipmenC basis , , , , , , , , , , , , , , , , , , 57a 5 6 8 s 8 3 7 . b Less: accumulated depreciation . . . . . . . . . . . . . . . . . . . . . . . . W . . I 57b _ ___137 r 085 o 4 5 5 9 4 6 . 57c 4 31 7 5 2 . 58 Other assets (describe ► SEE STATEMENT 7 ) 3 r 5 5 4 . I 58 28r423 * 59 Total assets add lines 45 through 58 must equal line 74) . . . . 870 456 . 59 976 , 4590 60 Accounts payable and accrued expenses . . .. . . . . . . . . . . . . . . . . . . . . . . . . . „ . 0 " Wo eo ” " 0 " M M0 1 f 6 8 3 . 60 1 816 . 61 Grants payable . . . . . . . . . . . . m . . . w . . . . . . . . . . . . . . . . . . . m 62 Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . 62 63 Loans from officers, directors, trustees, and key employees . . . . . . . . . . . . . e . . . . . . . . . _ . . . . . . . . . . . 63 J 64 a Tax-exempt bond liabilities . . . . . . . . . . . . . . . . . . . . . b Mortgages and other notes payable . . . . . . . . . . . . . . . . . .STMT . , . $. . , 43aO52 * 1 64b 65 Other liabilities (describe ► 1 65 66 Total liabilities add lines 60 throw h 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4 7 3 5 . 66 1 , 8169 Organizations that follow SFAS 117, check here ► and complete lines 67 through 69 and lines 73 and 74. 67 Unrestricted . . . • . • . • . . . . . • . • . . . 761 , 573 * 67 974 , 643 * io 68 Temporarily restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64r1489 68 aB 69 Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 COrganizations that do not follow SFAS 117, check here ► F�l and complete lines LL 70 through 74. is 70 Capital stock, trust principal, or current funds 70 . . . . . . . . . 0 . 040 . . . . . . . . . . . . . . . . . . . . . . . X71 Paid-in or capital surplus, or land, building, and equipment fund , , , , , , , , , , , , , , , , , 71 a 72 Retained earnings, endowment, accumulated income, or other funds 72 Z 73 Total net assets or fund balances (add lines 67 through 69 OR lines 70 through 72; column (A) must equal line 19; column (B) must equal line 21 ) „ . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . 825s 721 * 73 974 , 643o 74 Total liabilities and net assets / fund balances (add lines 66 and 73) 870r456 * 74 976 , 4599 Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments. 123021 01-02-02 3 Form 990 2001 EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST INC 5 - 2094472 Pa e4 Part IV=A Reconciliation of Revenue per Audited Paft lV-B Reconciliation of Expenses per Audited Financial Statements with Revenue per Financial Statements With Expenses per Return Return a Total revenue, gains, and other support a Total expenses and losses per per audited financial statements ► a 1 6 8 8 9 2 3 . audited financial statements . . . ► a 1 540 001 b Amounts included on Zine a but not on b Amounts included on linea but not on line 12, Form 990: line 17, Form 990: ( 1 ) Donated services ( 1 ) Net unrealized gains and use of facilities $ on investments . . . . . . $ < 482 . (2) Prior year adjustments (2) Donated services reported on line 20, and use of facilities . . . $ Form 990 _ $ (3) Recoveries of prior (3) Losses reported on year grants . . . . . . . . . . . . $ line 20, Form 990 (4) Other (specify): (4) Other (specify): A $ Add amounts on lines ( 1 ) through (4) . . . . . . . . . ► b < 482 * Add amounts on lines ( 1 ) through (4) . . . . . . . . . ► b 0 c Line a minus line b . . . . No. c 1 689 4 0 5 . c Line a minus line b ► c ' 1 5 40 001 d Amounts included on line 12, Form d Amounts included on line 17, Form 990 but not on line a: 990 but not on line a : ( 1 ) Investment expenses ( 1 ) Investment expenses not included on K ` not included on line 6b, Form 990 $ line 6b, Form 990 . . . $ (2) Other (specify): (2) Other (specify): $ $_... Add amounts on lines ( 1 ) and (2) ► d 00 Add amounts on lines (1 ) and (2) . . . e Total revenue per line 12, Form 990 i a Total expenses per line 17, Form 990 (line c plus line d) No- Ile 1 , 689 , 405 . (line c plus line d) e 1 . 540 . 001 PartN List of Officers, Directors, rustees, and Key Employees (List each one even if not compensated.) (B) Title and average hours (C) Compensation (D o (E) Expense (A) Name and address per week deovroted to (If not pal , enter "n ae a account and corn ensation other allowances AL _FORTE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ RESIDENT PO BOX 249 _ _ _ _ FORT PIERCE FL 34954 10 0 . 0 . 0 . MIKE DILLMANRESIDENT 3525 W ._ MIDWAY ROAD FORT PIERCEs FL 34950 10 0 . 0 . 0 . JIM HARTLEY _ _ _ _ _ _ _ _ _ _ _ REASURER 2222 COLONIAL RD ,_ STE_ # 200 _ _ _ _ _ _ _ _ _ FORT PIERCE FL 34950 10 0 . 0 . 0 . THERESA GARBARINO =MAYXECUTIVE DI CTOR 3525 We MIDWAY ROAD FORT PIERCE FL 34981 - 40 74 009 . 7 355 . 0 . DOUG BOURIE _ _ _ _ _ _ _ _ _ _ _ _ _ SST . EXECUTr. . DIREC R 3525 We MIDWAY ROAD FORT PIERCE FL 34981 40 831 . 4 685 . 0 . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - N Q O a 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $ 100,000 fromd byour �or-9a�naation and all related organizations, of which more than $10,000 was providey the related organizations? If Yes ' attach schedule ► L� Yea ® No Form 990 (2001 ) EXCHANGE CLUB CENTER FOR THE PREVENTION Form 990 (2001 ) OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 Pages J . PartVtj Other Information Yes No 76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes; attach a detailed description of each activity . . . . . . . . . . . . 76 X 77 Were any changes made in the organizing or governing documents but not reported to the IRS? . . . . . . . . . . . . . 77 X If "Yes, attach a conformed copy of the changes. 78 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . 782 X b If 'Yes; has it filed a tax return on Form 990-T for this year? . . . . . . . I . . . . . . . . . . . . . . . . N /A . . , . , . . . . 78b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? . . _ , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 X If 'Yes; attach a statement 80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? . . . . . . . . . . . . . . . . . . . . . . 80a X b If 'Yes; enter the name of the organization ► and check whether it is exempt OR El nonexempt. 81 a Enter direct or indirect political expenditures. See line 81 instructions . . . . . . . . . . 812 00 b Did the organization file Form 1120-POL for this year? , , , , , , , , , , , , , , , , , , , , , I . . . . . . 1 , _ , . . . . . . . . . . . . . I . . . . . . 81b X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fairrental value? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82a X b If 'Yes; you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an expense in Part 11. (See instructions in Part IIL) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 82b N / A 83 a Did the organization comply with the public inspection requirements for returns and exemption applications? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83a X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? . . _ . . . 83b X 84 a Did the organization solicit any contributions or gifts that were not tax deductible? , , , , , , , , , , , , , , „ _ , , , , , , . , , , , , , . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . /A , . . . . . .. . . 84a b If 'Yes; did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/.A . . . . . . . . . 846 85 501 (c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/,A . . . , . . . . . 85a b Did the organization make only in-house lobbying expenditures of $2,000 or less? . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . / A . , , . . , , . . 85b If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year. c Dues, assessments, and similar amounts from members , , , , , , , , , , , , , , , , , , , , , 85c N A d Section 162(e) lobbying and political expenditures „ _ , . 85d N /A e Aggregate nondeductible amount of section 6033(e)( 1 )(A) dues notices . . . . . . . . . . . . . . . . . 85e N / A f Taxable amount of lobbying and political expenditures (line 85d less 85e) , , , , , , , , _ 85f N / A . .. g Does the organization elect to pay the section 6033(e) tax on the amount in 85f? . . . . . . . . . . . .. . . . . . . . N /A , , , , , , , , , 85 h If section 6033(e)( 1 )(A) dues notices were sent, does the organization agree to add the amount in 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N /A . . . . . . . . . . . . 85h 86 501 (c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 12 86a N /A b Gross receipts, included on line 12, for public use of club facilities , , , , , , , , , , , , , , , , 86b N A 87 501 (c)(12) organizations. Enter. a Gross income from members or shareholders . , , , , , , 87a N A b Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) , , , , . . . . . . . . . . . . . . . . . . . . . 87b N / A ...... 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301 .7701 -2 and 301 .7701 -3? If 'Yes; complete Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 a 501 (c)(3) organizations. Enter. Amount of tax imposed on the organization during the year under. section 491110o. 0 . ; section 4912 ► 0 . ; section 4955 ► 0 b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? If Yes; attach a statement explaining each transaction , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 89b X c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . . . . ► 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . dEnter. Amount of tax on line 89c, above, reimbursed by the organization , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 09 90 a List the states with which a copy of this return is filed ► NONE b Number of employees employed in the pay period that includes March 12, 2001 , , , , , , , , , , , , , , 01 , , , , , , , , , , 90b 5 7 91 The books are in care of ► EXECTUTIVE DIRECTOR Telephone no. ► ( 407 ) 465 - 6011 Located at ► _ 3 525 W . MIDWAY ROAD , FORT PIERCE FL ZIP + 4 ► 34981 I 92 Section 4947(a)(1) nonexempt charitable trusts riling Form 990 in lieu of Form 1041 - Check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► and enter the amount of tax-exempt interest received or accrued during the tax Year . . . . . . . . . . . . . . . . . . . . . . . ► 192 ( N/ A 0 02-04�02 5 Form 990 (2001 ) EXCHANGE CLUB CENTER FOR THE PREVENTION Form 990 (2001 ) OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 20. 94472 Page e e.agt.VII I Analysis of Income-Producing Activities See Specific Instructions on page 32. Note : Entergross amounts unless otherwise I Unrelated business income Excluded by section 512, 513, or 514 {E) indicated. (A) (g) (C) (p) Business Amount Exclu- Related or exempt 93 Program service revenue: code she Amount function income a DIVORCE GROUP 42 336 . b POSITIVE PARENTING 3 455 . c HIGH HOPES f2 955 . d COUNSELING 661 170 . e f Medicare/Medicaid payments , , g Fees and contracts from government agencies . . . . . . . . . . . . 94 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . 95 Interest on savings and temporary cash investments , 00 , , , , , 00 , , , , , , . 14 7 , 362 * 96 Dividends and interest from securities . 0 . . . . . 0 . . 0 . 0 . . . . . . . . 97 Net rental income or (loss) from real estate: a debt-financed property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . b not debt-financed property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Net rental income or (loss) from personal property . . . . . . 99 Other investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Gain or (loss) from sales of assets other than inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . < 1 509 . > 101 Net income or (loss) from special events . . . . . . . . . .. . . . . . . . Oil 15 9 5 8 . 102 Gross profit or (loss) from sales of inventory . . . . . . . . . . . . 103 Other revenue: a OTHER INCOME 5r961 * b C d e 104 Subtotal (add columns (B), (D), and (E)) . . . . . . . . . . . . . . . . . . O . _. '` 23 , 320ol 714 , 3680 105 Total (add line 104, columns (B), (D), and (E)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 737 , 6889 Note: Line 105 plus line 1d, Part 1, should equal the amount on line 12, Pan' 1. } Part V1111 Relationship of Activities to the Accomplishment of Exempt Purposes (See Specific Instructions on page 32.) Line No . Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization 's exempt purposes (other than by providing funds for such purposes). SEE STATEMENT 9 Part IX Information Regarding Taxable Subsidiaries and Disregarded Entities (See Specific Instructions on page 33.) Name, address, and)EIN of corporation, Percentage of Nature of activities Total n come End or-year Partnership, or disre arded entity ownershio interest i assets % N /A % % Part X' Information Regarding Transfers Associated with Personal Benefit Contracts (See Specific Instructions on page 33. (a) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? . . . . . . . . . . . , Yes No (b) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . 0 Yes ® No Note : If 'Yes ' to b rile Form 8870 and Form 4720 see instructions). Under penalties of perW, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It Is true, Please correct, and complete. Declaration of preparer ther than officer) Is based on all information of which preparer has any knowledge. SignIL ft j 2 Here ' Signature of officer Date ' Type or print name and title Preparer's Dat Check I Preparer s SSN or PTIN Paid signature / 2 employed ► Q Preparer's Firm's name (or Use Only yours K AINES & ASSOCIATES , CHTD EIN ► �;oyea 1905 SOUTH 25TH STREET , SUITE 202 1-02- FRT PIERCE FLORIDA 34947 Phoneno. ► ( 561 ) 461 - 1155 01-02-02 LP � 4 6 Form 990 (2001 ) SCHEDULE A Organization Exempt Under Section 501 (c) (3) OMB No. 1545-0047 (Form 990 or 990-EZ) (Except Private Foundation) and Section 501 (e), 501 (1), 501 (k), 501 (n), or Section 4947(a)( 1 ) Nonexempt Charitable Trust �� O j Department of the Treasury Supplementary Information-(See separate instructions.) Internal Revenue Servioe ► MUST be completed by the above organizations and attached to their Form 990 or 990-EZ. Name of the organization EXCHANGE CLUB CENTER FOR THE PREVENTION Employer identification number OF CHILD ABUSE OF THE TREASURE COAST INC 59 = 2094472 Part"I Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions. List each one. If there are none, enter 'None') (a ) Name and address of each employee paid (b) Title and average hours (d) Contributions to per week devoted to c Compensation employee benefit (e) xpenoe more than $50,000 ( ) p plans 6 deferred account and other OSlfinn compensation allowances THERESA GARBARINO =MAY _ _ _ _ _ _ _ . . . . . . . XECUTIVE DI FORT PIERCE FLORIDA 40 74 , 0099 7r355 * DOUG _BORRIE SST . ED FORT PIERCE FLORIDA 40 51 , 8319 4o6859 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total number of other employees paid over $50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .► 0 Pact' It Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions. List each one (whether individuals or firms). If there are none, enter 'None.') (a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation NONE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - = - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total number of others receiving over $50,000 for professional services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ► 0 LHA For Paperwork Reduction Act Notice , see the instructions for Form 990 and Form 990-EZ. Schedule A (Form 990 or 9904Z) 2001 123101 12-20-01 7 EXCHANGE CLUB CENTER FOR THE PREVENTION Schedule A (Form 990 or 990-EZ) 2001 OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 Page 2 Part lll ' Statements About Activities (See page 2 of the instructions.) Yes No 1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If 'Yes; enter the total expenses paid or incurred in connection with the lobbying activites ► $ $ (Must equal amounts on line 38 , Part VI-A, X or line i of Part VRI ) 1 Organizations that made an election under section 501 (h) by filing Form 5768 must complete Part VI-A. Other organizations checking 'Yes; must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities. 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? (if the answer to any question is ' Yes, ' attach a detailed statement explaining the transactions.) a Sale, exchange, or leasing of property? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . 2a X b Lending of money or other extension of credit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b X c Furnishing of goods, services, or facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 2c X it Payment of compensation (or payment or reimbursement of expenses if more than $1 ,000)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 2d X e Transfer of any part of its income or assets? 2e X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . : . . . . 3 Does the organization make grants for scholarships, fellowships, student loans, etc.? (See Note below.) . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 3 X 4 Do you have a section 403(b) annuity plan for your employees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X Note : Attach a statement to explain how the organization determines that individuals or organizations receiving grants orloans from it in furtherance of its charitable programs 'qualify' to receive payments. Part` 11/ Reason for Non- Private Foundation Status (See pages 3 through 6 of the instructions.) The organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 F�i A church, convention of churches, or association of churches. Section 170(b)( 1 )(A)(i). 6 F"I A school. Section 170(b)( 1 )(A)(ii). (Also complete Part V.) 7 A hospital or a cooperative hospital service organization. Section 170(b)( 1 )(A)(iii), 8 0 A Federal, state, or local government or governmental unit Section 170(b)( 1 )(A)(v), 9 A medical research organization operated in conjunction with a hospital. Section 170(b)( 1 )(A)(iii). Enter the hospital's name, city, and state 00- 10 10 0 An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)( 1 )(A)(iv). (Also complete the Support Schedule in Part IV-A) 11a ® An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170(b)( 1 )(A)(vi). (Also complete the Support Schedule in Part IV-A.) llb A community trust. Section 170(b)( 1 )(A)(vi). (Also complete the Support Schedule in Part IV-A.) 12 An organization that normally receives: ( 1 ) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc., functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975, See section 509(a)(2). (Also complete the Support Schedule in Part IV-A.) 13 0 An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in: ( 1 ) lines 5 through 12 above: or (2) section 501 (c)(4) (5) or (6) if they meet the test of section 509(a)(2) (See section 509(a)(3).) Provide the following information about the supported organizations. (See page 5 of the instructions.) (b ) Line number (a) Name(s) of supported organization(s) from above 14 An organization organized and operated to test for public safety. Section 509(a)(4). See page 6 of the Instructions. Schedule A (Form 990 or 990-En 2001 123111 01-07.02 8 Schedule A (Form 990 or EXCHANGE CLUB CENTER FOR THE PREVENTION Pa (� 990-EZ) 2001 OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 ge3 PartJV=A Support Schedule (Complete only A you checked a box online 10, 11 , or 12.) Use cash method of accounting. Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accountin . Calendar year (or fiscal year beginning in ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► a 2000 b 1999 c 1998 d 1997 a Total 15 Gifts, grants, and contributions received. (Do not include unusual grants. See line 28.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 , 437 , 6630 940 238 . 1 024 540 . 844 , 177a 4 , 246 , 618 , 16 Membership fees received . . . . . . . . . 17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organ'ization's charitable, etc., purpose . . . . . . . . . . . . 52t541 * 5 7 5 8 2 . 50 , 355 * 48 504 . 208 8 982 . 18 Gross income from interest, dividends, amounts received from payments on securities loans (sec- tion 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the 9870 7 3 3 . 18 4 2 7 . organization after June 30, 1975. . . 12 , 049 * 4 658 . 19 Net income from unrelated business activities not included in line 18 20 Tax revenues levied for the organization's benefit and either paid to It or expanded on its behalf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge . . , . . . . , , . . , 22 Other income. Attach a schedule. Do not SEE STATEMENT 10 include gain or Qoss) from sale of capital assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 , 375 * 20 , 271a 28 , 370o 19P1229 81 138 . . 23 Total of lines 15 through 22 1 515 6 2 8 . 1 0 2 2 7 4 9 , 1 , 104 , 252 , 912 5 3 6 . 4 , 555 , 1659 24 Line 23 minus line 17 . . . . . . . . . . . . . . . 1 463 087 . 965 , 167 * 1 , 053 , 897o 864 032 . 4 , 346 , 1830 25 Enter 1 % of line 23 . . . . . . . . . . . . . . . . . . 15 jo 156 * 1 10j, 2279 , 11 ff 043 . 9 r 125 . 26 Organizations described on lines 10 or 11 : a Enter 2% of amount in column (e), line 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 26a 86 r924 * b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization) whose total gifts for 1997 through 2000 exceeded the amount shown in line 26a. Do not file this list with your return . Enter the total of all these excess amounts . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 26b of . c Total support for section 509(a)(1 ) test: Enter line 24, column (e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 26c 4m 346 18 3 . d Add: Amounts from column (e) for lines: 18 18 , 4 2 7 . 19 22 81 , 138 * 26b ► 26d 99 565 a e Public support (line 26c minus fine 26d total) . . . . . . . . . . . . . . . . . . . . . . . ► 26e 4r246 , 618 *. . . . . . . . . . . . . . . . f Public support percentage line 26e numerator divided by line 26c denominator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 26f 9 7 . 7 ) 91 % 27 Organizations described on line 12: a For amounts included in lines 15, 16, and 17 that were received from a *disqualified person; prepare a list for your records to show the name of, and total amounts received in each year from, each *disqualified person! Do not file this list with your return . Enter the sum of such amounts for each year: N/A (2000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 1999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 1998) . . ( 1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b For any amount included in line 17 that was received from each peson (other than 'disqualiffed persons'), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000. (Include in the list organizations described in lines 5 through 11 , as well as individuals.) Do not file this list with your return . After computing the difference between the amount received and the larger amount described in ( 1) or (21 enter the sum of these differences (the excess amounts) for each year. N /A (2000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 1999) . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . ( 1998) ( 1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Add: Amounts from column (e) for lines: 15 16 17 20 21 ► 27c N / A d Add: Line 27a total and line 27b total ► 27d NIA . . . . . . . . . . . . . . . . . . . . . . . . e Public support (line 27c total minus line 27d total) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 27e NIA . . . . . . . . . . . . . . . . . . . . . . . . . f Total support for section 509(a)(2) test: Enter amount on line 23, column (e) . . . 11 . . . . ► 27i N A g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) , 1110P27 N /A % . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h Investment income percentage line 18 column a numerator divided by line 27f denominator . . . . . . . . . ► 27h NIA % 28 Unusual Grants: For an organization described in line 10, 11, or 12, that received any unusual grants during 1997 through 2000, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, anyal brief description of the nature of the grant Do not file this list with your return. Do not include these grants in line 15. NONE 123121 12.29-01 9 Schedule A (Form 990 or 9904Z) 2001 I EXCHANGE CLUB CENTER FOR THE PREVENTION Schedule A (Form 990 or 990-EZ) 2001 OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 Page 4 Part ; V Private School Questionnaire (See page 7 of the instructions.) N /A (To be completed ONLY by schools that checked the box on line 6 in Part IV) 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing Yes No instrument, or in a resolution of its governing body? . , . . . . . . . . . . . . . . . . . . . . . Re . , . . . . . . . . . . . . * . * . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 31 If "Yes," please describe; if 'No; please explain. (if you need more space, attach a separate statement) 32 Does the organization maintain the following: a Records indicating the racial composition of the student body, faculty, and administrative staff? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32a b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? . . . . . . . . . . . . . . . . . . . . . 32b c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . 32c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Copies of all material used by the organization or on its behalf to solicit contributions? , . . . . . . . . 32d . . . . . . . . If you answered Tom to any of the above, please explain. (If you need more space, attach a separate statement) 33 Does the organization discriminate by race in any way with respect to: a Students' rights or privileges? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33a b Admissions policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336 c Employment of faculty or administrative staff? d Scholarships or other financial assistance? 33d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e Educational policies? . . . . . . . . . . . . . . fUse of facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33f . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . gAthletic programs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . h Other extracurricular activities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . I . . . . . . . 33h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you answered 'Yes" to any of the above, please explain. (If you need more space, attach a separate statement) .. . .... .. ... . :. . ..: . ... .....: . . . . . 34 a Does the organization receive any financial aid or assistance from a governmental agency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34a b Has the organization's right to such aid ever been revoked or suspended? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34b If you answered 'Yes' to either 34a or b, please explain using an attached statement 35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Proc, 75-50, 1975-2 C.B. 587, covering racial nondiscrimination? If "No; attach an explanation Schedule A (Form 990 or 990-EZ) 2001 123131 12-2" 1 10 EXCHANGE CLUB CENTER FOR THE PREVENTION Schedule A (Form 990 or 990-EZ) 2001 OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 Pae 5 Parf'VI-A'` Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions.) N/ A (To be completed ONLY by an eligible organization that filed Form 5768) Check ► a M if the organization belon s to an affiliated group. Check ► b 0 if you checked Nam and 'limited controP rovisions 9A. Limits on Lobbying Expenditures (a) (b) Affiliated group To be completed for ALL (The term 'expenditures' means amounts paid or incurred.) totals electing organizations N /A 36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) „ „ 37 38 Total lobbying expenditures (add lines 36 and 37) . . . . . . . . . . . . . . . . . . . . . . . . . . . . „ . , 38 39 Other exempt purpose expenditures . . . . . . . . . . 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Total exempt purpose expenditures (add lines 38 and 39) . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 41 Lobbying nontaxable amount. Enter the amount from the following table - If the amount on line 40 is - The lobbying nontaxable amount is - Not over $500,000 20% of the amount on line 40 Over $500,000 but not over $ 1 ,000,000 , , , , , , . , . . . , $ 100,000 plus 15% of the excess over $500,000 Over $ 1,000,000 but not over $ 1,500,000 . . . . . . . . . $ 175,000 plus 1096 of the excess over $ 1,000,000 . . . . . . 41 Over $ 1 ,500,000 but not over $ 17,000,000 . . . . . . . . . $225,000 plus 5% of the excess over $ 1,500.000 Over $ 17,000,000 . . .;; . ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Grassroots nontaxable amount (enter 25% of line 41 ) , 1 , , , , , , , , , , , , , , , , , , 42 43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . 43 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 . . . . . . . . . . 44 Caution: If there is an amount on either line 43 or line 44, you must file Form 4720. 4-Year Averaging Period Under Section 501 (h) (Some organizations that made a section 501 (h) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50 on page 11 of the instructions.) Lobbying Expenditures During 4-Year Averaging Period N/ A Calendar year (or (a) (b) (c) (d) (e) fiscal year beginning in ) ► 2001 2000 1999 1998 Total 45 Lobbying nontaxable amount . . . . . . . . . . . . . . . . . . . . . . . . 0 . 46 Lobbying ceiling amount 150% of line 45 a . . . . . . . . . 0 . 47 Total lobbying expenditures . . . . . . . . . . . . . . . . . . 0 48 Grassroots nontaxable amount . . . . . . . . . . . . . . . . . . . . . . . . 0 . 49 Grassroots ceiling amount 150% of line 48(e . . . . . . . . . 0 . 50 Grassroots lobbying expenditures . . . . . . . . . . . . . . . . . . 0 . Part' WB' I Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI-A) (See page 12 of the instructions.) N / A During the year, did the organization attempt to influence national, state or local legislation, including any attempt to Yes No Amount influence public opinion on a legislative matter or referendum, through the use of a Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Paid staff or management ( Include compensation in expenses reported on lines through h . ), , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , c Media advertisements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . dMailings to members, legislators, or the public ,, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , e Publications, or published or broadcast statements , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 0 . . . . . . . . . . . . . I Grants to other organizations for lobbying purposes . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . _ . . . . . . . . . . . _ , _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . g Direct contact with legislators, their staffs, government officials, or a legislative body „ _ . . . I . . . , . . . . I , , , , , , , , , , , , , , , , , , , , , h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means . , , . . . . . . . . I Total lobbying expenditures (Add linesc through h.) , , , , , , , , , , 1 . of If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities. 123141-o1 Schedule A (Form 990 or 9904Z) 2001 11 Schedule A form 990 or 990-EZ EXCHANGE CLUB CENTER FOR THE PREVENTION ( ) 2001 OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 Pages Part' .W: Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (See page 12 of the instructions.) 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501 (c) of the Code (other than section 501 (c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of Yes No (I) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51a(i) X (ii) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a(ii) X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Other transactions: (i) Sales or exchanges of assets with a noncharitable exempt organization b(i ) X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (ii) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b(ii X (iii) Rental of facilities, equipment, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . _ . . . . . . . . . . . b(iii) X (iv) Reimbursement arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b(iv) X (v) Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b(v) X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (vi) Performance of services or membership or fundraising solicitations . . . . . . . . . . . . . . . . I . . . . b(vi) X c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . . . . . . . . . . . . . . c X d If the answer to any of the above is 'Yes; complete the following schedule. Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received: N / A (a) (b ) (c) .(d) Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements 52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501 (c) of the Code (other than section 501 (c)(3)) or in section 527? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] [� Yes ® No b If 'Yes; complete the following schedule: N A (a) (b) (c) Name of organization Type of organization Description of relationship 123151 12-2e-01 Schedule A (form 990 or 990-EZ) 2001 12 Schedule B Schedule of Contributors OMB No. 1545-0047 (Form 990, 990-EZ, or 890-PF) Supplementary Information for � oo Department or the Treasury line 1 of Form 990, 990-EZ and 990-PF (see Instructions) internal Revenue service Name of organization Employer Identification number EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 Organization type (check one): Filers of: Section: Form 990 or 990-EZ ® 501 (c)( 3 ) (enter number) organization ED 4947(a)(1 ) nonexempt charitable trust not treated as a private foundation ED 527 political organization Form 990-PF 501 (c)(3) exempt private foundation Q 4947(a)(1 ) nonexempt charitable trust treated as a private foundation Q 501 (c)(3) taxable private foundation Check if your organization is covered by the General rule or a Special rule. (Note: Only a section 501 (c)(7), (8), or (10) organization can check box(es) for both the General rule anda Special rule-see instructions.) General Rule- For organizations filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (n money or property) from any one contributor. (Complete Parts I and II.) Special Rules- ® For a section 501 (c)(3) organization filing Form 990, or Form 990-EZ, that met the 33 1 /39eo support test of the regulations under sections 509(a)(1 )/170(b)(1 )(A)(v) and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2% of the amount on line 1 of these forms. (Complete Parts I and II.) 0 For a section 501 (c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any one contributor, during the year, aggregate contributions or bequests of more than $1 ,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. (Complete Parts I, If, and III .) 0 For a section 501 (c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any one contributor, during the year, some contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not aggregate to more than $1 ,000. (If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the Parts unless the General rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more during the year.) . . . . . .. . . . . . . . . . . . . . . .. .. . . ► $ Caution: Organizations that are not covered by the General rule and/or the Special rules do not rile Schedule B (Form 990, 990-EZ, or 990-PF), but they must check the box in the heading of their Form 990, Form 990-EZ, or on line 1 of their Form 990-PF, to certify that they do not meet the riling requirements of Schedule B (Form 990, 990-Q, or990-PF). Schedule B (Form 990, 990-EZ, or 990-PF) (2001 ) 123457 12-29,01 13 Schedule 8 (Form 9900 990-E!4 or 990-PF) (2001) Page 1 to 2 of Part i Name of organization Employer identification number EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 Part I Contributors (See Specific Instructions) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution BOARD OF COUNTY COMMISSIONERS OF 1 INDIAN RIVER COUNTY Person Payroll [D $ 3 7 , 2 51 , Noncash [] (Complete Part II if there VERO BEACH FLORIDA is a noncash contribution.) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution 2 EXCHANGE CLUB OF FORT PIERCE Person Payroll �] $ 113 , 332 * Noncash 0 (Complete Part II if there FORT PIERCE FLORIDA is a noncash contribution.) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution FLORIDA DEPARTMENT OF CHILDREN AND 3 FAMILIES Person Payroll Q $ 235 , 3849 Noncash F] (Complete Part II if there FORT PIERCE FLORIDA is a noncash contribution.) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution 4 HOSPICE OF MARTIN AND ST LUCIE COUNTY Person Payroll Q $ 53 , 6790 Noncash Q (Complete Part 11 if there STUART FLORIDA is a noncash contribution .) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution MARTIN COUNTY CHILDRENS SERVICE 5 COUNCIL Person Payroll $ 69 , 201 * Noncash [] (Complete Part 11 if there STUARTt FLORIDA is a noncash contribution.) (a) (b) (c) (CO No. Name, address and ZIP + 4 Aggregate contributions Type of contribution ST . LUCIE COUNTY CHILDRENS SERVICE 6 COUNCIL Person EE Payroll [� $ 146 , 202 * Noncash Q (Complete Part II if there FORT PIERCE FLORIDA is a noncash contribution.) 12W2 12-29-01 14 Schedule 8 (Form 990, 990-EZ, or 990-PF) (2001 ) Schedule B (Form 990, 990-E7, or 990-PF) (2001) Page 2 to 2 of Part i Name of organization Employer identification number EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST INC 59 - 2094472 . ..... . .. .. . . .. . Part ( : ' ' Contributors (see specific Instructions.) a. (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution 7 UNITED WAY OF INDIAN RIVER COUNTY Person Payroll Q $ 113 , 332 * Noncash Q (Complete Part If if there VERO BEACH FLORIDA is a noncash contribution.) (a) (b) (c) (Co No. Name, address and ZIP + 4 Aggregate contributions Type of contribution 8 UNITED WAY OF MARTIN COUNTY Person Payroll [Q $ 41 , 975 * Noncash Q (Complete Part II if there STUART , FLORIDA is a noncash contribution) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution 9 UNITED WAY OF ST LUCIE COUNT Person Payroll Q $ 5 7 , 212 . Noncash Q (Complete Part II if there FORT PIERCE FLORIDA is a noncash contribution.) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution Person 0 Payroll [] $ Noncash Q (Complete Part II if there is a noncash contribution .) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution Person Payroll Q $ Noncash �] , (Complete Part II if there is a noncash contribution.) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution Person 0 Payroll Q $ Noncash Q (Complete Part II if there is a noncash contribution.) 123432 1249-01 15 Schedule 0 (Form 990, 9904Z, or 990-PF) (2001 ) EXCHANGE CLUB CENTER FOR THE PREVENTION 59 - 2094472 FORM 990 GAIN ( LOSS ) FROM PUBLICLY TRADED SECURITIES STATEMENT 1 GROSS COST OR EXPENSE NET GAIN DESCRIPTION SALES PRICE OTHER BASIS OF SALE OR ( LOSS ) DISPOAL OF LONG TERM CD 19 , 524 . 20 , 000 . 0 . < 476 . > TO FORM 990 , PART I , LINE 8 19 , 524 . 20 , 000 . 0 . < 476 . > 16 STATEMENT ( S ) 1 EXCHANGE CLUB CENTER FOR THE PREVENTION 59 - 2094472 FORM 990 GAIN ( LOSS ) FROM SALE OF OTHER ASSETS STATEMENT 2 DATE DATE METHOD DESCRIPTION ACQUIRED SOLD ACQUIRED DISPOSAL OF ASSETS VARIOUS VARIOUS PURCHASED GROSS COST OR EXPENSE NET GAIN NAME OF BUYER SALES PRICE OTHER BASIS OF SALE DEPREC OR ( LOSS ) 50 . 11083 . 0 . 0 . < 11033 . > TO FM 990 , PART I , LN 8 50 . 1 , 083 . 0 . 0 . < 11033 . > FORM 990 SPECIAL EVENTS AND ACTIVITIES STATEMENT 3 GROSS CONTRIBUT . GROSS DIRECT NET DESCRIPTION OF EVENT RECEIPTS INCLUDED REVENUE EXPENSES INCOME FUNDRAISING EVENTS 26 , 837 . 26 , 837 . 10 , 879 . 15 , 958 . TO FM 990 , PART I , LINE 9 26 , 837 . 26 , 837 . 10 , 879 . 15 , 958 . FORM 990 OTHER CHANGES , IN NET ASSETS OR FUND BALANCES STATEMENT 4 DESCRIPTION AMOUNT UNREALIZED LOSS ON INVESTMENTS < 482 . > RELEASE OF ASSETS < 64 , 148 . > RELEASE OF ASSETS 64 , 148 . TOTAL TO FORM 990 , PART I , LINE 20 < 482 . > 17 STATEMENT ( S ) 2 , 3 , 4 EXCHANGE CLUB CENTER FOR THE PREVENTION 59 - 2094472 FORM 990 OTHER EXPENSES STATEMENT 5 ( A ) ( B ) ( C ) ( D ) PROGRAM MANAGEMENT DESCRIPTION TOTAL SERVICES AND GENERAL FUNDRAISING INSURANCE 12 , 237 . 91790 . 2 , 447 . EDUCATIONAL MATERIALS 10 , 564 . 10 , 564 . CLIENT EXPENSES 10 , 273 . 10 , 273 . UTILITIES 13 , 626 . 10 , 901 . 21725 . ADVERTISING 81274 . 51792 . 21482 . DUES AND SUBSCRIPTIONS 3 , 199 . 3 , 199 . FEES AND LICENSES 866 . 866 . OTHER EXPENSES 2 , 052 . 1 , 539 . 513 . PROFESSIONAL SERVICES 17 , 010 . 5 , 103 . 11 , 907 . CONTRACT LABOR 76 , 503 . 61 , 202 . 151301 . TRAVEL & CONFERENCES 36 , 721 . 33 , 049 . 31672 . BACKGROUD INVESTIGATION 4 , 397 . 4 , 397 . REPAIRS AND MAINTENANCE 14 , 397 . 10 , 079 . 4 , 318 . TOTAL TO FM 990 , LN 43 210 , 119 . 162 , 689 . 47 , 430 . FORM 990 NON- GOVERNMENT SECURITIES STATEMENT 6 OTHER PUBLICLY TOTAL CORPORATE CORPORATE TRADED OTHER NON- GOV ' T SECURITY DESCRIPTION STOCKS BONDS SECURITIES SECURITIES SECURITIES INVESTMENTS 67 , 371 . 67 , 371 . TO 990 , LN 54 COL B 67 , 371 . 671371 . 18 STATEMENT ( S ) 5 , 6 EXCHANGE CLUB CENTER FOR THE PREVENTION 59 - 2094472 FORM 990 OTHER ASSETS STATEMENT 7 DESCRIPTION AMOUNT DEPOSITS 689 . INVESTMENT IN TIMESHARE 2 , 734 . INVESTMENT IN UNITED FOR FAMILIES 251000 . TOTAL TO FORM 990 , PART IV , LINE 58 , COLUMN B 28 , 423 . FORM 990 MORTGAGES PAYABLE STATEMENT 8 DESCRIPTION BALANCE DUE HARBOR FEDERAL 0 . TOTAL INCLUDED ON FORM 990 , PART IV , LINE 64B , COLUMN B FORM 990 PART VIII - RELATIONSHIP OF ACTIVITIES TO STATEMENT 9 ACCOMPLISHMENT OF EXEMPT PURPOSES LINE EXPLANATION OF RELATIONSHIP OF ACTIVITIES 93A REVENUE FROM COUNSELING PARENTS THAT ARE FILING FOR DIVORCE TO EDUCATE THEM ON HOW TO DEAL WITH ISSUES RELATED TO THEIR CHILDREN SO AS TO REDUCE CHILD ABUSE AND NEGLECT . 93B REVENUE FROM PARENTING GROUPS FOR COUNSELING TO BE MORE UNDERSTANDING PARENTS IN ORDER TO REDUCE CHILD ABUSE 93C REVENUE FROM PROGRAM OF CHILDREN WITH DIVORCING PARENTS 93D REVENUE FROM SEMINAR ' S AND WORKSHOPS ON CHILD ABUSE 93E REVENUE FOR COUNSELING SERVICE TO OTHER AGENCIES 103A REVENUE FROM MISCELLANEOUS GOODS AND SERVICES PROVIDED . SCHEDULE A OTHER INCOME STATEMENT 10 2000 1999 1998 1997 DESCRIPTION AMOUNT AMOUNT AMOUNT AMOUNT MISCELLANIOUS REVENUE 1 , 960 . 2 , 770 . 11 , 154 . 211 . FUNDRAISING 11 , 415 . 17 , 501 . 17 , 216 . 181911 . TOTAL TO SCHEDULE A , LINE 22 13 , 375 . 201271 . 281370 . 19 , 122 . 19 STATEMENT ( S ) 7 , 8 , 91 10 8 : 53 AM EXCHANGE CLUB CASTLE 05/23/03 Balance Sheet Cash Basis As of March 31 , 2003 Mar 31 , 03 ASSETS Current Assets Checking/Savings 10200 • HARBOR FEDERAL OPERATING 52 ,673. 57 10261 • MSDW - Money Market 29020. 51 10300 • HARBOR FEDERAL SAVINGS ACCOUNT 95 ,593 .66 10500 • PETTY CASH 10510 • PC - FORT PIERCE 125. 00 10520 • PC - STUART 25.00 10545 • PC HF/IRC 50 .00 Total 10500 • PETTY CASH 200.00 10600 • Indian River Capital Campaign 21419. 68 13000 • RESTRICTED CASH RESERVES 13025 • BOARD RESERVES 225,000 .00 13050 • MAINTENANCE RESERVE 15, 000 . 00 13075 • RETIREMENT RESERVE 19, 999 . 98 Total 13000 • RESTRICTED CASH RESERVES 259,999. 98 Total Checking/Savings 4120907 .40 Other Current Assets 10264 • MSDW - Pref Stock 46, 183 .71 10266 • MSDW - Mutual Fund 51000 .00 10267 • MSDW - Fixed Income 17, 114. 32 11000 • Mortgage Receivable - Current 11494. 00 12010 • Less Curent Portion of MR - 11494.00 12050 • MSDW INVESTMENTS 10265 • MSDW STOCK ACCOUNT 11557 . 36 10270 • ACCUMULATED GAIN (LOSS) -21483 . 77 Total 12050 • MSDW INVESTMENTS -926.41 Total Other Current Assets 67 , 371 . 62 Total Current Assets 480 ,279. 02 Fixed Assets 14600 • PROPERTY & EQUIPMENT 14700 • FURNITURE & FIXTURES 102 , 085. 00 14750 • VEHICLE 31656. 00 14800 • LAND 1061250.40 14900 • BUILDINGS 356,846.40 16600 • ACCUMULATED DEPRECIATION - 137 ,085 . 00 Total 14600 • PROPERTY & EQUIPMENT 431 ,752. 80 Total Fixed Assets 431 , 752 . 80 Other Assets 10700 • SECURITY DEPOSITS 713 . 73 12000 • MORTGAGE- MOODY ESTATE/GARRISON 439819. 54 12075 • UNITED FOR FAMILIES , INC 25, 000 . 00 16625 • TIMESHARE INVESTMENT 31138. 00 16650 • ACCUMULATED AMORTIZATION -404 . 00 Total Other Assets 72 , 267 .27 TOTAL ASSETS 984,299.09 LIABILITIES & EQUITY Liabilities Current Liabilities Accounts Payable 2000 • Accounts Payable -222. 35 Total Accounts Payable -222. 35 Other Current Liabilities 2100 • Payroll Liabilities Page 1 8: 53 AM EXCHANGE CLUB CASTLE 05/23/03 Balance Sheet Cash Basis As of March 31 , 2003 Mar 31 , 03 23300 • MEDICARE PAYABLE 0. 01 23600 • AFLAC PAYABLE 23625 • AFLAC - STD 113 .40 Total 23600 • AFLAC PAYABLE 113 .40 23900 • SUNSHINE FUND 21230 .43 2100 • Payroll Liabilities - Other -113.40 Total 2100 • Payroll Liabilities 21230 .44 Total Other Current Liabilities 21230.44 Total Current Liabilities 2 ,008 . 09 Total Liabilities 21008.09 Equity 28000 • Retained Earning 974, 860 .62 Net Income 71430 . 38 Total Equity 982,291 . 00 TOTAL LIABILITIES & EQUITY 984,299.09 Page 2 /16/03 11 AM 05EXCHANGE CLUB CASTLE 05/ Cash Basis Profit & Loss Budget vs . Actual October 2002 through March 2003 TOTAL Oct '02 = Mar 03 Budget Ordinary Income/Expense Income 31000 • GRANTS 31000. 1 • HOMEBUILDERS 31001 • DCF/SLC/HB 103,072. 60 99, 947. 60 31002 • CSC/SLC/HB 59,479.84 66,950. 00 31004 • UW/ SLC/HB 191829.64 19, 500 .00 31021 • CSC/ MC / HB 46, 825. 54 41 , 099. 00 31022 • UW/ MC/ HB 19,661 . 18 19, 150.00 31031 • UW/IRC/HB 40,000 .02 40,000.00 31060 • CSN/IRC/HB 16, 167.06 17, 500 .00 31061 • UNITED WAY/ OKEE/HB 19000. 00 1 ,250 .00 Total 31000. 1 • HOMEBUILDERS 306,035. 88 305,396. 60 31000 .2 • HIGH HOPES 31003 • CSC/SLC/HH 15, 584 .65 14,500 .00 31006 • UW/SLC/HH 70000.02 71000 .00 31023 • HOSPICE/HH 81692 . 33 91088. 50 31033 • UW/IRC/HH 8,000 . 04 81000. 00 Total 31000.2 • HIGH HOPES 39,277. 04 38,588 . 50 31000.3 • FAMILY RESOURCE CENTERS 31016 • CSC/SLC/FRC 31298. 65 Total 31000. 3 • FAMILY RESOURCE CENTERS 31298.65 31000.4 • HEALTHY FAMILIES 31041 • HF/IRC 127, 359.65 170 ,704 .00 Total 31000.4 • HEALTHY FAMILIES 1279359. 65 170, 704 .00 31000.5 VISITATION CENTER 31042 • Safe Havens 10 , 027.77 89,428 .50 31070 • VOCA/SLC/VC 81851 .43 61622. 50 31071 • JR LEAGUE/IRCNC 15,882 .36 159210. 50 31072 • CSN/IRC/VC 5, 977.35 5 ,000 .00 31073 • DCF/IRCNC 19,948. 30 23 ,938.00 Total 31000.5 • VISITATION CENTER 60,687.21 1409199. 50 Total 31000 • GRANTS 536, 658.43 654, 888.60 31000.6 • Co Parenting 0 . 00 2,500. 00 33000 • BOARD FUNDRAISERS 33010 • SPONSORSHIPS 51150 .00 33020 • TICKET SALES 33021 • RAFFLE 205. 00 33023 • Food & Drink Sales 21301 . 12 33024 • Playground 233. 00 33026 • Craft Sales 85.00 33027 • Santa's Store 339.00 33020 • TICKET SALES - Other 31800.00 Page 1 of 4 10 : 11 AM EXCHANGE CLUB CASTLE 05/16/03 Cash Basis Profit & Loss Budget vs . Actual October 2002 through March 2003 TOTAL Oct '02 - Mar 03 Budget Total 33020 • TICKET SALES 6,963 . 12 33028 • Giving Tree 115. 00 33029 • Ornament Sales 780.00 33030 • BID REVENUE 33035 • SILENT AUCTION 10, 913 . 50 33040 • LIVE AUCTION 71575.00 33030 • BID REVENUE - Other 140.00 Total 33030 • BID REVENUE 18,628. 50 33000 • BOARD FUNDRAISERS - Other 36, 100. 00 68,500 .00 Total 33000 • BOARD FUNDRAISERS 67, 736. 62 68, 500.00 33045 • Capital Fundraising 21700.00 34075 • Other Value Visit Income 10,400. 00 34400 • OTHER FUNDRAISERS 0 . 00 20,999. 50 40030 • CONTRIBUTIONS 40050 • CORPORATION & FOUNDATION 41500.00 25, 000. 00 40070 • INDIVIDUAL & GROUP 645. 97 300626. 00 40080 • ANNUAL PLEDGE 11750 . 00 40030 • CONTRIBUTIONS - Other 3 ,975.00 Total 40030 • CONTRIBUTIONS 10 ,870.97 550626. 00 41700 • PROGRAM FEES 34200 • DIVORCE = FAMILIES FIRST 17,270 . 00 27 , 500.00 34300 • POSITIVE PARENTING 3,400 . 00 21500.00 34500 • VALUE VISIT FEES 11043 .00 34800 • HIGH HOPES CLASS 11293 .00 Total 41700 • PROGRAM FEES 23 ,006.00 30 , 000. 00 42150 • RENTAL FEES 1 ,275. 73 21500 . 00 424600 • INTEREST INCOME 31907. 67 31000 .00 42500 • IN KIND SUPPORT 11261 . 10 43000 • REIMBURSEMENTS 281 .84 44000 • MISCELLANEOUS INCOME 100.00 10000. 00 Total Income 6589198. 36 839, 014. 10 Gross Profit 658, 198. 36 839, 014 . 10 Expense 50000 • EMPLOYMENT EXPENSES 50100 • GROSS WAGES 383, 525.42 515,462 .62 51100 • RETIREMENT 0.00 19, 999. 98 51200 • HEALTH INSURANCE 13 ,254. 33 19,206 . 50 51250 • LIFE/ADD/DISABILITY 3 , 326 .44 51300 • WORKER COMP INS 41359. 08 61295.00 51400 • PAYROLL TAX 31 , 782.64 40, 132. 00 51500 • UNEMPLOYMENT TAXES 3 , 821 .29 41000. 00 51525 • BACKGROUND/DRUG TESTING 19901 .00 11539.50 Page 2 of 4 116/03 11 AM 05EXCHANGE CLUB CASTLE 05/ Cash Basis Profit & Loss Budget vs . Actual October 2002 through March 2003 TOTAL Oct *02 - Mar 03 Budget 50000 EMPLOYMENT EXPENSES - Other 47,941 .71 Total 50000 • EMPLOYMENT EXPENSES 489, 911 .91 606, 635. 60 52000 • CONTRACT LABOR 520100 • MARKETING 0.00 91796. 00 520200 • DATA ENTRY 0. 00 772.00 520300 • SECURITY GUARDS 51675. 00 26 ,000 . 00 52000 • CONTRACT LABOR - Other 26,210.31 Total 52000 • CONTRACT LABOR 31 , 885.31 36,568.00 53000 • TRAVEL - STAFFIVOL 13,759.08 19,865. 00 53100 • VEHICLE FUEUREPAIRS 457. 19 11200.00 53200 • CONFRENCE EXPENSE 21227 . 30 71219. 50 54000 • OFFICE RENTS 20, 321 . 55 26, 100.00 55000 • UTILITIES 55010 • ELECTRIC 31416.74 55020 • WATER 11584.27 55030 • TRASH 629.41 55000 • UTILITIES - Other 0 . 00 59184. 00 Total 55000 • UTILITIES 51630.42 51184 . 00 55100 • REPAIRS & MAINTENANCE 55600 • BUILDING & GROUNDS 5, 158.35 81050 . 00 55610 • SECURITY SYSTEMS 422. 55 725.00 63020 • COPIERS & EQUIPMENT 702 .47 51500.00 63025 • COPIER LEASE 2,040.00 63030 • COMPUTER & PHONES 41334. 19 21822. 52 Total 55100 • REPAIRS & MAINTENANCE 12, 657. 56 17, 097.52 56000 • TELEPHONE 56020 • LOCAL 61351 .70 7 ,200 . 00 56030 • INTERNET SERVICE 795.96 750.00 56040 • PAGER SERVICE 328.67 348. 00 56050 • CELLULAR 20567 . 78 21700.00 Total 56000 • TELEPHONE 10 ,044 . 11 10 , 998. 00 56200 • POSTAGE & DELIVERY 41160. 06 41550.00 56400 • PRINTING & REPRODUCTION 41995.40 11 , 300. 00 57000 • OFFICE SUPPLIES/EXPENSE 57010 • BOARD LUNCHES -202.29 57000 • OFFICE SUPPLIES/EXPENSE - Other 91995.51 10, 171 . 50 Total 57000 • OFFICE SUPPLIES/EXPENSE 91793 .22 10 , 171 . 50 57200 • OPERATING SUPPLIES 387 .84 57400 • ED & RESOURCE MATERIAL 11521 .49 3 , 645. 00 60000 • EQUIPMENT PURCHASES 15, 598.67 81705. 00 61020 • BANK CHARGES 5.00 62000 • INSURANCE 62030 • VAN INSURANCE 1 ,050.96 Page 3 of 4 10 : 11 AM EXCHANGE CLUB CASTLE 105/16/03 Cash Basis Profit & Loss Budget vs . Actual October 2002 through March 2003 TOTAL Oct '02 - Mar 03 Budget 62000 • INSURANCE - Other 0.00 150 Total 62000 • INSURANCE 1 ,050.96 15,487.50 66000 • PROGRAM EXPENSES 576000 • HIGH HOPES MATERIAL 11567. 87 31450.00 578000 • DIVORCE/FAMILIES FIRST 865.00 31000 .00 579100 • HIGH HOPES PUBLICATION 0. 00 51000.00 Total 66000 v PROGRAM EXPENSES 21432. 87 11 ,450. 00 70000 • ADVERTISING & PROMOTION 20409. 57 31325.00 70200 • PROFESSIONAL FEES - AUDIT 61600. 00 10 , 250.00 70400 • FOODBANK/CLIENT EXPENSE 1 ,312.80 31510.00 70600 • STAFF/VOL TRAINING 1 ,518 . 08 750. 00 70800 • FEES/LICENSE/PERMITS 549.00 11152.50 71050 • FUNDRAISER EXPENSES 81866 . 59 71200 • MEMBERSHIP/DUES/SUBSCRIPTIONS 11160. 10 72000 • MARKETING & PROMOTION 11008. 90 10,000.00 72200 • PROGRAM DEVELOPMENT 0 . 00 51000. 00 72400 • CREDIT CARD EXPENSES 627.40 350.00 72600 • LT MAINT FUND 0.00 71500.00 74000 • MISCELLANEOUS EXPENSE -124.40 999.98 9999 • Uncategorized Expenses 0.00 Total Expense 650,767. 98 839, 014. 10 Net Ordinary Income 71430. 38 0. 00 Net Income 7,430.38 0.00 Page 4 of 4 CAST14V GOVERNING BOARD ORGANIZATIONAL CHART OF DIRECTORS 2002 - 2003 EXECUTIVE DIRECTOR SECRETARIAL ASSISTANT SUPPORT MARKETING BOOKKEEPER HUMAN STAFF DIRECTOR RESOURCES HEALTHY FAMILIES SAFE FAMILIES VALUE VISITS GROUP SERVICES PROGRAM PROGRAM PROGRAM PROGRAM MANAGER MANAGER MANAGER MANAGER PROGRAM SUPERVISOR PROGRAM SUPERVISOR HEALTHY SAFE FAMILIES FAMILIES IRC IRC, SLC,MC,OKEE POSITIVE COUNSELORS COUNSELORS PARENTING HIGH HOPES FACILITATORS FACILITATORS HF IRC FAMILIES SUPPORT FOOD SECRETARIAL VALUE VISIT CO-PARENTING FIRST STAFF PANTRY SUPPORT OBSERVERS FACILITATORS FACILITATORS STAFF STAFF SLC, IRC, MC UAHuman Resources\Organizational Chart 2002-2003 r Internal Revenue Service District Director Department of the Treasury Date:• •' == • _ -t:n,pioyer rderrtiftcat►on Number: [..G JAN 291982 59=2094472 - j Accowiting Pertod: EadinY: _. Sept4inber - 30 ; roundatidn Status panjfkatioae , p Scan America of the Treasure 509 ( a) (1) & 170(b ) (1) (A ) ( vi ) Coast , Inc . Advance Ruling Period Enda 2414 Nebrasl �a Avenue 'GSeptember ' 30; -:1983- Fort pierce , Florida 33450 Person to Contact: ' Y: ' Burleson/eb Contact Telephone Number: ( 904) 791-2636 . ::-. . FFN: 580014494 . . .. . Dear Applicant : Based ori information supplied , and assumin r g your ' operatio'ns will be as stated in your app from licatton for recognitidtt of exemption , we havd de=termined you '•are * .exempt " Federal income tax under section 501 ( c ) 0 ( 3-) of the Internal- Revenue Code-.,, Becausey'ou are a newly •crda'ted organization , we are not now making i determination of ` g a; final, Your foundation status under section 509 ( a ) or the Code.: • 'Howevsr, ,we have determined that you can reasonably be expected to be aublicl su organization described in ^section 170 (b) ( 1) 09 (a) �l)(A ) vi & 5 publicly Pported . I 4 Accdrdin g y , you will • be treated as a publicly �supported - orgahizationf3and : -not as a private foundation , : during an advance -•rdling -periods ''ThiS 'advance ruling .period begins on the date of your inception 'and ends ori the date shown- above . ! i .. S, K •s :. t Within 90 `' clays after the end of your advance - ruling-4lieriod ; °you • 'must -74ubmit to us information •needed to - determine whether you have met = the: requirements of.!the.r applicable support test during the advance ruling perfod' . If You ' establishvithatryou, have been . a publicly supported organization , you will be classified as a section 509 ( a ) ( 1 ) or 509 ( a ) ( 2 ) organization as, long as you continue to meet the requirements of the applicable support test . If you do • not meet theublic su during the advance ruling period , p pport requirements future periods . Also ; if you are classified bas da private foundation , foundation :for treated as a private foundation from the date of p You will be sections 507 ( d ) and 4940 . Your inception for purposes 'of Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period . If you submit the required information within the 90 days , grantors and donors may continue to rely on the advance determination until the Service makes a final determination of Your foundation status . However , if notice that you will no longer be treated as a section 509 ( a ) ( 1 ) organization is published in the Internal Revenue Bulletin , grantors and donors may not rely on this determination after the date of such Publication . Also , a grantor or donor may not rely on this determination if he or she was in part responsible for , or was aware of , the act or failure to act that resulted in your loss of section 509 ( a ) ( 1 ) the Internal Revenue Service had given notice thats YOU w or acquired knowledge that classification as a section 509 a you would b © removed from ) ( 1 ) organization . 275 Peachtree Street, N. E., Atlanta . GA 3004.1 ,iz _771 If your sources . ' of support , or change , please let us know so we . can consider othe . effect of the rchanhe onod Operation exempt status and foundation status . Also , g Your n Your name or address . You should inform us of all changes in Generally , you -a1 .re. not , liable for social security a waiver of exe�ption . cerxil`icate as ( FICA ) taxes unless you file Act . If you have - paid FICA taxes withoutvfflingntheewaiverFedei�al ` Icisurance Contributions are not liable . for the: ;talc you should call us . you imposed under the Federal ilnemployment Tax Act ( FUTA ) _ Organizations _that " are ,not private foundations are not subject to the excise taxes under tChapter ; 42 .-of : the Code . other Federal excise taxes . If However , you are not automatically exempt from You have any questions about excise , employment , or Other Federal taxes please let us know . . Donors may deduct contributions to you as provided in section 170 of the Bequests * legacies , .,devises , transfers , or gifts to you or for your use are Code . deductible for Federal estate and gift tax p pro visions of sections 2055 , 2106 , -and 2522 of thesCoidethey meet the applicable You onl are - required to fide Form 990 , . Return , of Organization Exempt from Income Tax , only it your gross .receipts each return is required , 4t must be filed byethe 15th day lof of thear are normalyo niorefifth month * after the end of your annual accounting period . The law imposes a penalty of $10 a day , up to a maximum of .M OOO , - when a return is filed late , unless there is reasonable cause for the delay . You are not required to file Federal income , returns unless to the . tax on unrelated business income under section of the ' Co e . If you are ct " subject to this tax , you must file an - income tax return on Form .990 T . 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 othe Code . You need an employer identification number even if you have nd employees . If an employer identification number was not entered on your on' a number be assigned to . you and • you will be advised of it . Piease useplicathat number on all will returns. you file and - in all correspondence with the Internal Revenue Service . Because this letter could help resolve an . Y 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 , ntst c Directo cc ; Eugene J . O ` Neill Internal Revenue Service DistrictDirector Department of the Treasury MAR 0 I Person to Contact: Ann Price-/lch' Telephone Number: (404 ) 221 - 4516 Exchange Club Center for the Prevention of Child Abuse Refer Reply to: of the Treasure Coast , Inc . E0 : 7201 : AP 2414 Nebraska Avenue Fort Pierce , FL 33450 Employee Identification Number ,* umnber . File Folder Number ; 580014494 Dear Sir or Madam ; (late of Exemptbm February 3 , 1981 Intemal Revenue code Section. 501 (c)(3) Gentlemen : Thank you for submitting the information shown below . We have made It a part of your file . • The changes indicated do not adversel and the exemption letter issued to yt affect your exempt status you continues in effect . Please let us know about any future change in the character , Purpose , method of operation , name or address of Your This is a requirement for retaining your exempt statusorganization . Thank you for your cooperation . Sincerely yours , Dist c Dtrecto Item Chanced From To Name SCAN America of the Treasure Coast Inc . Shown Above 275 Peachtree Street, N . E. , Atlanta , GA 30043 • Letter 976 MO ) ( 747) F i CERTIFICATE OF AMENDMENT OF ARTICLES OF INCORPORATION OF SCAN AMERICA OF THE TREASURE COAST , INC . SCAN AMERICA OF THE TREASURE COAST , INC . , under its corporate seal and acting by its Vice President and Secretary , does hereby certify that the Board of Directors of said f Corporation did , under date of May 20 , 1982 , adopt a resolution setting forth a proposed amendment to the Articles of Incorporation of this Corporation as hereinafter set out and f did declare the advisability of such amendment and did call a meeting of the members of record entitled to vote for the . consideration thereof . It is further certified that on June 17 , 1982 , a meeting of all of the members of Scan America of the Treasure Coast , Inc . , a Florida corporation , was held at 2414 Nebraska Avenue , Fort Pierce , Florida at 5 : 30 o ' clock p . m . , notice of said meeting having been waived by all of the members and at said meeting a vote of the members of record entitled to vote in person or by proxy was taken for and against the proposed amendment and that upon the canvassing of the votes , it did appear that three - quarters of the members of said Corporation did vote in favor of the resolution as hereinafter set forth . RESOLUTION " RESOLVED , that the Articles of Incorporation of SCAN AMERICA OF THE TREASURE COAST , INC . , a Florida corporation , shall be amended so that ARTICLE I shall read as follows : ARTICLE I ' The name of this corporation shall be i EXCHANGE CLUB - SCAN AMERICA OF TIIE TREASURE COAST , INC . ' and that the Secretary of the corporation shall take the necessary steps to have the same officially changed I l �1 I i ' I i ! at the office of the Corporation Division of the I Department of State , State of Florida , Tallahassee , Florida . " IN WITNESS WHEREOF , the said corporation has caused these presents to be executed by its Vice President and Secretary and its corporate seal to be affixed hereto this I r- � f / 7 day of 1982 . i SCAN AMERICA OF TUE TREASURE COAST , INC . O U Cj By : t ti 1 tal er , Vice President y 19 81 . ATTEST • � aron rif in , ecretary I ( Corporate Seal ) STATE OF FLORIDA COUNTY OF ST . LUCIIi I HEREBY CERTIFY that on this day before me , an officer duly authorized to take acknowledgments in the State and County aforesaid , personally appeared JILL STALKER and SIIARON GRIFFIN , well known to me to be the Vice President and Secretary of SCAN AMERICA OF THE TREASURE COAST , INC . , and that they executedl the above Certificate f Amendment to Articles of Incorporation this / e7n Llay of , 1982( 0 I NO . PubITc,State of FlorTa nt - Large - _ My Commission Expires : NOTARY PUBLIC STATE OF FLORIDA AT lAWI Y ' MY COMMISSION EXPIRLS IEB is 1965 "4MD NIRU GENERAL INS , UNDLRWRI IERS ' r " 1 D.W. McKinnon , Director � acicl , nyof State Mrs . Nettie Sims , Chief � 1)ivision of Corporations Bureau of Corporate Records 904!488-9636 904/488. 9383 June 29 , 1982 - 01,1 Eugene J . O ' Neill , Esq . TO : __. _ �'`� - • - • 979 Beachland Blvd . Vero Bch . , Fla . 32960 GCI i _ Re . Charter Number 756175 ' Ref # : 85 No PO- pantie Dear Mr . O ' Neill : '-"' T ' - - This will acknowledge receipt of your Name - Change Amendment for EXCHANGE CLUB - SCAN AMERICA OF THE TREASURE COAST , INC . , which was filed on June 25 , 1982 . Your remittance totaling $ 15 . 00 has been received . Should you have any questions regarding this matter , please telephone ( 904 ) 487 - 1322 , the Word Processing section . Sincerely , �. .00 , dW e D . W . McKinnon , Director, Division of Corporations DWM/wk Division of Corporations • P . O . Box 6327 • Tallahassee , Florida 32301 Wp - 101 3 / 81 EXCHANGE CLUB - SCAN AMERICA OF TII1 TREASURE COAST , INC . ' and that the Secretary of the corporation shall take the necessary steps to have the same officially changed t CERTIFICATE OF AMENDMENT OF ARTICLES OF INCORPORATION OF EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE D/ B / A EXCHANGE CLUB CASTLE Exchange Club Center for the Prevention of Child Abuse , under its corporate seal and acting by its President and Secretary , does hereby certify that the Board of Directors of said corporation did , under date of August 28 , 1995 , adopt a resolution setting forth a proposed amendment to the Articles of Incorporation of this Corporation as hereinafter set out and did declare the advisability of such amendment and did call a meeting of the members of record entitled to vote for the consideration thereof . It is further certified that on August 28 , 1995 , a meeting of all of the members of Exchange Club Center for the Prevention of Child Abuse , D / B / A Exchange Club CASTLE , a Florida corporation , was held at 828 South US # l , Fort Pierce , Florida at 5 : 00 p . m . , notice of said meeting having been waived by all of the members and at said meeting a vote of the members of record entitled to vote in person was taken for and against the proposed amendment and that upon the canvassing of the votes , it did appear that three - quarters of the members of said Corporation did vote in favor of the resolution as hereinafter set forth . RESOLUTION " RESOLVED , , that the Articles of Incorporation . of Exchange Club Center for the Prevention of Child Abuse , D / B / A Exchange Club CASTLE , a Florida Corporation , shall be amended so that ARTICLE XIII shall read as follows : ARTICLE XIII RESOLVED that the President of the Board and the Treasurer are dully elected officers and as such are officially designated to represent the Exchange Club Center for the Prevention of Child Abuse , D / B / A Exchange Club CASTLE in any and all business dealings concerning the financial affairs of said corporation . Said individuals may also pledge , mortgage , or grant a security interest of any of this corporation ' s property , whether real , personal , tangible , intangible , or mixed , to secure any such loans and to discount bills receivable and any other paper held by this corporation without limit to amount . " IN WITNESS WHEREOF , the said corporation has caused these presents to be executed by its President and Secretary and ' ts corporate seal to be affixed hereto this e 1995 . 1 ' day of LLZk -- ' Exchange Club Center for the r�tnPreve on Cof Child Abuse z By . 4c Ant J . Donadio , President by � Attest Carolyn P eler , Secretary ( Corporate Seal ) STATE OF FLORIDA COUNTY OF ST . LUCIE I HEREBY CERTIFY that on this day before me , an officer duly authorized to take acknowledgements in the State and County aforesaid , personally appeared Anthony J . Donadio and Carolyn Peeler , well known to me to . be the President and Secretary of Exchange Club Center for the Prevention of Child Abuse , D / B / A Exchange Club CASTLE , and that they executed the above Certificate f Amendment to Articles of Incorporation this ag'4" ' day of 1995 . No ujary Public , State of Florida at jarge , My Commission Expires : l'pY Poet _�-'"""• cJUNE M. WILSON •£ Notary Public. State of Florida My Comm . Exp, Aug . 25, 1997 oc..rte° Comm . No. CC 311081 .,: o • f uo toll. % t %. -- it r G IY A " . 44 y _ i ^ ��0o W 01led FLORIDA DEPARIMEI`fT OFSTATE George (=firestone D .W. McKinnon , Director Scccct. uvof stale Mrs . Nettie Sims , Chief Division of Corporations 9041488 .9636 Bureau of Corporate Records 904/488 .9383 June 29 , 1982 �C) F' `i`C% : 11? Fli r Eugene Netll , Esq . 979 Beachland Blvd . F ' Vero Bch . , Fla . 32960 G C t. IN, Re : Charter Number 756175 oilto Ref # : 85 No t?4)spollow Dear Mr . O ' Neill : '-' ' T ' This will acknowledge receipt of your Name - Change Amendment for EXCHANGE CLUB - SCAN AMERICA OF THE TREASURE COAST , INC . , which was filed on June 25 , 1982 . Your remittance totaling $ 15 . 00 has been received . Should you have any questions regarding this matter , please telephone ( 904 ) 487 - 1322 , the Word Processing section . Sincerely , D . W . McKinnon , Director Division of Corporations DWM/wk Division of Corporations • P .O . Box 6327 • Tallahassee , Florida 32301 ' - 101 , R � CL' RTIFICA'10H% OF AMENDMENT OF ARTICLES OF INCORPORATION OF SCAN AMERICA OF THE TREASURE COAST , INC . SCAN AMERICA OF THE TREASURE COAST , INC . , under its corporate seal and acting by its Vice President and Secretary , does hereby certify that the Board of Directors of said Corporation did , under date of May 20 , 1982 , adopt a resolution setting forth a proposed amendment to the Articles of Incorporation of .this Corporation as hereinafter set out and did declare the advisability of such amendment and did call a , meeting of the members of record entitled to vote for the consideration thereof . It is further certified that on June 17 , 1982 , a meeting of all of the members of Scan America of the Treasure Coast , Inc . , a Florida corporation , was held at 2414 Nebraska Avenue , I'! Fort Pierce , Florida at 5 : 30 o ' clock p . m . , notice of said meeting having been waived by all of the members and at said meeting a vote of the members of record entitled to vote in person or by proxy was taken for and against the proposed amendment and that upon the canvassing of the votes , it did appear that three - quarters of the members of said Corporation did vote in favor of the resolution as hereinafter set forth , ; RESOLUTION " RESOLVED , that the Articles of Incorporation of SCAN AMERICA OF THE TREASURE COAST , INC . , a Florida corporation , shall be amended so that ARTICLE I shall read as follows : ARTICLE I ' The name of this corporation shall be ROXCHANG13 CLU11 - SCAN AMERICA OF THE TREASURIi COAST , INC . ' and that the Secretary of the corporation shall take the necessary steps to have the same officially changed I s I at the office of the Corporation Division of the i I Department of State , State of Florida , Tallahassee , Florida . " IN WITNESS WHEREOF , the said corporation has caused these presents to be executed by its Vice President and Secretary and its corporate seal to be affixed hereto this / day of , 1982 . I SCAN AMERICA OF THE TREASURE COAST , INC . 0 5, By : . r it t% talker ; Vice President ATTEST : �1 S •` — aron l t f 'ri in , ecretary I 1 ( Corporate Seal ) 1 I ! i STATE OF FLORIDA COUNTY OF S '1' , LUCIE I IIERLBY CL411TIFY that on this day before me , an officer duly authorized to take acknowledgments in the State and County � aforesaid , personally appeared JILL STALKER and Sl1ARON GRIFFIN , well known to me to be the Vice President and Secretary of SCAN AMERICA OF TIIE TREASURE COAST , INC . , and that they executed ) the above Certificate f Amendment to Articles of Incorporation this1�7r`' day of 1982 . I I ot . Puy ] State of Flor I:iaC. l . arLe . .. My e0m, mission Expires : NOTARY PUBLIC STATE OF FLORIDA AT LARD! KV COMMISSION EXPIR[S Its 18 1985 #OhOLD HRU GENERAL INS , UNDtRWRI ItRS �' APPLICATION FOR REGISTRATION OF FICTITIOUSNAME FILED 1 EXCHANGE CLUB C . A . S . T . L . E . DIVISION OF CORPORATIONS Fictitious Name to be Registered TALLAHASSEE , FLORIDA 08 - 09 - 93 0003 023 * * * 80 , 00 C9222 1 CDaC". 1 � � 0 2. 828 South U . S . Highway # 1 «. Mailing Address of Business U d 3 . County of St . Lucie 4 . City of Ft . Pierce , Florida 34950 5. FEI Number: ' N / A Zip Code This space for office use only A. Owner(s) of Fictitious Name If Individual(s) (use additional sheets if necessary): 1 . 2. Last First M.1, Last First M. I. Address Address City State Zip Code City State Zip Code �+ SSI# SS# 0 B . Owner(s) of Fictitious Name If Corporation(s) (use additional sheets if necessary). The Exchange Club Center For the Prevention of n 1 Child Abuse of the Treasure Coast , Ilic . Corporate Name Corporate Name 828 South U . S . Highway # 1 Address Address Ft . Pierce , FL 34950 City State Zip Code City State Zip Code Corporate Document Number: 75(a 115 Corporate Document Number: FEI Number: _j 9 FEI Number: ❑ Applied for ❑ Not Applicable ❑ Applied for ❑ Not Applicable I (we) the undersigned, being the sole (all the) party(ies) owning interest in the above fictitious name, certify that the-information Indicated on this form Is true and accurate. I (we) further certify that the fictitious name shown in Section 1 of this form has .been advertised at least `7 once in a newspaper as defined in chapter 50, Florida Statutes, in the county where the applicant 's principal place of business is located. I (we) understand that the signature(s) below shall have the same legal effect as If gnade under oath. (At Least One Signature Required) o Exchange Club Center - - for the Prevention or ✓ he Treasure Coast , Inc . by Chuck Kitzmiller , Pres . MIS a%m A Signature of Owner Date Signature of Owner Date Phone Number: 402 - 465 - 15011 Phone Number. FOR CANCELLATION COMPLETE SECTION 4 ONLY: FOR FICTITIOUS NAME OWNERSHIP CHANGE COMPLETE SECTIONS 1 THROUGH 4 : 7 I (we) the undersigned , hereby cancel the fictitious name c 0 U , which was registered on and was assigned registration number Signature of Owner Date Signature of Owner Date u � l FLORIDA DEPARTMENT OF STATE Jim Smith Secretary of State August 11 , 1993 EXCHANGE CLUB C. A . S . T. L. E. 828 SOUTH U . S . HWY # 1 FT PIERCE , FL 34950 Subject : EXCHANGE CLUB C.A.S.T. L. E. REGISTRATION NUMBER : G93221000123 This will acknowledge the filing of the above fictitious name registration which was registered on August 9 , 1993. This registration gives no rights to ownership of the name . Each fictitious name registration must be renewed every five years between July 1 and December 31 of the expiration year to maintain registration . Three months prior to the expiration date a statement of renewal will be mailed. IT IS THE RESPONSIBILITY OF THE BUSINESS TO NOTIFY THIS OFFICE IN WRITING IF THEIR MAILING ADDRESS CHANGES. Whenever corresponding please provide assigned Registration Number. For information regarding fictitious names on file or to search the record call ( 904) 488-9000 . Enclosed is your certificate (s) as requested . Should you have any questions regarding this matter you may contact our office at (904) 487-6058 . Fictitious Name Section Letter No , 493A00127500 Division of Corporations D °nCDnCPREDnCpnQ �nCDnCDVCDVCDUC�VCDVCDVCDVCDVCDVCDVCDVCDVCDVCDVCDV Hn 1 V vvvV �L ,� , n �� �VQ�RXrR� D CD CD CD CC ���� ��C�KE K .90 .a cn V DVC LOa c -- o V DVC o O coDOC . � U 'so M Kin D Csit: o Q ...i DCJ o ri a) r 0 c Q .o o DnC to a y . . . 5 0 C14 V _V3 N o ` a KIM Q cat cn w 0 sta j r-. .o o .. • ' . �.p co r In . .+ m t � ' o KIN t9l & w m O to .L 04 DVC �m r ; a cu c = ci N X D8CCho S W w o KNE D C ' , rs41110111110 04P,"', o Q H V CAN, v� EO :E V Iso Z �, ► o Dnc �-V mao CO � gcv?, D°c � 00 Ken a) iL E z V DVC .•- cu g inc Hca 'I) � o D C D�C CDN lJ O �,C U O d' N DVC v OC 3 o s I , . •1ii c w ,Ill .1 N Won � ? � . v DVVC �S ,L �J XURE nX ° VVV ° V � VV M�� V ' VVV �° V ° V ° VVDnCD CD CD nnn °nC in nC i nC�D� nCDnCD CCD C'D CD CD CD CD CD CDxD)nv?A V VVV V '[�� '11 '[� '[� /n '[� t�fl�r� CD CD CD CD CD C� �xRMR fiat Tribuneumsl P.O. Box 69 STATE OF FLOFTIOA FM Pierce, St We UWX Pads 3195/4069 COUNTY OF St LUCIE Before the undersigned authority personally appeared 1404'23421Nonce OF David T. Rutledge or Kathleen K. LeClair, who on oath ��movs Nam io V1ltions ft;.ttilcy Cdncerrt says that he /she is publisher, business manager of The Nottce :, ir hereby Own f<,o turned Name Tribune, a daily newspaper published at Fort Pierce in St. �- Lucie County, Florida; that the attached co of the ' Stators ••• ' chapr:r .Na• . 90-267a advertisement bein a . NOP [AM*, rept:ter T NOTICE CE OF FICTITIOUS N inthematterof. . . EX HANGE CLUB r .,.C qS T r (tousntar>e; fo � - FIcN- .ti .4 . r.H ,. �.. . . . . . . . . tFxef!Cr!g0 :C(t b C:A.i.T.LL . ! :- un ter1 whr0h1 a . ere en- 0?Oed :ki. ss.: x- was published in said newspaperthe . . .. . . . . . . . . . . . .. . . . Pecf fo : onocig .h wsi e in issues of u�J . . Q , . . .� � �,�. . . . . . ft' eFTeres `fXIoA a 3og blty eo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Affiant further says that The Tribune is a newspaper published at Fort Pierce, Thi! the 1a' Inferested in said St. Lucie County, Florida, and that the said newspaper h �d4bttt4less enterpttse, are os follows: been continuously published in SL Lucie County, Florida, each ay and has heretofore fie ;BoCtcf O Directors of entered as second dans mail matter at the post office in Fort Pierce, in said St. foe Exchooge *CTub Cenfet Lucie County, Florida, for a period of one year next preceding the first for me ' Prevention Gf Chikt publication of the attached copy of advertisement: and affiant further says that Abuse ; : of '. tlie ' Treasure' he has neither paid nor promised any person, firm or coPublish: Coasf� Inc. rebate, commission or refund for the corporation any discount, duty 30, 1993 .. : publication in the said ne paper. P�Po� of securing this advertisement for Sworn to and subscrib b fere e This . . . . . . . . . 30th 01 . 101 . . . . . . . . . - ay . . . . . . . . . . . 3 . . A. D. . . 199 . . . . . . . . . . . / 0 of Fl'da at urge 0000 . . . . . . . . . '). t . Public say mission Expires �?Y- f lx 0000 . , . . � 9.9a (SEAL) Notary Public Lil l i - Anne Senesac AA763828 r s BY-LAWS OF EXCHANGE CLUB C.A.S.T.L.E. Article I Section 1 . The corporate fiscal year shall end on September 30th of each year. Section 2. The members of the Corporation shall be the duly elected Governing Board of Directors. The annual meeting of the members of the Corporation shall be held no later than November of each year, at such place and hour as the members may determine. Notice of the annual meeting shall be given through invitation, in accordance with Article III, Section 4. Section 3 . A quorum for any meeting of the Governing Board of Directors of the Corporation shall consist of a majority of those present at any regularly scheduled business meeting, with a minimum of five (5) present. Section 3 . A quorum for any meeting of the Governing Board of Directors of the Corporation shall consist of one more than 50% of the members. Attendance via telephone conferencing to achieve a quorum is permissible. Any action by the majority of those present shall be the action of the Governing Board of Directors except amendments to the Articles of Incorporation and to the By-Laws . ARTICLE H Governing Board of Directors Section 1 . The business and property of the Corporation shall be managed by the Governing Board of Directors. The Governing Board of Directors shall be comprised of not less than 7 or more than 20 members, including the officers . Members will be elected for a minimum of a 1 -year term. Terrns run from October 1 through September 30. Members will not be compensated for services . Vacancies occurring on the Governing Board of Directors may be filled by a majority vote of the membership for the remaining term. Section 2 . Meetings of the Governing Board of Directors may be held monthly, and on call of the President, or in his/her absence, by the Vice Presidents. Al l meetings will be conducted under Roberts Rules of Order. Section 3 . A quorum for any meeting of the Governing Board of Directors shall be consistent with Article I, Section 3 . Section 4. The duties of the members shall be: A. To manage the affairs of the Corporation. B . To adopt such policies and procedures as may be consistent with the Articles of Incorporation and the By-Laws. Castle-Articles-Bylaws 18/27/2001 C. To chair or appoint such committees as it may deem expedient for carrying out the objectives of this Corporation, and to act upon the recommendations of such committees . D. To employ such persons as it may deem necessary for the successful execution of the objectives of this Corporation. E.To give at least once a year a full and complete report of its activities at a Meeting of the membership. F. To institute and monitor strategic planning procedures. Section 5 . No later than September 1 of each year, the President shall appoint a nominating committee of not fewer than three (3) members of the Governing Board of Directors. The nominating committee shall submit recommendations for new members of the Governing Board of Directors and officers for the following fiscal year, all of which shall be elected by a majority of the Governing Board of Directors. ARTICLE III Officers Section 1 . The officers of the Coporation shall be a President, a First Vice-President, a Second Vice- President, a Secretary and a Treasurer. These officers shall be elected in accordance with Article II, Section 5. These officers shall receive no compensation for their services. Section 2. Vacancies among the officers occurring during the year shall be filled in accordance with Article II, Section 1 , for the expired term(s). Section 3 . The duties of the officers will be those duties normally ascribed to those offices. The President shall preside at all Governing Board of Directors meetings and shall have a general supervision over the affairs of the Corporation and over the other officers; shall sign all written contracts of the Corporation and shall perform all such other duties as are incident to the office. In case of the absence or disability of the President, his/her duties shall be performed first by the First Vice-President, and in his absence, then by the Second Vice-President. Section 4. The Secretary shall issue notice for all Governing Board of Directors meetings and shall attend and keep the records and papers ; shall be custodian of the corporate seal ; shall attest with his/her signature and impress with the Corporate seal all written contracts of the Corporation and shall perform all such duties as are incident to the office. Castle-Articles-Bylaws 2 8/27/2001 Section 5 . The Treasurer shall provide oversight and monitor the books of account as provided by Corporation staff. The Treasurer shall report to the Governing Board of Directors on a monthly basis. ARTICLE IV Committees Section 1 . The President may appoint, subject to approval of the Governing Board of Directors, the following standing committees and such other committees as may be deemed necessary from time to time. Each of these committees shall consist of such number of members (or nonmembers) as the Governing Board of Directors and the President may deem advisable. Acts of such committees shall be subject to approval of the Governing Board of Directors. A. EXECUTIVE COMMITTEE The Executive Committee shall consist of the officers of the Board and the most recent Past President. Responsible for: Provide leadership for the Board as a whole; determining the yearly Board calendar; arranging for or providing annual Board Orientation; screening agenda for Board meeting and handling emergency business . B . NOMINATING COMMITTEE Responsible for: Reviewing involvement of present Board members and existing Board composition ; setting priorities for new Board membership based on needed areas of community representation and needed skills ; recruiting and nominating qualified candidates to the Board; providing new Board member orientation; and providing a slate of officers for the coming year's election of officers. co PERSONNEL Responsible for: Reviewing C.A.S .T.L.E. personnel policies, mileage reimbursements, salary ranges, benefits package and C.A.S .T.L.E. insurance package; recommend any changes in personnel policies mandated by federal law; advertise, interview and recommend candidates for Executive Director's position; and evaluate performance of the Executive Director, D. BUDGET AND FINANCE Responsible for: Monthly, quarterly and annual analysis of C.A.S.T.L.E. finances ; prepare monthly, quarterly and annual fiscal reports to the Board and funding entities ; prepare budget, preferably a line-item budget, for the next fiscal year; recommend to the Board investments and opportunities for C.A. S.T.L.E. funds ; arrange for annual audit; and assist C.A. S.T.L.E. staff in the preparation of financial information for grant applications and strategic planning. E. PUBLIC RELATIONS AND RECRUITMENT Responsible for: contacting the community of the upcoming establishment of the exchange club C.A. S .T.L.E. ; seek any volunteer services needed by the C. A. S .T.L.E. ; assist Executive Director in the recruitment of potential volunteer parent aides who are required to attend initial training; contact television, radio and newspaper media about significant events and public service announcements ; and maintain a speakers bureau and make members available for speaking engagements F. PROGRAM PLANNING Responsible for: Reviewing program and present Board policies regarding service delivery; recommend to the Board suggested program modifications or expansion ; evaluate report of C.A.S.T.L.E. 's progress in accomplishing its goals ; and educate and update the Board on all aspects of the C.A.S.T.L.E. at a yearly Board Orientation. G. LEGAL Responsible for: Developing and submitting Articles of Incorporation and Bylaws to appropriate state agencies ; completion and submission of 501 (c) 3 to maintain C.A.S .T.L.E, as a nonprofit organization; to advise the Board as to other matters as deemed necessary. H. FUND DEVELOPMENT Responsible for: Developing and securing funds for the C.A.S .T.L.E. 's operation (on a yearly and long- term basis), including, but not limited to: planning and coordinating fund-raising events, grant monitoring and implementation of planned gIvmg programs. Section 2. The Chairpersons of the standing committees may serve on the Governing Board of Directors. Section 3 . All Committees shall meet at such time as may be agreed upon by the majority of the members thereof, or upon call by the Chairperson of the Committee. ARTICLE V Property A member of this Corporation shall not have any vested right, interest or privilege of, in and to the assets, functions, affairs or franchises of this Corporation, nor any right interest or privilege which may be transferable or inheritable. Should the CASTLE no longer exist as non-profit agency, dispersal of assets will be made to local non- profit organizations, by a majority vote of the Governing Board . Any assets purchased with Federal, State, or County Funds will revert back to the funding source, when required by contract. Article VI Amendments Amendments to the Articles of Incorporation may be proposed and adopted, and amendments to the By- Laws of this Corporation may be made, altered or rescinded, by a 2/3 majority of the Governing Board of Directors. ARTICLE VII Proxy Voting No voting may be cast by proxies. This includes Governing Board of Director's meetings and all regular and special meetings of this Corporation in general . ARTICLE VIII Executive Director The Governing Board of Directors shall have the power to employ or terminate the Executive Director by a 75% vote of the membership at any officially called Governing Board Meeting. The Executive Director is a non-voting member of the Executive Committee and all other committees of the Corporation. The Executive Director carries out programs within the policies and general directives of the Board of Directors. The Executive Director recommends and develops policies and procedures for the various programs at the Center. The Executive Director is responsible for the day-to-day operation of the Center including personnel, administrative, and supervisory functions at the Center. The undersigned members do hereby certify at a properly convened meeting of the Governing Board of Directors held on the 24th day of September 2002 the foregoing by-laws were duly adopted by affirmation vote of the members then in office and that they constitute the official by laws of the said Corporation. Child Abuse Services, Training & Life Enrichment EXCHANGE CLUB CASTLE By-Laws Proposed for Amendment: Article I Section 3 : A quorum for any meeting of the Governing Board of Directors of the Corporation shall consist of a majority of those present at any regularly scheduled business meeting, with a minimum of five (5) present. Existing : A quorum any meeting of the Governing Board of Directors of the" Corporation shall consist of one more than fifty percent (50 %) of the members . Attendance via telephone conferencing to achieve a quorum is permissible. Any action by the majority of those present shall be the action of the Governing Board of Directors except amendments to the Articles of Incorporation and to the By-Laws . A vote was taken on this 24`h day of September 2002 at the Governing Board Meeting of the Exchange Club CASTLE to replace the existing By-Laws with the proposed Article I, Section 3 amendment. AT TEST• Presidpnj i 1 S` Vice Preside t 2° Vice President Treasurer /o / aa / pa, EXCHANGE CLUB CASTLE Mailing Address: P.O. Box 12908 a Fort Pierce, F134979 Office: 3525 SW Midway Road a Fort Pierce, FL 34981 Voice: 561 .465.6011 a Fax: 561 .465.6013 a Email: tgarbarino- may. exchangecastle.org Soonsored in Part by Exchange Clues. Department of Children and Families. United way of Indian River, Martin. St. Luca ane Okeechobee Counties. ChiWren's Services Counuls of Martin and St. Lucie Counties and CSN of Indian River County. Child Abuse Services, Training & Life Enrichment EXCHANGE CLUB CAS'T'LE By-Laws Proposed for Amendment: Article I Section 3 : A quorum for any meeting of the Governing Board of Directors of the Corporation shall consist of a majority of those present at any regularly scheduled business meeting, with a minimum of five (S) present. Existing , A quorum any meeting of the Governing Board of Directors of the Corporation shall consist of one more than fifty percent (50 %) of the members . Attendance via telephone conferencing to achieve a quorum is permissible. Any action by the majority of those present shall be the action of the Governing Board of Directors except amendments to the Articles of Incorporation and to the By-Laws . A vote was taken on this 24ffi day of September 2002 at the Governing Board Meeting of the Exchange Club CASTLE to replace the existing By-Laws with the proposed Article I, Section 3 E mendment. ATTEST: Ji President 1 " Vice Preside t oe 2° Vice President Treasurer --� A) / tea aa, EXCHANGE CLUB CASTLE Mailing Address: P. O. Box 12908 • Fort Pierce, Voice: 561 . 465. 6011 • Fax: 561 .465, 9 Office: 3525 SW Midway Road • Fort Pierce, FL 34981 6013 Email: tgarbarino-mayexchangecastle.org Sponsored in part by Exchange Quo& Oeparrment of Chsdren and Fandoes. United Way of lrxfian River. Children's Services Councils of Martin and Sr. Lucie Counties and CSN WMar"n• St. Lucie and Okeechobee Counties. h+d'an (liver Caunw a Fair and E.ouitable Treatment It is CASTLE policy that the Agency is committed to the principles of equality in employment. The CASTLE strictly prohibits discrimination against individuals because of race , color, religion , age, national origin , sex , sexual orientation , physical and mental disability, military status or any other status protected by law . This policy applies to recruitment, hiring, training, transfers , promotions, lay-offs , and other personnel policies and practices , including compensation , benefits , discipline and CASTLE sponsored programs and activities . It is CASTLE policy that the Agency is committed to ensuring equal employment opportunity for qualified individuals with disabilities . The Americans with Disabilities Act (ADA) prohibits discrimination against qualified individuals with disabilities . The ADA defines "disability" as a physical or mental impairment that substantially limits one or more of the major life activities of an individual , a record of such impairment, or being regarded as having such an impairment. The CASTLE recognizes its duty to provide reasonable accommodations to qualified individuals with known disabilities . It is the individual ' s responsibility to inform the CASTLE if a disability requires an accommodation in order to perform the essential functions of a position. If an individual believes that an accommodation is needed, the matter must be brought to the attention of an immediate supervisor or the Human Resources office. It is CASTLE policy to promote equal employment opportunity and a workplace that is reflective of its community through practices that encourage the hiring of personnel from diverse backgrounds . This is accomplished in the following manner: The Agency' s status as an equal opportunity employer is printed in each employment advertisement; job openings are posted with the workforce development board ; advertisements are placed in the most widely read newspaper(s) in each county. Further information on equitable treatment can be found in the CASTLE personnel policy. F Personnel Development Plan The CASTLE recognizes that its employees are vital to its continuing success and ability to provide quality services . Therefore, staff development and training programs designed to help each employee improve their professional skills and enhance their ability to fulfill the existing and changing requirements of their jobs , are offered. Training programs include in-service training classes , the distribution of relevant information , conferences , employing of consultants and speakers , videotaped 1 information , published curriculum, peer trainings , and shadowing of experienced employees . Training opportunities are offered in the following manner: Orientation : Every new employee is provided with an initial orientation during their first day on the job, usually reporting to the administrative office at the beginning of their first 17 MAY Q7-2003 09 : 26 HARBOR INSURANCE AGENCY 772 460 2315 P ., 02/03 OP IP CERTIFICATE OF LIABILITY INSURANCE EXCHA� I 1 05 /27 / 03 PRODUCER ION THIS CERTIFICATE IS IS3LIHD A8 A MATTER NRIGHTS UPON THE CERTIOF INFORNIA7E ONLY AND CONFERS O FICATE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 7ARBOR INSURANCE l00 ALTER THE COVERATSE AFFORDED BY THE POLICIES BELOW. 2222 Colonial RI Suite Fort Pierce FL 34950 - 5309 NAIC0 Phone : 772 - 461 - 6040 Fax : 772 - 460 - 2315 IN AFFORDING COURAGE INSURED tNsuRERA: Philadelphia IsLdeunit Ins c The Exchange Club center INSURER B: Turin Ci Fire Insurance Cc fo the Prevention of Ch Id Abuse DBA INSURER C: lQcBp48 : 12908 C ' A ' g • T . L . B . INSURERD: 1 Will, Ft Pielree IIk 34979 INSURER E: COVERAGES ATHE NY REQUIREMENT, TERM CE CONDITION ELOW bF HAVE ANY COENTFIACT OTHER EN ISSUED TO THE INOocuMENNAMED WITH RESPECOTo WHIICR THE ON THIS CERTIFICATE MAY BE 1 USS EDOR NOTWITHSTANDING POLICIES. AGGREGATE LIMITS SHOE MAY HAVE BEEN BEMAY PERTAIN, THE INSURANCE AFFORDED By THE ES DESCED RI PMHEREIN IS D IMCLAIMS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH 1150 EX LIMITS MSRM 011= POLICY AD DAnMD LTR NSR WMOF INSURANCE EACH OCCURRENCE i 000 0 00 QENERALLIABLTY 5100 000 03 / 26 / 03 nvA x X COMMERCIAL GENERAL LIABIUTY pup= 44130 M DEXP (Ayoneoon) s 5 000 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY S 1 , 000 000 A X Sexual/Dlolestatio GENERAL AGGREGATE s 2 000 000 PRODUCTS - COMP/OPAGO x2 000 000 GEWL AGGREGATE LIMIT APPLIES PER: POLICY JE�CT LOC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Em icciddrt) ANY AUTO ALL OWNED AUTOS (ForD1:1617 fin) RY 5 SCHEDULED AUTOS HIRED AUTOS (Peracciden � ) S NON-OWNED AUTOS PROPERTY DAMAGE S (ParacddeM) ALTO ONLY . EA ACCIDENT 5 GARAGE LIABILITY EAACC S OTHER THAN ANY AUTO AUTO ONLY: AGO i EACH OCCURRENCE S E(CESSNMBRELLA LIABILITY AGGREGATE 5 OCCUR F1 CLAIMS MADE _ 5 DEDUCTIBLE i RETENTIONS TOWI; STATU- RX ER Y LIMBS WORKERS COMPENSATION AND B EMPLOYERW LIABILITY 21(QBDU9567 12 / 01. / 02 12 / 01/ 03 E.L EACH ACCIDENT $ 500 0 ANFICREaOiPMRE1TOR)MBER �LUD O�CUTIVE EL DISEASE - EAEMPLO $ 500 000 dyea deSalbe under ELI DISEASE • POLICY LIMIT $ 500 000 3PEGIIAL PROVISIONS below OTHER000 , 000 A Frofeseional Liab PUPM044130 03 / 26 / 03 03 / 26 / 04 Occurrent: $ 1 , A re ate 512 000 000 DESCRIPTION OF OPERATIONS r LOCATIONS I VE]YCLES / EXCLUSIONS ADDED BY EN�R9EMENT / SPECIAL P 6 / 0022 NS- 03 / 26 / 03 , Company A : Umployes Dishonesty , Policy #pBPX019440 , 03 / 22 6 / 5100 , 000 Blanket • Certificate holder is an additional insured for general liability with respects to Value Visits . CANCELLATION CERTIFICATE HOLDER 1ND3:A - 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE WIRATION DATE THEREOF, TAB ISSUING INSURER WALL ENmAVOR TO MAIL 10 DAYS WRITTEN Indian River County NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Com ili 88 ionerA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR 1840 25th Street ENTATIVEs, Vero Reach FL 32960A ATI Cind DSc 7a ® p(:ORD RPORATION 1988 ACORD 25 (2001 !08) MAY-27-2003 09 : 27 HARBOR INSURANCE AGENCY 772 460 2315 P . 03/03 IMPORTANT If the certificate holder is an ADDITIONAL INSURED , the policy(ies) must be endorsed . A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) . if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy , certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) . DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s ), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon . The information contained in this transmission is client privileged and confidential, or considered confidential under state/federal statutes or regulations. It is intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copy of this communication is strictly prohibited If you received this message Jn error, please immediately notify us by the telephone and return the original message to us at our address via the United Stales Postal Service. Thank you. ACORD 25 (2001108) TOTAL P . 03