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Home My WebLink About2003-253F 4 . CHILDREN'S SERVICES ADVISORY COMMITTEE C/O Human Services 1840 25th Street V Vero Beach , Florida 32960-3394 Phone : 561 -567-8000 (Ext. 467 or 524) Fax: 978-1798 E-Mail : Jcarlsonabcc. co . indian-river.fl . us Mmasterson(o)bcc. co. indian-river.fl . us To : Beth Jordan From : Joyce Johnston- Carlson Date : October 21 , 2003 Re : Grant Contracts 2003 - 04 The attached is a Children ' s Service Advisory Committee Grant Contract for : Indian River County Healthy Start, Inc. 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. Beth Jordan Date lo - -.71 - o5 ... OCT 2 2003 CLERK TO THE BOARD 10 / 21 / 2003 TUE 12 : 36 FAX 561 563 9125 IRC HEALTHY START 2 002 / 002 10 / 21 / 2003 11 : 27 7725699585 PAGE 01 ACOR© DATE WWDO" TN. CERTIFICATE 0t= LIABILITY INSURANCE DATE WBANACK INSURANCE AGENCY THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RM3MTS UPON THE CERTIFICATE 2045 14TH AVE. MOLDER. THIS CERTIFICATE DOES NOT AMENb, EXTEND OR P O BOX 130 ALTER THE COVERAGE AFFORDED 8Y THE aLIGENi er NDNp, VERO BFACH FL 32861 PHONE: 772492-9388 INSURERS AFFORDING COVERAGE MAIC 11 INSURED INSURERA: AUTO OWNERS INSURMCE COMPANY F INDIAN RIVER COUNTS' HEALTHY ST,E,RT, INC. j IN$URER 8: HARTFORD UNDERWRITERS IN8URtNCE COMP1 • Y 160510TH ANL. .. . . . VERO BEACH FL 32980 INSURER C: INSURER b: INSURER E: THE POUMES OF INSURANCE LISTED IICLDW MANE BECN 158UE0 TO TME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWI7H9TANDIN6 ANY REOIIIREW"T, TERi.I OR CONOMON OF ANY CONTRACT eA OTHER D=k*NT WITH RESPECT YOWAICH THIS CRPTIPICATIt MAY pE 18EUEP OR MAY PERTAIN, rrE INSLIPAJIM AFFORWfiO by THE FOLICIE6 CifaCRIEIED HEREIN 19 IUBJECT To ALLTHE TERMII, EXCLU8lON8 AICD CONDIT"s OF SUCH POLICIES. AGGREGATE LIA S SHOWN WY HAVE t10EN FtOPXW NY PAID CLAWAs, , lL T1 P E OF lIIBDPAIIP.E --- T POLICY MQMfirA • - ? PWJD I LOFNTNIF Pcm-m F.V1RATM7M - -- QENERAL LIAMJTT 93411 .42740 MAR 10 08 MAR 10 04 CAGH OCCt)AITEMFE 6 1 ,OOOt000 COMERCWl GENEMLLLUILITV I MANAGE TU RENT90 . . . !I Hl*l0l E5wAens Ay I,®OQ l CLAIMS MADE ! X O=R MELT EXP My Mo PWWt11 111 go I S ow A i PERGON& i ASM INJURY Is 1 ,D40,t341J l I QFWRAkA43R60ATE I f, OD0,Dd0 GENT, AG4RE0ATI; 41MIT APPLES PER; I, , II s 1,OOI),004 PROOUCT$HroTR/IOP AGC. P MXY AUTOMOBILE IlABIlIY COMBNlED SINGLE LNtr S . . ANY AUTO (EI Itli6sn11. - , , , . . . ALU "Go AUTO$ i BODILY INJURY � - -- SCHEDULEDAJTOS HIRED AUT'0& I BODILY INJURY . NON-OWNECAuTOS I (Por 4Wan , 1 . .. _ . .. . FROPERTY004"CF I "RAGE LIARLITT AUTO ONLY - EA ACCIDENT S ANYAUTO � _.. _ .._. . . . I Any O i}{ER THAN _ EAACC., 1Ni . AUTO ONLY: '; EXCESS I UMIBEREILALWH[ITY EACH OCCURWMCE,- .. ; OCGUA l — GLAY5MADE AGGREGATE S I I DEDUCTIBLE . RETENTION WOWERB COIWENSATION AND 111100 001710 MAY S CS MAY 3441N6 ' OTHER - QAIPLOYERS LIAsa.Tly .. . ?�IfJ.L^Ta .. ._ . . . . . _ E.L. EACH ACCIDENT i 140 ,DOd UM ' E.L. DISEASE-EAEMPLOYEE1D0,DQts I IPEUM PROVOOM� kkW ! E-L. 0ISEA3114nLICY UNIT ., Q00,OOU OTHER: G I DESCRIPTION OF OPERATION8ILOGATION/YEHIGLL' /E?IGLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER 13 ALSO NAMED AS AN ADDINnONAL INSURED WITH REGARDS TO CONIMERGWt_ GENERAL LIABILITY COVERAGE . ALAO NOTE 10 DAYS NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM CERTIF I JAPWTIONALIN111UPWIMUNeRLETTIft CANCELLATIgN SKOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, THE ISSUING COMPANY "LLENDEAVORTO WILSD DAyS WRfTEN NOTICE TO 7kE CERTIFICATE HOLDER NAWO TO TIE LEFT, BUT FAILURE TO OC SD SHALL IMPOSE NO ODUGAA IVH OR LWBILRY OF ANY KINQ UPON THE INDIAN RIVER COUNTY BOARD OF INSURER, ITS AGkNTS OR REPRESENTATIVES. COUNTY COMMISSIONERS AUTHORIZFo REPKE.SENTATWE 1044 25TH ST VERO BEACH, FL 32960fc Aftntlon: 80TH JORDAN ' r ACORD 26 (2001 /06) Cel#{fiaata M 68548 Mlchale N. PDysell 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 Healthy Start Coalition ("Recipient of: (Address) Healthy Start Coalition 1603 10th Avenue Vero Beach , Florida 32960 TLC Newborn 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 , 20031 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 COUNTY BOARD OF COUNTY COMMISSIONERS By: Kenneth R. Macht , Chairman Attest : J . K . Barton , Clerk By: Deputy Clerk Approved : mes Chandler, C my Administrator Ap o ed as to form and legal sufficienc arm Fell , Assistant Coun At ney RECIPIENT : Healthy Start Coalition 1603 10th Avenue Vero Beach , Florida 32960 By: J a Name 9 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 St 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 184025 1h Street Vero Beach , Florida 32960-3365 Recipient : Scott Joseph , Director Healthy Start Coalition 1603 10th Avenue Vero Beach , Florida 32960 2 . Venue ; Choice of Law: The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida , only . The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract , or any breach hereof, as well as any litigation between the parties , shall be Indian River County , Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement : This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability : In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract , and every other term and provision of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent, this Contract is deemed severable . 5 . Captions and Interpretations : Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless the context indicates otherwise , words importing the singular number include the plural - 1 - 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 - i 0 0 (Policy Provisions : WC 0 0 0 0 0 0 A ) 77 GD INFORMATION PAGE wEc WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER : HARTFORD UNDERWRITERS INSURANCE COMPANY HARTFORD PLAZA , HARTFORD , CONNECTICUT 06115 NCCI Company Number. ln� THE Company Code : 6 HARTFORD 0 Suffix C) LARS RENEWAL o POLICY NUMBER : 91 WPr Gn:77nn 010 C) Previous Policy Number: r� HOUSING CODE : DV 0 1 . Named Insured and Mailing Address : INDIAN RIVER COUNTY HEALTHY CN ( No . , Street, Town , State , Zip Code) ( SEE ENDT ) 0 0 Ln 1603 10TH AVENUE * FEIN Number. 650363222 VERO BEACH , FL 32960 State Identification Number(s): The Named Insured is: CORPORATION Business of Named Insured : CIVIC ORGANIZATION Other workplaces not shown above: 1603 10TH AVENUE VERO BEACH , FL 32960 2. Policy Period : From 05 / 03 / 03 To 05 / 03 / 04 12:01 a .m. , Standard time at the insured's mailing address . Producer's Name : SID BANACK INSURANCE / SCIC P . 0 . BOX 29611 CHARLOTTE , NC 28229 Producer's Code : 227667 Issuing Office : THE HARTFORD 8711 UNIVERSITY EAST DRIVE CHARLOTTE NC 28213 ( 866 ) 467 - 8730 Total Estimated Annual Premium : $ 916 Deposit Premium : Policy Minimum Premium : $ 236 FL Audit Period: ANNUAL Installment Tenn : The policy is not binding unless countersigned by our authorized representative . Authorized Representative Foran WC 00 00 01 A (1 ) Printed in U .S .A. Page 1 (Continued on next page) Process Date : 03 / 08 / 03 Policy Expiration Date : 05 / 03 / 04 ORIGINAL ' • • - • 1 1 • • • ' • ' • • . 1 1 0911 • Ski we 1 • • • 1 1 All]Ell . 14 1 Leffmal81a ' • MINE • • • • • • • • • • • • • • ` � . 1 1 1 1 1 1 • ` 111 111 • • ` • ` : . 111 111 ` ` i INSURANCE COMPANY BUSINESSOWNERS POLICY DECLARATIONS 6101 ANACAPRI BLVD . , LANSING , MI 48917 - 3999 Renewal Effective 03 - 10 - 2003 AGENCY SID BANACK INSURANCE 12 - 0119 - 00 MKT TERR 051 ( 772 ) 562 - 3369 POLICY NUMBER 93 - 211 - 127 - 00 INSURED INDIAN RIVER CO HEALTHY START INC Company Use 20 - 57 - FL - 9303 Company POLICY TERM ADDRESS 1603 10TH AVE Bill 12 : 01 a . m . to 12 : 01 a . m . VERO BEACH FL 32960 - 6231 03 - 10 - 2003 03 - 10 - 2004 In consideration of payment of the Premium shown below , this policy is renewed . Please attach this Declarations and attachments to your policy . If you have any questions , Please consult with your agent . ENTITY : Corporation PROPERTY COVERAGES - ALL DESCRIBED LOCATIONS DED LIMITS PREMIUM Special Coverage Form Automatic Increase ( s ) 6 . 07 Building Limit $ 250 $ 5 , 000 $ 66 . 48 Employee Dishonesty BUSINESS LIABILITY PROTECTION LIMITS PREMIUM COVERAGES Liability and Medical Expense 51 , 0001000 Included Medical Expense - Per Person 5 , 000 Included Personal Injury Included Included Tenants Fire Legal 50 , 000 Included Hired Auto & Non - Owned Auto Liability 11000 , 000 $ 35 . 53 F0gP0009A ( 01P87 )PLY TO ALL 546790CA06 � 92 ) 54709 ( 04 - 94 ) 59350NSe 54510 ( 09 - 82 ) 2 ( 11 - 02 ) 546566 ( 08 - 91 ) 54663 ( 09 - 91 ) Countersigned By : �� t1/19MJ29: 11 AM �GHEDULE A Organization Exempt Under Section . 501 ( c) (3 ) (Form 990 or 990-EZ) (Except Private Foundation) and Section 501 (e), 501 (f), 501 (k), OMB No. 1545-M7 501 (n), or Section 4947(a)(1 ) Nonexempt Charitable Trust Department of the Treasury Supplementary InformationgSee separate instructions . ) 2001 Internal Revenue Service ► MUST be completed by the above organizations and attached to their Form 990 or 990-EZ Name of the organization Employer Identification number I . R . C . HEALTHY START COALITION INC 65 - 0363222 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 more (b) Title and average hours (d) Contributions to (e) Expense than $50,000 per week devoted to position (c) Compensation employee ben. plans & account and other deferred com ensation allowances NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . rotas number of other employees paid over 6501000 ► 0 Part If Compensation of the Five Highest Paid Independent Contractors for Professional Services ` See page 2 of the instr. List each one whether individuals or firms . If there are none enter " None . " (a) Name and address of each independent contractor paid more than $ 509000 (b) Type of service (c) compensation NONE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . rias number of others receiving over $50,000 for ' ofessional services ► 0 or Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ, Schedule A (Form 990 or 990-EZ) 2001 4 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY DISTRICT DIRECTOR C — 1130 ATLANTAv GA 30301 Ciatr- : Employer Identif i :_ 2ti =.: r it !: nliier : 65 - 02 6 :, APR 2 9 1993 � :.. � CoiFit act Person : ROBER T A AN METER 1NDIAN �HIVE" ii OIJOT`i HEALTHY OSTART Ielepohiine i'irirkrt' ir : i� F3LIt' I !ii1 Ii ! !� ( 404 ) 3 = 1 - 01 •^• r 19r. '•? 7TH S h ET Hccount i ng P ! :• r i od End i n 4 : June 30 1= c+ undatic, n status CIas = ificatic, n : 509 ( a ) ( 1 ) Advance RuIing Period 0egi _. : - October- 231 1992 Advance Ruling Per i c+ d .=. ;; ds : June 30 . 1997 Addenduili App I i es : Yes Clear App i icant : E. _ = ed t- 'Pt ir: fc+ r A! a4l0n Yo11 Supp ! i 'cli7 acid as = Llm n vC+ ur + p >= ra :" i ciT1s stated 1 rl v =. (if app ! ! Cat 14n for rr? C +? Oft 1 t 1 On tit • ?: eili , t I +irl z 3'; e :'1 iVe deter rit : r! '. t; Yi; are exempt f rom federal income tar•. Urder section 50 ! ( a ) of the I n tern :: p. 1e Code as an organization described in section 5o1 ( c ) ( 3 ) . t Because you are a newly created organizations r! e are not not-: aiak inti a f inaI deteritirlation of your ? c• unda iC+ n status - i " 5, i _ t tatu � under- � eL t. t on 0 `P ( a ) ref tale Code . Hot-Tever + we leave determined that you can r- easonab 1 y expect t be a pub ! is i supported organization described in sections 509 ( a ) ( 1 ) aTid 170 ( b ) ( i ) ( « ; ( vi ) . Accordingly , during an advance ruling period yrau wiII be tredted as a. publicly supported organization , and not as a private fciundatic+ rl . This advance ruling period begins and ends can the dates shown above . Within 90 days after theend c+ f vc+ ur advance ru l i nq peri cid • yc+ u must send us the i information neede_i t +, determine whether you have stet the r ca u : _' - ntents c: f the appi icabie support test during the advance rul ing period . I ; yc+ u estab l is " that You have been a pub [ i c i y supported cjrgan i zat i tins s-? e• i ! i ! ! r fy You as a ectiop. 509 ( a ) ( 1 ) or- 5Ct9 ( a ) ( 3 ) organizatiori as lc. ;tg as y ,. , t cc• n '•. = irlue tcg meet the requirements of the app I i cable support test . If you dop. c• t meet the public support requirements during the advance ruling period , sre siilt classify you as a private foundation for future peric• ds . Asc• , if we cIas ,_ y You as a private f oundat i con a we s-: i I i treat you as a private f undat i c. n f rc+ !1t Your beginning date for purpc+ ses cif t E0dasec • n . 7 : nd 4940 . Grantor --- and , c+ ntributors rilav 1" •? ! y on +-1li. r detErllilnatl +_ Tt -. ,hat you are not 3 PriV ] + e foundation until 90 da •y' s atf"ter the end !if yi Ur' ddvaTt . :_ . ` ll11n ( ptr1 + 7t1 . If yi+ c: 15end res the required Int + rrllat: i +in oithin the e) l7 a ' ir3T: * • . r- _ y COTitributor = 1111aV CCITltinUe to rely ._+ r, the advar; ce _= s -- terilti Tl atir -it Flrii I 1de1 ni .;;ik .=• a f inaI de to riitl nat i con of yr+ Ur f _+ +1nda :.; i +? r! tatqu i INIFI •: AN ' M � UIJ %? TY ifcaiJHt = Tr If :: e publ ish a notice ini., l3e t : - ernaI Reveal . E: ui lean stating that ; te i n0 IoPyt:- r Great t' c, U as a pUc I iC ' y' sUpGorted :.' r rdi 1 0n qr" a ? ieir Cant.fi c ,intributc' rs_ may nc' t rel !in this d '=• i" F T Y - - ermination a , Iver 'ane date :-te NUt i Ish 2= he notice . In t= ydito; 4-41111 Ir yeiU Ii, . r_-- y ,j it r' _ 1` a tUS as ci1 � J pub i i c 11ppOrteu riga n i - zu4. I c' rt t ynU l"jf aPt '=< r i: r Cc' T: t i b :: + l' r =:% d5 r esp ns r i c' „ _ - t c, r to - _ : i - F T _ r , t, r ,.1C � aria rc iif , file ac- f f a I ur � ; i. ha . r e s u } ted i n y1eur I c' ss ., f such status , that perc•- &- n n! ay ncet re l y on this determination f rim the date c' f the act e_ir f a i i ure t ., act , AlSC% 7 If a Qr3nt '.et c1i contributor IbUtc' r Ie .a :rTied that we had given notice that VC' li }: e_iu ld be reni '=• ':ped fr ', rt rja ssification ' as a publicly supported organization , then that person wa Y not rely on this deter- r i nat i c' rt as of the. date he or she acquired such knowledge . If you change your sources of _. _lppe_, rt , your ptlrpc' ses , character , or mr_ thod of cperation5 please let us know Oce .-: e can cljnsider the effect cif the v haT. () e ca r, your exempt status and foundation status . If u .ir:: end ; 111ir �, Y '-i _ r- nal dor. ument or t: V } ai15 , Please send 115 ci Copy of the amended doctinien - or Also , let Us know alI changes IL 4Cur name or address , As of January i , 1984 , yclid are iiabie for social securities ., the Federal Insurance Contribution _ Act _in aricturtts !ii 45100 or more you Pay to., each cif your rriiployees during a caleiidar year . Y4 are not 3 f ab l e fc. r. the to }; Iniposed under the Federal Unenipioyni '_ rit Ta >; Act ( FUTA ) , Organ iZaticens that are not pr- itv3te foundations are not subject to t- 11e pri- vate foundation excise taxes Under Chapter 42 of the Internal Rev ttue E.•ode . However , you are Ctc' t aUttir; dtlC + : V eye (:} t frliiti If p _ � h :_ r federal excise toxe -S . you have any quest ie_ens about exc i se , emp I c' yment , cer other federal taxes_ , please let us knoi-re Elonors may deduct contributions tc' yciu as provided in se- C: t i can 170 of 'c heInternal Revenue Code . Bequests , ieaaciese devises , transfers , ar gifts t • : you cer- fcor- your ase are deductible fcer Foderal estate and gift tax purposes if they meet the applicable pre_evis icons c' f sect i ons 2055 ? 21069 and 2r: 2 � cif the r ;, dt, . Doncirs may deduct ccentrit-uti -ins vvl only tct the extent thyt their cranr: ribUtions are gifts , with no con ideration received . Tirket p =urchases and sinli lar payments in Con junction with fundraisinq events may not necessari i � � qualify as t ductibie ccentributions , depending cin the crrCurli = tanCE! s . e •L " I i> e F e Ruling 67 - 24b , pub ished in Cumulative Eul letin 1967 - 2 , ort page 1047 i_,, i• , t - guidelines regarding when taxpayers may deduct payments ftir .admission to , c:er other- participation in , fundraisina activities fcer charity . You are not required to file Form 9901 Return of i; rgani -7atic' rt L >: :• nipt }= rc: ni Income I a ;: , i ; yr urross re t. r iia l i Y $ '2 -r„ 000 c, i,. 'es : . If y Celp �- �-. c- aCil year are ni. You receive Ec, rm x: 90 package i is the ma i I , s i mp I y attach the I abe 1 pros i ded check the bc: in the headin � tri_ indicate that.�, yLeUr aTl rl ual Qr +.:' ss r' pCelil is are normal Iy � ! , 000 c' r less , and sign ' �, - the return . If you ore required to r l i a r _ t11r` rt you hi 5t f i I :. I t to :' 4-he i Jt 11 dd '.' ' ' f _ f N + . ._ := EK riC h1 �. T �1Y• is-ir{ '• t :z f i f iii m .+ :jtn after ; he . rid _= r y , un nual acc +_+ ,int i fi _, ,ger i o : 'se cal : rge rjeDa i ty of 110 d day 1-: 1hen a retLlrn i :_ f i led l ate ± 1111 1 ess there I c rPa 1, _. 1 ,jb i e ai: s = f +'• r" the +delay . rias-lever 1 the aIIaXI IIIi ,lnl pelia l t ;.' , .: 1larLc • ann , t ';p 000 !ir 5: Jercellt of your � +' rg r eLr + t5 f ,_+ r t" - - - P ar 1•( hi .. t v � , rlav also charge this penal 4Y i f a rt 'turn i s n + + 11 e . t L II I1 I t % • , J + ! S p ledse UC �.A ,iLr i• e �' itrn t ,_, ,j; i] lrstr bef r, r- i. ly +_+ LI 13ie It . rill are not required to f i ie fed emraI income t >; returns ,unless yo _ ari:- subject to rl ; +_ tai, on unrelated business income under sectio+ n Ell ' of the t, :_, de . If }= _+ u are subject to this tax you must f i le an i11c !erfie tax return 1:111 FOri; 990 - TT 'Exempt Organization Business *income Tax Return , In this tette ; w rr- e not. determining +.ihether any of yowr r1resent or pri_+ prised activities. are unrc - 1 aced trade =-+ r business as def l iced In section F1 :: of the Code . You neerl an employer idefttrf ication number even if Vou have iio eel ? i3� V .:: es , If an emp l Styr r i dent i f i cat i cin number ;-las not enteri• d n your app s i cat i + n • I; e 111 ! I ass i gn _, n umber to you ai'id adv i e you of i t . Please Ilse that nu .m. _rl t+_ .r , n . all returns you f i I e and i n a l l ct_ir- r . � Cindence !.! i he ' t. _ ,_ - p tI! the lfl l. C . ild l f`. 0 Je ?I lie Service . If S: e s :: id in the Heading of this letter that an addendum april ie e t , addendum enclpsed is an integral par ' of this Ietter . Because this letter could help its resolve an • v q ue ' t i o P > 1 _ n _ about Y & Ur ipt status and foundation status , ° r, sh _� u l d Hee i t i 1i 1J �+ t r 7 - ur pereman - . it records . If you have any questionsmi please contact the person whose name 8nd telephone number are shown in the heading of this letter . 5-i cere l y Paul l: i i I iar.: s - ' District Direct =, r Enc losurt_ ( s : ; Addendum Farm ^_. 72 - C y Indian River County Healthy Start Coalition, Inc. — 2003-04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee PROGRAM COVER PAGE Organization Name : Indian River County Healthy Start Coalition Inc Executive Director: D . Scott Joseph M* SO Email : irchsc(a aol . com Address : 1603 10th Ave . Telephone : (772) 563 -9118 Vero Beach, Florida 32960 Fax : (772) 563 -9125 Program Director: Joan Gentgen Email :Joan Gentgen(aWoh state fl us Address : IRC Health Department - 1900 27th Street Telephone : (772) 794-7484 Vero Beach Florida 32960 Fax : (772) 794- 7453 Program Title : TLC Newborn Program Priority Need Area Addressed: Parenting Support and Education as well as Mental Wellness Brief Description of the Program : The TLC Program falls under two taxonomies : PH-610. 180 — Expectant/New Parent Assistance which provides services and education for new parents to prepare them for emotional and practical aspects of parenting and to promote bonding and nurturing of the newbornPH-620 . 150 — Communication Training, helpingparents communicate with children, health professionals and other parent/infant interaction skills focusing on positive growth and development The universal TLC (Touch Love Communicate) Newborn Program is a collaborative effort with the Coalition IR Memorial Hospital and IR County Health Department that focuses parent education infant health care information bonding advice brain development activities . Amount Requested from Funder for 2003 / 04 : $ 205000 Total Proposed Program Budget for 2003 / 04 : $ 78 , 000 Percent of Total Program Budget : 25 . 6 % Current Funding ( 2002 / 03 ) : $ 15 , 000 Dollar increase / ( decrease ) in request : $ 51000 Percent increase / ( decrease ) in request : 33 . 3 % Unduplicated Number of Children * to be served Individually : 1 033 Unduplicated Number of Adults * * to be served Individually : 1033 Unduplicated Number to be served via Group settings : Total Program Cost per Client : 1 37 . 75 W ill these funds be used to match another source ? Yes * * * If yes , name the source : * * * Partial - UW of IRC Amount : $ 55 , 000 . 00 * Does not include twins * * Does not include father The Organization 's Board of Directors has approved this ap4caon' (date). Ma 28 2003 Jean Anderson Name of President/Chair of the Board D . Scott Jose h Name of Executive Director/CEO 3 Indian River County Healthy Start Coalition, Inc. — 2003-04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee PROGRAM COVER PAGE Organization Name : Indian River Counjy Healthy Start Coalition Inc Executive Director: D . Scott Joseph, M. S . Email : irchsc(a,aol . com Address : 1603 10th Ave. Telephone : (772) 563 -9118 Vero Beach, Florida 32960 Fax : (772) 563 -9125 Program Director: Joan Gentgen Email : Joan Gentgen@,doh. state. fl. us Address : IRC Health Department - 1900 27th Street Telephone : (772) 794-7484 Vero Beach, Florida 32960 Fax : (772) 794- 7453 Program Title : TLC Newborn Program Priority Need Area Addressed:_Parenting Support and Education as well as Mental Wellness Brief Description of the Program : The TLC Program falls under two taxonomies : PH-610 . 180 — EMectant/New Parent Assistance which provides services and education for new parents to prepare them for emotional and practical as ects of parenting and to promote bonding and nurturing of the newborn. PH-620 . 150 — Communication Training helping Darents communicate with children health professionals and other parent/infant interaction skills focusing on positive growth and development. The universal TLC (Touch Love Communicate) Newborn Program is a collaborative effort with the Coalition IR Memorial Hospital and IR County Health Department that focuses parent education infant health care information bonding advice brain development activities . Amount Requested from Funder for 2003 / 04 : $ 209000 Total Proposed Program Budget for 2003 / 04 : $ 789000 Percent of Total Program Budget : 25 . 6 % Current Funding ( 2002 / 03 ) : $ 15 , 000 Dollar increase / ( decrease ) in request : $ 5 , 000 Percent increase / ( decrease ) in request : 33 . 3 % Unduplicated Number of Children * to be served Individually : 1 , 033 Unduplicated Number of Adults * * to be served Individually : 11033 Unduplicated Number to be served via Group settings : _ Total Program Cost per Client : 37 . 75 Will these funds be used to match another source ? Yes * * * If yes , name the source : * * * Partial - UW of IRC Amount : $ 55 , 000 . 00 * Does not include twins * * Does not include father The Organization 's Board of Directors has approved this application on (date). May 28 2003 Jean Anderson Name of President/Chair of the Board Signature D . Scott Jose h Name of Executive Director/CEO Signature 3 Indian River County Healthy Start Coalition, Inc. — 2003 -04 TLC Newbom Program IRC Board of County Commissioners — Children 's Services Advisory Committee 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 Indian River County Healthy Start Coalition is to establish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote normal growth and development. The vision is to provide the resources and mechanisms available in Indian River County that lead to healthy birth outcomes and brain development. The Vision Statement for the TLC Newborn program is "Healthy Families — Strong Communities" The mission statement for TLC is "Strengthening families of newborns by providing information, promoting understanding and reassuring parents. " 2. Provide a brief summary of your organization including areas of expertise, accomplishments and population served. The Coalition ' s purpose is to provide coordination and build broad-based community support for maternal and child health (MCH) . This is accomplished by establishing a partnership between the private and public sector, state and local government, community alliances and maternal and child health providers to provide coordinated community based care for pregnant women, infants and families with children up to age three for Healthy Start and age five for Healthy Families. Areas of expertise include birth and maternal data analysis, program planning, development, implementation, and addressing gaps in MCH services . Once gaps in service or poor birth outcome trends have been identified, then taking the necessary steps to improve these gaps in care by building bridges, linkages or adding new services if they currently do not exist to meet the MCH needs in Indian River County. Additional areas of expertise include outreach, providing educational opportunities addressing MCH issues, and ensuring a system is in place for pregnant women, infants and children. The IRCHS Coalition developed and put in place the TLC Newborn Program in 1998 , which serves approximately 1 , 000 infants each year, as well as the parents of these newborns . The Coalition also serves as the lead agency for Healthy Families — IRC, which provides intensive case management to over 100 families each year since 1999, with the primary goal of preventing child abuse in at-risk families . The Coalition also oversees Healthy Start Care Coordination services in partnership with the Indian River County Healthy Department, which served over 500 families in 2001 . Beginning in 2003 , the Coalition launched a child safety campaign and became a Safe Kids Chapter in January. The vision of Safe Kids is to "Protect the children of our community . . . through education, outreach and community involvement". The Safe Kids programs focuses on child passenger, infant, home and bicycle safety education and initiatives . The program has already proven to be extremely beneficial in bringing new resources to the community by getting over 60 child safety seats donated from the state, with potential Department of Transportation funds available for additional seats and safety interventions . To date, over 50 child passenger seat inspections have taken place by the Coalition ' s Outreach Coordinator, who plans and coordinates the Safe Kids program, 4 Indian River County Healthy Start Coalition, Inc. — 2003 -04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 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: Babies do not come with instruction books . In today' s system of health care, the mothers of newborns are released from the hospital within 48 hours, and in many cases is less than 24 hours . Unlike past generations , support systems, such as the newborn ' s grandmother, aunts or even available health care providers for these mothers are in many cases non-existent, particularly in the State of Florida, that has many transplant residents, leaving the mother and family to fend for themselves . In many cases, there is nowhere to turn for parents of newborns to help with even the most basic of infant care issues, such as : handling, feeding, nurturing, safety and growth/brain development. The TLC Newborn program fills this void and gap of care, education and support. Who : Indian River County residents have been averaging about 1 , 100 births each year. Of these births in 2001 , 65 .4% were from white mothers, 16 . 6% black, 16 . 7% Hispanic and 1 . 2 % "other" mothers . In 2001 , almost half, or 45 % of all births are covered under Medicaid or indigent funding, which amounts to 506 babies being from low income families . Of all the births in 2001 (the latest year for complete birth data), 39 . 3 % or 442 babies, were to unwed mothers, with black unwed births at 67 . 9% . In terms of education status of the newborn ' s mother, 25 . 5 %, or 287 of the mothers did not have a 12th grade education or GED . For Hispanic mothers, 61 . 2% did not finish high school. These figures above primarily address families at higher risk, but race, income status, lack of two parent homes, and education level are not the only risk factors for addressing the needs of an infant. How to properly take care of a baby crosses all socio and economic boundaries . Where : The TLC program serves mothers and families of newborns from the entire county, with 20. 3 % of the births in 2001 from the Vero Beach zip code (32960), 16 . 9% in the Oslo — southeast zip code (32962), 13 . 8 % in the Gifford/Winter Beach/Wabasso zip code (32967) , 12 . 2% in the Sebastian zip code (32958) and 9 . 1 % in the Fellsmere zip code (32948). Other parts of the county encompass the remaining percentage of births in 2001 . The information reported above is derived from birth outcome data provided to Healthy Start from the Florida Department of Health — Vital Statistic Office and shown in the Coalition ' s 2002 Needs Assessment and Service Delivery Plan. There are no programs or services that provide "universal" support for all families of newborns besides the TLC Newborn program in Indian River County. The TLC Newborn program has 96% participation of all families of newborns over the last three years, which amounts to almost 1 , 000 families each year receiving services addressing the needs of their infant. 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. The TLC Program is totally unique not only in Indian River County, but in the state of Florida. The program is unique due to it being universal in nature, and touches almost every family of newborns in Indian River County. Healthy Start Care Coordination and Healthy Families have a similar target populations with regard to the infants and families of newborns, but only serve those families who are scored "at-risk" on the Healthy Start/Families Postnatal screen and consent to program participation. They are primarily home- based case management programs , with the majority of services beginning prenatally. In 2002, Healthy Start served 306 infants and Healthy Families - IRC 131 infants and families . 5 Indian River County Healthy Start Coalition, Inc. — 2003-04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee Co PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Focus Area Parental Support and Education : Ages 0-5 — focus on "individual" parenting programs as well as Focus Area Mental Wellness Issues : Ages 0-5 — promoting enhanced emotional- social skills . 2 . Briefly describe program activities including location of services . Visits to Indian River Memorial Hospital are made six out of seven days of each week by the TLC Newborn personnel, who met 98 % of the families last year of every newborn either the day of delivery of the baby or the day after. Infants born on Sunday, the only day TLC does not visit the hospital, are normally contacted on the second day after delivery. Follow up phone calls are made with each family of a newborn who is interested in participating in the TLC Newborn program, which is over 96 percent of all newborn families in Indian River County. Follow up phone calls take place on a weekly basis in the first month. This frequency can be increased if the family chooses, or the TLC Family Associate identifies a need for greater contact. In the second month, calls are made to the family on an every other week basis . From months three through six , phone contacts are made on a monthly basis . An attractive, informative, age appropriate newsletters focusing on each month of the infant ' s life, in terms of growth and development, health and nutrition/feeding issues, immunizations, brain development tips and other parenting ideas are mailed on a monthly basis, dependent on the age of the infant. At the TLC Newborn office, the TLC representative mails specific educational material to each family who has accepted the program. These mailings usually reach the family' s home prior to the family' s arrival from the hospital ! The TLC Coordinator assigns individual families to TLC staff members (including herself) . Once a family is assigned to a staff member, that connection is maintained throughout the length of the program, which assists in building trust. Some families call the TLC Newborn office as additional assistance is needed. When referrals to other agencies or organizations are made to the family, the TLC staff member will follow up , regardless of the recommended call schedule. Referrals to community resources, such as the Healthy Start Care Coordination team, and concerns of individual families are reviewed by the TLC Newborn staff members on an as- needed basis . One of the primary reasons for the TLC program ' s success and high participation rate is its universal nature and non-invasive means of education and support . The education and support the families receive is in the comfort of their home in a manner that is not intrusive or disruptive. Mothers can also contact their TLC Family Associates at their convenience as questions or needs arise regarding the care and well-being of their infant. 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. As mentioned earlier, the major advantage of the TLC Newborn program is that it is universal in nature, with all families of newborns being eligible to participate. With the ability to reach families of newborns at the hospital and in their home, there are very few barriers to service delivery. The success of the TLC Newborn program is shown through its participation rate of over 95 percent over the last three years . As a comparison, the acceptance rate for the Healthy Start prenatal Screen was only 50% in 2002 and 6 Indian River County Healthy Start Coalition, Inc. — 2003-04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee 42% for the Healthy Start Infant/Postnatal Screen. This indicates nearly half of the pregnant women or infants in our county are NOT being screened for poor risk factors and could potentially be missed in terms of needing education and support. This is acceptable from a service delivery perspective, due to the limited staff of Healthy Start Care Coordination not being able to serve more than a few hundred families for ongoing case management anyway. But TLC fills this gap in care and services and provides a safety net for any families that were not screened for Healthy Start and might need additional case management or nursing services that Healthy Start or Healthy Families can offer. One of the best indicators of the success of the TLC program, in addition to the Healthy Start and Healthy Families programs , is the very low infant mortality rate in the last two years, which has been at 3 . 6 and 3 . 9 infant deaths per 1 , 000 live births in Indian River County, with postnatal infant deaths (infant dying between 28 to 365 days of life) being extremely low and way below the state average, which is the category that TLC services would most likely prevent. 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). TLC Coordinator — 30 hours per week (75 % Full Time Equivalent - FTE) TLC Assistant Coordinator — 20 hours per week Three (3) TLC Family Associates - 10 hours per week each (one Family Assoc . is bi-lingual) Secretary — 10 hours per week The TLC staff have nursing, psychology or child education backgrounds and all have college degrees . The continuity and professionalism of the current staff have been one of the cornerstones for theprogram ' s success over the last five years . 5. How will the target population be made aware of the program? Contact is made at the hospital with the mother and family of the newborn. TLC Newborn brochures, which describe the services, are at Indian River Memorial Hospital, Indian River County Health Department, and obstetric medical providers ' offices and distributed at health fairs . Hospital personnel enthusiastically describe and endorse TLC Newborn to the mothers . Because the program is universal in nature, much of the awareness comes from word of mouth from the 1 ,000 new moms and families the program serves each year, as well as from the grandparents and relatives of the newborn . The IRCHS Coalition also markets the program through its newsletter, public presentations, every other month Coalition meetings, and at health fairs or other public events . 6. How will the program be accessible to target population (i. e. location, transportation, hours of operation) ? Visits to Indian River Memorial Hospital are made six out of seven days of each week by the TLC Newborn personnel who meet the mother of every newborn either the day of delivery of her baby or the day after. Infants born on Sunday, are normally contacted on the second day after delivery. Follow up phone calls are made with each family of a newborn who is interested in participating in the TLC Newborn program, which is over 95 percent of all newborn families seen by TLC in Indian River County, 7 Indian River County Healthy Start Coalition, Inc. — 2003 -04 TLC Newborn program IRC Board of County Commissioners — Children 's Services Advisory Committee D. MEASURABLE OUTCOMES (Description of Intent) In order to show the impact your program is having on the target population and the community, the funders are requiring measurable outcomes . Please review the examples and summaries below to insure your understanding of what is expected. OUTCOMES : Describes what you want to achieve with the target population. Indicates the results of the services you provide, not the services you provide. Outcomes utilize action words such as maintain, increase, decrease, reduce, improve, raise and lower. ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the results stated in the outcomes . Activities utilize action words such as complete, establish, create, provide, operate, and develop . The activities should reflect the services described in the PROGRAM DESCRIPTION (C2) . D . MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all the elements or the Measurable Outcomes Add the tasks to accomplish the Outcome(s) * 1 . GOAL : 40 % of all clients who accept 1 . During the first month telephone calls will phone calls will be provided reassurance by be made to clients . The discussion of these the TLC Newborn staff during the first phone calls will be centered around care of the month. This will be measured by infant and development of the infant. If a documenting what area the client needed parent is identified as needing reassurance, reassurance in and what the staff did to then the staff will provide necessary promote reassurance. information both verbally and written in order to provide the parents reassurance. *2. GOAL : 30 % of clients who of clients 2 . During the first month and any time there who accept phone calls will receive after if a client is identified as needing additional mailouts/information/referrals additional information or has a need for a during the first month. referral staff will first explain the information and/or referral then send information in the mail to the client. The client will also be advised if at anytime they need further explanation to just call . *3 . GOAL : 30 % of the clients who accept 3 . If a client is identified as having a lack of phone calls will have a understanding understanding on any topic that TLC Newborn during the first month through has discussed with them or if their lack of explanations, literature, referrals and this understanding is related to a topic that TLC understanding will be measured by Newborn has not discussed with them, TLC evaluating if the client followed through Newborn staff will take the time to go over the with the suggestions, referral and/or topic until parent has verbalized their literature. understanding. TLC Newborn will then follow * note: These first three Outcomes Goals were modified from the up at the time of the next phone call to see if understanding had been retained by client. If previous ear's based on the recommendations provided at the 2003 8 Indian River County Healthy Start Coalition, Inc. — 2003 -04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee United Way training on goal and objective development. The goals not then the steps will be repeated. were altered to match the mission statement of the TLC program and utilize the more reliable progress reports from the TLC Family Associates to verify success in achieving the desired outcomes . The percentages were based on available data from the present progress reports and should increase dramatically in the following year. PROCESS OBJECTIVES 4. GOAL : TLC Newborn staff will visit 4 . Six out of seven days a week, a 98 % of women who deliver at Indian River representative of TLC Newborn will visit Memorial Hospital. Indian River Memorial Hospital and offer the TLC Newborn program to mothers of newborns . 5. GOAL : 93 % of mothers who are visited 5 . Continued promotion of the program at the hospital will accept the invitation to through press releases, brochures, and participate in the TLC Newborn Program. information to medical providers and health fairs . 6. GOAL : 90 % of families will be reached 6 . Persistent telephone calls to follow up with and result in a significant conversation with the family. a parent and/or caregiver two times the first month . 7. GOAL : 90 % of referrals will be followed 7 , The Family Associates will continue to track up and confirmed as to whether or not the referrals to families and report on whether they family acted on the referral. have followed through. 8. GOAL : 7.5 % of families will call 8 . Upon intake at the hospital and during requesting additional information, conversations with families, staff will reassurance or referrals. encourage participants to call in with questions or concerns . 9 Indian River County Healthy Start Coalition, Inc. — 2003 -04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee 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 Indian River County Health Dept. * Free office rent * Conference room access * Access to office equipment such as computers, copier, postage, fax and telephone services . * Staff supervision * Storage space * Payroll services * Cleaning * Purchasing services * Personnel services * clerical support * outreach All these services are provided in-kind, with no administrative fee. Indian River Memorial Hospital * Access to mothers, with appropriate guidelines . * Pertinent information, especially in case of infant mortality, which is discreetly relayed to TLC Newborn personnel when needed. As with all medical facilities, confidentiality is observed throughout. * Storage space for TLC paperwork, manuals and references in respective Labor and Delivery areas . * Positive promotion of TLC program to new mothers by all hospital staff. * Comfortable communication between medical providers and TLC staff. All these services are provided in-kind, with no administrative fee. IRC Library — Born to Read Provides two books to newborn families that are given Program to the family of the newborn by the Stork Club . The TLC staff provides evaluation two months after birth by asking the mother if they have read the books to their children, with a follow-up of emphasizing the importance of reading to their infant towards enhancing brain development. Visiting Nurses Association of the * Provides home visitation for mothers of newborns Treasure Coast experiencing breastfeeding difficulties or in need of greater breastfeeding education. Breastfeeding home visitation charge is $ 50. 00 per visit by the VNA. Indian River County Healthy Start * Overall program development, integration and Coalition communication within all four IRCHSC programs (Healthy Start, Healthy Families, Safe Kids & TLC) . (While the Coalition is the applying * Fundraising, PR and marketing of TLC program . agency, many in-kind collaborative * In cooperation/collaboration with the IRC Health efforts on behalf of the TLC program Department, TLC Program QA/QI, reports and take place) troubleshooting. * Provide TLC representation at United Way and other public events . * Presentations to All these services are provided in- community groups regarding the TLC Program . kind, with no administrative fee. * Development and presentation of TLC RFP/Grant(s) . * Fiscal oversight and reimbursement requests , 10 Indian River County Healthy Start Coalition, Inc. — 2003-04 TLC Newborn Program IRC Board of County Commissioners — Children's Services Advisory Committee 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 All babies born to Indian River County residents are eligible for the TLC program. The initial intake form that is completed at the hospital provides the program with all the demographic information that it needs to provide the funder with their information. All the information on the form is available for analysis, depending on the reporting requirements . The Coalition also receives all Indian River County resident birth information from the Florida Dept. of Health Vital Statistics office for birth outcome analysis purposes . 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 ? The initial intake form that is completed at the hospital provides basic reporting and baseline information for analysis purposes and demographics . For the 2003 -04 year, the progress chart form that the TLC Family Associates use will be modified to answer Goals One through Three . The TLC program has a special data base designed to monitor and document the process objectives . Surveys are sent out to the families during the third month of their child ' s birth and at the completion of the 12 month survey. This information is tallied and results put in the requested reports . Goals and objectives information are collected by each TLC staff member, and is inputted into a data base on a daily basis, with the number of families served, phone calls and referrals recorded, along with other needed information. The Twelve Month Survey is much shorter in length and focuses on open ended responses addressing major benefits of the program in terms of the TLC families perspective . The Three Month Survey is based on a "strongly agree" to "strongly disagree" Liekert scale format. The survey involves ten questions and addresses specific program issues . 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? Data collected will be compiled in reports requested by the funder and provided to the funder, The IRC Healthy Start Coalition, and the IRC Health Department. The Coalition and Board representatives hold a quarterly TLC committee meeting, which reviews the reports as well as overall program issues. The Coalition Board of Directors also receives the reports upon completion. In addition, a verbal report is provided by the TLC Coordinator at the every other month Coalition meetings . Lastly, a Program Managers meeting, involving TLC , Healthy Start, and Healthy Families Program Managers are held each month at the Coalition office. This meeting addresses program issues individually, which includes updating each Program Manager on the programs status, as well as ensuring overall communication, collaboration and integration. 11 Indian River County Healthy Start Coalition, Inc. — 2003-04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee 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 rior sections. Month/Period Activities All components of the TLC Newborn Program are in place, with a veteran TLC staff providing services . The hospital visits take place on a daily basis, except Sundays . The major programmatic action steps and activities of the TLC program are the following : Daily: Hospital visit by TLC Associate (except on Sundays) . * Retrieve security badge from Social Workers office . * Visit maternity ward nurses station for list of new deliveries . * Review list with TLC log for families who have been previously visited. * Prepare intake and request for services forms as well as TLC brochure. * Present TLC program to mom and family of newborn . * Complete intake form and have mom sign agreement to services form. * Repeat visit to all mothers of newborns not previously seen. * Complete TLC log located at hospital. Office : * Continue intake process , including logging information on computer and setting up file of family. * Assign families of newborns to TLC Assoc. (within one week of birth) . * Send customized mailing based on family' s needs . 1St Month : * Call families of newborns weekly for one month after birth of newborn . * First "Wee Wisdom" newsletter is mailed. * During second month (from birth), phone calls are made every two weeks . Monthly: * From third to sixth month (from birth) , calls are made one time per month. * Age (month) appropriate newsletter is mailed each month. * On second Friday of each month, newsletters are compiled for monthly mailings . * After 3rd and 12th month, appropriate program evaluation surveys are mailed. * On a quarterly basis, send sibling newsletter for families with children ages 13 months to age four will be mailed. 12 Indian River County Healthy Start Coalition, Inc. — 2003 -04 TLC Newbom Program IRC Board of County Commissioners — Children 's Services Advisory Committee H. PROJECTIONS FOR UNDUPLICATED CLIENTS Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2001/2002 . Budget 2002/03 Projections 2003/04 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 827 485 826 S . Indian River County 1 ,211 15455 1 ,240 Indian River Co. Total 2 , 038 1 , 940 29066 TOTAL SERVED 25038 15940 206 ( 10 19 families) (970 families) 1 0033 families) North IRC is made up of births in zip codes : 32958 , 32967, 32948 , 32970, and half of births from zip code 32963 . South IRC is made up of births from zip codes : 32966, 32960, 32968 , 32962 , 32961 and half of births from zip code 32963 Nm ber of Ullduplic ed Clief s by Age last; 3scal YearAd l CUMMt Fiscal Year Next Fiscal Year Location Budget M03 Projections 2MO4 - nc i. 1 . 1 . .duals amr IntvidtWs G mW oto 4 - (Pre-scklool) 1019 (infazrts) - 970 (ffi&ts) - 1033 (Mats) - MEN 5 to 10 - (Hemmtwy) 11 to 14 - (1V1'iddle) 15 to 18 - (Hgh School) 99 (teen 94 (teen mora,) - 100 (teem num) - 19 to 59 - (Addlts) 920 (rnotl>ets) - 876 (ms) - 933 (ns) - 60 + (Seticrs) - - - - - - TIIIAL, SERVED 29038 - 19910 - 2,066 - * The TLC NeWxmm program also provideus seiv m to fathers, who are not counted or shown 13 Indian River County Healthy Start Coalition , Inc. Page 14 2003-04 TLC Newborn Program 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 Speck Budget Forms. AGENCY/PROGRAM NAME : Indian River County Healthy Start Coalition , Inc. = TLC Newborn Progral FUNDER : IRC BOCC = CSAC L _ . AEN Y Proposed Total Program Funder Specific Total A REVENUES (SHOWDETAIL6 Budget gency CALCULAnoNs) g Budget Budget 1 Children's Services Council-St. Lucie 2 Children's Services Council-Martin 3 Children's Services Council-0keechobee 4 Advisory Committee-Indian River 20,000.00 209000.00 75,000. 00 5 United Way-St, Lucie County 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County 55,000.00 559000.00 9 Department of Children & Families 10 County Funds 11 Contributions-Cash 3 ,000.00 12 Program Fees 13 Fund Raising Events-Net 31000. 00 12,000.00 14 Sales to Public • Net 15 Membership Dues 16 Investment Income 17 Miscellaneous John's Island Community Service League 109000.00 109000.00 18 Legacies & Bequests DOH/FL Ounce/ 19 Funds from Other Sources March of Dimes 7499171 .00 20a Reserve Funds Used for Operating 20b In-Kind Donations (Not included in total) 30 ,000. 00 479000.00 21 TOTAL REVENUES (doesn't Include line lob $88,000 .00 $209000.00 $9049171 .00 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY (SHOW CALCULATIONS) Budget Budget Budget 22 Salaries - (must complete chart on next page) 54 ,000.00 20,000 .00 6129251 .00 0 Salary 23 FICA - Total salaries x 0. 0765 7.65% 41131 .00 0.00 469837.00 e Yemen - Annual pension or qua I le 24 staff 7.30% 11750. 00 0 . 00 249504.00 Life/Health - Medical/Dental/Short-term 25 Disab. 19.25% 4 ,616 . 00 0 .00 45,000.00 Workers Compensation - # effip5oyees x 261 rate (HF-IRC only 2,900.00 on a unemployment - prolec a 0.00 2,900.00 27 employees x $7,000 x UCT-6 rate (HF-IRC only 0. 00 11200. 00 5/27/03 14 Indian River County Healthy Start Coalition, Inc. Page 15 2003-04 TLC Newbom Program SALARIES A B D Gross Annual Portion of C % of Gross Annual POSITION LISTING Salary program Proposed Funder Specific Budget Salary Position Tifle / Total Hrs/wk (Agency) Requested(CIA) Example: Executive Director/ 40 hrs 70,000.00 10,000.00 5,000.00 7. 14% TLC Coordinator (30 hours) 31 ,972.00 23,979.00 13,200.00 41 .29% TLC Assistant Coordinator (20 hours) 12,517.00 12,517.00 61800.00 54 . 33°/ Family Associate (10 hours) 41509.00 4 ,509. 00 0. 00% Family Associate ( 10 hours) 41509 . 00 41509.00 0.00% Family Associate ( 10 hours) 4,509.00 49509.00 0. 00% Secretary ( 10 hours) 3 ,977.00 3 ,977.00 0 .00% #DIV/0! Healthy Families - IRC 249, 881 .00 0. 00% IRC Healthy Start Care Coordination 183,424.00 0 . 00% IRC Healthy Start Coalition , Inc. 116,953 .00 0 . 00% #DIV/0 ! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0! Total Salaries $612,251 .001 $54 ,000 . 00 $20 ,000.00 3 .27% FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B c D E F G Specific RCA 7. 65% Pension Health InsWorker's Unemp/oyme Total Fringes Funder Column C only, from line 22 to 27) Budget (A x % .) Compens. nt Compens. Specific Position Title / Total Hrs/wk Example: Case Manager/ 40hrs 51000.00 382.50 200.00 500.00 300,001 200.00 1,582.50 TLC Coordinator (30 hours ) 13,200 .00 0 . 00 0.00 0. 00 0 .00 TLC Assistant Coordinator (20 hours) 61800.00 0 .00 0.0 Family Associate ( 10 hours) 0 . 00 0. 00 0.0 Family Associate ( 10 hours) 0. 00 0. 00 0 .0 Family Associate ( 10 hours) 0 .00 0 . 00 0. 00 Secretary ( 10 hours) 0 .00 0 . 00 0 .0 0. 00 0 .00 0 . 0 0 . 00 0 .00 0 . 0 0. 00 0 . 00 0 .0 0. 00 0 . 00 0 .0 0 .00 0 . 00 0. 00 0. 00 0 . 00 0 .0 0 .00 0 .00 0. 00 0. 00 0. 00 0 .00 0 . 00 0 . 00 0 .00 0 .00 0 . 00 0. 00 0 . 00 0. 00 0 .00 0 . 00 0 .00 0 . 0 0.00 0. 00 0 .00 0. 001 0 . 001 0 . 0 Total Funder Request Fringe Benefits $20 ,000. 001 $0 . 001 $0 . 00 $0 .00 SO- 001 $0 .0 5/27/03 15 Indian River County Healthy Start Coalition , Inc. Page 16 2003-04 TLC Newborn Program B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific AGENCY USE ONLY TO P Total Agency SNOW DETAIL Budget Budget Budget 28 Travel-Daily 5 staff at 11425.00 0.00 18,500.00 # of Staff x average # of miles/wk x 50 wks x average 21 $ = Estimated Daily Travel/Mileage Reimb. miles per week. 29 Travel/Conferences/Training 500.00 0 .00 12,000.00 • National Conference (cost per staff) local and • Training/Seminar (cost per staff) regional training • Other Trainings (cost of travel , lodging , for TLC Coord . registration , food) And/or staff 30 Office Supplies 800. 00 0. 00 61000.00 • Office supplies (monthly average x 12 monthly months = estimated cost of office supplies average of based on present history. $66.66 31 Telephone 0. 00 0.00 11 ,000 .00 • # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Provided in-kind by IRC County Estimated cost of long distance Health Department (CHD) 32 Postage/Shipping Average of 41884 .00 0. 00 81000.00 • Quarterly Mailing of Newsletter 1100 pieces per Monthly mailing of age appropriate • Special events , etc. month at .37 newsletter, surveys , sibling newsletters • Bulk mailings - appeals cents and first mailing the week of birth . 33 Utilities 0.00 0.00 69500. 00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) Provided in-kind by CHD 34 Occupancy (Building & Grounds) 0.00 0.00 26 ,600.00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes Provided in-kind by CHD 35 Printing & Publications 2 ,719.00 0.00 69000.00 Quarterly Newsletter ($ x 4) Letterheads , Envelopes , etc. Update and re- Fundraising materials printing of Other newsletters. 36 Subscription/Dues/Memberships 0.00 0.00 21000 .00 • Dues • Subscriptions to Newspapers/magazines, etc. 37 Insurance 0.00 0.00 29530.00 • Directors/Officers Liab. • Commercial/General Insurance • Bond Ins. Provided in-kind by IRCHSC and • Auto Insurance CHD 38 Equipment : Rental & Maintenance 0 . 00 0.00 4 ,500 .00 • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other Provided in-kind by CHD 39 Advertising 0.00 0.00 100.00 • Newspaper ads • Fundraising ads/promotions Provided in-kind by IRC Healthy • Other (vacancies) Start Coalition (IRCHSC) or CHD 40 Equipment Purchases: Capital Expense 0 .00 0. 001 5,000 . 00 5/27/03 16 Indian River County Healthy Start Coalition , Inc. Page 17 2003-04 TLC Newbom Program • Computer/monitor (# x $) • Laser Printer 41 Professional Fees (Legal, Consulting) 0.00 0.00 13000.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other Provided in-kind by IRCHSC or CHID 42 Books/Educational Materials Age-approriate 500.00 0 . 00 22500.00 • Books/videos brochure and • Materials ($ x staff) bookliet info. 43 Food & Nutrition 0.00 0.00 0.00 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 44 Administrative Costs 0 .00 0 .00 35,242.00 • Admin. Cost (% of total budget) Provided in-kind by IRCHSC or CHID (HSCC and HF4RC 45 Audit Expense 0 . 00 0 . 00 9,500.00 • Independent Audit Review Provided In-kind by IRCHSC 46 Specific Assistance to Individuals 0.00 0.00 29000.00 • Medical assistance • Meals/Food • Rent Assistance • Other 47 Other/Miscellaneous 175. 00 0 .00 3,000.00 • Background check/drug test • Other Volunteer luncheon 48 Other/Contract 60 BF visits at 29500 .00 0 . 00 9,000.00 Sub-contract for program services $50.00 per visit VNA breastfeeding home visits 49 TOTAL EXPENSES $80,900.00 $20,000. 001 $9031664.00 5/27/03 17 IRCH Sfthy Slat CoWlSon. Inc. 2°03-04 TLC NevAmn PWmn UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME : IRC HealthyStart Coalition , Inc. - TLC Newborn Program FY 01/02 FY 02/03 FY 03/04 % INCREASE FYE 7/1/01 - 6/30/02 FYE 7/1/02 - 6/30/03 FYE 7/1 /03 - 6/30/04 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Cool. ByCol. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0. 00E#DIV101 ! 2 Children's Services Council-Martin 0.00 ! 3 Children 's Services Council-Okeechobee 0.00 4 AdvisoryCommittee-Indian River 55 000.00 550000 0 75,000.006.36% 5 United Way-St. Lucie County 0.00 ! 6 United Way-Martin County0.00 #DIV/0! 7 United Way-Okeechobee County 0.00 #DIV/01 e United Way-Indian River County 49 510.00 50 000. 00 55 000. 00 10.00% 9 Department of Children & Families 0.00 #DIV/0! 10 CountyFunds 0.00 #DMO! 11 Contributions-Cash 2s522.00 3.000.00 #DIV/0! 12 Program FeesEm 0.00 #DIV/01 13 Fund Raising Events-Net 51000.001 M 12 000.00 12 000.00 0.00% 14 Sales to Public-Net 0.00 #DIV/O! 15 Membership Dues 0.00 #DIV/01 16 Investment Income 0.00 #DIV/01 17 Miscellaneous 10 000.00 #DIV/0! 18 Legacies & Bequests 0.00 #DIV/01 19 Funds from Other Sources 788 119.00 758 083.00 749171 .00 -1 . 18% 20a Reserve Funds Used for Operating 10 000.00 0.00 -100.00% 20b In-Kind Donations (Not Included In total) 17 067.00 15 000.00 4700000 213.33% 21 TOTAL 900151 .00 885w083.00 904171 .00 2. 16% EXPENDITURES 22 Salaries 580 562.00 M 597 670.00 612 251 .00 2.447 23 FICA 44 413.00 42 016.00 46 837.00 11 .47% 24 Retirement 26125.00 24 504.00 24 504.00 0.00% 25 Life/Health 35 075.00 61 774.00 45 000.00 -27. 15% 26 Workers Compensation 27500.00 2250000 21900. 00 16. 00% 27 Florida Unemployment 19200.001 - 19200.00 10200.00 0.00% 28 Travel-Daily 16 325.0017 650.00 18 500.00 4.82% 29 Travel/Conferences/Training 11 590.00 13 500.00 12 000.00 -11 . 11 % 30 Office Supplies 79653.00 59000,00 600000 20.00% 31 Telephone 16 943.00 10 550.00 11 000.00 4.277 32 Postage/Shipping 89014.001 - 61700.001 81000.00 19.40% 33 Utilities 3j842.00 6 500.006 500.00 0.00% 34 Occupancy (Building & Grounds 26p444.00 24 600.00 26 600.00 8. 13% 35 Printing & Publications 49643.00 54000.00 6 000.00 20.00% 36 Subscription/Dues/Memberships 193S8.00 10100.00 200000 81 .82% 37 Insurance 79448.001 29530.001 21530.00m 0.00% 38 E ui ment:Rental & Maintenance 41800.00 4 750.00 4 500.00 -5.26% 39 Advertising 551 .00 98.00 100.00 2.04% 4o Equipment Purchases:Ca ital Expense 91500.00 1 500.00 5,000.00 233.33% 41 Professional Fees (Legal, Consulting) 12 138.000.00 1 000mmm� .00 #DIV/01 42 Books/Educational Materials 39364.001 29400.001 22500.00 4. 17% 43 Food & Nutrition 0.00 0.00 0.00 #DIV/0! 44 Administrative Costs 39 233.00 35 242.00 35 242.00 0.00% 45 Audit Expense 14 500.00 1050000 9$500.00 -9.52% 46 Specific Assistance to Individuals 39000.00 21000.00 21000. 00 0.00% 47 Other/Miscellaneous 11 910.00 1y163.001 39000.00 157.95% 48 Other/Contract 14 285.00 30000.00 90000.00 200. 00% 49 TOTAL 907 416.00 883 447.00 903 664.00 2.29% 5o REVENUES OVER/ UNDER EXPENDITURES -71265.001 11636.00 507.00 -69.01 % 5mm3 to Indim Rb County Hea yStart C94iti . fm. 200304 TLC Ne Program UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : IRC HealthyStart Coalition, Inc. - TLC Newborn Program FY 01 /02 FY 02/03 FY 03/04 % INCREASE FYE 7/1 /01 - 6/30/02 FYE 7/1/02 . 6/30/03 FYE 7/1/03 - 6/30/04 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (Col. C-Col. eucol. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIWO! 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Children's Services Council-Okeechobee 0.00 #DIW0 ! 4 Advisory Committee-Indian River 15 000.00 %000.00 20 000.00 33.33% 5 United Way-St. Lucie County 0.00 #DIV/01 6 United Way-Martin County #DIV/0 ! 7 United Way-Okeechobee County #DIWOI 8 United Way-Indian River County49 510.001 M 50 000.00jH_ 10.00% 9 Department of Children & Families #DIV/0 ! 10 CountyFunds #DIWOI 11 Contributions-Cash #DIV/0! 12 Program Fees DIV/01 13 Fund Raisin Events-Net 3 000.00 3 000.000.00% 14 Sales to Public-Net DIV/0!15 Membershi Dues DIWOI 16 Investment Income 0.00 #DIV/01 17 Miscellaneous 10 000.00 #DIV/01 18 Legacies & Bequests 0.00 #DIWO! 19 Funds from Other Sources 0.00 #DIV/0 ! 2oa Reserve Funds Used for Operating 0.00 #DIV/01 lob In-Kind Donations (Not minded in total) 30 000.00 30000=00 30 000.00 0.00% 21 TOTAL 67 510.00 68,000.00 : 88 000.00 29.41 %1 EXPENDITURES 22 Salaries 49163.00 47 877.44 54 000.00 12.79% 23 FICA 3 760.00 3 662.00 4131 .00 12.81 % 24 Retirement 2190.00 19346.00 19750.00 30.01 % 25 Life/Health 2 273.00 39550.00 41616.001 30.03% 26 Workers Compensation 0.00 0.00 2,900.00 #DIV/01 27 Florida Unemployment 0.00 0.00 0.00 #DIV/01 28 TraveiwDaily 940.00 2,000.00 11425.00 -28.75% 29 Travel/Conferences/Training 48.00 11000,00 500.00 -50.00% 30 Office Supplies 4 604.00 11000,00 : 800.00 -20.00% 31 Telephone 43.00 0.00 0.00 #DIV/0! 32 Postage/Shipping 51489.00 31500.00 4p884.00 39. 54% 33 Utilities 0.00 0.00 0.00 #DIV/01 34 Occupancy (Building & Grounds 0.00 0.00 0.00 #DIWO ! 35 Printing & Publications 21220.00 17000.00 29719.00 171 .90% 36 Subscription/Dues/Memberships 0.00 0.00 0.00 #DIV/01 37 Insurance 0.00 0.00 0.00 #DIV/01 38 Equipment: Rental & Maintenance 0.00 0.00 0.00 #DIV/01 39 Advertising 0.00 0.00 0.00 #DIV/01 4o Equipment Purchases:Ca ital Expense 0.00 0.00 0.00 #DIV/01 41 Professional Fees (Legal, Consulting) 29389.00 0.00 0.00 #DIV/01 42 Books/Educational Materials 21285.001 400.00 500.00 25.00% 43 Food & Nutrition 0.00 0.00 0.00 #DIV/01 44 Administrative Costs 0.00 0.00 0.00 #DIW0l 45 Audit Expense 0.00 0.00 0.00 #DIWOI 46 Specific Assistance to Individuals 0.00 0.00 0.00 #DIV/01 47 Other/Miscellaneous 169.00 163.00 175.00 7.36% 48 Other/Contract 0.00 250000 2500.00 0.00% 49 TOTAL 75 573.00 6799844 80 900.00 18.97% 5o REVENUES OVER/ UNDER EXPENDITURES .8,063.001 1 .56 7, 100.00 455028.21 % 527103 19 IRC Healthy Start Coalition, Inc. TLC Newborn Program UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : IRC Healthy Start Coalition , Inc. - TLC Newborn Program FUNDER : IRC Board of County Commissioners - CSAC 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 54 , 000 .00 209000 . 00 37 .04% 23 FICA 4 , 131 . 00 0 . 00 0 .00 % 24 Retirement 19750 . 00 0 . 00 0 .00% 25 Life/Health 49616 . 00 0 . 00 0 . 00 % 26 Workers Compensation 29900 .00 0 . 00 0 .00 % 27 Florida Unemployment 0 .00 0 .00 #DIV/0 ! 28 Travel =Daily 19425 . 00 0 . 00 0 . 00 % 29 Travel/Conferences/Training 500 . 00 0 .00 0 .00% 30 Office Supplies 800 . 00 0 . 00 0 .00 % 31 Telephone 0 . 00 0 .00 #DIV/01 32 Postage/Shipping 41884.00 0 . 00 0 .00 % 33 Utilities 0 .00 0 .00 #DIV/01 34 Occupancy ( Building & Grounds 0 .00 0 . 00 #DIV/0 ! 35 Printing & Publications 21719 . 00 0 .00 0 . 00% 36 Subscription/Dues/Memberships 0 .00 0 . 00 #DIV/0 ! 371nsurance 0 . 00 0 . 00 #DIV/0 ! 38 Eq ui ment : Rental & Maintenance 0 .00 0 . 00 #DIV/01 39 Advertising 0 . 00 0 . 00 #DIV/01 Q Equipment Purchases : Capital Expense 0 . 00 0 . 00 #DIV/01 41 Professional Fees (Legal , Consulting ) 0 . 00 0 . 00 #DIV/01 42 Books/Educational Materials 500 . 00 0 .00 0 . 00 % 43 Food & Nutrition 0 . 00 0 . 00 #DIV/0 ! 44 Administrative Costs 0 . 00 0 .00 #DIV/01 45 Audit Expense 0 . 00 0 .00 #DIV/01 46 Specific Assistance to Individuals 0 . 00 0 . 00 #DIV/01 47 Other/Miscellaneous 175. 00 0 .00 0 .00% 48 Other/Contract 29500 . 00 0 . 00 0 . 00 % 49 TOTAL $80 ,900 . 00 $20 , 000 . 00 $0 .25 5/27/03 20 IRC Healthy Start Coalition, Inc. 2003-06 TLC Newborn Program UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: IRC Healthy Start Coalition, Inc. = TLC Newborn Program FUNDER: IRC Board of County Commissioners - Children's Services Advisory Committee UNE /TEM EXPLANATION FOR VARIANCE #DIV/O! #DN/0! #DN/0! The TLC Coordinators portion of time with the TLC Program has increased by 6 hours, or from 60% to 75% of her time for 2003-04, to truly reflect the amount of time spent on the TLC program. In the past years, Healthy Start Care Coordination funds were used to cover the 15% difference. However, due to a full-time Bi-lingual Outreach Coordinator being added to Healthy Start Care Coordination for Advisory Committee-Indian River. 2003 and 2004 , the 33.3% difference in funds are needed to match this March of Dimes grant position for the upcoming year. #DIV/01 #DIV/0! #DN/01 #DN/0! #DN/Ol #DN/01 #DN/O! #DN/0! #DN/O! #DN/0! #DN/OI #DIV/0! #DN/0! #DIVIO! TLC is paying a greater percentage of the TLC Coordinators position and utilizing the latest retirement percetages from the IR County Retirement Health Dept. TLC is paying a greater percentage of the TLC Coordinators position and utilizing the latest health benefits percetages as provided by Life/Health the IR County Health Dept., which also could reflect inreases in premiums. #DN/01 #DN/0! #DIV/01 Postaae/ShirlDina Postage has increased in the last fiscal year, along with the number of newsletter mailing due to sibling and special mailings. #DN/Ol #DN/01 The supply of newsletters will need to be updated and replenished as stocks deminish, as well as reflecting potential increases in Printing & Publications printing expenses. #DN/O! #DN/01 #DNI01 #DN/Ol #DN/0I #DN/01 A large number of brochures, pamphlets and educational items will need to be replenished, as well as factoring increases in costs of Books/Educational Materials items. #DN/0! #DIV/0! #DN/Ol #DIV/0! 527/03 21 IRC Heallhy Start CoaMm. Inc. 2003-04 TLC Newbom PrWmn UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME : IRC Healthy Start Coalition, Inc. - TLC Newborn Program FUNDER: IRC BOCC - CSAC LINE ITEM EXPLANATION FOR VARIANCE he I LC Coordinators portion of time with the TLC Program has increased y ours, or m o to 75% of hertime r , to truly reflect the amount of time spent on the TLC program. In the past years, Healthy Start Care Coordination funds were used to cover the 15% difference. However, due to a full-time Bi-lingual Outreach Coordinator being added to Healthy Start Care Coordination for 2003 and 2004 , the 33.3% difference in funds are needed to match this March of Dimes grant position forthe upcoming year. For 2003/04 FY, BOCC-CSAC funds are being used to support the .75 FTE TLC Coordinator and the .50 FTE Assistant TLC Coordinator, Salaries as compared to supporting the TLC Family Associates in 2002/03. #DNIO! #DN/0! #DN/0! #DN/O! #DNIO! #DN/0! #DN/0! #DN/O! #DIV/01 #DIV/0! #DIVIO! #DN/0! #DIV/O! #DNIO! 527/03 22 Indian River County Healthy Start Coalition, Inc. — 2003-04 TLC Newborn Program IRC Board of County Commissioners — Children 's Services Advisory Committee ORGANIZATION : Indian River Healthy Start Coalition Inc PROGRAM . TLC Newborn Program 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) , a 0 0 a I I I I I I I * 0 0 0 . . . . 4 " " , * . . . . . . . . . . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 , a " 1 * * * 5 C . PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1010 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . * * 61 , 106 1 * 11 * 0600000 * 0 8 X E. COLLABORATION (one page maximum) 10 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X 2 . Measures . . . . . . . . . . a @ * # * * a a & * 000 . . . . . . 0 . . . . . . . . 0 0 . . . . . 0 0 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X G. TIMETABLE (one page maximum) 0 . . . . . . 0 . . 6 . 1 . . . . . . . . . . . . . . . . 12 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . , . , " Goa 13 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1 Indian River County Healthy Start Coalition, Inc. — 2003-04 TLC Newbom Program IRC Board of County Commissioners — Children 's Services Advisory Committee I. BUDGET FORMS X 1 . Budget Narrative Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 X 3 . Total Program Budget. . . . * IV 66 6400069 go * * * 19 X 4 . Funder Specific Budget. 1 11 000 6 " 1 * * * I ' ll * $ 00 . . . . 20 X 5 . Explanation for Variances — Total Program Budget . . . . . 0 21 X 6 . Explanation for Variances — Funder Specific Budget . 22 na J. FUNDER SPECIFIC/ADDITIONAL SHEETS X K. APPENDIX 2 Combined Appendix �J � For the 2003 - 2004 Indian River County Healthy Start Coalition ' s Grant Applications for Healthy Famlies - IRC Program and TLC Newborn Program 2003 Indian River County Healthy Start Coalition Board of Directors Board Member Phone Numbers E-Mail Term (start) Term (end) Affiliations Jean Anderson 772-388-2948 (H) TLCJean@aol . com 2/Jan '02 Dec '04 Community Resident/ President Fax: 772-38 &2948 Volunteer-founder of 9785 61 st Place TLC program in NY. Sebastian, FL 32958 Fanny Muskulus 772-234-8892 (Ii) Tobyl@atlantic.net Aug '00 Dec '03 Community Resident/ Vice President Volunteer 1563 Coral Oak Lane Vero Beach, FL 32963 Christine Horrocks 772478 -6882 chorrocksmail@cs. com Treasurer Fax : 772478-6947 4625 5th Place Vero Beach, FL 32968 Josie Lieberman 772- 589-6054 (II) Secretary Fax: 772-589-6053 Ellen66666@aol. com Aug '99 Dec '02 Community Resident/ 8580 Seacrest Drive Volunteer Vero Beach, FL 32963 MikeBurgelin 772-388- 8578 (H) mike burgehn@juno . comJune 'O1 Dec '04 President, I.B . 0 401 Candle Avenue Fax: 772-581 -8388 Employer Services Sebastian, FL 32958 Cell : 772-532-2261 Ken Hoffman 772-234-9426 M KenH@gate. net May '00 Dec '02 local Attorney 530 Camelia Lane Fax : 772-234-9427 Vero Beach, FL 32963 Margaret Ingram 772-564-3300 (VV) Spider4B@aol. com Aug '00 Dec '03 Teacher-Beachland Teacher 772-5624739 Elementary School 3551 Mockingbird Drive Vero Beach, FL 32963 Page One of Two Board Member Phone Numbers E-Mail Term (start) Term (end) Affiliations NfikeLundeen 772- 564-2627(W) strgsol@aol.com Sept '99 Dec '03 Owner- Storage 3900 US HWY 1 Fax : 772- 564-2628 Solutions PakMail Vero Beach, FL 32967 Other : 772470-3666 Pat Lundell 772-589 -3288 DLLundell@aol. com Aug '99 Dec '03 LearningNest 1140 49th Avenue Child Care Center-Owner Vero Beach, FL 32966 Teacher-Glendale Elementary David Shapiro 772-9784640 (W) dshapiro@VBPD . org May '00 Dec '02 Vero Beach Police Dept . 1055 20th Street 772-978-4691 Vero Beach, FL 32960 Updated : 2/26/03 Page Two of Two Y INDIAN RIVER COUNTY HEALTHY START COALITION, INC. Financial,Statements with Independent Auditors' Report Years ended June 30, 2002 and 2001 2- 1' r f Table of Contents Page Independent Auditors ' Report , . " . . . 10001 * 1 2 Financial Statements : Statements of Financial Position . , , * , * . . . . . . . 3 Statementsof Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 r E Statements of Functional Expenses . . " , " , . . . ' Ile , 1 . 1100 , 1111 , 119 , 0 * 486068 09 , 91111 . 01111 1 ' Ile woo so 5 Statementsof Cash Flows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Notes to Financial Statements , " . . . . . . 011111 001 , 10011 , * to , * , 1111 , 1900 * 4 too . . . . 9060 ' e " * 1 7 - 9 Additional Information : Schedule of Expenditures of State Financial Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Independent Auditors' Report on Compliance and>on. Internal Control over Financial Reporting based on an Audit of Fina-nciaTStatements Performed in Accordance with Government Auditing Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Independent Auditors ' Report on Compliance and Internal Control over Compliance Applicable to Each Major State Financial Assistance Project. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 - 13 Management Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 - 15 . . . . . . . . . . . . . . . . . . . . . Schedule of Findings and Questioned Costs16 Summary Schedule of Prior Audit Findings . . . , . , . . . . . . . , ' , , , , 0 & & * a & ISO , 17 - 19 F. MAS ® ,Haire, Kl� etz., Nuttall, Field MICO AEL L. OKMETZECPA, PFS 'HAIR , CPA �' SCOTT A. NUTTALL, CPA, CFP re Co ., charted po DANIEL E. FIELD, CPA /, y ® Q 6i BRIAN J. ELWELL, CPA, CVA Ima PATRICK K. GRAHAM, CPA L.119 , ® � I Tax, Business and Financial Consultants HARVEY L. HERRST, CPA mma WR TERESA M. L.450TA, CPA Independent Auditors ' Report To the Board of Directors Indian River County Healthy Start Coalition, Inc. We have audited the accompanying statements of financial position of Indian River County Healthy Start Coalition, Inc. (a nonprofit organization) as of June 30, 2002 and 2001 , and the related statements of activities , functional expenses , and cash flows for the years then ended. These financial statements are the responsibility of the Indian River County Healthy Start Coalition, Inc . ' s management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audits in accordance with generally accepted auditing standards and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States . 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 baths, 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 audits provide a reasonable basis for our opinion. : In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Indian River County Healthy Start Coalition, Inc . as of June 30, 2002 and 2001 , and the changes in its net assets and its cash flows for the years then ended in conformity with generally accepted accounting principles . In accordance with Government Auditing Standards, we have also issued our report dated November 7, 2002, on our consideration of Indian River -County Healthy Start Coalition, Inc . 's internal control over financial reporting and on our tests of its compliance with certain provision of laws , regulations , contracts and grants . That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be read in conjunction with this report in considering the results of our audit. Our audit was performed for the purpose of forming an opinion on the basic financial statements of Indian River County Healthy Start Coalition, Inc , taken as a whole. The accompanying schedule of expenditures of state financiral assistance is presented for purposes of additional analysis as required by Chapter 10. 650, Rules of the Auditor General, and is not a required part of the basic financial statements . Such information has been subjected to the auditing procedures applied in the audit of the basic financial statements and, in our opinion, is fairly stated, in all material respects , in relation to the basic financial statements taken as a whole . O' Hairre, Kmetz, Nuttall , Field & Co. , chartered Certified Public Accountants November 7, 2002 3111 CARDINAL DRIVE • VERO BEACH , FLORIDA 32963 • TELEPHONE (772) 231 -6902 • FACSIMILE (772) 231 -4099 email@oknf-cpas . com Indian River County Healthy Start Coalition, Inc. 'r Statements of Financial Position June 30, 2002 2001 Assets Current Assets : Cash $ 1422820 $ 127, 142 Grants receivable 145 , 390 164 ,694 Deposits 1 ,254 2 , 865 ' Other 41657 4, 954 Total current assets 2941121 . 2999655 Property and equipment, net 48 ,772 62 ,489 Total assets $ 342 , 893 $ 362 , 144 Liabilities and Net Assets Liabilities $ Operating and program costs payable $ 124 , 301 $ 105 ,555 Grant payable - 16 , 000 Accrued expenses 4 ,763 - Deferred revenue 882000 88 ,000 Accrued compensated absences 5 556 2 858 Total liabilities 222 , 620 212,413 Net Assets : Unrestricted 108 , 273 1499731 Temporarily restricted 12,000 Total net assets 120,273 1492731 Total liabilities and net; assets $ 342, 893 $ 3629144 See accompanying notes to financial statements. -3 - Indian River County Healthy Start Coalition, Inc . ' Statements of Activities Year ended June 30 , 2002, with comparative totals for 2001 Temporarily Total Total Unrestricted Restricted 2002 2001 Revenues Grants from governmental agencies - $ 808 , 811 $ - $ 808 , 811 $ 8112770 United Way grant 49, 510 - 497510 492940 Contributions 277308 127000 39 , 308 24,708 Other revenue 2 ,522 - 2,522 22192 Total revenues 88 $ 9151 12,000 900, 151 888 ,610 Expenses Program services : Coalition services 135 ,619 - 135 ,619 1142979 Care Coordination 312 , 988 - 312, 988 2162451 Healthy Families 3899932 - 389, 932 3752798 One to three - - - 65 ,738 TLC newborn 77 ,792 - 777792 83 ,352 TANF - - - 14, 119 Total program services 9169331 - 916 , 331 870,437 Supporting services : Management and general 13 ,278 - 13 ,278 109917 Total expenses 9297609 - 9299609 881 ,354 Increase (decrease) in net assets (41 ,458) 12 ,000 (29 ,458) 71256 Net assets , beginning of year 1497731 - 149 ,731 142 ,475 Net assets , end of year $ 108 ,273 $ 122000 $ 1209273 $ 149 ,731 See accompanying notes to financial statements. -4- Indian River County Healthy Start Coalition, Inc. Statement of Functional Expenses Year ended June 30, 2002, with comparative totals for 2001 Program Supporting Total Total Services Services 2002 2001 Coalition Care Healthy TLC Management Services Coordination Families Newborn and General Salaries and wages $ 55 ,047 $ 214, 191 $ 249 ,928 $ 499163 - $ . 12,233 $ 580,562 $ 5509814 Payroll taxes and benefits 4,703 509389 44, 953 89223 0 19045 1099313 107,743 Total payroll 59,750 2649580 2949881 57,386 13 ,278 689 , 875 6 Advertising 476 - 75 - - 551 41431 Insurance 41650 x : - 21798 - - 7,448 3 , 565 Postage 11966 - 559 59489 - 89014 69125 Telephone 49606 41876 79418 43 - 169943 14, 924 Utilities 19422 - 21420 - - 39842 31069 Printing 19626 125 672 21220 - .41643 91977 Professional fees 9,451 87438 61360 27389 - 26 ,638 20,085 Travel and education 5 ,501 37769 17,657 988 - 27, 915 44,516 Other 3 , 155 47504 4,08.2 . 169 - 119910 69180 Supplies 21 ,616 1 , 178 9,243 4, 604 - 369641 32,087 Rent 109304 - 16 , 140 269444 329522 Depreciation 11 ,096 4,439 41439 2,219 - 22, 193 15 ,686 Publications - 1 ,079 - 21285 - 39364 39939 Contract services - 20,000 23 , 188 - - 43 , 188 257691 Total expenses $ 135 ,619 $ 3129988 $ 389 ,932 $ 779792 $ 13 ,278 $ 929, 609 $ 881354 See accompanying notes to financial statements. -5- Indian River County Healthy Start Coalition, Inc. Statements of Cash Flows Years ended June 30, 2002 2001 Cash flows from operating activities , Increase (decrease) in net assets $ (29,458) $ 7,256 Adjustments to reconcile increase (decrease) in unstricted net assets to net cash flows provided by operating activities : Depreciation 22, 193 15,686 Loss on disposal of assets 21466 - (Increase) decrease in : Grant receivable 19,304 (53,549) Deposits 1 ,611 - Other 297 ( 1 ,354) Increase (decrease) in : Operating and program costs payable 189746 339987 Grant payable ( 16,000) - Accrued expenses 41763 (3 ,890) Deferred revenue - (79000) Accrued compensated absences 2,698 (4 ,336) Net cash provided by (used for) operating activities 26 ,620 ( 13 ,200) Cash flows from investing activities , Purchase of equipment ( 109942) (501253) Net increase (decrease) in cash 159678 (639453) Cash, beginning of year 1275142 190,595 Cash, end of year $ 1429820 $ 1277142 See accompanying notes to financial statements. Indian River County Healthy Start Coalition, Inc. y r Notes to Financial Statements Note I — Summary of Significant Accounting Policies Organization The Indian River County Healthy Start Coalition, Inc. (the Coalition) is a Florida nonprofit organization created in 1992. The Coalition's mission is to establish a system which will enable all women to have access to prenatal care and that all infants have access to services that promote normal growth and development. Method of Accounting The accompanying financial statements have been prepared on the accrual basis of accounting. Net Assets Contributions received are recorded as unrestricted, temporarily restricted, or permanently restricted support, depending on the existence and/or nature of any donor restrictions. Support that is restricted by the donor is.reported as an increase in unrestricted net assets if the restriction expires in the reporting period in which the support is recognized. All other donor-restricted support is reported as an :increase in temporarily or permanently restricted net assets , depending on the nature of the restriction. When a restriction expires , that is , when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the statement of activities as net assets released from restrictions . Property and Equipment Property and equipment acquisitions greater than $500 are capitalized and are stated at cost. Donated property and equipment is recorded at the fair market value at the date of the gift. Depreciation is provided on a straight-line basis over the estimated useful life of the asset, which range from 5 - 10 years . Income Tax Status The Coalition is exempt from federal income tax under Section 501 (c)(3) of the Internal Revenue Code. In addition the Coalition has been determined not to be a private foundation within the meaning of Section 509(a) of the Code. Functional Allocation of Expenses The cost of providing the various programs and other activities has been summarized on a functional basis in the statement of functional expenses . Accordingly, certain costs have been allocated among the programs and supporting services benefited. Contributed Services The Coalition receives a significant amount of donated services from unpaid volunteers who assist in fund-raising, jadministration and program services . However, these amounts have not been recognized in the ' accompanying financial statements because the criteria for recognition of such volunteer effort under SFAS No . 116 have not been satisfied . -7- Indian River County Healthy Start Coalition, Inc. ; Notes to Financial Statements (continued) Note 1 — Summary of Significant Accounting Policies (continued) Use of Estimates The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures . Accordingly, actual results could differ from those estimates . Note 2 — Uninsured Cash Balances The Coalition maintains depository accounts at three local banks . Cash accounts at each bank are insured by the FDIC up to $ 100,000. Amounts in excess of insured limits were approximately $51 ,000 at June 30, 2002, Note 3 — Property and Equipment, net The following is a summary of property and equipment: Balance Balance June 30, 2001 Additions Deletions June 30, 2002 Furniture and equipment $ 95,349 $ 109942 $ (3 ,608) $ 102,683 Accumulated depreciation (32, 860) (22, 193) 1 , 142 (53 ,911 ) $ 62,489 $ ( 11 , 251 ) $ (2,466) $ 48 ,772 Note 4 — Temporarily Restricted Net Assets At June 30, 2002, temporarily restricted net assets consisted of a $ 12,000 contribution restricted toward a family assessment worker position. There were no temporarily restricted net assets at June 30, 2001 . Note 5 — Deferred Revenue Deferred revenue consists of the following:" June 30, 2002 2001 Ounce of Prevention/Healthy Families grant $ 88,000 $ 887000 -8 - r Indian River County Healthy Start Coalition, Inc. r Notes to Financial Statements (continued) Note 6 — Accrued Compensated Absences Accrued compensated absences reflect the liability of the Coalition for accrued annual leave and compensatory leave of its employees . Note 7 — Leases On June 29, 2001 , the Coalition entered into a 48-month lease for office space, with monthly payments of $ 850, effective August 1 , 2001 . The future minimum lease payments required under the non-cancelable operating lease are as follows : Years ended June 30, Amount 2003 $ 10,667 2004 119201 2005 119761 2006 984 $ 34,613 Note 8 — Concentrations For the fiscal years ended June 30, 2002 and 2001 , the Coalition received approximately 90% and 91 % of its revenue, respectively, from governmental agency grants . Additionally, substantially all coalition services are provided by Indian River County Health Department and Exchange Club C.A.S .T.L:E, Note 9 — Property Disposition The Ounce of Prevtiention/Healthy Families Florida reserves the right to retrieve any and all equipment and furniture with a value greater than $500, which was purchased with funds provided through the grant, upon completion or termination of the grant contract. The Coalition has purchased equipment and furniture of approximately $59 ,000 under the Ounce of Prevention/Healthy Families Florida grant, as of June 30, 2002 . -9 - r Indian River County Healthy Start Coalition, Inc. r Schedule of Expenditures of State Financial Assistance Year ended June 30, 2002 , State Agency or State Agency/Pass-through CSFA Pass -through State Grantor/Program Title Number Number Expenditures State of Florida Department of Health Prenatal and Infant Health Care Coalition 64 .013 COHP7 $ 82, 500 Parents Support Groups 64 . 013 COHP7 51452 Care Coordination Services . 64 .013 COHP7 l %577 Ounce of Prevention Fund of Florida Healthy Families Florida 64 .035 . HFO1 -02-30 3209854 $ 577 ,383 Y 4 - 10 'HAIR , CPA MMIMM Haire/ metz/ Nuttall, Field MIO AEL L. OMETZECPA, PFS SCOTT A. NUTTALL, CPA, CFP Co .' chartered r DANIEL E. FIELD, CPA �r ■ 66 / 6 BRIAN J. ELWELL, CPA, CVA Is1 ' 4 I ® PATRICK K. GRAHAM, CPA A T ® I Tax, Business and Financial Consultants HARVEY L. HERRST, CPA =110k • TERESA M. LASOTA, CPA Independent Auditors ' Report on Compliance and on Internal Control over Financial Reporting Based on an Audit of Financial Statements Performed in Accordance with Government Auditing Standards To the Board of Directors Indian River County Healthy Start Coalition, Inc . We have audited the financial statements of Indian River County Healthy Start Coalition, Inc. as of and for the year ended June 30, 2002, and have issued our report thereon dated November 7, 2002. We conducted our audit in accordance with generally accepted auditing standards and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States . Compliance As part of obtaining reasonable assurance about whether Indian River County Healthy Start Coalition, Inc . 's financial statements are free of material misstatement, we performed tests of its compliance with certain provisions of laws , regulations, contracts and grants , noncompliance with which could have a direct and material effect on the determination of financial statement amounts. However, providing an opinion on compliance with those provisions was not an objective of our audit, and accordingly, we do not express such an opinion. The results of our tests disclosed no instances of noncompliance that are required to be reported under Government Auditing Standards, Internal Control over Financial Reporting In planning and performing our audit, we considered Indian River County Healthy Start Coalition, Inc . 's internal control over financial . reporting in order to determine our auditing procedures for the purpose of expressing our opinion on the financial statements and not to provide assurance on the internal control over financial reporting. Our consideration of the internal control over financial reporting would not necessarily disclose all matters in the internal control over financial reporting that might be material weaknesses. A material weakness is a condition in which the design or operation of one or more of the internal control components does not reduce to a relatively low level the risk that misstatements in amounts that would be material in relation to the financial statements �being audited may occur and not be detected within a timely period by employees in the normal course of performing their assigned functions . We noted no matters involving the internal control over financial reporting and its operation that we consider to be material weaknesses . However, we noted other matters involving the internal control over financial reporting, which we have reported to management of Indian River County Healthy Start Coalition, Inc . in a separate letter dated November 7, 2002 . This report is intended solely for the information and use of the Board of Directors , management, federal and state awarding agencies and pass-through entities . However, this report is a matter of public record and its distribution is not limited. � 0 ` A40 ea O ' Haire, Kmetz, Nuttall , Field & Co. , chartered Certified Public Accountants November 7 , 2002 3111 CARDINAL DRIVE • VERO BEACH , FLORIDA 32963 • TELEPHONE (772) 231 -6902 • FACSIMILE (772) 231 -4099 email@oknf-cpas . com 'MaieMetz, Nuttall, ®® leTHOMAS F. O'HAIRE, CPAr ,® , MICHAEL L. KMETZ, CPA, PFS P ' ® C® ., chartered P SCOTT A- N- CPA, CFP DANIEL E. FIELDIELD,, CPA PA BRIAN J. ELWELL, CPA, CVA �®VAT A 1 Tax, Business and Financial Consultants ARVEYL. HE RST, C APA C wMall MWO 03 TERESA M . LASOTA, CPA Independent Auditors ' Report on Compliance and Internal Control over Compliance Applicable to Each Major State Financial Assistance Project To the Board of Directors Indian River County Healthy Start Coalition, Inc . ,. Compliance We have audited the compliance of Indian River County Healthy Start Coalition, Inc . with the types of compliance requirements described in the Executive Office of the Governor's State Projects Compliance Supplement, that are applicable to, each of its major state financial assistance projects for the year ended June 30, 2002. Indian River County Healthy Start Coalition, Inc . 's major state financial assistance projects are identified in the summary of auditor's results section of the accompanying Schedule of Findings and Questioned Costs. Compliance with the requirement of laws, regulations, contracts and grants applicable to each of its major state financial assistance projepts is the responsibility of Indian River County Healthy Start Coalition, Inc . 's management. Our responsibility is to express an opinion on Indian River County Healthy Start Coalition, Inc . 's compliance based on our audit. We conducted our audit of compliance in accordance with generally accepted auditing standards ; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States ; and Chapter 10.650, Rules of the Auditor General . Those standards, and Chapter 10. 650, Rules of the Auditor General, require that we plan and perform the audit to obtain reasonable assurance about whether noncompliance with the types of compliance requirements referred to above that could have a direct and material effect on a major state financial assistance project occurred. An audit includes examining, on a test basis, evidence about Indian River County Healthy Start Coalition, Inc. 's compliance with those requirements and performing such other procedures as we considered .necessary in the circumstances . We believe that our audit provides a reasonable basis for our opinion. Our audit does not provide a legal determination on Indian River County Healthy Start Coalition, Inc . 's compliance with those requirements . In our opinion, Indian RivevCounty Healthy Start Coalition, Inc . complied, in all material respects , with the requirements referred to above that are applicable to each of its major state financial assistance projects for the year ended June 30, 2002. Internal Control over Compliance The management of Indian River County Healthy Start Coalition, Inc . is responsible for establishing and maintaining effective internal control over compliance with requirements of laws , regulations, contracts and grants applicable to state financial assistance projects . In planning and performing our audit, we considered Indian River County Healthy Start Coalition, Inc . 's internal control over compliance with requirements that could have a direct and material effect on a major state financial assistance project to determine our auditing procedures for the purpose of expressing our opinion on compliance and to test and report on internal control over compliance in accordance with Chapter 10 . 650, Rules of the Auditor General . 3111 CARDINAL DRIVE • VERO BEACH , FLORIDA 32963 • TELEPHONE (772) 231 -6902 • FACSIMILE (772) 231 -4099 email@oknf- cpas . com f r Our consideration of the internal control over compliance would not necessarily disclose all matters in the internal control that might be material weaknesses. A material weakness is a condition in which the design or operation of one or more of the internal control components does not reduce to a relatively low level the risk that noncompliance with applicable requirements of laws , regulations , contracts and grants that would be material in relation to a major state financial assistance project being audited may occur and not be detected within a timely period by employees in the normal course of performing their assigned functions. We noted no matters involving the internal control over compliance and its operation that we consider to be material weaknesses . This report is intended for the information of the Board of Directors, management, federal and state awarding agencies and pass-through entities . However, this report is a matter of public record and its distribution is not limited. 01 O' Haire, Kmetz, Nuttall, Field & Co. , chartered Certified Public Accountants November 7 , 2002 - 13 - � a 're, mete, Nuttall, Field THOMAS F. KMETZE, CPA � � f '®. {v bf i MICHAEL L KMETZ, CPA, PFS SCOTT A. NUTTALL, CPA, CFP �O ., chartered � 0 DANIEL E. FIELD, CPA 6i /, + / / BRIAN J. ELWELL, CPA, CVA PATRICK K. GRAHAM, CPA L�® ® � t An Tax, Business and Financial Consultants HARVEY L HERRST, CPA e TERESA M. LASOTA, CPA Management Letter To the Senior Management and Board of Directors Indian River County Healthy Start Coalition, Inc. We have audited the financial statements of Indian River County Healthy Start Coalition, Inc. , as of and for the year ended June 30, 2002, and have issued our report thereon dated November 7, 2002. We conducted our audit in accordance with generally accepted auditing standards and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States . We have issued our Independent Auditor' s Report on Compliance and on Internal Control over Financial Reporting, Independent Auditor' s Report on Compliance and Internal Control over Compliance Applicable to each Major State Financial Assistance Project, and Schedule of Findings and Questioned Costs . Disclosures in those reports and schedule, which are dated November 7, 2002, should be considered in conjunction with this management letter. Additionally, our audit was conducted in accordance with Chapter 10. 650, Rules of the Auditor General. The Rules of the Auditor General (Section 10. 654( 1 )(d)) require disclosure in the management letter of the following matters if not already addressed in the auditor' s reports on compliance and internal controls or schedule of findings and questioned costs : ( 1 ) violations of laws , rules, regulations , and contractual provisions that have occurred, or are likely to have occurred ; (2) improper or illegal expenditures ; (3) improperor inadequate accounting procedures ; (4) failures to properly record financial transactions ; and (5) other inaccuracies, shortages , defalcations , and instances of fraud discovered by, or that come to the attention of, the auditor. Our audit disclosed no matters required to be reported. However, we noted the following other matters involving internal control over fmahcial reporting and compliance: Other Comments Segregation of Duties The size of the Organization's accounting and administrative staff precludes 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 remains involved in the financial affairs of the organization to provide oversight and independent review functions . 3111 CARDINAL DRIVE • VERO BEACH , FLORIDA 32963 • TELEPHONE (772) 231 -6902 • FACSIMILE (772) 231 -4099 email@oknf-cpas. com r r Indian River County Healthy Start Coalition, Inc. November 7, 2002 Page 2 Quarterly Payroll Tax Returns During our audit we noted that the wage data from the first pay period in the calendar year 2002 was not included in the respective federal quarterly wage report. As such, it appears that payroll taxes (along with penalty and interest assessments) are owed. This situation occurred during a transition among the organization ' s accounting personal . We recommend that the first quarter Form 941 (and any related returns affected), be corrected as soon as possible. To that end, management is currently working with their payroll tax preparation service to correct the problem. This management letter is intended solely for the information and use of Indian River County Healthy Start Coalition, Inc. ' s Board of Directors and management, the State of Florida Office of the Auditor General and state awarding agencies. Hewever, this report is a matter of public record and its distribution is not limited. A ACO O ' Haire, Kmetz, Nuttall, Field & Co. , chartered Certified Public Accountants November 7, 2002 - 15 - Indian River County Healthy Start Coalition, Inc. Schedule of Findings and Questioned Costs State Financial Assistance Projects Year Ended June 30, 2002 A. Summary of Audit Results 1 . The auditor's report expresses an unqualified opinion on the financial statements of Indian River County Healthy Start Coalition, Inc. 2. No reportable conditions' relating to the audit of the financial statements are reported in the Independent Auditors' Report 3 . No instances of noncompliance material to the financial statements . of Indian River County Healthy Start Coalition, Inc. were disclosed during our audit. 4. No reportable conditions relating to the audit of the state financial assistance projects is reported in the Independent Auditors' Report on Compliance and Internal Control over Compliance Applicable to Each Major State Financial Assistance Project in accordance with Chapter 10. 650, Rules of the Auditor General . 5 . The. auditor's report on compliance for the major state financial assistance project for Indian River County Healthy Start Coalition, Inc . expresses an unqualified opinion. 6. No audit findings or questioned costs relative to the major state financial assistance projects, as are required to be reported under Chapter 10.650, Rules of the Auditor General, are reported in Part C of this schedule. 7. The projects tested as major State projects include: State Project CSFA No. State of Florida Department of Health Healthy Start Coalition Care Coordination Services 64.013 Ounce of Prevention Funds of Florida Healthy Families Florida 64.035 8 . The threshold for distinguishing Type A and B programs was $ 173 ,000 for major state financial assistance projects . B. Findings - Financial Statements Audit None C. Findings and Questioned Costs - Major State Financial Assistance Projects None - 16- Indian River County Healthy $tart Coalition, Inc. Summary Schedule of Prior Audit Findings State Financial Assistance Projects Year Ended June 30, 2002 Prior-Year Findings — Financial Statements Audit 01 =1 Bank Reconciliation 's (2001) Reportable Condition: Bank reconciliation' s for the last eight months of the fiscal year ended June 30, 2001 , had not been completed. This condition is deemed to be a material weakness . Criteria: Timely bank reconciliation' s are a basic required internal control procedure. Effect: Proper control and oversight of the cash receipts and disbursements functions was compromised. Recommendation We recommend that timely and accurately prepared bank reconciliation ' s be required to be prepared monthly, reviewed and signed by either the executive director or a member of the Board of Directors . Current Status: Management agrees with the auditors recommendation concerning bank reconciliation ' s. The bank reconciliation ' s have been brought current through June 30, 2002. Management will ensure future reconciliation ' s are prepared on a monthly basis. Additionally, management has established a new policy whereby the monthly reconciliation' s will be reviewed and signed off by the finance committee. 01-2 Grant Reimbursement Requests (2001) Reportable Condition: Grant revenue was not requested or reported in a timely manner. Payments under certain grants were not requested or reported until four months after they were earned. This was the result of error by the financial secretary, and lack of oversight by management. This condition is deemed to be a material weakness . Criteria : Revenue should be accrued in a timely manner in accordance with generally accepted accounting principals. P Effect: Revenue and the related grant receivables were materially understated . Additionally, the organization risked expiration of the period of availability of grant funding. Recommendation: The executive director, treasurer and the Board of Directors need to provide more review and oversight of reimbursement requests . Current Status.* Management agrees with the auditor's recommendation regarding grant revenue. Grant revenue requests have been brought current. The Executive Director is now reviewing and approving all grant requests in order to insure that these revenues are reported and being received in a timely manner. - 17- Indian River County Healthy Start Coalition, Inc. Summary Schedule of Prior Audit Findings (continued) State Financial Assistance Projects 01w3 Review and Oversight (2001) Reportable Condition: At the beginning of our audit we noted a copious number of errors , omissions , misstatements and misclassifications in the organizations accounting records and financial statements . This was the result of errors by the financial secretary and lack of proper review and oversight by the executive director, finance committee, and Board of Directors. This condition is deemed to be a material weakness . Criteria: The accounting records should be timely and accurately, maintained in accordance with generally accepted accounting principals . Effect: Accounting records and financial statements that are materially misstated. Recommendation: The executive director should be providing more accounting review and oversight. To qaccomplish this , we suggest that the executive director take classes in the principals of accounting. Additionally, the finance committee should be strengthened by the recruitment of Board member' s with financial or accounting backgrounds . Lastly, the size of the organization's accounting and administrative staff precludes 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 becomes more intimately involved in the financial affairs of the organization to provide oversight and independent review functions. Current Status: Management agrees with the auditor's recommendation regarding more involvement of the Board of Directors , and the Executive Director providing more accounting review and oversight. A new policy has been adopted whereby the Executive Director and Fiscal Coordinator meet weekly to review questions, problem areas and various other accounting processes in order to insure conformity with generally accepted accounting principles. The Executive Director has taken and successfully passed a course on the' `principals of accounting. An individual with accounting expertise now serves on the Finance Committee and the Board , of Directors . Lastly, the Board of Directors passed several motions in the March 2002 Board meeting that have resulted in more involvement by the board , with respect to financial matters . - 18 - Indian River County Healthy �Start Coalition, Inc. Summary Schedule of Prior Audit Findings (continued) State Financial Assistance Projects Prior-Year Findings and Questioned Costs - Major State Financial Assistance Projects 01 -4 State of Florida Department of Health Ounce of Prevention Funds of Florida Healthy Families Florida CSFA No. 64.035 Contract No. HF99-00-30 Grant period — year ended June 30, 2001 Reportable Condition: $ 16,000 was advanced to Indian River County Healthy Start Coalition, Inc . , in anticipation of allowable reimbursement requests from Exchange Club CASTLE (the service provider), for unemployment compensation claims and related expenses. Subsequently; claims for reimbursement from Exchange Club CASTLE (the service provider), . related to unemployment compensation claims and related expenses were submitted to ' The Ounce of Prevention Funds of Florida for reimbursement, instead of being paid from the $ 16,000 advance. This condition is not deemed to be a material weakness . Criteria: Unearned funds applicable to the Healthy Families Florida grant are required to be returned within 30 calendar days after discovery of overpayment. Effect: Unearned funds had been held for over one year. Recommendation: The $ 16,000 should be returned to the Ounce of Prevention Funds of Florida as soon as possible. Current Status: Management agrees with the auditor's recommendation concerning monies due the Ounce of Prevention Funds, and has repaid the $ 16,000 advance. i - 19- of ra IuZw. NVG / AV AM Form 990 OMB No. 1545.0047 Return of Organization Exempt From Income Tax 2001 Under section 501 ( c), 527, or 4947(a) ( 1 ) of the Internal Revenue Code (except black lung Department of the Treasury benefit trust or private foundation) Open to Public Internal Revenue Service The organization may have to use a copy of this return to satisfy state re ortin re uirements. Inspection A For the 2001 calendar year or tax year beginning 7 / 01 / 01 and endin 6 / 30 / 02 B Check if applicable: Please C Name of organization use IR D Employer ID number Address change label or 65 - 0363222 Name change print or I . R " C " HEALTHY START COALITIONf INC E Telephone number Initial return type. Number and street (or P.O. box If mail is not delivered to street address) Room/suite 772 - 563 - 9118 Final return See 1603 10TH AVENUE Specific F Accounting method: Cash Amended return Instruc City or town , state or country, and ZIP + 4 ® Accrual Other (specify) Application pending Ltions . VERO BEACH FL 32960 ► * Section 501 (c)(3) organizations and 4947(a)(1 ) nonexempt charital leH and I are not applicable to section 527 organizations. trusts 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 : H(b) If "Yes," enter no. of affiliates ► NIA J Organization type H(C) Are all affiliates included? ® N/A D Yes No check onl one ► 501 (c) 3 s insertno. 4947(a )( 1 ) or 527 (If "No," aft. a list See Instr. ) K Check here ► if the organization's gross receipts are normally not more than H(d) Is this a separate return filed by an N/A $25,000. The organization need not file a return with the IRS; but if the organization organization covered by a group rutin ? Yes No received a Form 990 Package in the mail, it should file a return without financial data. I Enter 4-di it GEN ► Some states require a complete return. M Check ► W if the organization is not required L Gross receipts: Add lines 6b 8b 9b, and 10b to line 12 ► 900 151 to attach Sch. B Form 990, 990-EZ or 990-PF) . Part I Revenue Expenses , and Changes in Net Assets or Fund Balances See Specific Instructions on paqe 16 . 1 Contributions , gifts , grants , and similar amounts received : a Direct public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a 4 0 68 7 b Indirect public support lb 4 9 r 5 10 c Government contributions . . . . (grants) . . . _ . 1c 54r998 d Total (add lines 1a through 1c) (cash $ 145 , 195 noncash $ ) 1d 145 r 195 2 Program service revenue including government fees and contractsfrom Part VII , line 93 ( ) . . . . . . . . . . . . . . . . . . . . . . s 753 813 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 4 Interest on savings and temporary cash investments � 0I 4 1 143 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Dividends and interest from securities , . , , . , , . 9 5 6a Grossrents6a b Less: rental expenses 6b c Net rental income or (loss) (subtr ine 6b from line 6a ) R 7 Other investment income (describe ► 7 e . . . . . . v 8a Gross amount from sales of assets other A Securities B Other eIn than inventory u b Less: cost or other basis and sales expenses8b 2 466 c Gain or (loss) (attach schedule) 8c — 2 466 O O) . SEE . STMT 1 Sd — 2 466 d Net gain or (loss ) (combine line 8c, columns A and B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Special events and activities (attach schedule) a Gross revenue (not including $ of contributions reported on line 1a ) ga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Less : direct expenses other than fundraising expenses 9b . . . . . . . . . . . . . . . . . . . . . . . c Net income or (loss ) from special events (subtract line 9b from line 9a ) 9c . . . . . . . . . . . . . . . . 10a Gross sales of inventory, less returns and allowances 10a b Less : cost of goods sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10b c Gross profit or (loss ) from sales of inventory (aft. sch . ) (subtract line 10b from lia ne 10a ) 10c 11 Other revenue (from Part VII , line 103) . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Total revenue add lines 1d , 2 31 4 5 , 6c, 7 , 8d , 9c, 10c, and 11 . , . 12 897r685 E 13 Program services (from line 44 , column (B)) x 13 913 865 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p 14 Management and general (from line 44 , column (C)) _ 14 13 , 278 n 15 Fundraising (from line 44, column (D)) 5 s 16 Payments to affiliates (attach schedule ) 1 esc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s 17 Total expenses add lines 16 and 44 , column A 17 927 r 143 A 18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 — 29 , 458 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N s ee 19 Net assets or fund balances at beginning of year (from line 73 , column (A)) 19 14 9 7 31 t t 20 Other changes in net assets or fund balances (attach explanation) Y0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s 21 Net assets or fund balances at end of year combine lines 18 , 19 and 20 21 120 , 273 For Paperwork Reduction Act Notice, see the separate instructions . DAA Form 990 (2001 ) .. . r :u r u IaIGUVG y.Gy HIVI Form 990 2001 I . R . C . HEALTHY START COALITION INC 65 - 0363222 Part II Statement of All organizations must complete column (A). Columns (B), (C), and (D) are required for section 501 (c)(3) and (4) organizations e 2 Functional Expenses and section 4947(a o nonexem t charitable trusts but o tional for others. See Specific Instructions on pa a 21 . Do not include amounts reported on line 6b 8b 9b 10b or 16 of Part I . (A) Total (B) Program (c) Management services and eneral (D) Fundraising 22 Grants and allocations (attach schedule) (cash $ non- cash $ 22 23 Specific assistance to individuals 24 Benefits paid to or for members 24 25 Compensation of officers , directors , etc. 25 48 210 43 389 4 821 26 Other salaries and wages . . . . . . . 26 532 352 524 940 7 412 . . . . . . . . . . . . . . . . . . . . . . 27 Pension plan contributions 27 28 Other employee benefits 28 64 9 0 0 64 791 10 9 29 Payroll taxes 29 4 4 413 4 3 477 9 3 6 30 Professional fundraising fees 30 31 Accounting fees 32 Legal fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 32 33 Supplies 33 36 641 36 641 34 Telephone . . . . . . . . . . . . . . . . . . . . 34 16 943 1 6 9 4 3 35 Postage and shipping . . . 35 8 014 8 014 36 Occupancy 36 2 6 4 4 4 2 6 4 4 4 . . . . . . . . . . . . . . . . 37 Equipment rental and maintenance 37 38 Printing and publications38 8 007 8 007 39 Travel . . . . . . . . . . . . 39 16 119 16 119 . . . . . . . . . . . . . . . . . . . . . . 40 Conferences , conventions, and meetings . . . . . . . 40 11 796 11 796 41 Interest 41 42 Depreciation, depletion , etc. (aft. sch.) . . . . . . . . . . . . . 42 22 194 22 194 43 Other expenses not covered above (itemize): a43a b SEE . STATEMENT 2 . . . w • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43b 91 110 9 1 110 c 43c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . 43d e 43e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Total functional expenses (add lines 22 - 43) Organizations completing columns (B)4D), carry these totals to lines 13-15 44 92 7 14 3 913 8 65 13 2 7 8 Joint Costs. Check ► LJ if you are following SOP 98-2. 0 Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? If "Yes; enter (i) the aggregate amount of these joint costs $ ► Yes No (iii) the amount allocated to Management and general $ (ii) the amount allocated to Program services $ and (Iv) the amount allocated to Fundralsln $ Part III Statement of Program Service Accom lishments See Specific Instructions on page 24 . What is the organization's primary exempt purpose? ► SEE STATEMENT 3 Program Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expenses AI( organizations must describe their exempt purpose achievements in a clear and concise manner. State the number • • • • • • • • . • . . . . . . . . (Required for 501 (c)(3) and of clients served , publications issued , etc. Discuss achievements that are not measurable. (Section 501 (c)(3) and (4 ) (a) orgs. , and 4947(a)( 1 ) or anizations and 4947(a)( 1 ) nonexem t charitable trusts must also enter the amount of rants and allocations to others . trusts; but optional for a SEE STATEMENT 4 others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b SEE STATEMENT 5 Grants and allocations $ 44 6 141 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C SEE STATEMENT 6 Grants and allocations $ 77f792. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Grants and allocations $ 389r932 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Grants and allocations $ e wooOther ro ram services attach schedule Grants and allocations $ f Total of Program Service Ex enses should equal line 44 , column B , Pro ram services) ► 913 865 Form 990 (2001 ) if 1 l y 12/14/2002 7:43 AM Form 990 (2001 ) I . R . C . HEALTHY START COALITION , INC 65 - 0363222 Page 3 Part IV Balance Sheets (See Specific Instructions on page 24 . ) Note : Where required , attached schedules and amounts within the description (A) ( B) column should be for end-of-year amounts only. Beginning of year End of year 45 Cash-non-interest-bearing 127 , 142 45 142 , 820 46 Savings and temporary cash investments 46 47a Accounts receivable 47a b Less : allowance for doubtful accounts 47b 47c 48a Pledges receivable 48a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Less : allowance for doubtful accounts 48b 48c . . . . . . . . . . . . . . 49 Grants receivable 164 , 694 49 145r390 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Receivables from officers , directors , trustees , and key employees A (attach schedule) 50 s 51a Other notes and loans receivable (attach s schedule) 51a e b Less : allowance for doubtful accounts . . . . . . . . . . . . . . t 52 Inventories for sale or use52 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s 53 Prepaid expenses and deferred charges 4 954 53 4 657 54 Investments-securities ► Cost FMV 64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55a Investments-land , buildings , and equipment basis 55a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Less : accumulated depreciation (attach schedule ) . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . 55b 55c 56 Investments-other (attach schedule ) . . , . 56 57a Land , buildings, and equipment: basis 57a 11 0 0 M a 4 a a 102 or 683 b Less : accumulated depreciation (attach schedule) . . . . . . . . 57b 53 r 911 62F489 57c 48 , 772 58 Other assets (describe ► SEE STMT 7 ) 2 , 865 58 1 254 59 Total assets add lines 45 through 58 must equal line 74 . . . . . . . . . . . . . . . . . . . . . . . . 362 , 144 59 342 8 9 3 L 60 Accounts payable and accrued expenses 121 , 555 6o 12 9 0 64 1 61 Grants payable 61 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 62 Deferred revenue88 , 000 62 8 8 0 0 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b 63 Loans from officers , directors , trustees , and key employees (attach i 1 schedule) i 64a Tax-exempt bond liabilities (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t b Mortgages and other notes payable (attach schedule) 64b I e 65 Other liabilities (describe ► SEE STMT 8 ) 2 r 858 65 5 r 556 s 66 Total liabilities add lines 60 through 65 212 , 413 66 222 62 0 Organizations that follow SFAS 117, check here ► and complete lines 67 through 69 and lines 73 and 74. N F 67 unrestricted 14 9 7 31 67 108 , 273 e u 68 Temporarily restricted 68 12 , 000 tn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d 69 Permanently restricted 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A Organizations that do not follow SFAS 117, check here Pop and s B complete lines 70 through 74. s a 70 Capital stock, trust principal , or current funds 70 e1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t a 71 Paid-in or capital surplus, or land , building , and equipment fund 71 . . . . . . . . . . . . . . . . . . . . . s n 72 Retained earnings , endowment, accumulated income , or other funds 72 . . . . . . . . . . . . . . . . c 73 Total net assets or fund balances (add lines 67 through 69 OR lines e 70 through 72; r column (A) must equal line 19; column (B) must equal line 21 ) 149 , 731 73 12 0 2 7 3 74 Total liabilities and net assets / fund balances add lines 66 and 73 362 r 14 41 74 1 342t893 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 111 , the organization's programs and accomplishments. DAA 011e 1111y1ZuuZ W:l1 AM Form 990 2001 I . R . C . HEALTHY START COALITION INC 65 - 0363222 Part IV=A Reconciliation of Revenue per Audited Part IV-B < Reconciliation of Expenses per Audited a e a Financial Statements with Revenue per Financial Statements with Expenses per Return See S ecific Instructions page 26 . Return a Total revenue , gains, and other support a Total expenses and losses per per audited financial statements ► a 900F1511 audited financial statements Ta 929r 609 b Amounts included on line a but not onb Amounts included on line a but not line 12, Form 990: on line 17, Form 990: (1 ) Net unrealized gains on (1 ) Donated services and use , investments $ of facilities $ (2) Donated services and use (2) Prior year adjustments of facilities $ reported on line 20, (3) Recoveries of prior Form 990 $ year grants $ (3) Losses reported on line 20, (4) Other (specify): Form 990 $ SEE STMT 9 (4) Other (specify): $ 2 r 466 SEE STMT 10 Add amounts on lines (1 ) through (4) ► b 2F466 $. . . , . . . . . . . 2 466 Add amounts on lines (1 ) through (4) ► b 2 466 c Line a minus line b ► c 897 685 c Line a minus line b ► c 927 , 143 d Amounts included on line 12, d Amounts included on line 17 , Form 990 but not on line a: Form 990 but not on line a: ( 1 ) Investment expenses (1 ) Investment expenses not included on line 6b , not included on line 6b, Form 990 $ Form 990 $ (2) Other (specify): (2) Other (specify): . . . . . . . . . . $ $ Add amounts on lines (1 ) and (2) ► d Add amounts on lines (1 ) and (2) ► d e Total revenue per line 12, Form 990 a Total expenses per line 17, Form 990 line c lus lined . . . . . . . . . . . . . . . . ► e 8 9 7 6 8 5 line c lus lined ► ei 927 143 Part V List of Officers , Directors , Trustees , and Key Employees (List each one even if not compensated ; see Specific Instructions on page 26. (f3) Title and average (C) Compensation (D) Contrib. to E Expense (A) Name and address hours per week (if not paid, ente empfoYee benefit account and other devoted to sftion plans & deferred allowances SC.0TT . . JOSEPH EXEC . DIR , VERO BEACH FL 40HRS WK 48 210 0 0 FOR BOARD SEE ATTACHED SCHEDULE BOARD 14EMBE 2 HRS WK 0 0 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $ 100,000 from your organization and all related organizations , of which more than $10 ,000 was provided by the related organizations? ► Yes ® No If "Yes," attach schedule-see Specific Instructions on page 27. DAA Form 990 (2001 ) 8779 12/24/2002 7:43 AM Form 990 2001 I . R . C . HEALTHY START COALITION INC 65 - 0363222 Pa e 5 Part VI Other Information See S ecific Instructions on page 27 . Yes No 76 Did the organization engage in any activity not previously reported to the IRS? If "Yes ," attach a detailed description of eachactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �� 77 Were any changes made in the organizing or governing documents but not reported to the I .RS ? . . . . . . . . . . . X . . . . . . . . If "Yes ," attach a conformed copy of the changes . . . . . . . . . . . . . . . . . . 6 . . . . 0 . . . . 78a Did the organization have unrelated business gross Inc. of $ 1 ,000 or more during the year covered by this return ? . . . . . . . . . . . I . . . . 78a X . . . If "Yes ," has it filed a tax return on Form 990 -T for this year? X 78b 79 Was there a liquidation , dissolution , termination , or substantial contraction during the year? If "Yes ," attach a statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 X 80a 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 ft is exempt OR a nonexempt. 81a Enter direct or indirect political expenditures . See line 81 instr. b Did the organization file Form 1120-POL for this year? 6 . 81 b X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82a Did the organization receive donated services or the use of materials , equipment, or. facilities at no charge . . . . or at substantially less than fair rental 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 111 . 83a 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? N/A 83b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a Did the organization solicit any contributions or gifts that were not tax deductible? 84a X b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? N/A 84b 85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 (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? N/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 d Section 162(e) lobbying and political expenditures )( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e Aggregate nondeductible amount of section 6033(e)( 1 )(A))(AA) dues notices 85e ' f Taxable amount of lobbying and political expenditures (fine 85d less 85e g Does the organization elect to pay the section 6033(e) tax on the amount in 85f? N /A 85 . . . . . . . . . . . . . . . . . . . . . . h If section 603 3(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? . . . . N /A 85h . . . . . . . . . . . . . . . . . . 86 501 (c)(7) orgs. Enter: a Initiation fees and capital contributions included on line 12 86a b Gross receipts, included on line 12 , for public use of club facilities 86b 87 501 (c)( 12) orgs . Enter: a Gross income from members or shareholders vol b Gross income from other sources . (Do not net amounts due or paid to other sources against amounts due or received from them. . , . a . . . . . . . . . . . . . . . . . 87b 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89a 501 (c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under: section 4911 ► 0 ; section 4912 ► 0 ; section 4955 ► 0 b 501 (c)(3) and 601 (c)(4) orgs . 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 c Enter: Amount of tax imposed on the organizationtnanagers or disqualified persons during 4 46the year under sections 4912 , 4955, and 4958 ► 0 d Enter: Amount of tax on line 89c, above , reimbursed by the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90a 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 (See instructions . ) 90b 91 The books are in care of ► IRC HEALTHY START , INC . . . . . . . . . . . Telephone no. ► 772 - 563 - 9118 Located at ERO BEACH , FLORIDA ZIP + 4 ► 34 2 9 6 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Section 4947(a )( 1 ) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here ► and enter the amount of tax-exempt interest received or accrued during the tax year ► 92 Form 990 (2001 ) DAA 8779 12/24/2002 7:34 AM Form990 (2001 ) I . R . C . HEALTHY START COALITION , INC 65 - 0363222 Page6 Part VII Analysis of Income-Producin Activities See Specific Instructions on paqe 32 . Note : Enter gross amounts unless otherwise Unrelated business income Excluded by sec. 512, 513 , or 514 (E) indicated. A g C D Related or Business code Amount clusion Amount exempt function 93 Program service revenue: code income a GOVERNMENTAL PROGRAM REVENUE 687 816 b c d e f Medicare/Medicaid payments . . . . . . . . . . . . . . . . . 65r997 g Fees and contracts from government agencies . . . . . . . . . . . . . 94 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . 95 Interest on savings and temporary cash investments 14 1 14 3 96 Dividends and interest from securities . . . . . . . . . . . . . . . . . . . . . 97 Net rental income or (loss ) from real estate : a debt-financed property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 - 214166 101 Net income or (loss) from special events . . . . . . . . . . . . . . . . . . . 102 Gross profit or (loss) from sales of inventory . . . . . . . . . . . . . . . . 103 Other revenue: a b C d e 104 Subtotal (add columns (B ), (D ), and (E)) 0 — 1 323 753 813 105 Total (add line 104, columns (B), (D), and (E)) ► 752 , 490 _Note: Line 105 plus line 1d , Part 1 , should equal the amount on line 12 Part I . Part Vill Relationship of Activities to the Accomplishment of Exempt Purposes seeSpecific 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 0 of the organization's exempt purposes other than by providingfunds for such purposes) . 93C INCOME FROM GOVERNMENTAL GRANTS PROVIDE FOR PRENATAL CARE TO INFANTS ; ASSISTS WOMEN IN ESTABLISHING AND MAINTAINING BEHAVIORS WHICH ARE CONDUCTIVE TO THE OPTIMUM HEALTH AND SEE STATEMENT Part IX Information Re ardin Taxable Subsidiaries and Disreciarded Entities seeSpecific Instructions on paqe 33. (A) ( B) (C) ( D) ( E) Name , address, and EIN of corporation , Percentage of Nature of activities Total income End-of-year partnership, or disregarded entity_ ownership interest assets N /A q o� o� o� Part X Information Regarding Transfers Associated with Personal Benefit Contracts SeeSpecific Instructions on 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? Yes No . . . . . . . . . . . . . . . . . . . . . . . . Note : If "Yes" to b file Form 8870 and Form 4720 see instructions) . Under penalties of perjury, I declare that 1 have;examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Please Sign Here Signature of officer EEUUU Date Type or Print n ;ndtitle. Preparer's Date Check if Preparees SSN or PTIN (See Gen. Instr. W) Paid signature self- employed ► P00293972 Preparer's Firm's name (or yours ' O ' HAIRS KMETZI NUTTALL FIELD & CO . EIN ► 59 - 1718139 Use Only if self-employed ), 3111 CARDINAL DR , Phone address, and ZIP + 4 VERO BEACH FL 32963 no. ► 772 - 231 - 6902 DAA Form 990 (2001 ) 8779 12/24/2002 7:44 AM Form 990 (2001 ) I . R . C . HEALTHY START COALITION , INC 65 - 0363222 Page6 Part VII Analysis of Income -ProducingActivities See Specific Instructions on page 32 . Note: Enter gross amounts unless otherwise Unrelated business income Excluded by sec. 512, 513 , or 514 (E) indicated . (A) (B) (C) (D) Related or Business code Amount Exclusion Amount exempt function 93 Program service revenue : code income a GOVERNMENTAL PROGRAM REVENUE 687 816 b C d e f Medicare/Medicaid payments 65 9 9 7 g Fees and contracts from government agencies . . . . . . . . . . . . . 94 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . 95 Interest on savings and temporary cash investments 14 1 , 143 96 Dividends and interest from securities . . . . . . . . . . . . . . . . . . . . . 97 Net rental income or (loss) from real estate : a debt-financed property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 — 2 466 101 Net income or (loss) from special events . . . . . . . . . . . . . . . . . . . 102 Gross profit or (loss ) from sales of inventory 103 Other revenue : a b C d e 104 Subtotal (add columns (B ), (D), and (E)) 0 — 1 r 3231 753 t 813 105 Total (add line 104, columns (B), (D), and (E)) ► 752 , 4 90 Note: Line 105 plus line 1d , Part I , should equal the amount on line 12, Part I . PartVIII Relationship of Activities to the Accomplishment of Exempt Purposes seeSpecific 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 providingfunds for such purposes) . 93C INCOME FROM GOVERNMENTAL GRANTS PROVIDE FOR PRENATAL CARE TO INFANTS • ASSISTS WOMEN IN ESTABLISHING AND MAINTAINING BEHAVIORS WHICH ARE CONDUCTIVE TO THE OPTIMUM HEALTH AND SEE STATEMENT 11 Part IX Information Regarding Taxable Subsidiaries and Disregarded Entities seeSpecific Instructions on page 33. (A) (B) ( c) (D) (E) Name , address , and EIN of corporation , Percentage of Nature of activities Total income End-of-year partnership , or disregarded entity ownership interest assets N /A o� o� G/ Part X Information Regarding Transfers Associated with Personal Benefit Contracts see Specific Instructions on . 33. (a) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? Yes No ( ) g g y pay premiums, direct) or indirectly, on a personal benefit contract . Yes No b Did the organization , Burin the year, a y y p contract? . Note : If "Yes" to b file Form 8870 and Form 4720 see instructions) . Under penalties of perjury, 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, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Please ' Sign Here Signature of officer Date ' Type or print name and title. Preparer's Date Check If Preparer's SSN or PTIN (See Gen. Instr. W) Paid signature em to ed ► F1 P00293972 Preparer's Firm's name (or yours ' OI HAIRE FCMETZ NUTTALL FIELD & CO . EIN ► 59 - 1718139 Use Only if self-employed), 3111 CARDINAL DR . Phone address, and ZIP + 4 VERO BEACH FL 32963 no. ► 772 - 231 - 6902 DAA Form 990 (2001 ) 6779 11/19/2002 9: 11 AM SCHEDULE A Organization Exempt Under Section 501 ( c) (3 ) (Form 990 or 990-EZ) (Except Private Foundation) and Section 501 (e) , 501 (f) , 501 (k), OMB No 1545-0047 501 ( n), or Section 4947(a)(1 ) Nonexempt Charitable Trust Department of the Treasury Supplementary InformationgSee separate instructions . ) 2001 Internal Revenue Service ► MUST be completed by the above organizations and attached to their Form 990 or 990-EZ Name of the organization Employer identification number I . R . C . HEALTHY START COALITION INC 65 - 0363222 Part I Compensation of the Five Highest Paid Employees Other Than Officers , Directors , and Trustees See paqe 1 of the instructions . List each one . If there are none enter " None . " (a) Name and address of each employee paid more (b) Title and average hours (d) Contributions to (e) Expense than $50,000 per week devoted toposition (c) Compensation employee ben. plans & account and other deferred compensation allowances NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total number of other employees paid over $50,000 ► Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services See page 2 of the instr. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total number of others receiving over $50,000 for professional services . , , , . . . _ . . ► 0 For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ. Schedule A (Form 990 or 990-EZ) 2001 DAA 8779 11 /Of 9/2002 9: 11 AM Schedule A Form 990 or 990-EZ 2001 I . R . C . HEALTHY START COALITION INC 65 - 0363222 Pae 2 Part III Statements About Activities (See page 2 of the instructions . ) Yes No 1 During the year, has the organization attempted to influence national , state , or local legislation , including any attempt to influence public opinion on a legislative matter or referendum? If "Yes ," enter the total expenses paid 1 X or incurred in connection with the lobbying activities ►$ (Must equal amount on line 38, Part VI-A, or line 1 of Part VI-B . ) 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? 2a X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Lending of money or other extension of credit? . . . 2b X . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Furnishing of goods, services , or facilities? . 2c X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Payment of compensation (or payment or reimbursement of exp. 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 or loans from it in furtherance of its charitable programs " uali ' to receive pavments. Part IV 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 A church , convention of churches , or association of churches. Section 170(b)( 1 )(Axi). 6 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 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 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. ) 11b 8A 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 33 1 /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 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 . (a) Name(s) of supported organization(s) (b) Line number from above 14 I I An organization organized and operated to test for public safety. Section 509(a) (4) (See page 6 of the instructions .) DAA Schedule A ( Form 990 or 990-EZ) 2001 6 / 1U 111TJIZUUL9: 11 AM - Schedule A (Form 990 or 990-EZ) 2001 I . R . C . HEALTHY START COALITION , INC 65 0363222 Pa e 3 Part IV A Support Schedule (Complete only if you checked a box on line 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 ► :!9 2000 b 1999 c 1998 d 1997 a Total 15 Gifts, grants , and contributions received. (Do not include unusual rants. See line 28 . 36 242 588 720 249 , 003 226 436 2 000 401 16 Membership fees received 17 Gross receipts from admissions, merchandise sold or services performed, or fumishing of facilities in any activity that is related to the organization's charitable, etc , purpose 18 Gross inc. from int, dividends, amounts received from pymt. on securities bans (section 512(a)(5)), rents, royalties, & unrelated busn. taxable inc. (less sec. 511 taxes) from businesses acquired by the organization after June 30, 1975 . . . . . 2 142 11656 3 798 19 Net income from unrelated business activities not included in line 18 . . . . . . . 20 Tax revn. levied for the organization's ben. & either paid to it or expended on its behalf 21 The value of serv. or fad. fumished to the org. by a governmental unit without charge. Do not incl. the value of serv. or fac. gen- erally fumished to the Dublic without charge 11 , 659 41 3 8 0 53 039 22 Other income. Attach a schedule. Do not incfrom ale of cap.n or ( asets STMT 12 4r667 4 667 23 Total of lines 15through 22 . . . . . . . . . . . 938F384 590r376 265 , 329 267r816 2061 905 24 Line 23 minus line 17 . . . . . . . . . - 938 384 590r376 .265 329 267r816 2 061 905 25 Enter 1 % of line 23 . . . . . . . - 9r384 5 904 2f6531 2 678 26 Organizations described on lines 10 or 11 : a Enter 2% of amount in column (e), line 24 ► 26a 41 2 3 8 . . . . . . . . . . . . . . . . . . . . . . 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 retum. Enter the total of all these excess amounts . . . . . . . . . . . 10- 26b c Total support for section 509(a)(1 ) test: Enter line 24, column (e) ► 26c 2 061 905 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Add: Amounts from column (e) for lines: 18 3 , 798 1g 22 4 # 667 26b ► 26d 8 465 e Public support (line 26c minus line 26d total) . . . . . . . . . . . ► 26e 2 053 440 f Public support percentage line 26e numerator divided by line 26cdenominator ► 26f 9905895 % . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 b For any amount included in line 17 that was received from each person other than "disqualified persons"), ( 1997) p ( q p "), 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 (2), enter the sum of these differences (the excess amounts ) for each year: N/A 2000 ) . . . . . . . . . . . . . . . . . . ( . . . ( 1999) . . . . . . . . . . . . . . . . . . . . . . . - 16 ( 1998) . . . . . . . . . . . . . . . . . . . . . . . ( 1997) . . . . . . . . . . . . . . . . . . . . . . . . c Add: Amounts from column a) for lines : 15 17 20 21 ► 27c d Add: Line 27a total ► 27d and line 27b total e Public support (line 27c total minus line 27d total) . . . . . . . . . . . . ► 27e . . . . . . . . . . . . . . . f Total support for section 509(a )(2) test: Enter amount on line 23, column (e) ► 4 1 27f g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) ► 27 % Investment income Percentage line 18 column a numerator divided b line 27f denominator ► 2711 28 Unusual Grants : For an organization described in line 101 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, and a brief description of the nature of the grant. Do not file this list with your return Do not include these grants in line 15 DAA Schedule A ( Form 990 or 990-EZ) 2001 8779 11 /19/2002 9: 11 AM Schedule A (Form 990 or 990-EZ) 2001 I . R . C . HEALTHY START COALITION , INC 65 0363222 Pae 4 Part V Private School Questionnaire (See page 7 of the Instructions . ) 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 , N /A Yes No other governing instrument, or in a resolution of its governing body? 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during 30 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? 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? 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? 32c . . . . . . . . . . d Copies of all material used by the organization or on its behalf to solicit contributions?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32d If you answered "No" to any of the above , please explain . (If you need more space, attach a separate statement. ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Does the organization discriminate by race in anyway with respect to: a Students' rights or privileges? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Admissions policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Employment of faculty or administrative staff? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Scholarships or other financial assistance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e Educational policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Use of facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33f g Athletic programs? h Other extracurricular activities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you answered "Yes" to any of the above, please explain . (if you need more space, attach a separate statement. ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34a 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? 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 . . . . . . . . . . . . . . . . . . 35 Schedule A (Form 990 or 900 -EZ) 2001 DAA 8779 11 /19/2002 9: 11 AM Schedule A (Form 990 or 990-EZ) 2001 I . R . C . HEALTHY START COALITION , INC 65 - 0363222 Page 5 Part VkA Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions . ) To be completed ONLY bv an eligible organization that filed Form 5768 N /A Check ► a if the organization belongs to an affiliated group . Check ► b if you checked "a" and 'limited control" provisions apply. Limits on Lobbying Expenditures (a) (b) Affiliated group totals To be completed for ALL electing he term "expenditures" means amounts paid or incurred. organizations 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0000 . . . 40 Total exempt purpose expenditures (add lines 38 and 39) 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 10% of the excess over $ 1 ,000,000 1 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 ) 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36 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 44you 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 Calendar year (or (a) (b) (c) (d) (e) fiscal year beginning in ► 2001 2000 1999 1998 Total 45 Lobbying nontaxable amount . . . . . . . 46 Lobbying ceiling amount ( 150% of line 45(e)) 47 Total lobbying expenditures . . . . . . . . 48 Grassroots nontaxable amount . . . . . 49 Grassroots ceiling amount ( 150% of line 48(e)) 50 Grassroots lobbying expenditures Part VI -B Lobbying Activity by Nonelecting Public Charities For reporting only by organizations that did not complete Part VI -A) See paqe 12 of the instr. N /A During the year, did the organization attempt to influence national , state or local legislation , including any Yes No Amount attempt to influence public opinion on a legislative matter or referendum, through the use of. a Volunteers . . . . . . 01 . 04 . . . . 0 . 0 . . . . . . 10 . . . . . . . . . . . . . . . . . . . b Paid staff or management (include compensation in expenses reported on lines c through h. ) c Media advertisements d Mailings to members , legislators , or the public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e Publications, or published or broadcast statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Grants to other organizations for lobbying purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g Direct contact with legislators , their staffs, government officials , or a legislative body h Rallies , demonstrations , seminars , conventions , speeches , lectures , or any other means . . . . . . . . . . . . . . . . . . . . . . . I Total lobbying expenditures (add lines c through h. ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If '"Yes" to any of the above , also attach a statement giving a detailed description of the lobbying activities. Schedule A ( Form 990 or 990-EZ) 2001 DAA 8779 11 /19/2002 9: 11 AM Schedule A (Form 990 or 990-EZ) 2001 I . R . C . HEALTHY START COALITION , INC 65 - 0363222 Page 6 Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (See paqe 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 $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (ii) Other assets a ii X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Other transactions : ( 1) Sales or exchanges of assets with a noncharitable exempt organization . . . . . . . . . . . . . b i X . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . (ii) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . bu (iii) Rental of facilities , equipment, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . b iii X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . (iv) Reimbursement arrangements b iv X (v) Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (vi) Performance of services or membership or fundraising solicitationsb vi X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Sharing of facilities , equipment, mailing lists , other assets, or paid employees c X 0 4ad 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 poods, other assets , or services received : (a) (b) (c) (d) Line no. Amount Involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements N /A 52a 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 followinq schedule : (a) (b) (c) Name of organization Type of organization Description of relationship N /A DAA Schedule A (Form 990 or 990-EZ) 2001 8779 11/10/20029: 11 AM Form 4562 Depreciation and Amortization OMB No. 1545-0172 (Rev. March 2002) ( Including Information on Listed Property) 2001 Department of the Treasury Internal Revenue Service POP See separate instructions. 111� Attach to our tax return. Seach men tNo, 67 Name(s) shown onreturn I . R . C . HEALTHY START COALITION , ZINC Identifying number Business or activity to which this form relates 65 - 0363222 INDIRECT DEPRECIATION Part I Election To Expense Certain Tangible Property Under Section 179 Note : If vou have any listed property, complete Part V before you complete Part I . 1 Maximum amount. See page 2 of the instructions for a higher limit for certain businesses 1 $24, 000 2 Total cost of section 179 roe ) " " " " " " ' " " " ' 2 property rty placed in service (see page 3 of the instructions 3 Threshold cost of section 179 property before reduction in limitation . . . . . . . . . . . . . _ 3 $2009000 4 Reduction in limitation . Subtract line 3 from line 2. If zero or lest, enter -0- 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dollar limitation for tax year. Subtract line 4 from line 1 . If zero or less, enter -0-. If married fili secrate , see 6 3 of the instr. 5 a Des cri tion of roe b Cost (business use on c Elected cost 7 Listed property. Enter the amount from line 29 8 Total elected cost of section 179 property. Add amounts in column (c) , lines 6 and 7 8 9 Tentative deduction. Enter the smaller of line 5 or line 8 10 Carryover of disallowed deduction from line 13 of your 2000 Form 4562 10 11 Business income limitation . Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11 12 Section 179 expense deduction . Add lines 9 and 10, but do not enter more than line 11 . , . . . . 13 Carryover of disallowed deduction to 2002 . Add lines 9 and 10, less line 12 ► 13 Note: Do not use Part II or Part III below for listed propertV. Instead , use Part V. Part 11 Special Depreciation Allowance and Other Depreciation Do not include listedroe . 14 Special depreciation allowance for certain property (other than listed property) acquired after Sept. 10, 2001 (see pg. 3 of the instr.) 14 885 15 Property subject to section 168(f)( 1 ) election (see page 4 of the instructions ) 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Other depreciation (including ACRS see page 4 of the instructions -4e 6833 _ Part III MACRS Depreciation (Do not include listed property. ) (See paqe 4 of the instructions . ) Section A 17 MACRS deductions for assets placed in service in tax years beginning before 2001 18 If you are electing under section 168(i)(4) to group any assets placed in service during the tax 17 14 3 72 year into one or more general asset accounts, check here rl Section B_ sets Placed in Se ice., During 2001 Tax Year Usin the General De reciation S stem a Classification of property (b) Month and (c) Basis for depreciation (d) Recovery ( ) P party yeaseM� in (business/investment use period (e) Convention (f) Method (g) Depreciation deduction only-see instructions) 19a 3-year property b 5 ear property2 , 065 5 . 0 M 2 0 ODB 10 4 c 7-year propert d 10 ear property e 15-year property f 20-year property 25-year propertyS/L s . h Residential rental 2 25 6 s. MM S/L property 27.5 vrs. MM S/L I Nonresidential real 39 yrs . MM S/L ro ert MM S/L Section C-Assets Placed in Service Durinq 2001 Tax Year Usingthe Alternative De reciation S stem 20a Class life b 12-year S/L- 12 yrs . S/L c 40-year 40 vrs . MM S/L Part IV Summa See page 6 of the instructions . 21 Listed property. Enter amount from line 28 22 Total. Add amounts from line 12, lines 14 through 17, tines 19 and 20 in column ' 4 (g), and line 21 . Enter here and on the appropriate lines of your return. Partnerships and S corporations-see instr. 22 22 194 23 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs F23T For Paperwork Reduction Act Notice, see separate instructions . Form 4562 (2001 ) (Rev. 3-2002) DAA THERE ARE NO AMOUNTS FOR PAGE 2 8779 I . R . C . HEALTHY START COALITION , INC 12 /24/2002 7 : 46 AM 65-0363222 Tax Asset Detail 7/01 /01 - 6/30/ 02 Page 1 FYE : 6/30/2002 Date In Sec 179 Exp Tax Sec Prior Current End Net Asset Property Description Service Cost Current = c 168 (k) Amt Depreciation Depreciation Depreciation Book Value Method Period Group : 26 * LEASEHOLD IMPROVEMENT 12/07/99 3 ,608 . 66 0. 00 0. 00 11142. 74 0.00 11142 . 74 2,465 . 92 S/L 5 . 0 65 LEASEHOLD IMP. - DRYWALL 7/25/01 32550 . 00 0 .00c 0. 00 0. 00 650. 83 650. 83 21899 . 17 S/L 5 . 0 66 LEASEHOLD IMP. - ELECTRIC 8/27/01 680 . 00 0 .00c 0. 00 0. 00 113 . 33 113 . 33 566 . 67 S/L 5 . 0 67 LEASEHOLD IMP - CARPET 9/ 17/01 1 ,312.05 0.00c 0 . 00 0. 00 196 . 81 196 . 81 1 , 115 . 24 S/L 5 . 0 68 LEASEHOLD IMP . A/C 6/25/02 2,450 . 00 0.00c 0. 00 0. 00 0.00 0 .00 2,450 . 00 S/L 5 . 0 No Group 11 ,600 .71 0.00c 0 .00 19142 .74 960 .97 22103 .71 9,497 . 00 * Less : Dispositions 3 ,608 .66 0.00 0 .00 1 , 142. 74 0.00 12142 . 74 2,465 . 92 Net No Group 7,992.05 0. 00c 0. 00 0. 00 960. 97 960 . 97 71031 . 08 Group : GENERAL 1 COMPUTER & PRINTER 6/ 19/93 3 ,000 . 00 0.00 0 . 00 32000. 00 0.00 3 ,000. 00 0 .00 S/L 5 . 0 2 COLOR MONITOR 6/ 16/93 450 .00 0. 00 0. 00 450. 00 0.00 450. 00 0. 00 S/L 5 . 0 3 COMPUTER 486 -SX 6/ 16/93 13250. 00 0.00 0 . 00 13250. 00 0. 00 1 ,25Q . 00 0. 00 S/L 5 . 0 4 OKIDATA LASER PRINTER 6/04/93 12095 . 00 0. 00 0. 00 1 ,095 .00 0 . 00 12095 .00 0 . 00 S/L 5 . 0 5 TELEPHONE 6/01 /93 85 . 52 0. 00 0. 00 69 . 11 8 . 55 77 . 66 7 . 86 S/L 10 . 0 6 CABINETS / LOCK BOX 6/04/93 245 . 89 0.00 0. 00 198 .77 24. 59 223 . 36 22 . 53 S/L 10 . 0 7 FURNITURE 9/ 10/93 450 . 00 0 .00 0. 00 352. 50 45 .00 397. 50 52 . 50 S/L 10 . 0 8 FAX 9/ 10/93 250. 00 0. 00 0.00 195 . 83 25 .00 220. 83 29 . 17 S/L 10. 0 9 TYPEWRITTER 10/20/93 119 . 00 0 . 00 0 . 00 119 . 00 0.00 119 .00 0. 00 S/L 5 . 0 10 COMPUTER 11 /01 /93 575 . 00 0. 00 0. 00 575 .00 0.00 575 . 00 0 .00 S/L 5 . 0 11 CONFERENCE TABLE 5/06/94 160. 00 0 . 00 0. 00 114. 67 16 . 00 130. 67 29. 33 S/L 10. 0 12 COMPUTER & PRINTER 5/06/94 2,566 . 00 0 . 00 0 . 00 2,566 .00 0.00 2,566 .00 0 . 00 S/L 5 . 0 13 TELEPHONE 8/26/94 95 .21 0. 00 0. 00 95 .21 0.00 95 .21 0 . 00 S/L 5 . 0 14 OFFICE CHAIRS 1 /09/95 398 .00 0.00 0 . 00 258 .70 39 . 80 298 .50 99 . 50 S/L 10. 0 15 KEYBAORD DRAWER & UPGR/ 3/06/95 154 . 86 0. 00 0. 00 154. 86 0 .00 154 . 86 0. 00 S/L 5 .0 16 (2) ROOM DIVIDERS 4/20/95 100. 00 0. 00 0. 00 100.00 0.00 100.00 0. 00 S/L 5 . 0 17 1 . 7 CU. FT. REFRIGERATOR 8/24/95 99 . 76 0. 00 0 .00 58 .21 9. 98 68 . 19 31 . 57 S/L 10 . 0 18 UTILITY TABLE 28X48 6/30/96 239 . 94 0. 00 0. 00 119. 95 23 . 99 143 . 94 96 . 00 S/L 10 . 0 19 SYMPHONIC 13 " COLOR TV/VC. 6/20/96 279 .00 0. 00 0 .00 279 . 00 0.00 279 . 00 0. 00 S/L 5 .0 20 METAL STORAGE CABINET 8/ 15/95 99 . 99 0.00 0 .00 59 . 17 10. 00 69 . 17 30 . 82 S/L 10 . 0 21 COMPUTER SIP DRIVE 6/28/96 401 .25 0.00 0 . 00 401 .25 0. 00 401 . 25 0 . 00 S/L 5 . 0 22 LAPTOP COMPUTER 7/ 12/96 900.00 0.00 0 . 00 900.00 0. 00 900 . 00 0 . 00 S/L 5 . 0 23 LASER PRINTER 4/ 17/97 799 . 99 0.00 0. 00 666 . 67 133 . 32 799 .99 0 . 00 S/L 5 . 0 24 COMPUTER (3) 1 /01 /98 42424. 79 0. 00 0 . 00 32097. 36 884.96 39982 . 32 442.47 S/L 5 . 0 25 M3 ARISE DISPLAY UNIT 8/ 19/98 12299 .00 0.00 0 . 00 736 . 10 259 . 80 995 .90 303 . 10 S/L 5 . 0 27 TELEPHONE SYSTEM -HS 1 /20/00 11694. 60 0 . 00 0 .00 480. 14 338 . 92 819 .06 875 . 54 S/L 5 . 0 28 TELEPHONE SYSTEM -HF 1 /20/00 29885 .40 0. 00 0.00 817 . 53 577 .08 11394.61 11490. 79 S/L 5 . 0 29 TELEPHONE HEAD SET-TLC 1 /20/00 74 . 62 0 . 00 0. 00 21 . 14 14 .92 36 . 06 38 . 56 S/L 5 . 0 30 MONITOR 12/ 14/99 139 . 98 0 .00 0. 00 44. 33 28 . 00 72. 33 67 . 65 S/L 5 . 0 31 COMPAQ PRESARIO 12/ 13/99 549 . 98 0 . 00 0. 00 174. 16 110.00 284 . 16 265 . 82 S/L 5 . 0 32 HP DESKJET 812C PRINTER 12/ 13/99 149 .98 0 .00 0. 00 47. 50 30.00 77 . 50 72. 48 S/L 5 . 0 33 OFFICE 2000 SOFTWARE 12/ 13/99 199 .97 0 .00 0. 00 63 . 32 39 .99 103 . 31 96 . 66 S/L 5 . 0 34 HP LASER JET PRINTER (2) 12/ 13/99 799 .98 0.00 0. 00 253 . 33 160. 00 413 . 33 386 . 65 S/L 5 . 0 35 OFFICE 2000 SOFTWARE 12/ 13/99 199 .97 0. 00 0. 00 63 . 32 39 . 99 103 . 31 96 . 66 S/L 5 . 0 36 HP DESKJET 812C PRINTER (3 ) 12/ 13/99 449 . 94 0.00 0 . 00 142.48 89. 99 232 .47 217 .47 S/L 5 . 0 37 WORKS SUITE 2000 (3 ) 12/ 13/99 269 . 91 0. 00 0 . 00 85 .47 53 .98 139 .45 130. 46 S/L 5 . 0 8779 I . R . C . HEALTHY START COALITION , INC 12/24/2002 7 : 46 AM 65-0363222 Tax Asset Detail 7/01 /01 - 6/30/ 02 Page 2 FYE : 6/30/2002 Date In Sec 179 Exp Tax Sec Prior Current End Net Asset Property Description Service Cost Current = c 168 (k ) Amt Depreciation Depreciation Depreciation Book Value Method Period Group : GENERAL (continued) 38 COMPAQ PRESARIO (3 ) 12/ 13/99 19649 . 94 0. 00 0 .00 522 .48 329 . 99 852.47 797.47 S/L 5 .0 39 WORKS SUITE 2000 12/ 14/99 89 . 97 0.00 0 .00 28 .49 17. 99 46 .48 43 .49 S/L 5 . 0 40 MONITORS (5) 12/ 14/99 699 . 90 0. 00 0. 00 221 .64 139 .98 361 .62 338 .28 S/L 5 . 0 41 COMPAQ PRESARIO (2) 12/21 /99 19099 . 96 0. 00 0. 00 329 . 99 219 . 99 549. 98 549 . 98 S/L 5 . 0 42 STORAGE CABINET 2/ 15/00 329 .00 0. 00 0.00 93 .22 65 . 80 159 . 02 169 . 98 S/L 5 . 0 43 HP8670 3/28/00 17599 .99 0.00 0.00 400.00 320. 00 720. 00 879 . 99 S/L, 5 . 0 44 HP PRINTER 3/28/00 600.00 0.00 0 . 00 150.00 120.00 270.00 330. 00 S/L 5 . 0 45 SONY LAPTOP 3/28/00 21399. 99 0.00 0. 00 600. 00 480.00 1 ,080. 00 19319 . 99 S/L 5 . 0 46 OFFICE 2000 PRO 3/28/00 599 .90 0. 00 0 .00 149.98 119 . 98 269 . 96 329 . 94 S/L 5 . 0 47 MONITOR M70 3/28/00 536 .00 0.00 0. 00 134. 00 107.20 241 . 20 294. 80 S/L 5 . 0 48 UPS 500 BACKUP 3/28/00 329. 99 0.00 0. 00 82. 50 66 . 00 148 . 50 181 .49 S/L 5 . 0 49 TELEPHONE ADD-ON3/27/00 700.00 0. 00 0.00 175 .00 140 .00 315 .00 385 . 00 S/L 5 . 0 50 SONY LAPTOP 3/28/00 21499.99 0. 00 0.00 625 .00 500. 00 19125 . 00 11374. 99 S/L 5 . 0 51 LASER PRINTER 3/28/00 499.99 0.00 0. 00 125 . 00 100.00 225 . 00 274 .99 S/L 5 . 0 52 PRINTER 2000CN 4/ 11 /00 899 .99 0.00 0.00 225 .00 180. 00 405 . 00 494. 99 S/L 5 . 0 53 OFFICE FURNITURE 7/28/00 21 ,859.47 0. 00 0. 00 32122. 78 5 ,353 .34 8 ,476 . 12 13 ,383 . 35 20ODB 7. 0 54 RICOH 450 COPIER 7/31 /00 10,550.00 0.00 0. 00 21110.00 39376 . 00 5 ,486 . 00 51064 .00 20ODB 5 . 0 55 RICOH 220 COPIER 7/31 /00 42600. 00 0. 00 0. 00 920. 00 12472 . 00 2 ,392. 00 2,208 . 00 20ODB 5 . 0 56 CANNON IR330 COPIER 7/31 /00 72876 .00 0.00 0 .00 1 ,575 . 20 2 ,520.32 49095 . 52 3 ,780.48 20ODB 5 . 0 57 COMPUTER 10/31 /00 1 ,359 .96 0.00 0. 00 271 . 99 435 . 19 707. 18 652.78 20ODB 5 . 0 58 COMPUTER MONITOR & PRINT 10/31 /00 1 ,494. 06 0.00 0.00 298 . 81 478 . 10 776 . 91 717. 15 20ODB 5 . 0 59 COMPUTER HARDDRIVE 5/21 /01 479 . 88 0. 00 0.00 95 . 98 153 . 56 249 . 54 230 . 34 20ODB 5 . 0 60 DESK CHAIR & BOOKCASE 6/28/01 889 . 74 0. 00 0 .00 127. 11 217. 89 345 . 00 544 . 74 20ODB 7. 0 61 COMPUTER NETWORKING 6/29/01 1 , 145 . 00 0.00 0.00 229 .00 366 .40 595 .40 549 . 60 20ODB 5 . 0 62 COMPUTER 5/07/02 12000. 00 0. 00c 300.00 0 .00 335 . 00 335 .00 665 . 00 20ODB 5 . 0 63 COMPUTER 4/04/02 1 ,649. 50 0. 00c 494. 85 0.00 552. 58 552 .58 11096. 92 20ODB 5 . 0 64 CREDIT CARD MACHINE 6/ 17/02 300. 00 0.00c 90.00 0.00 100.50 100. 50 199 . 50 20ODB 5 . 0 GENERAL 0.00c � 884�85 31 2 ( ,231 . 67 52 417740. 83 Grand Total 106,291 .46 0. 00c 884. 85 322860. 99 229192 . 64 552053 . 63 512237. 83 Less: Dispositions 39608 .66 0. 00 0. 00 12142. 74 0. 00 1 , 142. 74 22465 . 92 Net Grand Total 102,682. 80 0.00c 884. 85 31 ,718. 25 2 532910. 89 48 ,771 . 91 8779 I . R . C . HEALTHY START COALITION , INC 11 / 19/2002 9 : 11 AM 65-0363222 Federal Statements FYE : 6/30/2002 Statement 1 - Form 990 , Part I , Line 8c - Sale of Assets Other Than Inventory - Other How Whom Desc Rec'd Sold Date Date Sale Cost & Gain/ Acquired Sold Price Expense Deprec - Loss LEASEHOLD IMPROVEMENT PURCHASE 12 / 07 / 99 7 / 01 / 01 $ $ 31609 $ 11143 $ - 21466 TOTAL $ 0 $ 31609 $ 11143 $ - 21466 1 8779 I . R . C . HEALTHY START COALITION , INC 11 / 19/2002 9 : 11 AM 65- 0363222 Federal Statements FYE : 6/30/2002 Statement 2 - Form 990 , Part 11 , Line 43 - Other Functional Expenses Total Program Mgt & Fund - Description Expenses Service General Raising EXPENSES ADVERTISING 551 551 BANK CHARGES 25 25 INSURANCE 71448 7 , 448 OFFICE 697 697 UTILITIES 3 , 842 31842 PROFESSIONAL FEES 26 , 638 26 , 638 DUES 799 799 MISCELLANEOUS 71923 71923 CONTRACT SERVICES 43 , 188 43 , 188 TOTAL $ 91 , 111 $ 91 , 111 $ 0 $ 0 Statement 3 - Form 990 , Part III - Organization 's Primary Exempt Purpose TO ESTABLISH A SYSTEM WHICH WILL ENABLE ALL WOMEN TO HAVE ACCESS TO PRENATAL CARE AND THAT ALL INFANTS HAVE ACCESS TO SERVICES THAT PROMOTE NORMAL GROWTH AND DEVELOPMENT , Statement 4 - Form 990 , Part 111 , Line a - Statement of Program Service Accomplishments CARE COORDINATION COALITION - TO ESTABLISH A SYSTEM WHICH WILL ENABLE ALL WOMEN TO HAVE ACCESS TO PRENATAL CARE AND TO GUARANTEE THAT ALL INFANTS HAVE ACCESS TO SERVICES THAT PROMOTE NORMAL GROWTH AND DEVELOPMENT , Statement 5 - Form 990 , Part III , Line b - Statement of Program Service Accomplishments TLC NEWBORN ( SUCCESS BY SIX ) - A PROACTIVE PROGRAM WHICH REACHES ALL NEWBORN FAMILIES IN THE COUNTY TO PROMOTE FAMILY VALUES AND HEALTHY BABIES AND OFFERS ASSISTANCE AND SUPPORT FOR THOSE REQUESTING HELP , Statement 6 - Form 990 , Part III , Line c - Statement of Program Service Accomplishments HEALTHY FAMILIES INDIAN RIVER COUNTY - A COMMUNITY BASED , VOLUNTARY HOME VISITATION PROJECT THAT PROMOTES POSITIVE PARENTING AND CHILD DEVELOPMENT , THEREBY PREVENTING CHILD ABUSE AND NEGLECT AND OTHER POOR OUTCOMES . 2 -6 8779 I . R . C . HEALTHY START COALITION , INC 11 / 19/2002 9 : 11 AM 65-0363222 Federal Statements FYE : 6/30/2002 Statement 7 - Form 990 , Part IV, Line 58 - Other Assets Beginning End of Description of Year Year DEPOSITS $ 21865 $ 1 , 254 TOTAL $ 21865 $ 11254 Statement 8 - Form 990 , Part IV, Line 65 - Other Liabilities Beginning End of Description of Year Year COMPENSATED ABSENCES $ 21858 $ 51556 TOTAL $ 21858 $ 51556 7-8 8779 I . R . C . HEALTHY START COALITION , INC 11 / 19/2002 9 : 11 AM 65-0363222 Federal Statements FYE0 6/30/2002 Statement 9 - Form 990 Part IV-A - Other Revenue Included in Financial Statements Description Amount LOSS ON DISPOSAL OF LEASEHOLD IMPROVEMENTS $ 21466 TOTAL $ 2 , 466 Statement 10 - Form 990 Part IV-B - Other Ex enses Included in Financial Statements Description Amount LOSS ON DISPOSAL OF LEASEHOLD IMPROVEMENTS $ 21466 TOTAL $ 2 , 466 9 - 10 8779 I . R . C . HEALTHY START COALITION , INC 11 / 19/2002 9 : 11 AM 65-0363222 Federal Statements FYE : 6/30/2002 Statement 12 = Schedule A, Part IV-A, Line 22 - Other Income Description 2000 1999 1998 1997 RETURN OF PRIOR YEARS EXEMPTED EXP ' S $ $ $ 4 , 667 $ TOTAL $ 0 $ 0 $ 41667 $ 0 12 2001 -2002 Italian River County Healthy Start Coalition Board ofDirectors Board Member Phone Numbers -Mail Term (start} Term. (end) AfEliatlons Mike Lundeen 772-564-2627(8) strgsol@aol.com Sept 99 Der, "03 Owner- Storage President Fax : 772-564-2628 Solutions & PalcMail 4340 North Us # 1 Other: 772-770-3666 Vero Beach, FL 32967 Fanny Muskulus 772-234- 8892 (H) Tobyl@veronet .corn Aug '0a Dec '03 Community Resident( Vice President Volunteer 1563 Coral flak Lane Vero Beach, FL 32963 Mice Burgelin 772-3884578 (I3) 1nRce burge(inPjmio.eom June. '01 Dec '04 President,I. B. C. Treasurer Fax: '772-581 -8388 ne Employer Services 532 Quarry LaCell: 772- 532-2261 Sebastian, FL 32958 ' Tears Anderson 772-388-2948 (H} TLCJean@aol, com 2/Jan '02 Dec '04 Community Resident!' Secretary Fax: 772-388-2948 4785 61st PlaceVolueer-founder of TLC program � NY. Sebastian, TL 32958 '{en Hoffman. 772-234-9426 (W) KenH@gate.net gate.net May '00 Dec '02 local Attorney 530 Camelia Lane Fax: 772-234 9427 Vero Beach, FL 32963 Aargaret Itigrarn 772-564 -3300 (W) Sp1der4B@aoLcotn Aug 100 Dec '03 Teacher-Beacldand reacher 772-5624739 (1- Elementary School 3551 Mockingbird Drive hero Beach, EL 32963 Page lone of DM Board Illember Phone Numbers E-Mail Term (start) Term end A Josie Lieberman 772-589-6054 (H) Ellen66666@aol.com Aug '99 Dec '02 Community Residentf 8580 Seacrest Drive Fax: 772-589-6053 Volunteer Vero Beach, FL 32963 Pat Lundell 772-589-3288 DLLundell@aol. corn Aug '99 Dec '03 Learning Nest 1140 49th Avenue Child Care Center-Owner Vero Beach, FL 32966 Teacher-Glendale Elementary Margaret Molter 772J70-9303 www.ancor2001rehab. comJwie '01 Dec '04 Administartor, ANCOR REHAB Fax : 772r7709393 ancormkt@bellsouth.net ANCOR REHAB 2001 9th Avenue, Ste. 201 Vero Beach, FL 32960 David Shapiro 772-97 &-4640 ('SA ) dshapiro@VBPD .org Nfay '00 Dec '02 Vero Beach Police Dept . 1055 20th Street 772-9784691 Vero Beach, FL 32960 Debbie Voorhees 772-5674311 ext. 35027(W) Indian River Memorial Hosp .Fax: 772-5634730 Direct: 772-794-5027 Aug '00 Dec '03 Indian River 1000 36th Street Memorial Hospital Vero Beach, FL 32960 Page TWO, of TWO 877911 /06/200210:41 AM Form 8868 Application for Extension of Time To File an (December 2000) Exempt Organization Return OMB No. 1545-1709 Department of the Treasury Internal Revenue Service ® File a separate application for each return. ® If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box ® If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form). Note: Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 88158. "M Automatic 3-Month Extension of Time- Only submit original (no copies needed) Note Form 990-T corporations requesting an automatic 6-month extension-check this box and complete Part I only All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns. Partnerships, REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041 . Type or Name of Exempt Organization Employer identification number print File by the I . R . C . HEALTHY START COALITION INC 65 - 0363222 due date for Number, street, and room or suite no. If a P.O. box, see instructions. filing your 1603 10TH AVENUE return.rn. See instructions. City, town or post office, state, and ZIP code. For a foreign address, see instructions. rVERO BEACH FL 32960 Check type of return to be filed (file a separate application for each return): Form 990 Form 990-T (corporation) Form 4720 Form 990-13L Form 990-T (sec. 401 (a) or 408(a) trust) Form 5227 Form 990-EZ Form 990-T (trust other than above) Form 6069 Form 990-PF Form 1041 -A Form 8870 • If the organization does not have an office or place of business in the United States, check this box ® If this is for a Group Return, enter the organization's four digit Group Exemption NumberGEN ( ) . If this is for the whole group, check this box ® . If it is for part of the group, check this box b� 0 and attach a list with the names and EINs of all members the extension will cover. 1 I request an automatic 3-month (6-month, for 990-T corporation) extension of time until _ 2 / 17 / 03 to file the exempt organization return for the organization named above. The extension is for the organization's return for. P calendar year or 10* tax year beginning _ 7 / 01 / 01 , andending _ 6 / 30,L02 2 If this tax year is for less than 12 months , check reason: Initial return Final return Change in accounting period 3a If this application is for Form 990-BL, 990-PF , 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions . . . $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature and Verification Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and co plete, and that I am authorized to prepare this form. Si nature P . / Title P L/�/�J Date Pop Nov 12 2002 For Paperwork Reduction Act Notic ee Instruction Form 8868 (12-2000) COPY DAA Healthy Start Coalition Fiscal Year: July 2002 = June 2003 Interim Statement of Activity for the 2 months ended April 30, 2003 Variance Year to Date % Actual Actual Monthly of Actual Actual Annual Budgets of Budget March April Budget to Budget YTD Yrly Budget Remaining Remaining Income 300 • Contributions Income *" Restricted 180.00 40.00 40.00 520.00 Other 0.00 430.05 329 . Administration Fee - Ounce 1 ,008.54 894.75 395.83 498.92 4,321 .85 41750.00 428.15 9% 360 . Miscellaneous Income 18.14 0.00 18.14 32.06 (32 .06) #DIV/01 Events (meal reimbursement) 10294.50 166.67 1 ,127.83 11449.50 2 ,000.00 550.50 28% Fundraising 52.32 125.00 (125.00) 52.32 10500.00 1 ,447.68 97% Appropriation of Net Assets 3,500.00 (36500.00) 42 ,000.00 42,000.00 100% State Contracts 0.00 0.00 DOH 12 ,500.00 (122500.00) 75,000.00 150,000.00 75,000.00 50% Program Reimbursement (HF4RC ) 166.67 (166.67) - 29000.00 2,000.00 100% Interest Income 0.00 0.00 - - Total income 19240.86 21247.39 16,854.17 (14,606.78) 819285.78 2029250.00 121 ,394.27 60% Expense 522.Continuing Education 83.34 (83.34) 784.00 10000.00 216.00 22% Credit Card/Bank service charges 5.00 7.73 41 .67 (33.94) 157.31 500.00 342 .69 69% 530 . Insurance 957.96 916.00 774.84 141 .16 71097.01 9,298.00 21200.99 24% 544 . Payroll 79353.46 70300.96 9,034.73 (10733.77) 900487.77 1088416.77 170929.00 17% 546 . FICA Expense 562.54 558.53 691 .16 (132.63) 61922.16 8,293.86 1 ,371 .70 17% 550 • Postage/Shipping 332.13 208.34 123.79 508.78 21500.00 11991 .22 80% 555 . Outside Print Service 895.46 166.67 728.79 21000.00 29000.00 - 0% 560 • Professional Fees(Karen McHenry) 1 ,920.00 11920.00 22021 .95 (101 .95) 19,200.00 240263.37 51063.37 21 % 561 .5 Payroll Service 87.80 87.80 75.00 12.80 1 ,232.47 900.00 (332.47) -37% 571 . Equipment Rental 43.87 48.87 125.00 (76.13) 413.71 11500.00 11086.29 72% 572 . Office Rent 892.50 892.50 892.50 0.00 81925.00 10,710.00 10785.00 17% 575 • Repairs/Maintenance 147.92 298.92 83.34 215.58 11623.77 16000.00 (623.77) -62% 580 • Subscriptions/Dues 23.90 107.04 125.00 (17.96) 1 ,802.34 1 ,500.00 (302.34) -20% 591 .5 Events 280.76 418.05 250.00 168.05 30950.15 31000.00 (950.15) -32% 592 . Supplies-0ffice 1 ,127.19 202.94 166.67 36.27 4,157.97 2,000.00 (20157.97) -108% 597 • Telephone 254.32 236.08 300.00 (63.92) 21079.88 31600.00 11520.12 42% 600 • Travel 374.99 454.23 375.00 79.23 4,691 .86 41500.00 (191 .86) 4% 610 • Utilities 143.07 430.75 125.00 305.75 1 ,610.46 10500.00 (110.46) -7% Capital Expenditures 333.34 (333.34) 39247.88 41000.00 752.12 612 Marketing 198.77 20004.72 1 ,000.00 1 ,004.72 6,925.52 129000.00 50074.48 42% Contribution Expense 0.00 238.47 (238.47) Un-Employment compensation 955.00 0.00 11910.00 (10910.00) Total Expense 15,329.05 17,112.71 16,873,601 239.21 169,966.51 202,482.00 32,515.49 16% Budget Adjustment made for payroll and Fica Expense torofess on ees for Karen McHenry Deleted line Item 591 - No budgeted amount for this categoiry, Reclassed entries to 591.5, 600 and 612 Untm to ment compensation Is a non budgeted item that will need to be paid again at the and of March Repairs and Maint over due to storage units. Storage coded to re and maint due to fad that rent only includes office 211 had 3 edods in January urance p ma pn s Tor o s comp. Maint high for April due to Colkitt coming to replace the Thermostat in the conf room.($151.00) Utilities high for April due to broken thermostat in conf room. See attached receivables from Safe Kids Healthy Start Coalition Consolidated Budget Report Page 1 Healthy Start Coalition - Healthy Families Fiscal Year: July 2002 , June 2003 Interim Statement of Activity for the 2months ended April 30, 2003 Variance Year to Date %, Actual Actual Monthly of Actual Actual Annual Budget $ of Budget March April Budget to Budget YTD Yrly Budget Remaining Remaining Income 300 • Contributions Income "' 0.00 - - #DIV/0! Restricted 0.00 100.00 ( 100.00) #DIVlO! Restricted - Donation 0.00 65.00 (65.00) #DIV/01 Restricted- John's Island 0.00 10,000.00 12 ,000.00 21000.00 17% Contributions - Other 40.00 40.00 60.00 (60.00) #DIV/0 ! 310 . State Contract-HFF/Ounce 44,981 .97 51 ,335.82 24,582 .08 26, 753.74 266,401 .21 294,985.00 28,583.79 10% 320 • Grants ` I.R.Exchange Club 125.00 ( 125.00) 1 875.00 10500.00 625.00 42% BOCC 81888.90 41444.45 41444.44 0.01 31 , 111 . 12 400000.00 81888.88 22 % Guardian Angel 180.00 0.00 11631 .42 362. Fundraising 166.67 (166.67) 11079. 18 28000.00 920.82 46% Prior Period Revenue 0.00 (1088569.65) 108,569.65 Total Income 54,050.87 55,820.27 299318. 19 26,502.08 2029753.28 350,485.00 147,731 .72 42% Expense 520 • Capital Expense 0.00 0.00 - 500.00 500.00 100% 526 , Contract/Grant Administration 1 ,402.45 913.44 2 ,021 .32 ( 11107.88) 91714.26 24,255.77 14,541 .51 60% Credit Card/Bank Service Charges 0.00 - - 530 • Insurance 174.08 174.08 83.00 91 .08 11033.97 11000.00 (33.97) -3% 547 . Wages-Outside Programs 15,625.20 14,661 .80 20,022.46 (5,360.66) 125,286.82 228,369.43 1030082.61 45% 548 . Benefits-Outside Programs 727.82 727.82 11688.45 (960.63) 41751 .63 261280.61 210528.98 82 % 549 , FICA-Outside Programs 11159.99 11094.32 11531 .72 (437.40) 91496. 11 19, 786.74 10,290.63 52% 551 , Participant/Education Materials 35.00 39.85 41 .67 (1 .82) 74.85 11341 .05 11266.20 94% 550 • Postage/Shipping 54.85 62.50 (7.65) 317.84 750.00 432. 16 58% 555 . Outside Print Service 33.34 (33.34) 505.00 400.00 (105.00) -26% 556 . Advertising 8.09 (8.09) - 97.00 97.00 100% 560 • Professional Fees 275.00 250.00 25.00 275.00 3,000.00 21725.00 91 % 571 . Equipment Rental 125.00 (125.00) 49.00 11500.00 1 ,451 .00 97% 572 , Office Rent 1 ,200.00 11050.00 1 ,200.00 (150.00) 81340.00 14,400.00 60060.00 42% 575 • Repairs/Maintenance 83.00 30.00 83.34 (53.34) 685.30 10000.00 314.70 31 % 580 • Subscriptions/Dues/Permits 16.67 (16.67) 64.00 200.00 136.00 68% 591 , Food/Consumable Program Supplies 52.53 83.34 (30.81 ) 1 159.53 11000.00 840.47 84% 592 . Office Supplies 26.56 27.37 200.00 (172.63) 923.80 21400.00 11476.20 62% 594 . Family Supplies/Assist Participants 75.00 200.00 125.00 75.00 586.84 875.00 288. 16 33% 597 • Telephone 418.56 75. 71 440.00 (364.29) 20455.42 5,280.00 2,824.58 53% 600 • Travel 224.68 755.89 833.34 (77.45) 51437. 15 119000.00 51562 .85 51 % 607 . Training & Conferences 636.60 83. 13 208.34 (125.21 ) 2, 183.41 3,500.00 1 $ 16.59 38% 610 • Utilities 400. 12 0.00 135.42 (135.42) 1 21358.60 2,358.60 - 0% 625 • Background Check 47.08 (47.08) 335.00 565.00 230.00 41 % 521 . Donation Expenses-AP Conference 0.00 201 .05 (201 .05) Total Expense 22, 189.06 20,215.79 29, 154.93 (89939. 14) 175,033.53 3491859.20 174,825.67 50% Reduction in advanced payable of $88,000.00 to $58,666.66 (1998 advance for start up costs) Outside print over budget due to guardian angel brochures Budget admendment being done to address utilities Reclassed fatherhood program expense from care coordination to HF training $588.60 $6,000.00 Budget adjustment reflected on March budget Budget adjusted back to origingal with ex of Benefits, Utilities and part ed mats. Used dollars from benefits to cover overage in utilities of $733.60 and participant educational materials $841 .05. Healthy Start Coalition " Care Coordination Fiscal Year: July 2002 - June 2003 Interim Statement of Activity for the 2 months ended April 30 , 2003 Variance YTD Budget % Actual Actual Monthly of actual Actual Annual Dollars of Budget March April Budget to Budget YTD Yrly Budget Remaining Remaining Income 300 . Contributions - Restricted 0.00 0.00 - 310 . State Contract 0.00 0.00 - DOH 18,080.25 (18,080.25) 1050869.25 216,963.00 111 ,093.75 51 % 311 .5 ACHA Medicaid Waiver 6,908.25 405.00 41498.73 (41093.73) 44,856.25 53,984.70 96128.45 17% 311 .6 ACHA Medicaid WaiverSOBRA 4,590.00 1985325 (11853.25) 19,991 .00 229239.00 26248.00 10% 320 . Grants 0.00 0.00 - United Way-I.R. Co. 0.00 0.00 - - - Exchange Club 72.92 (72.92) 875.00 875.00 March of Dimes 10,000.00 101000.00 10,000.00 Prior Period RevenueSobra May (19$ 69.50) Total Income 11 ,498.25 10,405.00 24,505.14 ( 14,100.14) 1 1621022.00 2949061 .70 1 132,039.70 45% Expense 521 . Contribution Expense 0.00 - 526 . Contract/Grant Administration Expense 11750.00 583.33 (583.33) 30500.00 70000.00 30500.00 50% 547 . Wages-Outside Programs 58,010.65 18,548.54 (18,548.54) 101 ,737. 18 222 ,582 .45 120,845.27 54% 548 .Taxes & Benefits-Outside Programs 13,020.19 4,358.15 (41358.15) 231860.69 52,297.82 289437. 13 54% 555 . Outside Print Service 219.58 83.33 (83.33) 536. 17 1 ,000.00 463.83 46% 560 • Professional Fees(Enhanced) 381 .40 375.00 (375.00) 11880.00 41500.00 21620.00 58% 569.0 Breastfeeding Support (VNA) 41 .67 (41 .67) 300.00 500.00 200.00 40% 569.5 Screening Liaison 400.00 400.00 433.33 (33.33) 3,129.00 5200.00 2,071 .00 40% 571 . Equipment Rental/Maintenance 192.70 133.33 (133.33) 282 .55 13600.00 10317.45 82% 575 • Repairs/Maintenance 53.00 0.00 0.00 473.00 - (473.00) 594.1 EXC Family Supplies 1 183.54 72.92 110.62 19127.26 875.00 (252.26) -29% 597 • Telephone 10426.94 333.33 (333.33) 2 ,711 .03 41000.00 19288.97 32% 600 9 Travel 457.46 166.67 (166.67) 921 .42 21000.00 11078.58 54% 607 . Training & Conferences 41 .67 (41 .67) 1 11 .92 500.00 488.08 98% 615SIS System 166.67 (166.67) 643.61 1 26000.00 1 ,356.39 68% Total Expense 75,911 .92 583.64 1 25,337.94 (24,764AO) l 141 ,113.83 1 304,055.27 162,941A4 54% Expenses on March budget reflect Oct-Dec 02 Line item 560 - Reclassed $588.60 to Healthy families for fatherhood program. Actual expense in March for this line item was $970.00 March of Dimes added to budget in April. This money is to be used for the Spanish outreach person and have added $10,000.00 to wages. Will receive another $10,000.00 in fiscal 03104. Healthy Start Coalition = TLC Fiscal Year: July 2002 - June 2003 Interim Statement of Activity for the 2 months ended April 30, 2003 Variance Year to Date % Actual Actual Monthly of Actual Actual Annual Budget $ of Budget March April Budget to Budget YTD Yrly Budget Remaining Remaining Johns Island-Restricted 03104 101000.00 (101000.00) 300 . Contributions 20.00 0.00 170.00 Fund-11aising 10,000.00 1 ,083.33 1 ,083.33 12 ,495.00 139000.00 505.00 4% 320 • Grants ` 0.00 - UWIRC 31333.34 3,333.34 39333.33 (0.01 ) 29,999.72 40,000.00 10,000.28 25% BOCC 51000.01 1 ,666.67 1 ,666.67 (0.00) 10,000.35 15,000.00 41999.65 33% Prior Period Revenue 0.00 (11667.00) - Johns Island-Restricted 03104 (10,000.00) 100000.00 (10,000.00) Total Income 18,353.35 5,000.01 1 61083.33 1 ,083.32 50,998.07 68,000.00 14,999.93 22% EXPENSE 547 . Wages-Outside Programs 3,291 .13 30492.89 39989.75 496.86 30,496.93 47,877.00 17,380.07 36% 548 , Benefits-Outside Programs 256.73 281 .65 408.08 126.43 39068.98 49897.00 1 ,828.02 37% 549 . FICA-Outside Programs 251 .77 267.21 305.25 38.04 2 ,139.95 31663.00 10523.05 42% 550 • Postage/Shipping 495.83 304. 15 1 291 .67 (12.48) 2 ,751 .38 31500.00 748.62 21 % 555 . Outside Print Service 213.89 2.01 83.33 81 .32 19082 .37 10000.00 (82.37) -8% 569 . Professional Fees VNA Home Visits 200.00 150.00 208.33 58.33 11250.00 21500.00 1 ,250.00 50% 592 , Supplies-Office 107.00 83.33 83.33 427.55 1 ,000.00 572.45 57% 595 . Supplies-Events 13.58 13.58 300.45 163.00 (137.45) -84% 600 • Travel 166.67 166.67 317.80 21000.00 ll682.201 84% 607 . Training and Conferences 340.00 83.33 (256.67) 340.00 11000.00 660.00 66% 551 .Educational Materials 161 .98 2,625.15 . 33.33 (21591 .82) 2 ,876.28 400.00 (26476.28) -619% Misc Expense-Background Check 31 .00 (31 .00) 101 .00 (101 .00) 0.00 41978.33 7,494.06 5,666.67 (1 ,827.39) 45,152.69 68,000.00 22,847.31 34% 595. Events - Credit for softballs returned from Scotts Sporting Goods. TLCBudgetReportC0NS0L0203 . x1s 1 Indian River County Healthy Start Coalition , Inc . — 2002 = 2003 Programs Maternal & Child Health Indian River County Contracted Services Healthy Start Coalition IRCHSCMissionStatement To establish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote optimal growth and development. Healthy Start TLC Newborn Healthy Families Safe Kids of Care Coordination Program Indian River County Indian River County Board of Directors Goal: Goal: Goal: Goal: To prevent poor birth outcomes and To strengthen families of newborns To prevent child abuse through education To identify and target the Injury problems provide education, support and guidance by providing Information, promoBng and coordinated support to promote positive most prevalent in our county and to for optimal growth and development of understanding and reassuring parents. parent/child interaction and bonding. leadership and coordination for commune IRCHSC pregnant women and InfentIchild. wide injury prevention initiatives, education Administrative Staff Most Agency: IRC Health Department Host Agency: IRC Health Department Host Agency: Exchange Club CASTLE and safety events. Coro Funding Sources: Core Funding Sources: Host Agency: IRC Healthy Start Coalition Executive Director Core Funding Sources: United Way of Indian River County - FL Ounce of Prevention FL Dept of Health Success by Six IRC Board of County Commissioners - Core Funding Sources: 1.0 FTE FL Agency for Health Care Administration IRC Board of County Commissioners - Children's Services Advisory Committee FL Department of Health (Coalition Funds) Children's Services Advisory Committee National Safe Kids Outreach Administrative Fiscal Staff., Staff: 0.6 FTE Supervisor Staff: 1 .0 FTE Program Manager Staff: Coordinator Assistant Coordinator 3.4 FTE HS Care Coordinators 0.6 FTE Coordinator 1 .0 FTE Supervisor .25 FTE Safe Kids Coordinator .50 FTE 1 ,0 FTE .75 FTE 1 .0 FTE MomCare Advisor 1 Family Associate at .50 FTE 1 .0 FTE Family Assessment Worker Community Agency Volunteers 1 .0 FTE HS Administrative Assistant 3 Family Associates at .25 FTE 6.0 FTE Family Support Workers Core Funding Source: 1 .0 FTE BI-Lingual Outreach Coordinator 0.25 FTE Administrative Assistant 1 .0 FTE Admin. Assist/Data Clerk Target Population: Florida Department of Health (DOH) Target Population: Target Population: Target Population: Children ages 0 to 14 Total Programmatic Budget: $835,083.00 Pregnant women & children up to age 3 Family of newborns up to age 1 Pregnant women & children up to age 5 Eligibility: • Indian River County Residents Primary Duties/Services: Eligibility: Ellgibilily: Eligibility., Ali program participation Is voluntary ' Develop and/or enhance a system of care for maternal • Must be screened for HS pre or • Having a newbom baby Pregnant women with a positive HF and services are generally offered at and Infant/child health services. postnatally and agree to participate • All program participation is voluntary score on the universal HS screen, no charge. Depending on source of child • Develop a 3 Year Needs Assessment and Service In program services. and services are offered at no charge. and/or Infants up to two weeks after safety seat funding, a nominal fee might Delivery Plan. • All program participation is voluntary birth, who are then assessed and qualify be charged. • Conduct quality assurance & quality Improvement and services are offered at no charge. Primary Dudes/Services; for program participation. (QA/CI) for all contracted service agencies. e Provides parenting support, education All program participation Is voluntary Primary Dutlas/Services: • Identify local maternal and child health (MCH) needs Primary Duties/Services: and guidance through: and services are offered at no charge. • Provides routine child passenger safety and resources and secure funding/programs to meet • HS screen (prenatal and postnatal) a Phone consultation weekly in first seat Inspections at health sites or on a those needs. processing and initial contacts, month, every two weeks In second Primary Duties/Services: one-on-one basis through appointments. • Provide public education, awareness and a forum for • Care coordination services month, and once per month In • Provides Intensive parenting education • Provides child passenger safety seat public involvement on MCH issues. (assessment/tracking/ongoing case months three through five. and support through home visits, classes one time per month for expecting management, counseling, MCH 9 Monthly newsletters addressing age • Provides assessment of child through mothers at IR Memorial Hospital as well coordination and support). appropriate levels of development for age appropriate growth and development as general public at main library. r hAo to offer its • "Other-Enhanced" services for. infant as well as age appropriate activities and parent/child Interaction. 0 Provides child safety presentations W glabludo to file following , ns psychosocial and nutrition counseling, health and Informational tips. • Promotes parent/child bonding, family elementary school children In IRC schools , financial support breast-feeding support, childbirth • Potential home visit for families with empowerment activities and goal setting. Develops and coordinates safety eventsprograms smoking cessation, parenting classes an identlfled crisis or risk factor. • Assures medical home selection and age and educational/promotionai activities to in the hvos , f filleilles it) Indian River County: and education. • Home-based breast-feeding support appropriate health activities. address child safety topics such as: fire • MomCare/SOBRA Choice Counseling. by Visiting Nurses Association • Linkages to family support services. safety, bicycle safety, water safety as L L John'sIslandCommunity • Referrals to other programs/agendas lactation Specialist. • Referrals to other programs/agencies. well as other topics. a John's Island Foundation meeting needs of family. • Sibling Quarterly Newsletter • Obtains both financial and in-kind a March of Dimes • Referrals to other programs/agencies. resources for child safety efforts. Exchange Club of In ' a Coordinates child passenger safety seat .�. •.w`Y° training or certification. •... ..w. .. • >& RECEIVEO rFP 0 9 2002 Florida Department of Agriculture & Consumer Services N _ CHARLES H. BRONSON, Commissioner Tallahassee, Florida Division of Consumer Services + • September 6, 2002 2005 Apalachee Pkwy W Tallahassee, Florida 32399-6500 Phone: 1 -800-HELP-FLA URL: http://www. 800helpfla.com Refer To: CH5628 INDIAN RIVER COUNTY HEALTHY START COALITION, INC . 1603 TENTH AVENUE VERO BEACH, FL 32960 RE: INDIAN RIVER COUNTY HEALTHY START COALITION, INC . REGISTRATION# : CH5628 EXPIRATION DATE: August 30, 2003 Dear Sir or Madam: The above-named organization/sponsor has complied with the registration requirements of Chapter 496, Florida Statutes, the Solicitation of Contributions Act. A COPY OF THIS LETTER SHOULD BE RETAINED FOR YOUR RECORDS . The Solicitation of Contributions Act requires an annual renewal statement to be filed on or before the date of expiration of the previous registration. The Department will send a renewal package approximately 60 days prior to the date of expiration as shown above. Thank you for your cooperation. If we may be of further assistance, please contact the Solicitation of Contributions section. Sincerely, CHARLES H. BRONSON COMMISSIONER OF AGRICULTURE 70M &&&"& Tom Clements Regulatory Consultant 850410-3714 / 8004354352(Florida Only) clement@doacs . state.fl .us Page 77 ARTICLES OF INCORPORATION OF INDIAN RIVER COUNTY HEALTHY START COALITION , INC . We the undersigned incorporators of these Articles of Incorporation , natural persons competent to contract , at least a majority of whom are residents of the State of Florida , hereby form ourselves together for the purpose of forming a corporation not for profit under Chapter 617 , Florida Statutes , as follows : ARTICLE I NAME The name of the corporation shall be : Indian River County Healthy Start Coalition , Inc . ARTICLE II DURATION The period of duration of this corporation is perpetual unless dissolved according to law . The existence of the corporation shall commence with filing with the Secretary of State . ARTICLE III PRINCIPAL OFFICE Indian River County Healthy Start Coalition , Inc . 1900 27th Street IL Vero Beach , FL 32960 ARTICLE IV PURPOSES This corporation is organized exclusively for charitable , educational , and scientific purposes , including , for such purposes , the making of distributions that qualify as exempt organizations under 501 ( c ) ( 3 ) of the Internal Revenue Code , or corresponding section of any future federal code . Within the limits set forth in the preceding sentence , these purposes include : 1 . To assure that the existing economic , social , and geographic barriers to maternal and child health care , including prenatal and infant health care , in Indian River County are minimized , and that an adequate number of health care Page 78 providers . are available to assist pregnant women and their children . 2 . To promote and protect the health and well - being of all pregnant women ' and their children in Indian River County through the provision and accessibility of health programs to fully meet the health requirements of this population . 3 . To establish a . partnership between the private and public sector , state and local government , community alliances , and maternal and child health care providers to provide coordinated community - based care for pregnant women and infants . 4 . To develop a maternal and infant care plan for Indian River County which shall include at a minimum provisions to : a . Perform community assessment , using the Planned Approach to Community Health ( PATCH ) and other assessment instruments and processes , to identify the need in Indian River County for comprehensive , preventive , and primary health care for pregnant women and infants . These assessments shall be used to : 1 . Determine the priority target groups for receipt of care ; 2 . Determine outcome performance objectives jointly with Department of Health and Rehabilitative Services ; 3 . Identify potential local providers of service . b . Design a prenatal and infant health care service delivery plan which shall be consistent with local community objectives . Such plan shall include at a minimum the following basic as well as enhanced services for high risk clients : 1 . Prenatal care and delivery ; 2 . Infant health care including immunizations ; 3 . Case finding and outreach , 4 . Assessment of health , social , environmental , and behavioral risk factors ; 5 . Case management utilizing a service delivery plan ; 6 . Home visit to support the delivery of and participation in prenatal and infant primary care services ; and 7 . Child birth and parenting education . Page 79 c . Solicit the allocation of available providers based on reliability and availability and define the role of each I n the service delivery plan . d . Determine the allocation of available federal , state , and local resources to particular providers . e . Review , monitor , and advise the Department of Health and Rehabilitative Services concerning the performance of the service delivery system and make annual adjustments if necessary in the design of the delivery system , the provider composition , targeting of services , and other factors necessary for achieving projected outcomes . f . Build broad - based community support . ARTICLE V MEMBERSHIP The qualifications for members and the manner of their admission are given - below : 1 . Any person having an interest in activities which affect the health of the women and infants of Indian River County . 2 . Membership requires approval of the corporation ' s Board of Directors . ARTICLE VI INITIAL DIRECTORS The number, constituting the initial Board of Directors of the corporation is five , and the names and addresses of the persons who are to serve initially are : Name Address Florence Sudbrock Safespace PO Box 2822 Vero Beach , Fl 32960 Virginia Crandall , CNM , MSN Indian River Memorial Hospital 1000 36th Street Vero Beach , FL 3296 Lois Looby , RN Children ' s Medical Services 1803 S . 25th Street Ft . Pierce , FL 34950 Page t50 Herbert Hooven Treasure Coast Health Council 8895 N . Military Trail Suite 300E Palm Beach Gardens , FL 33410 Jean Kline , BSN HRS - Indian River County Public Health Unit 1900 27th Street Vero Beach , FL 32960 ARTICLE VII POWERS The corporation shall have all powers now or hereafter granted by law to nonprofit corporations under Chapter 617 of the Florida Statutes , and in addition thereto shall have all powers lawfully necessary or required to carry out its purposes and objectives . The corporation shall have the power and authority to receive , buy and otherwise acquire by gift , devise , inheritance or otherwise real and personal property of the kind and character necessary to promote the purposes and objectives of the corporation and hold , use , pledge , mortgage , encumber , sell , lease , invest , and reinvest the same , and collect and disburse the income and principal thereof for such purposes , and to borrow money and issue notes and bonds of any kind and character . A recitation in any deed of conveyance made by the corporation that the sales has been authorized by a majority of the Board cf Directors shall protect the purchaser of such property . ARTICLE VII LIM .TTATIONS This corporation is organized under a non - stock basis in compliance with Section :; 501 . ( c ) ( 3 ) of the Internal Revenue Code , or corresponding section of any future federal tax code . 1 . All assets and earnings of the corporation shall be used exclusively for the exempt purposes hereinbefore set forth , including payment of expenses incidental thereto . 2 . No earnings of the corporation will in any event inure to the personal benefit of any member , officer , or board member of the corporation or to any organization or individual , provided that reasonable compensation may be paid to any member , officer , or board member of the corporation in exchange of one or more of its purposes stated herein . Page 81 3 . The corporation shall have no capital stock , pay no dividends , distribute no part of the income to its members , directors , or officers , and private property of the subscribers , members , directors , and officers shall not be liable for the debts of the corporation . 4 . Notwithstanding any other provision of these articles , the corporation shall not carry on any activities not permitted to be carried on by . ( a ) an organization exempt from federal income taxation under section 501 ( c ) ( 3 ) of the Internal Revenue Code of 1954 ( or corresponding provisions of any subsequent revenue laws ) or ( b ) a corporation , contributions to which are deductible under Section 170 ( c ) ( 2 ) of the Internal Revenue Code of 1954 ( or corresponding provisions of subsequent revenue laws ) . 5 . No substantial part of the activities of the corporation shall be carrying on of propaganda , or otherwise attempting to influence legislation , and the corporation shall not participate in , or intervene in ( including the publishing or distribution of - the statements ) , any political campaign on behalf of or in opposition to any candidate for public office . ARTICLE IX BYLAWS The Bylaws of the Corporation shall be adopted by the initial Board of Directors and general membership at the organization meeting of the COALITION . Bylaws may thereafter be amended by affirmative vote of two - thirds ( 2 / 3 ) of the DIRECTORS present and voting , at any meeting of the DIRECTORS called for that purpose provided that such meeting be held after first giving thirty ( 30 ) days written notice mailed to each member of the DIRECTORS . Prior written notice may be waived by the member of the DIRECTORS provided the waiver of notice be in writing . ARTICLE X DISSOLUTION In the event of dissolution , all assets remaining after payment of all costs and expenses of such dissolution shall be disbursed to such scientific , educational , and charitable organizations rules exempt by the Internal Revenue Service under Section 501 ( c ) ( 3 ) and Section 170 ( c ) ( 2 ) of the Internal Revenue Code of 1954 ( or corresponding provisions of any subsequent revenue laws ) having goals and objectives similar to those of this corporation as may be selected by the last Board of Directors , and none of the assets will be distributed to any members , officers , or directors of this corporation . age ARTICLE XI INCORPORATORS The name and address of each incorporator is : Name Address Florence Sudbrock Safespace PO Box 2822 Vero Beach , F1 32960 Virginia Crandall , CNM , MSN Indian River Memorial Hospital 1000 36th Street Vero Beach , FL 3296 Lois Looby , RN Children ' s Medical Services 1803 S . 25th Street Ft . Pierce , FL 34950 Herbert Hooven Treasure Coast Health Council 8895 N . Military Trail Suite 300E Palm Beach Gardens , FL 33410 Jean Kline , BSN HRS - Indian River County Public Health Unit 1900 27th Street Vero Beach , FL 32960 ARTICLE XII REGISTERED AGENT i' The name of the initial registered agent of this corporation is" Jean L . Kline , HRS- Indian River County Public Health Unit , 1900 27th Street , Vero Beach , FL 32960 . ARTICLE XII ACCEPTANCE OF DESIGNATION AS REGISTERED AGENT Acknowledgment Having been named to accept service of process for the Indian River County Healthy Start Coalition , Inc . at the place designated in this certificate , I hereby accept and agree to act in said capacity and agree to comply with the provisions of the Florida Corporation Act relative to keeping op e said office . Page b3 IN WITNESS THEREOF , the undersigned incorportor ( s ) has ( have ) executed these Articles of Incorporation this / q 'M day of l¢ Pyr Sig ature ( s of Incorporator ( s ) : W ' A State of Florida County of,Q,d,�a__ THE FOREGOING instrument was acknowledged and sworn to before me this I �t day of fir' , 19 '7 -z. by ( name of incorporator ) of ( name of incorporation ) . ( SEAL ) Notary Public DOR-rte V QRAL .o p' DORM v. CAYLOR My Commission Expires : 5-� , L - Ld I ' �; art CWUMMiccMMSORS r Sep2mber M 19% NON - PROFIT ARTICLES OF INCORPORATION FILING FEE : $ 110 Page 77 ARTICLES OF INCORPORATION OF INDIAN RIVER COUNTY HEALTHY START COALITION , INC . We the undersigned incorporators of these Articles of Incorporation , natural persons competent to contract , at least a majority of whom are residents of the State of Florida , hereby form ourselves together for the purpose of forming a corporation not for profit under Chapter 617 , Florida Statutes , as follows : ARTICLE I NAME The name of the corporation shall be : Indian River County Healthy Start Coalition , Inc . ARTICLE II DURATION The period of duration of this corporation is perpetual unless dissolved according to law . The existence of the ith filing with the Secretary of corporation shall commence w State . ARTICLE III PRINCIPAL OFFICE Indian River County Healthy Start Coalition , Inc . 1900 27th Street z Vero Beach , FL 32960 ARTICLE IV PURPOSES This corporation is organized exclusively for charitable , educational , and scientific purposes , including , for such purposes , the making of distributions that qualify as exempt organizations under 501 ( c ) ( 3 ) of the Internal Revenue Code , or corresponding section of any future federal code . Within the limits set forth in the preceding sentence , these purposes include : 1 . To assure that the existing economic , social , and geographic barriers to maternal and child health care , including prenatal and infant health care , in Indian River County are minimized , and that an adequate number of health care Page 78 providers are available to assist pregnant women and their children . 2 . To promote and protect the health and well -being of all pregnant women and their children in Indian River County through the provision and accessibility of health programs to fully meet the health requirements of this population . 3 . To establish a partnership between the private and public sector , state and local government , community alliances , and maternal and child health care providers to provide coordinated community - based care for pregnant women and infants . 4 . To develop a maternal and infant care plan for Indian River County which shall include at a minimum provisions to : a . Perform community assessment , using the Planned Approach to Community Health ( PATCH ) and other assessment instruments and processes , to identify the need in Indian River County for comprehensive , preventive , and primary health care for pregnant women and infants . These assessments shall be used to : 1 . Determine the priority target groups for receipt of care ; 2 . Determine outcome performance objectives jointly with Department of Health and Rehabilitative Services ; 3 . Identify potential local providers of service . b . Design a prenatal and infant health care service delivery plan which shall be consistent with local community objectives . Such plan shall include at a minimum the following basic as well as enhanced services for high risk clients 1 . Prenatal care and delivery ; 2 . Infant health care including immunizations ; 3 . Case finding and outreach ; 4 . Assessment of health , social , environmental , and behavioral risk factors ; 5 . Case management utilizing a service delivery plan ; 6 . Home visit to support the delivery of and participation in prenatal and infant primary care services ; and 7 . Child birth and parenting education . Page 79 c . Solicit the allocation of available providers based on reliability and availability and define the role of each in the service delivery plan . d . Determine the allocation of available federal , state , and local resources to particular providers . e . Review , monitor , and advise the Department of Health and Rehabilitative Services concerning the performance of the service delivery system and make annual adjustments if necessary in the design of the delivery system , the provider composition , targeting of services , and other factors necessary for achieving projected outcomes . f . Build broad - based community support . ARTICLE V MEMBERSHIP The qualifications for members and the manner of their admission are given below . 1 . Any person having an interest in activities which affect the health of the women and infants of Indian River County . 2 . Membership requires approval of the corporation ' s Board of Directors . ARTICLE VI INITIAL DIRECTORS L ` The numbeer. constituting the initial Board of Directors of the corporation is five , and the names and addresses of the persons who are to serve initially are : Name Address Florence Sudbrock Safespace PO Box 2822 Vero Beach , F1 32960 Virginia Crandall , CNM , MSN Indian River Memorial Hospital 1000 36th Street Vero Beach , FL 3296 Lois Looby , RN Children ' s Medical Services 1803 S . 25th Street Ft . Pierce , FL 34950 Page 60 Herbert Hooven Treasure Coast Health Council 8895 N . Military Trail Suite 300E Palm Beach Gardens , FL 33410 Jean Kline , BSN HRS - Indian River County Public Health Unit 1900 27th Street Vero Beach , FL 32960 ARTICLE VII POWERS The corporation shall have all powers now or hereafter granted by law to nonprofit corporations under Chapter 617 of the Florida Statutes , and in addition thereto shall have all powers lawfully necessary or required to carry out its purposes and objectives . The corporation shall have the power and authority to receive , buy and otherwise acquire by gift , devise , inheritance or otherwise real and personal property of the kind and character necessary to promote the purposes and objectives of the corporation and hold , use , pledge , mortgage , encumber , sell , lease , invest , and reinvest the same , and collect and disburse the income and principal thereof for such purposes , and to borrow money and issue notes and bonds of any kind and character . A recitation in any deed of conveyance made by the corporation that the sales has been authorized by a majority of the Board ci Directors shall protect the purchaser of such property . ARTICLE VIZ LIM .TTATIONS This corporation is organized under a non - stock basis in compliance with Section : ; 501 . ( c ) ( 3 ) of the Internal REvenue Code , or corresponding section of any future federal tax code . 1 . All assets and earnings of the corporation shall be used exclusively for the exempt purposes hereinbefore set forth , including payment of expenses incidental thereto . 2 . No earnings of the corporation will in any event inure to the personal benefit of any member , officer , or board member of the corporation or to any organization or individual , provided that reasonable compensation may be paid to any member , officer , or board member of the corporation in exchange of one or more of its purposes stated herein . Page 81 3 . The corporation shall have no capital stock , pay no dividends , distribute no part of the income to its members , directors , or officers , and private property of the subscribers , members , directors , and officers shall not be liable for the debts of the corporation . 4 . Notwithstanding any other provision of these articles , the corporation shall not carry on any activities not permitted to be carried on by . ( a ) an organization exempt from federal income taxation under section 501 ( c ) ( 3 ) of the Internal Revenue Code of 1954 ( or corresponding provisions of any subsequent revenue laws ) or ( b ) a corporation , contributions to which are deductible under Section 170 ( c ) ( 2 ) of the Internal Revenue Code of 1954 ( or corresponding provisions of subsequent revenue laws ) . 5 . No substantial part of the activities of the corporation shall be carrying on of propaganda , or otherwise attempting to influence legislation , and the corporation shall not participate in , or intervene in ( including the publishing or distribution of the statements ) , any political campaign on behalf of or in opposition to any candidate for public office . ARTICLE IX BYLAWS The Bylaws of the Corporation shall be adopted by the initial Board of Directors and general membership at the organization meeting of the COALITION . Bylaws may thereafter be amended by affirmative vote of two - thirds ( 2 / 3 ) of the DIRECTORS present and voting , at any meeting of the DIRECTORS called for that purpose provided that such meeting be held after first giving thirty ( 30 ) days written notice mailed to each member of the DIRECTORS . Prior written notice may be waived by the member of the DIRECTORS provided the waiver of notice be in writing . ARTICLE X DISSOLUTION In the event of dissolution , all assets remaining after payment of all costs and expenses of such dissolution shall be disbursed to such scientific , educational , and charitable organizations rules exempt by the Internal Revenue Service under Section 501 ( c ) ( 3 ) and Section 170 ( c ) ( 2 ) of the Internal Revenue Code of 1954 ( or corresponding provisions of any subsequent revenue laws ) having goals and objectives similar to those of this corporation as may be selected by the last Board of Directors , and none of the assets will be distributed to any members , officers , or d = rectors of this corporation . age o /. ARTICLE XI INCORPORATORS The name and address of each incorporator is : Name Address Florence Sudbrock Safespace PO Box 2822 Vero Beach , Fl 32960 Virginia Crandall , CNM , MSN Indian River Memorial Hospital 1000 36th Street Vero Beach , FL 3296 Lois Looby , RN Children ' s Medical Services 1803 S . 25th Street Ft . Pierce , FL 34950 Herbert Hooven Treasure Coast Health Council 8895 N . Military Trail Suite 300E Palm Beach Gardens , FL 33410 Jean Kline , BSN ERS - Indian River County Public Health Unit 1900 27th Street Vero Beach , FL 32960 ARTICLE XII REGISTERED AGENT The name of the initial registered agent of this corporation i " Jean L . Kline , HRS= Indian River County Public Health Unit , 1900 27th Street , Vero Beach , FL 32960 . ARTICLE XII ACCEPTANCE OF DESIGNATION AS REGISTERED AGENT Acknowledgment Having been named to accept service of process for the Indian River County Healthy Start Coalition , Inc . at the place designated in this certificate , I hereby accept and agree to act in said capacity and agree to comply with the provisions of the Florida Corporation Act relative to kepingope�sai office . G Page 83 IN WITNESS THEREOF , the undersigned incorportor ( s ) has ( have ) executed these Articles of Incorporation this l 9 7'n day of r 19221 . Sig ature ( s ) of Incorporators ) T State of Flori da :County THE FOREGOING instrument was acknowledged and sworn to before me this 19 day of 19 9 Z. by ( name of incorporator ) of ( name of incorporation ) . ( SF. PZ ) Notary Public Dop; tjV . QAyLo .tZ, DORTHA My Commission Expires S � , � • Zd 15q (� ?a ? V. CArioR ft _ cc yes SORB y: d s.owrlw n, 19% eaou nhu rnor ►un vduwK[. PC- NON - PROFIT ARTICLES OF INCORPORATION FILING FEE : $ 110 BYLAWS INDIAN RIVER COUNTY HEALTHY START COALITION,_ INC. (Revised 02-27-97) (Revised for effective date 7/ 1 /01 ) ARTICLE I : MISSION SECTION 1 . NAME AND LOCATION : The name of the Corporation shall be INDIAN RIVER COUNTY HEALTHY START COALITION, INC . (hereinafter "COALITION") . The COALITION is a 501 (c) not for profit corporation. (a) The main office of the Corporation shall be in Indian River County. (b) The fiscal year of the Corporation shall begin on the first day of July of each year. (c) The Seal of the Corporation shall bear the name of the Corporation, the word FLORIDA, the words CORPORATION NOT FOR PROFIT and the year of incorporation. SECTION 2. PURPOSE : The intent of the COALITION is to establish a system that attempts to guarantee that : ( 1 ) all women have access to prenatal care; and (2) all infants have access to services that promote normal growth and development. SECTION 3 . GOALS : The COALITION shall attempt to meet the following goals : A. To assure that the existing economic, social and geographic barriers to maternal and child health, including prenatal and infant care, in Indian River County are minimized, and that an adequate number of health care providers are available to assist pregnant women and their children. B . To promote and protect the health and well-being of all pregnant women and their children in Indian River County through the provision and accessibility of health care programs to fully meet the health requirements of this population. C . To establish a partnership between the private and public sector, federal, state and local government, community alliances and maternal and child health care providers to provide coordinated community-based care for pregnant women and infants, to reduce adverse maternal or infant outcomes in Indian River County. SECTION 4 . RESPONSIBILITIES In carrying out the intent of the COALITION, the COALITION shall be responsible for developing a maternal and infant health plan to try and meet the purpose and goals stated in Sections 2 and 3 of this Article. Such plans should attempt to include the following : A. Perform community assessments, using the Planned Approach to Community Health (PATCH) or other assessment instruments and processes, to identify the need in Indian River County for comprehensive, preventive, and primary health care for pregnant women and infants . These assessments should be used to : 1 . Determine the target priority groups for receipt of care; 2 . Determine outcome performances objectives; and 3 . Identify local potential providers of services . B . Design a prenatal and infant health care service delivery plan which should be consistent with local community objectives for enhanced services for pregnant women, infants, and children to age 3 such as : 1 . Prenatal care and delivery. 2 . Infant health care including immunizations. 3 . Case finding and outreach. 4. Assessment of health, social, environmental, and behavioral risk factors . 5 . Case management utilizing a service delivery plan. 6 . Home visiting to support the delivery of, and participation in, prenatal and infant primary care services . 7. Childbirth and parenting education. 8 . Developmental evaluation and intervention for infants-at-risk. C. Solicit and select local service providers based on reliability and availability, and define the role of each in the service delivery plan control/agreement. D . Determine the allocation of available federal, state, and local resources to particular providers. E. Review, monitor, and advise concerning the performance of the service delivery system and make annual adjustments, if necessary, in the design of the delivery system, the provider composition, targeting of services, and other factors necessary for achieving projected outcomes . F. Build broad-based community support. SECTION 5. COMPLIANCE : The COALITION will operate and conduct all business and affairs under all local, state and federal laws, rules, and regulations ; including Internal Revenue Code, Section 501 (C) . ARTICLE II : COALITION MEMBERSHIP SECTION 1 . COALITION MEMBERSHIP : The membership of the COALITION shall be open to all citizens , institutions, organizations, and agencies (including state, federal and local agencies) interested in achieving the goals and objectives of the COALITION who have fully completed a "Coalition Application Form" during a fiscal year and have been approved by the BOARD. The COALITION membership period shall be a maximum of two years with all memberships ceasing on June 30th of the second year. Members who would like to renew membership must affirmatively respond to renew their membership prior to June 30th of the second membership year. The BOARD shall develop application forms and shall seek to achieve the broadest membership base possible. Agencies, institutions, or other organizations represented by multiple COALITION members shall have only one voting right and the COALITION members representing the agency, institution, or organization shall designate which COALITION member may vote on behalf of the agency, institution, or organization. No COALITION member may represent more than one individual, agency, institution, or organization, at any point in time. SECTION 2 . OTHER CLASSIFICATIONS : The BOARD shall have the power and authority to create any additional specific Membership classifications with voting or non- voting rights and limit the number of Members in each classification. SECTION 3 . ANNUAL/SPECIAL MEETINGS : The membership shall meet at a minimum on an annual basis . Special meetings of the members may be called by the President, the Board, or 30% of the Members signing a petition requesting such a special meeting. No business other than that specified as the purpose in the notice of the special meeting shall be discussed or transacted at any such meeting. ARTICLE HI : BOARD OF DIRECTORS SECTION 1 . COMPOSITION : The Board of Directors, (herein after referred to as the BOARD), shall consist of not fewer than five (5) and not more than fifteen ( 15) persons, all of whom shall be eighteen years of age or older. BOARD members should be elected by the last regular BOARD meeting of the calendar year. Elected BOARD members shall commence their term in January of each year. The BOARD shall elect BOARD members or, if a majority of BOARD members decide, the BOARD may delegate the election of BOARD members to COALITION members if such election is conducted by the end of the calendar year. No BOARD member shall be a service provider or representative of a service provider. In addition, no BOARD member shall have a family member who is a service provider or representative of a service provider. Family member is defined as a spouse, child, sibling, parent, in-laws, fiance, or significant other - dating the same person continuously for more than two years . Nor shall any COALITION employee be a member of the BOARD . SECTION 2 . TERM : The BOARD shall hold office from the time of their appointment until the expiration date of their term on the BOARD, or until their successors have been duty elected and qualified. The term of office shall be three (3) years, or the remainder of term, if appointed to complete a term vacant by a previous BOARD member. A BOARD member shall be deemed to have served one term if that person has served for more than 50% of a term . No BOARD member may serve more than two successive terms . SECTION 3 . RULES OF ORDER:All policies and all procedural matters shall be governed by the latest edition of "Roberts Rules of Order. " SECTION 4 . ANNUAL MEETING : The BOARD shall hold an annual meeting at which the officers are elected from among the BOARD members . SECTION 5. REGULAR AND SPECIAL MEETINGS : Regular meetings of the BOARD may be established by the BOARD. Special meetings of the BOARD may be held from time to time upon calls issued by the President or a majority of the BOARD . The BOARD shall meet no less than quarterly. SECTION 6. NOTICES OF MEETINGS : Notices of regular meetings of the BOARD shall be sent by mail to the preferred address of each BOARD member five (5) days prior to the date set for the meeting and, if required by law, in accordance with the Sunshine Law. Notices can be sent via email or facsimile provided that a hard copy of the notice is simultaneously mailed the same day. Notice of special meetings requires 24-hour notice. Notices for special meetings can be submitted solely via email, facsimile, or personal delivery. SECTION 7. QKORUM .9 A simple majority of the BOARD shall constitute a quorum at a BOARD meeting. A majority of BOARD members present at a meeting at which a quorum is present, is necessary for the adoption of any matter voted on by the members, unless a greater proportion is required by law, the Articles of Incorporation of the Corporation, or any provision of the Bylaws. SECTION 8. MINUTES : Minutes of all meetings will be taken and distributed to all members of the BOARD by the next scheduled meeting. SECTION 9. POWERS & DUTIES : All routine management functions, including the operating budget of the COALITION, shall be vested in the BOARD, but are subject to delegation by the BOARD to COALITION officers or to the Executive Director. SECTION 10. ANNUAL BUDGET : Two thirds of BOARD members present at a BOARD meeting must approve the annual COALITION budget. SECTION 11 : HONORARY BOARD : Honorary BOARD members may be persons who are particularly well known, respected and who have achieved extra ordinary personal and/or public success. The Honorary BOARD members may attend the Board and Member meetings but shall have no vote or assigned duties . SECTION 12. IMMUNITY FROM LIABILITY: BOARD members who perform their duties in compliance with federal and Florida law shall have no liability by reason of being or having been on the BOARD . SECTION 13 . ATTENDANCE : BOARD members who fail to attend three (3 ) successive BOARD meetings may be asked to resign from the BOARD . SECTION 14, REMOVAL : Removal shall be in accordance with local, state, and federal laws and shall override any language to the contrary in these By-Laws . Two thirds of BOARD members present at a Board meeting may terminate a BOARD member for any reason. No BOARD member shall be terminated without at least 10-business days notice (verbal or written) of the scheduled Board meeting where such termination will be discussed and determined. However, the 10-day business day notice is not required if a Board member is alleged to have committed a felony or alleged to have stolen COALITION property. In such instances, notice shall be provided as soon as possible. SECTION 15 , RETURN OF MATERIALS : Any BOARD member who voluntarily or involuntarily leaves shall deliver all materials pertaining to their office to their successors, or if none has been elected or appointed, to the COALITION's Executive Director within ten ( 10) days following the date of termination of his or her term of office. ARTICLE IV: OFFICERS SECTION 1 . OFFICERS : The officers of the COALITION shall consist of a President, Vice-President, Treasurer, and Secretary, all of whom shall be elected by the members of the BOARD . Officers should be elected by the last regular BOARD meeting of the calendar year. Elected officers shall commence their term in January of each year. Only BOARD members are eligible to be officers . All officers shall hold office from the date of their election until respective successors are duly elected and qualified . No officer shall be a service provider or representative of a service provider. In addition, no officer shall have a family member who is a service provider or representative of a service provider. Family member is defined as a spouse, child, sibling, parent, in-laws, fiance, or significant other - dating continuously for more than two years . Nor shall any COALITION employee be an officer. SECTION 2. TERM : Each officer shall be elected for a term of one year, by a majority of the BOARD at the annual meeting. No officer shall serve more than four successive terms . SECTION 3 . NOMINATIONS & ELECTION : The nomination and election of officers should take place by the last regular BOARD meeting of the calendar year. Officers shall be elected by the majority vote of the BOARD . SECTION 4. VACANCIES : Officer vacancies caused by reasons of death, resignation or otherwise, shall be filled by a majority vote of the BOARD. The new officer elected to fill the vacancy will serve for the remainder of the term. SECTION 5. REMOVAL : Removal shall be in accordance with local, state, and federal law and shall override any language to the contrary in these By-Laws . An officer may be removed by BOARD members . Two thirds of BOARD members present at a Board meeting may terminate an officer for any reason. No officer shall be terminated without at least 10-business days notice (verbal or written) of the scheduled Board meeting where such termination will be discussed and determined. However, the 10-day business day notice is not required if the officer is alleged to have committed a felony or alleged to have stolen COALITION property. In such instances, notice shall be provided as soon as possible. SECTION 6 : RETURN OF MATERIALS : Any officer who voluntarily or involuntarily leaves shall deliver all materials pertaining to their office to their successors, or if none has been elected or appointed, to the COALITION's Executive Director within ten ( 10) days following the date of termination of his or her term of office. SECTION 7. PRESIDENT : The President shall sign for and on behalf of the COALITION or in its name, all instruments of writing necessary, convenient, or advisable to be executed for or on behalf of the COALITION. While actively engaged in conducting the business and affairs of the COALITION, the President shall be charged with all duties and have all authority customarily performed and exercised by the chief executive officer of a corporation organized under the laws of the State of Florida. The President is authorized to sign checks on behalf of the COALITION. SECTION 8 . VICE PRESIDENT : The Vice President shall perform the duties of the President when the President is absent, ill or otherwise incapacitated, including the execution of instruments and have such other responsibilities as may be designated by the President. The Vice President is authorized to sign checks on behalf of the COALITION. SECTION 9. TREASURER: The Treasurer shall serve as chief financial officer and will be responsible for supervision of the collection and disbursement of all monies of the Corporation under the direction of the BOARD . The Treasurer shall review financial records and present quarterly financial statements to the BOARD . The Treasurer shall ensure appropriate bank reconciliations and review annual financial reports . The Treasurer is authorized to sign checks on behalf of the COALITION. SECTION 10. SECRETARY : The Secretary shall keep and be responsible for the minutes of all BOARD and membership meetings, including attendance. The Secretary is authorized to sign checks on behalf of the COALITION. SECTION 11 . EXECUTIVE COMMITTEE : The Executive Committee shall consist of the elected officers and, at the sole discretion of the Executive Committee, the immediate past President. ARTICLE V : PERSONNEL SECTION 1 . EXECUTIVE DIRECTOR: The BOARD shall employ an Executive Director of the Coalition who shall serve at the pleasure of the BOARD and perform such duties and responsibilities as defined by the BOARD . The BOARD shall determine the qualifications and compensation of the Executive Director. SECTION 2. PERSONNEL SELECTION PROCEDURES : Except for the Executive Director who shall be hired by, evaluated by, and may be dismissed by the BOARD, other COALITION employees will be hired, evaluated on a periodic basis, and shall serve at the pleasure of the Executive Director. The Executive Director shall dictate the policies, procedures, duties and responsibilities of COALITION employees with the understanding that any financial issues must be in compliance with the COALITION' s budget. ARTICLE VI : COMMITTEES SECTION 1 . STANDING COMMITTEES : The Board may designate standing/ad hoc committees on an as needed basis . The President shall appoint the committees chairs with the approval of the BOARD . In all cases the chairperson of each committee shall be a member of the Board. ARTICLE VII : MISCELLANEOUS PROVISIONS SECTION 1 . BOOKS AND RECORDS : The COALITION will keep correct and complete books and records of account, and will also keep minutes of the proceedings of its Members, BOARD, and committees . The COALITION will keep as its registered office a Membership Register of the names, addresses, classes and other details of the membership of the COALITION, the Articles of Incorporation and Bylaws (including amendments) as well as shall be available to the Members or public for inspection upon reasonable request during business hours . SECTION 2 . NON-STOCK CORPORATION: This Corporation will not have or issue shares of stock. No dividend will be paid, and no part of the income or assets of the COALITION will be distributed to its Members, BOARD, or Employees . SECTION 3 . INDEMNIFICATION : Any person made or threatened to be made a party to any action or proceeding, whether civil or criminal, by reason of the fact that he/she is or was a director, officer or employee of the Corporation (or serves, or served, any other corporation while he/she was a director, officer, or employee of the Corporation) shall be and hereby is indemnified by the Corporation against all judgments, fines, amounts paid in settlement and reasonable expenses including attorney ' s fees actually and necessarily incurred as a result of any such action or proceeding, or any appeal therein, to the full extent permitted and in the manner prescribed by law. In the case of indemnification of a person who is or was an employee (rather than a director or officer) of the Corporation, such indemnification shall be, unless otherwise provided by law, to the same extent permitted and in the manner prescribed by Florida law for the indemnification of directors and officers . SECTION 4. CONFLICTS OF INTEREST : Florida law has a code of ethics for public officers and employees . All officers, BOARD members, and Executive Directors shall comply with the code of ethics, including avoiding any conflict of interest or appearance of a conflict of interest. In carrying out its provider selection and allocation functions, COALITION members shall declare any conflict of interest and may not vote on any issue related to the organization they represent or organizations with which they are affiliated . No compensation shall be paid to members, BOARD members, or employees of the corporation directly or indirectly for goods and/or services provided to the corporation by such member, BOARD member or employee thereof, without full and complete disclosure to the BOARD or the membership respectively, as appropriate of the nature and circumstances of the transactions involved and the approval of such transactions by the BOARD and membership respectively. ARTICLE VIII : AMENDMENTS SECTION 1 : BYLAWS : The COALITION ' S bylaws may be amended, modified, altered or rescinded by the BOARD at any BOARD meeting at which a majority is present and voting, provided that the notice of the meeting contains a full statement of the proposed change. The bylaws may not be amended, modified, altered or rescinded by the BOARD at any BOARD meeting unless 2/3 of the BOARD members present vote for such change. ARTICLE IX. DISSOLUTION OF THE COALITION : SECTION 1 : DISSOLUTION : Dissolution of the COALITION shall be accomplished in accordance with federal and state laws . SECTION 2 : ASSETS : No person, firm or corporation shall ever receive any dividends or profits from the undertaking of this Corporation, and upon dissolution of this organization all of its monetary assets remaining after payment of all costs and expenses of such dissolution shall be distributed to organizations which have qualified for exemption under Section 501(c)(3) of the Internal Revenue Code, or to the Federal Government, or to a State or local government for a public purpose, and none of the assets will be distributed to any member, officer or director of this Corporation. Nit IAN UVER COUNTY fiEAL----,THY START COALITION, INC ., EMPILOYE.....I.E. . HANDBOOK 00 EQUAL EMPLOYMENT OPPORTUNITY STATEMENT AND ANTI =HARASSMENT/RETALIATION POLICY It is the policy and practice of this Coalition to provide equal employment opportunities without regard to race, color, age, religion, sex, marital status, national origin, disability, or any other legally protected status to all employees of Coalition. This policy relates to all phases of employment including, but not limited to, recruitment, placement, promotion, demotion, transfer, termination, rates of pay or other forms of compensation, selection for training, conditions of employment, performance appraisals, discipline/counseling, and participation in Coalition activities . All employees are expected to understand and fully comply with this policy. Employees who observe discrimination or feel they have been discriminated against have an obligation to immediately report such concerns to the Executive Director or any corporate officer. Employees who observe, hear, or feel that a client has been discriminated against have an obligation to report such concerns to the Executive Director or any corporate officer. In addition, the Coalition prohibits retaliation against any employee who raises a concern of discrimination or who participates in such an investigation. Any employee who violates this policy will be subject to disciplinary action up to and including discharge. SEXUAL AND OTHER FORMS OF IMPERMISSIBLE HARASSMENT Purpose . It is the policy of Coalition to maintain a work environment (including work-related activities such as business trips, trade shows, and Coalition related social events) that is free from all forms of harassment or intimidation whether from Coalition employees or third parties such as vendors , customers, clients, contractors, distributors, guests, or other individuals . Scope . This policy covers all Coalition employees . The Coalition prohibits any form of harassment; that is, verbal or physical conduct that downgrades, demeans, degrades, mocks, or shows hostility or aversion toward an individual because of his or her race, color, religion, sex, filing of a valid workers ' compensation claim or attempt to file such a claim, national origin, age, disability, or any other legally protected status or that of his or her relatives, friends, employees, or other third parties such as guests, customers, clients, contractors, vendors, and distributors . Guidelines . 1 . Such conduct is prohibited if it : • Has the purpose or effect of creating an intimidating, hostile or offensive working environment; January 2002 2 200M4 IRC BOCC - CSAC Goals and Outcomes Budget Workshop Attendance Christi Walters , Healthy Families - IRC Program Manager, attended the BOCC -CSAC sponsored workshop in May 2003 . D . Scott Joseph , Executive Director of the IRC Healthy Start Coalition , has attended the workshops in the past , when he served as the Health Planner for the St . Lucie Healthy Start Coalition , Inc . ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDM ) OCT 801 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND SID BANACK INSURANCE AGENCY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 2045 14TH AVE. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P O BOX 130 POLICIES BELOW, VERO BEACH FL 32961 PHONE: 772-562-3369 FAX: 772-562-3466 COMPANIES AFFORDING COVERAGE INSURED COMPANY A: AUTO-0WNERS INSURANCE COMPANY INDIAN RIVER COUNTY HEALTHY START, INC . COMPANY B: ZENITH INSURANCE COMPANY 1603 10TH AVE. VERO BEACH FL 32960 COMPANY C: COMPANY D: COMPANY E: COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMIDDIYY) DATE (MM/DDfM GENERAL LIABILITY 93-211127-00 MAR 10 02 MAR 10 03 EACH OCCURRENCE $ 12000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any One Fire) $ 509000 CLAIMS MADE Ix] OCCUR MED. EXP (Any One Person) $ 51000 A PERSONAL & ADV INJURY $ 1 ,000,000 GENERAL AGGREGATE $ 19000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 170002000 POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ 1 ,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ E DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 26560 MAY 3 01 MAY 3 02WC STA;U OTHER EMPLOYERS' LIABILITY B E.L. EACH ACCIDENT $ 1 OO,000 E.L. DISEASE-EA EMPLOYEE $ 1000000 E.L. DISEASE-POLICY LIMIT $ 5009000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER INCLUDED AS AN ADDITIONAL INSURED BUT ONLY WITH RESPECT TO OPERATIONS OF THE NAMED INSURED RECEIVED APR 3 0 20 CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE ISO SHALL INDIAN RIVER COUNTY, FLORIDA INSURER, IT; AGENTS OR REPRESENTATIVES.IOOR LIABILITY OF ANY KIND UPON THE 1840 25TH STREET VERO BEACH FL 32960- AUTHORIZED REPRESENTATIVE Attention : JOYCE JOHNSTOWCARLSON ACORD 25S (7/97) Certificate # 40209 Sidney M . Banack , Jr. Indian River County Grant Contract l� This Grant Contract ("Contract's 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 Healthy Start Coalition ("Recipient's ; of: (Address) Healthy Start Coalition 1603 10th Avenue Vero Beach , Florida 32960 Healthy Families - IRC 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 Fifty Five Thousand Dollars ($55 , 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 COUNTY BOARD OF COUNTY COMMIS ONERS l . yS By: Kenne cht, C airm n Attest : J . K. Barton , Clerk B Y: Deputy Clerk Approved : VL�� r, ounty Administrator gLdIlCe egal sufficiency: . Fell , Assistant ounty Attorney RECIPIENT : Healthy Start Coalition 160310 th Avenue Vero Beach , Florida 32960 By : laef Name 13r�Q 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 30th) must be submitted on a timely basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year . This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expenses by type . These summaries should be broken down into salaries , benefits , supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a . Travel expenses for travel outside the County including but not limited to ; mileage reimbursement, hotel rooms , meals , meal allowances , per Diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c. Any expenses not associated with the provision of the program for which the County has awarded funding . d . Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " - 1 - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices : Any notice , request , demand , consent , approval or other communication required or permitted by this Contract shall be given or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail ( postage prepaid) , return receipt requested at the addresses of the parties shown below : County : Joyce Johnston-Carlson , Director Indian River County Human Services 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Scott Joseph , Director Healthy Start Coalition 160310 th Avenue Vero Beach , Florida 32960 2 . Venue ; Choice of Law: The validity , interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida , only . The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract , or any breach hereof, as well as any litigation between the parties , shall be Indian River County , Florida for claims brought in state court , and the Southern District of Florida for those claims justifiable in federal court. 3 . Entirety of Agreement: This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability: In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract , and every other term and provision of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent, this Contract is deemed severable . 5 . Captions and Interpretations : Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless the context indicates otherwise , words importing the singular number include the plural - 1 - 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 - 00 (Policy Provisions : WC 0 0 0 0 0 0 A ) � 7 GD INFORMATION PAGE wEc WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER : HARTFORD UNDERWRITERS INSURANCE COMPANY HARTFORD PLAZA , HARTFORD , CONNECTICUT 06115 NCCI Company Number: 1D� THE Company Code : 6 HARTFORD 0 Suffix C) LARS RENEWAL C POLICY NUMBER : 0 Previous Policy Number: HOUSING CODE : DV 1 . Named Insured and Mailing Address : INDIAN RIVER COUNTY HEALTHY CN (No . , Street, Town , State , Zip Code) ( SEE ENDT ) 0 0 u' 1603 10TH AVENUE M * FEIN Number: 650363222 VERO BEACH , FL 32960 State Identification Number(s) : The Named Insured is: CORPORATION Business of Named Insured : CIVIC ORGANIZATION _ Other workplaces not shown above: 1603 10TH AVENUE VERO BEACH , FL 32960 2. Policy Period: From 05 / 03 / 03 To 05 / 03 / 04 12:01 a . m . , Standard time at the insured's mailing address. Producer's Name : SID BANACR INSURANCE / SCIC P . 0 . BOX 29611 CHARLOTTE , NC 28229 Producer's Code: 227667 Issuing Office: THE HARTFORD 8711 UNIVERSITY EAST DRIVE CHARLOTTE NC 28213 ( 866 ) 467 - 8730 Total Estimated Annual Premium : $ 916 Deposit Premium . Policy Minimum Premium : $ 236 FL NOR Audit Period: ANNUAL Installment Term : The policy is not binding unless countersigned by our authorized representative . Authorized Representative Form WC 00 00 01 A (1 ) Printed in U .S .A. Page 1 (Continued on next page) Process Date : 03 / 08 / 03 Policy Expiration Date : 05 / 03 / 04 ORIGINAL Ir r � • i i 11 • i i 11 • • � • � � ' • • • i '. 1 1 1 1 1 1 • • 111 111 • • • i '. 1 1 1 1 1 1 '. 111 111 • • • • 1 • 1 • • • Maimff • INSURANCE COMPANY BUSINESSOWNERS POLICY DECLARATIONS 6101 ANACAPRI BLVD . , LANSING , MI 48917 - 3999 Renewal Effective 03 - 10 - 2003 AGENCY SID BANACK INSURANCE 12 - 0119 - 00 MKT TERR 051 ( 772 ) 562 - 3369 POLICY NUMBER 93 - 211 - 127 - 00 INSURED INDIAN RIVER CO HEALTHY START INC Company Use 20 - 57 - FL - 9303 Company POLICY TERM ADDRESS 1603 10TH AVE Bill 12 : 01 a . m . 12 : 01 a . m . VERO BEACH FL 32960 - 6231 to 03 - 10 - 2003 03 - 10 - 2004 In consideration of payment of the premium shown below , this policy is renewed . Please attach this Declarations and attachments to your policy . If you have any questions , please consult with your agent . ENTITY : Corporation PROPERTY COVERAGES - ALL DESCRIBED LOCATIONS DED LIMITS PREMIUM Special Coverage Form Automatic Increase ( s ) Building Limit 6 . 0 % Employee Dishonesty $ 250 $ 5 , 000 $ 66 . 48 BUSINESS LIABILITY PROTECTION LIMITS PREMIUM COVERAGES Liability and Medical Expense $ 1 , 000 , 000 Included Medical Expense - Per Person 5 , 000 Included Personal Injury Included Included Tenants Fire Legal 50 , 000 Included Hired Auto 8 Non - Owned Auto Liability 11000 , 000 $ 35 . 53 FORMS THAT APPLY TO ALL LOCATIONS : 54510 ( 09 - 82 ) BP0002 ( 01 - 87 ) BP0006 ( 01 - 87 ) BP0009 ( 01 - 87 ) 54679 ( 06 - 92 ) 54709 ( 04 - 94 ) 59350 ( 11 - 02 ) 54656 ( 08 - 91 ) 54663 ( 09 - 91 ) Countersigned By : �� r / 11/19/2032 9: 11 AM �GHEDULE A Organization Exempt Under Section . 501 (c) (3 ) (Form 990 or 990-Ez) (Except Private Foundation) and Section 501 (e), 501 (f), 501 (k), OMB No. 1545-0047 501(n), or Section 4947(a)(1 ) Nonexempt Charitable Trust Department of the Treasury Supplementary Information4See separate instructions .) 2001 Internal Revenue Service ► MUST be completed b the above organizations and attached to their Form 990 or 990-EZ Name of the organization Employer Identification number I . R . C . HEALTHY START COALITION INC 65 - 0363222 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 more (b) Title and average hours (d) Contributions to (e) Expense than $50,000 per week devoted to position MCompensation employee ben. plans d account and other deferred corn ensation atlowances NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . rotal number of other employees paid over 6501000 ► Q Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services See page 2 of the instr. List each one whether individuals or firmts . 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )(al number of others receiving over $50,000 for ofessional services ► 0 x Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ, Schedule A (Form 990 or 990 -EZ) 2001 4 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY DISTRICT DIRECTOR C - 1130 ATLANTA , GA 30301 Crate : tm to er Identlf 1C iti ._^. :k P Y r`t riif� er : APR 2 9 1993S 32% 22, F - ,`� L C � rltac d Person ROBER T A VAN METER INDIAN ""c" ' iliUNT`i HEALTH � ^IR Lis' ntyct ti : T lele �a „ +_ane F< ufllb • ie : GALI r1Qi1 Ii ! '' : 404 ) o .: ] - is1 ^ r n - - 191:; 0 � 711i �' i _ ET OL rE i Q E A, c ' vim. 0 ^accounting P • • r i od End i FiI, : June 30 1-oundation Status Classification & 509 ( a ) ( 1 ) Advance Ruling F' er i rid ) eg i Pc a - - October 222 , 1991 Advance Ruling F' er” i od ds : June 30 , 1917 Addendum Applies : Yes Clear App i icant : i Eased c :, Information YC' 11 =5LPpl i 'e- d , and assum ; nrj :' iiilr- _, !] ;� rastins t-± i i l as stated in VC111C app i Kat i on for reCoarl i ti IW �=ii exe1} rit i vri , we iiave deter r,i : ni: . t dee exempt # YoGi federal i nconle tai' under sect i on '' J1 ( a } Of the In sterna I Re '-' enI Lode as an organization described in section 501 ( c ) ( 3 ) . Because you are a newly created organization , tie are not now mz( k ing a f i ne I deteris i riat i on of your f oundat i on status under" sect i ti 5 i { - i i ' r1 _� C � d i if t. h ; ; t_ide . However , s-le have determined that you can reasonably expect to be a pub ! is , supported organization described in sections 50 ( a ) %' I a ;id 170 ( b ) : 1 ) ( A ( vi > . Accordiist, ly , during an advance rul ing period yi-' u ui I E br treated 8s .; publ icly suppi.-trted organization , and not as a private foundation . This deviance ruling period begins and ends on the dates shos-in aliovP. . . Within 90 days after the_ end of your advance ru l i n q per- i _id , you must send us the tnformatirin neede-dto determine whether you have wet the r- • t7u ' :_ - ments i= f the applicable support test durinq the advance ruling period . I ; you estab l is " that you have been a put, I i c I y supported orGan i -Zat i t:, n , 1-4e sl i ! i f you as a <.astction 509 ( a ) ( 1 ) or- 509 ( a ) ( 2. ) organization as Iown q as Vou con 't. : inue to meet the req ui reraents of the app ! icab le support test . If you do not meet the pubs is support requirements during the advance r" uIing per ir_vd7 i-ie i-ii ! i classify yr: u as a private foundation Tor future periods . Also , if we cir: t: t_. ify you as a private f �� ur: dation , we s : i I I treat you as c private foundation froii; your beg i nn i Tig date for purposes of = ect i on r' 07 ( d ) and 4940 . Grantor -; and Contributors may r- t- ly on Qu. r d et r_ rill i n a t i �� i ': hat vi-ju are n1il: a Qri 'v + !� f ,� un ,+ ati t_Ir1 unci ! 90 days- a t -& I - fl_ the grid tour advanC {_ r` ltl ITII; per ! } If you _ end us tht_ r" requieri inf !� rmat: lj� r! iii thin the 90 aa �tr' uTr . , r yr. a C _1iltr ! b (lti_jrE fi1aV CvTltlnUe to rely ort the advanc r• tertiiinatioTi 1.l ? iii I 1-t E' OiatC -• a f Inas dett:, ritiinatiorl of yr11r fi-sandaIiiilj c. I; atil5 . t li i TAN . iIVE its: : 01irNTY iic_. ALT 'rit' S T0% If Ae pool i s h a notice in the E .- . ernaI Rever, uo Eau letin = tatinq that S: 1 ' i rice icin i- r.. treat :ec, u as a , i i pl. f_'- i c : y supported +_1r' Se'Arl 1 Za l I cln qr- d ot �' r _; disci Ce:, rltr- IbUtc' r5 may nr' t rely an this de� 'C� rtlllnatic, n afis P. date . riot l ce . in c' t . , er ` R _ da t to pub i I sh 2= ile ] alt n 1T SIDU li, y _+ y ,_ tty. STd tUs as aUlei ie J ,. p i r ` '� ppa4 LO cigar, i — . au icert , no l: ran tr4r c' r 4a r: tri bUtl' r stds res arlsly ! !' t ,! R rs ver e': as ai-tare' ref , the a r: t ; re r- fail u r t4 to ct , t. hiit resu ! ted in your loss such status , that pe - i ; n li'l & Y Dai_ rely ejrl this deter- minatic# n f7- Oni the , e date . e - f the act cir to i i urG tae & ct , Alsc; % if a grantor or contributor learned that we had given licit ice that yr, u i : r, uld be rerlie:. :� ed fr '� ri classificatir' rl ' a = a publicly suppcerted cer- gani , aticerl , then that person niay r: ce r - this - n as t rely y r, n r dote r re s not i e ' of tFir : da % (` he , r she acquired such knowledge , If You !-range yeour sources ,_if support , your purpe; ses , ciiaracter , Cr mit: hcld of operations please let us know sr, s'te can consider- the effect r, f the Chan (je ,, n Ve_lur e }: Ompt _status and foundation status . If eiu , - 1 document o �? • y - ] mend , , lr C, rQan l jai: i eii} d i r / ! arts , please send us a c ,, py c, f the amended dock -ment ce ` r tart -; s ? : > . Ais +1 , let us krirei-t all changes in `v -or name r, address , As of J nuary 1 , " _ i9 - 4 , yycl are lab t e fear scec i a i sec ur i i e i; axe = under Federal Insurance Ccentributi ,:` ns r; ,= i ,= n anic' tr; ts Co7 $ 100 or mcire yr, u. pay Tr, each cif your rfliplovees durina a cdle ifd � r year . Y' i, U yr t• , ; • ' rl t ' idblF' fcr tale td }: imposed under the Federal Unempl •jyme_ 11t 1' ay Act ( FUTA ) Organizatirens that are not private foundations are neer ; object to the pri =- vate foundation excise taxes under- Chapter 42 of the Internal Revtiue � eJde . IlalteVer � you are not dUt!� matlCa ? iy exempt from cath -= r federal excise ta :; es , if you have any gttestir, rls about exc i se , enip I :syment , or ,_ether- federal taxes , p l ease let us know . Lle_onors may deduct ccentr- ibuticons te_, you as provided in s (:' cticen 170 ce , f ' - he Internal Revenue Code . 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S-fycere I y ours , _ Paul hi 11 iap.: s District Directur Enc1osurt-_ ( si : Addendum Form 872 — C S Indian River County Healthy Start Coalition, Inc. — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee PROGRAM COVER PAGE Organization Name : Indian River Copjjjy Healthy Start Coalition Inc Executive Director: D . Scott Joseph, M . S . Email : irchsc(o)aol . com Address : 1603 10`h Ave . Telephone : (772) 563 -9118 Vero Beach, Florida 32960 Fax : (772) 563 -9125 Program Director: Christi Walters Email : cwaltersgexchan2ecastle . oriz Address : 1906 10`h Court Telephone : (772) 567- 5700 Vero Beach, Florida 32960 Fax : (772) 567- 7133 Program Title : Healthy Families - IRC Priority Need Area Addressed: Parenting Support and Education as well as Mental Wellness Brief Description of the Program : The taxonomy definition for the Healthy Families program is PH-236 .240 — Family Support Centers . Healthy Families—IRC is a community based voluntary home-visiting program designed to promote positive parent-child interaction and child growth and development therefore enabling children to grow up healthy safe and nurtured While the Healthy Families program is not a support center, the staff provide a wide variety of social services that are designed to promote and support healthy development of families help families cope towards mental wellness, improve family interaction skills and help at-risk families to resolve problems in the pre-crisis stage before they become unmanageable and child abuse takes lace. Amount Requested from Funder for 2003 /04 : $ 559000 Total Proposed Program Budget for 2003 /04 : $ 3529985 Percent of Total Program Budget : 15 . 6 % Current Funding (2002 /03 ) : $ 409000 Dollar increase /( decrease ) in request : $ 159000 Percent increase /( decrease ) in request : 37 . 5 % Unduplicated Number of Children to be served Individually : 153 Unduplicated Number of Adults * * to be served Individually : 127 Unduplicated Number to be served via Group settings : _ Total Program Cost per Client : 1260 . 66 Will these funds be used to match another source ? Yes If yes , name the source : HFF - Florida Ounce of Prevention Amount : $ 294 ,985 . 00 * * Does not count father or significant other The Organization 's Board of Directors has approved this applic n on (date). May 28, 2003 Jean Anderson Name of President/Chair of the Board ignature D . Scott Josgph Name of Executive Director/CEO Signature 3 Indian River County Healthy Start Coalition, Inc. — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee 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 Indian River County Healthy Start Coalition is to establish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote normal growth and development. The vision is to provide the resources and mechanisms available in Indian River County that lead to healthy birth outcomes and brain development. The Vision/Mission Statement for the HF-IRC program is "To enhance parent ' s ability to promote and maintain healthy family life through education and coordinated support which is individualized for each family. " 2 . Provide a brief summary of your organization including areas of expertise, accomplishments and population served. The Coalition ' s purpose is to provide coordination and build broad-based community support for maternal and child health (MCH) . This is accomplished by establishing a partnership between the private and public sector, state and local government, community alliances and maternal and child health providers to provide coordinated community based care for pregnant women, infants and families with children up to age three for Healthy Start and age five for Healthy Families . Areas of expertise include birth and maternal data analysis, program planning, development, implementation, and addressing gaps in MCH services . Once gaps in service or poor birth outcome trends have been identified, then the necessary steps are taken to improve these gaps in care by building bridges, linkages or adding new services if they currently do not exist to meet the MCH needs in Indian River County. Additional areas of expertise include outreach, providing educational opportunities addressing MCH issues, and ensuring a system is in place for pregnant women, infants and children . The Coalition serves as the lead agency for Healthy Families — IRC in partnership with the Exchange Club C .A. S . T . L. E . , who is the contracted service agency. The program has provided intensive case management to over 100 families each year since 1999 , with the primary goal of preventing child abuse in at-risk families . The IRCHS Coalition also developed and put in place the TLC Newborn Program in 1998 , which serves approximately 1 , 000 infants each year, as well as the parents of these newborns . In addition, the Coalition oversees Healthy Start Care Coordination services in partnership with the Indian River County Health Department, which served over 500 families in 2002 . Beginning in 2003 , the Coalition launched a child safety campaign and became a Safe Kids Chapter in January. The vision of Safe Kids is to "Protect the children of our community . . . through education, outreach and community involvement". The Safe Kids programs focuses on child passenger safety, infant, home and bicycle safety education and initiatives . The program has already proven to be extremely beneficial in bringing new resources to the community by getting over 60 child safety seats donated from the state, with potential Department of Transportation funds available for additional seats and safety interventions . To date, over 100 child passenger seat inspections have taken place by the Coalition' s Outreach Coordinator, who plans and coordinates the Safe Kids program . 4 Indian River County Healthy Start Coalition, Inc. — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee B . PROGRAM NEED STATEMENT (Entire Section B not to exceed one age) 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. a. What : Pregnancy and raising a child places many new or additional burdens and stressors on a family, including financial, emotional and even physical stress . Along with the joys of parenthood can be the realization of the major responsibilities of raising a child to be healthy and ready to learn by the time they enter their school years . HF focuses on families with risk factors for child abuse addressing parenting components that will improve parent/child interactions and enhance overall brain development. b . Who : Factors associated with increased risk for child abuse, poor birth outcomes and poor infant/child growth and development include : marital status, age of mother, moving three times in one year, alcohol or substance use, high stress level, not wanting the pregnancy, depression, history of mental health counseling, and partner being unemployed. In many cases, these risk factors are more prevalent for low income families . Indian River County residents have been averaging about 1 , 100 births each year. Of these births in 2001 , 65 . 4% were from white mothers, 16 . 6% black, 16 . 7% Hispanic and 1 . 2% "other" mothers . In 2001 , almost half, or 45 % of all births were covered under Medicaid or indigent funding, which amounts to 506 babies being from low income families . Of all the births in 2001 (the latest year for complete birth data), 39 . 3 % or 442 babies, were to unwed mothers, with black unwed births at 67 . 9 % . In terms of education status of the newborn ' s mother, 25 . 5 %, or 287 of the mothers did not have a 12th grade education or GED . For Hispanic mothers, 61 . 2 % did not finish high school . In the latest report detailing HF-IRC families being served, 33 . 3 % were Caucasian, 30.4% Black, 34 . 3 % Hispanic and 2 . 0% other. c. Where : Healthy Families — IRC serves families from the entire county, with 53 % served from south county, and 47 % from the north county area. d. Collaboration of Area of Need : The HF program is modeled after the highly successful national HF America initiative that is based on critical program elements that have been defined by over 20 years of research and represent best practices in home visitation. Only two reported child abuse cases for families receiving HF-IRC services have occurred since 1999, which is noteworthy since these families are at greater risk for committing child abuse. 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. Healthy Start Care Coordination provides ongoing case management to high-risk families , placing emphasis on the pregnant woman to help ensure a healthy birth outcome, as well as pregnant women or infants with medical risk factors . Typical caseloads in the Healthy Start program are 50 pregnant women and/or infants per Healthy Start Care Coordinator. Statewide, the Healthy Start program is only funded at 47 percent of the true at-risk client needs . Due to the complex and labor intensive problems addressed, Healthy Start Care Coordination only provided 100 infants and their families ongoing care coordination in the last year. This leaves almost 1 , 000 families with newborns that might be at risk for child abuse and could be eligible for Healthy Families . The program is designed to work on parent/child bonding and interaction with the target child until the child reaches age five . Healthy Families also requires that low caseloads be maintained at an average of 20 families per worker, but no more than 25 . The low caseloads and the extended duration of services greatly enhance the opportunity to positively impact families . Healthy Families-IRC is the only program in Indian River that is designed to stay with families up to five years . 5 Indian River County Healthy Start Coalition, Inc. — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Parenting Support and Education & Mental Wellness 2 . Briefly describe program activities including location of services. The primary location of services takes place in the family' s home. Healthy Families is a voluntary, intensive home visiting program that occurs on a weekly basis . Family Support Workers (FSW) , who are trained paraprofessionals, provide case-management services focusing on parent/child bonding, infant/child growth and development, ensuring well baby care and immunization schedule compliance and support the family empowering them to set and achieve goals. Family caseloads for the FSW ' s are by design, kept to under 25 families, to ensure the intensity of the home-based services are manageable . HF can initiate services either prenatally or up to two weeks after the birth of the target child . HF Florida and the Florida Department of Health have collaborated to develop a Universal Prenatal Screen. The screen is offered to the pregnant woman on her first obstetric (OB) visit with her prenatal care provider. In Indian River County, during the spring of 2001 , a Screening Liaison position was provided by the IRCHS Coalition to Partner' s In Women ' s Health, (the primary OB provider for pregnant women who have Medicaid or are indigent) in order to better coordinate the screening process and ensure that the pregnant woman is referred to the program (HS or HF) that can best meet her needs based on the risk factors presented. The implementation of this Screening Liaison position has dramatically improved the referral process and has eliminated any duplication of services . HF—IRC receives the screens from the HS Care Coordination (HSCC) office and makes contact with all pregnant mothers who had a positive screen for HE HF focuses on parenting education and services directly related to parent/child bonding and infant care and development. Once the positive HF screen is received, the HF-IRC Family Assessment Worker (FAW) contacts the HSCC office to determine the status of the pregnant woman and if she is being served by HS Care Coordination. The FAW conducts a face-to-face two-hour comprehensive assessment to determine if she would be eligible for HF services . If the pregnant woman is eligible after the assessment for HF and is not receiving HS services, then on-going HF services would begin. The majority of all HF referrals come from the HS screen prenatally. However, referrals can take place within two weeks after the birth of the infant. Postnatal referrals routinely come from the Indian River Memorial Hospital (IRMH) representatives after delivery. For the first time since the inception of the HF-IRC back in the summer of 1998, eight families will "graduate" from the HF-IRC program this summer. Of these families, seven are employed and two have increased their level of education. Of these eight participants, six were unemployed at the time of entering the HF-IRC program. One hundred percent of the families being served have conformed to their well child/EPSTD standards (which includes immunizations) , with 100% of the families surveyed showing overall satisfaction with services . 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. HF focuses on families with risk factors for child abuse addressing parenting components that will improve parent/child interactions and enhance overall brain development. The HF program is modeled after the highly successful national HF America initiative that is based on critical program elements that have been defined by over 20 years of research and 6 Indian River County Healthy Start Coalition, Inc. — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee represent best practices in home visitation. As mentioned earlier, only two reported child abuse cases for families receiving HF-IRC services have occurred since 1999 . HF Florida, which is the state-based administrator of the all HF programs, contracted with a research and evaluation firm to do overall program evaluation. In a report presented in April 2002 , it found that 98 % of all children who participated in HF had no finding of child maltreatment or substantiated child abuse . The national HF initiative has many years of research and has demonstrated that home based case management, parenting education and child development has been the most effective means for addressing parent support and education as well as mental health and wellness . 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers . Project Manager ( 100%) - Masters degree in social work, psychology, or a related field (or BA with 2 additional years of experience in the field), and 2 years experience in direct service delivery and supervision. The primary role is to provide leadership , direction and overall program supervision for all HF— IRC staff. Supervisor ( 100%) - Masters degree in social work, psychology, or a related field (or BA with 2 additional years of experience in the field), and 2 years experience in direct service delivery and supervision. Duties are to report to Program Manager, provide direct supervision of FSW ' s and to review caseloads of HF-IRC staff. Family Assessment Worker ( 1 - 100%) - One-year college credit in a related field, with two years of experience delivering services to children and families . Duties are to review referrals made by OB providers or other sources in the community. For all referrals, interviewing/conducting the eligibility tool with parents to determine eligibility for HF . Family Support Worker (six FSW ' s at 100%) - One-year college credit in a related field, with two years of experience delivering services to children and families . Responsible for initiating and maintaining regular (at least weekly) and long-term contact/support with families . Data Entry Clerk—Admin. Asst. ( 100%) - Accurate and timely information processing; experience with data entry computer systems . Duties include the review of master copies of documents ; u dates HF—IRC database. . 5. How will the target population be made aware of the program? The primary site for reaching potential HF clients is through the Screening Liaison located at Partners in Women ' s Health . Partners is the primary obstetric Medicaid provider in this county, whose patients would most likely be eligible for Healthy Families . The Screening Liaison provides orientation on the HF program during new client intake days at Partners, which is every Friday morning. IRMH is also a source for HF program referrals . Because the IRCHS Coalition is the lead agency for HF- IRC , awareness is also created through The Coalition ' s networking, and it ' s three other programs (Healthy Start, TLC and Safe Kids) . The CASTLE also assists in marketing the program as well as individuals from the Coalition ' s Board of Directors , partnering agencies and other not- for- profit programs . The Coalition also promotes the program through its newsletter, public presentations, bi -monthly Coalition meetings, and at health fairs or other public events . 6. How will the program be accessible to target population (i. e. location, transportation , hours of operation) ? The HF-IRC program can serve the entire county. Since HF-IRC is a home-based visitation program, there are few barriers for program participation. The FSWs have flexible hours and can work nights or Saturdays in order to visit families at their convenience . The FSW ' s can also meet families at their OB or pediatric providers offices , WIC or any other convenient location. 7 Indian River County Healthy Start Coalition, Inc . — 2003-04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee 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) Note : These outcomes and activities are based on the standard HF Florida and national HF program guidelines and requirements . 1 . Ninety (90) percent of target children will 1 . FSW ' s will address immunization schedules be fully immunized by age two (2) . with family and record usage . 2 . Ninety (90) percent of target children will 2 . The Well Baby checkups will be monitored, be up-to-date with Well-Baby Checks . with the infant ' s medical home established. Families will be encouraged to seek and utilize a pediatrician and/or clinic for ongoing medical care for infant and child. 3 . Ninety-five (95) percent of the children in 3 . FSW ' s will address proper parenting skills families who participant in HF-IRC for six with family, as well as Shaken Baby Syndrome months or longer will have no findings of some Education, partner interaction and anger indications or verified child maltreatment management, while receiving Healthy Families services . 4 . Ninety-five (95 ) percent of participating 4 . Outcomes Satisfaction surveys will be families will report an overall satisfaction with distributed to all HF clients two times per year the service they receive . to determine client ' s satisfaction with the program. S . At least eighty (80) percent of all 5 . The Family Assessment Worker will assessments must occur either prenatally or conduct assessments per referral during the within the first two weeks after the birth of the target period for HF client enrollment. target child. 6 . Ninety (90) percent of families enrolled 90 6 . All FSW ' s will complete a Family Support days or longer will have updated their Plan for enrolled clients, developing mutual Individual Family Support Plan within the goals and activities the family will strive to previous ninety days . obtain. 7 . One hundred ( 100) percent of eligibility 7 . All potential HF clients will be given an assessments will be conducted using a eligibility assessment as part of the enrollment standardized tool . process in Healthy Families . 8 Indian River County Healthy Start Coalition, Inc . — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee 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 ro ram The C.A.S.T.L. E . * Provides administrative and fiscal oversight for (Contracted service agency for contracted HF-IRC service staff. HF-IRC services) * Assist the IRCHSC in marketing and increasing awareness of HF-IRC in Indian River County. * Provides in-house programs for referral to HF-IRC and from HF-IRC families . All these services are provided in-kind, with no administrative fee from BOCC-CSAC. Indian River County Health * Provides coordination of HS/HF prenatal screen. Department * Communication on potential HF client ' s status . * Medical/nursing based services for HF client on an "as-needed" basis . * WIC and needed health care services at CHD clinics . All these services are provided in-kind Indian River Memorial Hospital * Provides referrals to HF-IRC program from Delivery/ Nursery Department for identified high-risk families . All these services are provided in-kind. IRC Library — Born to Read * Provides two books to newborn families that are given Program to the family of the newborn by the Stork Club . The HF-IRC emphasizes the importance of reading to their infant towards enhancing brain development. All these services are provided in-kind. Visiting Nurses Association of the * Provides Home visitation for mothers of newborns Treasure Coast experiencing breastfeeding difficulties or in need of greater breastfeeding education. Partners in Women 's Health * Primary site for Healthy Families referrals . Partner' s employs , under contract from the Coalition, the Screening Liaison who provides HF-IRC orientation, education, and processing of the Universal Screen. Indian River County Healthy Start * Overall program development, integration and Coalition communication within all four IRCHSC programs . * Fundraising, PR and marketing of HF-IRC program (While the Coalition is the applying * In cooperation/collaboration with the Exchange Club agency, many in-kind collaborative CASTLE, HF-IRC Program QA/QI, reports . efforts on behalf of the HF-IRC * Provide HF-IRC representation at public events program take place) * Presentations to community groups re : HF-IRC * Development and presentation of HF-IRC Grant(s) * Fiscal oversight and reimbursement requests . All these services are provided in-kind, with no administrative fee from BOCC-CSAC. 9 Indian River County Healthy Start Coalition, Inc . — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee 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 Comprehensive data on each HF — IRC family who enrolls is entered in a Healthy Families database, developed by Healthy Families Florida. This data includes demographic information. The parent(s) and the Family Support Worker monitor infant developmental stages, with updates documented in the family record. HF — IRC participates in statewide evaluation and provides outcome and performance data in the format and frequency specified by Healthy Families Florida. The HF-Florida database is updated on a weekly basis, with reports also generated on a weekly basis, which is provided to the Project Manager and Supervisor, who then share the general information and/or discrepancies with the appropriate FSW. The Healthy Families Florida Contract manager performs sites reviews on a quarterly basis, as well as Coalition and HF-IRC Advisory Board reviews . Last year, the HF-IRC program tied for third in the state out of 40 plus HF programs, for meeting its program goals and objectives . 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? The outcomes are based on data needed by HF Florida as well as HF-IRC , which are compiled and entered into the HFF database at regularly scheduled intervals . Based on strict HFF criteria, families develop goals based on their assets and needs, and must achieve these through the program to "graduate" to higher levels, which would need less intensity of services , which empowers the family to become self-sufficient. The required data and outcomes are monitored by HFF as well as locally by the HF-IRC Program Manager and the Coalition. These measures are based on 30 years of research by Healthy Families America, 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? Database is compiled and updated on a weekly basis, with reports also generated on a weekly basis that the FSW and Supervisor review . Monthly reports are provided to the HF- IRC Advisory Board, and quarterly reports are submitted to the Coalition and CSAC . Data and programmatic reports are submitted to the HF-IRC Advisory Board on a monthly basis, the Coalition Executive Director and Board of Directors on a quarterly basis , the HFF Contract Manager on a monthly basis, who also conducts on-site QA/QI every three months . Reports are provided at the public Coalition meetings bi-monthly. All of the QA/QI partners, which include Healthy Families Florida, the Advisory Board and the Coalition address program outcomes from a global sense and work towards strategies and solutions that can be shared with the HF-IRC service staff, who then apply the action steps to benefit the families they serve. 10 Indian River County Healthy Start Coalition , Inc. — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children 's Services Advisory Committee 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 fundin ear. In completing the timetable, review information detailed in prior sections. Month/Per Activities iod Healthy Families — IRC is in its fifth year of operation, and has no start-up steps . The major steps for the overall program are : Pregnant women are offered the universal screen by the Screening Liaison at Partners in Women ' s Health. The voluntary screen looks at risks for child abuse . A consent form is also signed by the client if they have a positive score for Healthy Families on Weekly the universal HS/HF screen. Referrals can also come from the social worker at Indian River Memorial Hospital at the time of birth. Additional referrals can come from any agency in the community. Families can be eligible for assessment during pregnancy or up to two weeks after the birth of their child. The screen is sent to the Healthy Start Care Coordination office for processing. All screens are then forwarded to the Healthy Families Family Assessment Worker (FAW) for a face-to-face assessment to determine if they are eligible for Healthy Families . The FAW communicates with the HS Care Coordination team to determine the potential HF client ' s status prior to performing the assessment. On-going After the assessment, if the family is eligible for Healthy Families, and is interested in participation, the Program Manager reviews the case with the FAW. The case (family) then goes to the HF Supervisor, who reviews the family' s needs and determines the best Family Support Worker for case management assignment. The family is then assigned to a FSW. Phone contact must be attempted within 72 hours . A subsequent home visit attempt must be completed within 5 days. Once contact is made with the family, initial goal(s) setting is done within one month of opening case. Supervision is conducted weekly with all FSW ' s, who review all cases for minimum of two hours with each FSW. Goals are reviewed and updated with family and Supervisor every 90 days . Can be modified during 90 days if needed. For pregnant women, the determination of weekly or bi-weekly visits during pregnancy is made. After birth, visits are weekly for a minimum of 6 months . Bi-weekly visits can be done if the mom returns to work, with phone contacts in between. Six to eight months after birth, the Supervisor and FSW will determine if the family can move to level two, which is bi-weekly visits . This determination would be based on the family' s progress in meeting their goals and well as overall family needs . The Ages and Stages child assessment tool is conducted every four months and goes all the way to 60 months . The Parent Child Assessment/Observation tool is done at one month, then every six months . Home Safety checks at one month then six months . The family and target child have goals and levels to achieve for program graduation. 11 Indian River County Healthy Start Coalition, Inc. — 2003 -04 Healthy Families — IRC Program IRC Board of County Commissioners — Children's Services Advisory Committee H• PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Undu licated Clients by Location Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2001/2002 Budget 2002/03 Projections 2003/04 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County* 116 S . Indian River County* 132 �' 136 132 146 Indian River Co. Total 252 148 TOTAL SERVED 278 280 252 278 280 * Counts infant and mother ( 126 families * * Does not count father ) ( 139 families) ( 140 families ) or partner EMISSION Number of Undu licated Clients by Age Location Last Fiscal Year Current Fiscal Year Next Fiscal Year Actual 2001/2002 Budget 2002/03 Projections 2003/04 Individuals Group Individual Group Individual Group 0 to 4 - (Pre-school) 116 - 139 5 to 10 - (Elementary) 140 _ 11 to 14 - (Middle) - 15 to 18 - (High School) 11 - 12 - - 19 to 59 - (Adults) 115 _ - 13 _ 127 127 60 + (Seniors) _ _ - - TOTAL SERVED 242 - 278 280 _ 12 IRC Healthy Start Coalition, Inc. 2003-04 Healthy Families - IRC 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 : IRC Healthy Start Coalition , Inc . = Healthy Families = IRC FUNDER : IRC BOCC = CSAC 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 Lbe used for calculations and to write information only. B GRAY AREAS FOR REVENUES AGENCY USE ONLY Proposed Total Program Funder Speck Total Agency tL�,AnONS) Budget Budget Budet 9 1 Children's Services Council-St, Lucie 2 Children's Services Council -Martin 3 Children's Services Council -0keechobee 4 Advisory Committee-Indian River 55,000. 00 559000.00 75,000 . 00 5 United Way-St. Lucie County 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County 55,000 . 00 9 Department of Children & Families 10 County Funds 11 Contributions-Cash 39000.00 31000. 00 12 Program Fees 13 Fund Raising Events-Net 14 Sales to Public • Net 12,000.00 15 Membership Dues 16 Investment Income 17 Miscellaneous (John's Island CSL) 10 ,000. 00 18 Legacies & Bequests 19 Funds from Other Sources 294 , 985.00 749, 171 . 00 20a Reserve Funds Used for Operating 20b In-Kind Donations (Not included in total) 12,000 . 00 47,000.00 21 TOTAL REVENUES (doesn't include line lob) $352 ,985 .00 $55,000.00 $904, 171 . 00 C D EXPENDITURES GRAYAREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY (SNOW CALCULATIONS) Budget Budget Budget 22 Salaries - (must complete chart on next page) 2499882 . 00 51 ,090.00 612,251 . 00 0 Salary 23 FICA - Total salaries x 0.0765 7.65% 19, 116.00 3 ,908.39 46 , 837.00 e Yemen - Annual pension for qua I le G 24 staff eligible staff) 91000 .00 0. 00 249504.00 1 e eat - e Ica enta ort-term for those unde 25 Disab. plan in HF 6 ,000.00 0. 00 45,000. 00 or ers uompensation - # employees x 26 rate 1 .20% 2 ,900. 00 0 . 00 2,900. 00 oil a Unemployment - ft prolec e 27 employees x $7,000 x UCT-6 rate per case basis 0.00 19200 . 00 13 IRC Healthy Start Coalition, Inc. 2003-04 Healthy Farnilies - IRC SALARIES A Gross Annual B D POSITION LISTING Salary Portion of Salary on Proposed C % of Gross Annual Position Title / Total Hrs/wk (Agency) Program Funder Specific Budget Salary Example: Executive Director / 4o his 70,000.00 10,000. 00 Requested(CIA) Project Manager (40 hrs) 34, 742.00 5,000. 00 7. 14% Supervisor (40 hrs) 30, 030 . 00 34.742.00 0. 00% Family Assessment Worker (FAW) (40 hrs ) 25,379. 00 30,030. 00 0. 00°/ Family Support Workers (6 FSW's) (40 hrs) 134, 984. 00 25,379. 00 0 .Ooo/ .50 Data Entry Assist. - . 50 FAW (40 hrs) 240747.00 1340984.00 51 ,090 .00 37 . 85% 24,747. 00 0. 00% #DIV10! TLC Newborn Program 54 000.00 IRC Healthy Start Care Coordination 191 ,416.00 0 . 00% IRC Healthy Start Coalition , Inc. 116, 953 . 00 0. 00°/a 0 .00% #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0! #DIV/0 ! #DIV/0! Total Sa/aries $612v251 .001 $2499882- 007"""""""" $51 ,090.001 249,882. 00 $51 ,090.00 8. 340/61 FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B CD E G Column C only, from line 22 to 27) Specific FICA 7,65% Pension Health Ins. Worker's Unemployme Total Fringes Funder Position Title / Total Hrs/wk Budget (A x %) Compens, nt Compens. Specific Example: Case Manager / 40hrs 52000.00 362,50 200.00 500. 00 300.00 200.00 Project Manager (40 hrs) 0. 00 0 . 00 1.582.50 Supervisor (40 hrs) 0. 00 0. 00 0 .0 Family Assessment Worker ( FAW) (40 hrs) 0 . 000 . 0 0.00 Family Support Workers (6 FSW's) (40 hrs ) 51 ,090 . 00 3,908 . 39 0 . 0. 50 Data Entry Assist. - .50 FAW (40 hrs ) 0. 00 0 . 00 3 , 908. 3 0 0. 00 0 . 00 0. 00 0 0. 000. 0 0 . 00 TLC Newborn Program 0.00 0. 00 0. 0 IRC Healthy Start Care Coordination 0. 0 0 . 00 0. 00 IRC Healthy Start Coalition , Inc.0 0 . 0 0 . 00 0. 00 0 . 0 0 0 . 00 0 . 00 0 . 0 0 0 . 00 0 . 00 0 . 0 0 0 . 00 0 . 00 0. 0 0. 00 0 . 00 0 0. 0 0 0. 00 0 . 00 0. 0 0 0. 00 0. 00 0. 0 0 0 .00 0. 00 0. 0 0 0 .00 0 . 00 0 .0 0 0 .00 0 .00 0 .0 0. 00 0 .00 0 . 0 Total Funder Request Fringe Benefits $51 ,090. 00 $31908. 39 $0 . 001 $0. 00 $0 . 00 $0 .001 $3 ,908. 3 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific TotalAgency enc AGENCY USE ONLY TO g y SHOW DETAIL Budget Budget Budget 14 IRC Healthy Start Coalition, Inc. 2003-04 Healthy Families - IRC 28 Travel-Daily 50 , 70. 00 10 staff at .29 189500.00 # of Staff x average # of miles/wk x 50 wks x cents per miles $ = Estimated Daily Travel/Mileage Reimb. per week 29 Travel/Conferences/Training 3 ,500. 00 • National Conference (cost per staff) 12 ,000. 00 • Training/Seminar (cost per staff) • Other Trainings (cost of travel , lodging , New staff registration , food) training Existing staff on-going training 30 Office Supplies 2 ,500.00 Office supplies (monthly average x 12 Monthly 6,000. 00 average of months = estimated cost of office supplies $200 .00 for based on present history. office supplies 31 Telephone 39500.00 11 ,000.00 # Phone lines x average cost per month x 4 lines at $20 12 months = local phone cost per line - - Average long distance calls x 12 months = service is $360 Estimated cost of long distance per month 32 Postage/Shipping Individualized 750.00 • Quarterly Mailing of Newsletter mailings of 8,000. 00 • Special events , etc. education material or special program • Bulk mailings - appeals announcements 33 Utilities • Electricity ($ x 12 months) Average of 1 ,625.00 6,500 .00 • Water/Sewer ($ x 12 months) $ 135.43 per • Garbage ($ x 12 months) month 34 Occupancy (Building & Grounds) 9,000.00 26 ,600 .00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) $750 monthly Safe Families with CASTLE is paying a • Real Estate Taxes rent portion of the rent 35 Printing & Publications 500. 00 6 , 000 .00 • Quarterly Newsletter ($ x 4) HF brochure • Letterheads, Envelopes , etc. and educational • Fundraising materials materialdevelopment • Other and printing U Subscription/Dues/Memberships 100.00 21000. 00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, Includes memberships or subscription etc. beneficial for HF - IRC 37 Insurance 1 ,000.00 2,530. 00 • Directors/Officers Liab. • Commercial/General Insurance • Bond Ins. Liability • Auto Insurance Insurance 38 Equipment : Rental & Maintenance 1 ,500. 00 41500.00 • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) Copier • Copier Maintenance ($ x 12 months) maintenance at $48. 00 per • Computer Maintenance ( $ x 12 months) month and Other computer repair 39 Advertising 87, 55 100. 00 • Newspaper ads • Fundraising ads/promotions Potential job • Other (vacancies) vacancies 40 Equipment Purchases : Capital Expense 0.00 5,000.00 • Computer/monitor (# x $) • Laser Printer 41 Professional Fees (Legal, Consulting) 190.00 1 , 000.00 • Legal advice ( estimated #hrs x $) • Consultant fees background II Other checks 15 IRC Healthy Start Coalition, Inc. 2003-04 Healthy Families - IRC 42 Books/Educational Materials 500. 00 2,500.00 • Books/videos Parenting support and educational • Materials ($ x staff) materials 43 Food & Nutrition 0 . 00 0. 00 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 44 Administrative Costs 10% of HFF 299498. 50 35,242.00 • Admin. Cost (% of total budget) Amount 45 Audit Expense Portion of CASTLE 31000. 00 99500. 00 Independent Audit Review and Coalition audits 46 Specific Assistance to Individuals 1 ,285.00 2,000.00 Medical assistance Meals/Food Rent Assistance $500 for client Other safety seats $ 1 ,000.00 for client necessities 47 Other/Miscellaneous 0. 00 3,000.00 • Background check/drug test • Other 48 Other/Contract 9,000.00 Sub-contract for program services 49 TOTAL EXPENSES $352,944.05 $54v998. 391 $9031664 .00 16 IRC HaM y sw cwPo . Inc. 2003-04 Hea y F°nilres - IRC UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME : IRC Healthy Start Coalition , Inc. - Healthy Families - IRC FY 01102FFYE 02/03 FY 03/04 % INCREASE FYE 7/1 /01 - 6/30/002 - 6/30/03 FYE 7/1103 . 6/30/04 CURRENT VS. NEXT FY BUDGET AB C D ACTUALTAL PROPOSED (col. C-eol. BNcol. a REVENUES GETED BUDGETED 1 Children 's Services Council-St. Lucie 0.00 #DIV/0 ! 2 Children's Services Council-Martin 0. 00 #DIV/01 3 Children 's Services Council-Okeechobee 0. 00 #DIV/0! a AdvisoryCommittee-Indian River 559000.00 5500000 75 000.00 36. 36% 1 United Wa SL Lucie County 6 United Way-Martin County 0. 00 #DIV/01 7 United Wa -Okeechobee County 0. 00 #DIV/0!0.00 #DIV/O! 8 United Way-Indian River County 49P510.00 - 50 000.00 55 000.00 10.00% 9 Department of Children & Families 0.00 #DIV/01 10 County Funds 0. 00 #DIV/0! 11 Contributions-Cash 2,522.00 3,000.00 #DIV/01 12 Program Fees 0.00 #DIV/0! 13 Fund Raisina Events-Net 51000.00 12 000.00 12p000.00 0.00% 14 Sales to Public-Net 15 Membership Dues 0.00 #DIV/01 0.00 #DIV/0! 16 Investment Income 17 Miscellaneous 0.00 #DIV/0! 16 Legacies & Bequests 10 000.00 #DIV/01 0.00 #DIV/01 19 Funds from Other Sources 788 119.00 758 083.00 749171 .00 1 . 18% 20a Reserve Funds Used for Operating 10 000.00 0.00 100.00% lob In-Kind Donations (Not Included in total) 17 067.00 15 000.00 4700000 213.33% 21 TOTAL 900151 .00 885 083.00 904 171 .00 2. 16% EXPENDITURES 22 Salaries 580 562.00 597 670.00 612 251 .00 2.44% 23 FICA 44p413.00 42 016.00 46 837.00 11 .47% 24 Retirement 26125.00 2450400 24 504.00 0.00% 25 Life/Health 35 075.00 61w774.00 1 45,000.00 26 Workers Compensation 21500.00 2500.00 20900. 00 16. 00% 27 Florida Unemployment 1 200.00 1p200,00 1 200. 00 0. 00% 26 Travel-Dailv 16 325.00 17 650.00 1850000 4.82% 29 Travel/Conferences/Training 11 590.00 13 500.00 127000. 00 -11 . 11 % 30 Office Supplies 71653.00 59000. 00-0 61000. 00 20.00% 31 Telephone 16 943.00 10 550.00 11 000.00 4,27% 32 Postage/Shipping 89014.00 69700.00 81000.00 19.40% 33 Utilities 3o842,00 6,500.00 6,500.00 0.00% 34 Occupancy (Building & Grounds). 26 444.00 2460000 26,600.00 8. 13% 35 Printing & Publications 4 643.00 5 000.00 69000.00 20. 00% 36 Subscri tion/Dues/Membershi s 1 358.00 1 100.00 2,000.00 81 .82% 37 Insurance 70448.00 2p530.00 2 530.00 0. 00% 3a E ui ment:Rental & Maintenance 4,800.00 4,750. 00 4 500.00 5.26% 39 Advertising551 .00 98.00 100. 00 2.04% 40 Equipment Purchases:Ca ital Expense 9P500.00 1 ,500.00 5 000. 00 233. 33% at Professional Fees (Legal, Consultin 12 138.00 0.00 1 000. 00 #DIV/01 42 Books/Educational Materials 39364.00 2 400.00 2; 500, 4. 17% 43 Food & Nutrition 0.00 0.00 0.00 #DIV/0! 44 Administrative Costs 39p233.00 3524200 35 242.00 0.00% 45 Audit Expense 14 500.00 10 500. 00 92500. 00 9. 52% 46 Specific Assistance to Individuals I 3 000.002 000.00 27000. 00 0.00% 47 Other/Miscellaneous 11 910.00 1p163.00 37000. 00 157.95% 46 Other/Contract 14 285.00 3 000.00 9 o00. 00 200.00% 49 TOTAL 907 416. 00 883 447.00 903o664. 00 2.29% 5o REVENUES OVER/ UNDER EXPENDITURES -7,265.00 1 ,636. 00 507. 00 .69.01 % 17 IRC Heatlhy Start Cotli4m, Mc. 2003-00 Hed yFancies . IRC UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : IRC HealthyStart Coalition, Inc. - Healthy Families - IRC FY 01/02 FY 02/03 FY 03104 % INCREASE FYE 7/1/01 - 6/30/02 FYE 7/1/02 - 6/30/03 FYE 7/1/03 - 6/30/04 CURRENT VS. NEXT FY BUDGET A BC D ACTUAL TOTAL PROPOSED (col. C-col. B)Icol. B REVENUES BUDGETED BUDGETED 1 Children 's Services Council-St. Lucie 0.00 0.00 #DIV/0! 2 Children's Services Council-Martin 0.00 0. 00 #DIV/0! 3 Children's Services Council-Okeechobee 0.00 0. 00 #DIV/01 4 Advisory Committee-Indian River 40p000.00 4000000 55,000. 00 37.50% 5 United Way-StLucie County0.00 0. 00 #DIV/01 6 United Way-Martin County 0. 00 0.00 #DIV/01 7 United Way-Okeechobee County 0.00 0.00 #DIV/0! 8 United Way-Indian River County 0.00 0. 00 #DIV/0! 9 Department of Children & Families 0.00 0. 00 #DIV/01 10 County Funds 0.00 0.00 #DIV/0! 11 Contributions-Cash 0.00 3,000. 00 #DIV/01 1z Program Fees 0.00 0.001 #DIV/0 ! 13 Fund Ralsina Events-Net no 29000. 00 0.00 -100.00% 14 Sales to Public-Net 0.00 0. 00 #DIV/O! 15 Membership Dues 0.00 0.00 #DIV/0! 16 Investment Income 0.00 0.00 #DIV/01 17 Miscellaneous 0.00 0.00 #DIV/01 18 Legacies & Bequests 0.00 0.00 #DIV/0! 19 Funds from Other Sources 350 931 .00 294 985.00 294 985.00 0.00% 2oa Reserve Funds Used for Operating 0.00 0. 00 #DIV/01 20b In-Kind Donations (Not Included In total) 12v000.00 12 000.00 0. 00% 21 TOTAL390 931 .00 350 485.00 352v985.00 0.71 % EXPENDITURES 22 Salaries 249t928.001 240 270.20 249 882. 00 4.00% 23 FICA 19 119.4918 380.67 19, 116. 00 4.00% 24 Retirement 13 335.51 8,800.0 91000.00 2.27% 25 Life/Health 97500.00 91900. 00 61000.00 -39. 39% 26 Workers Compensation 29998.00 2v883.24 2 900.00 0. 58% 27 Florida Unemployment 0.00 0.00 0. 00 #DIV/0! 28 Travel-Daily 10111 .00 10 000. 00 7500.00 25. 00% 29 Travel/Conferences/Training 7,564.00 3150.00 3500.00 11 . 11 % 30 Office Supplies 1 5145.00 21400.00 250000 4. 17% 31 Telephone 7 418.00 5 280.00 3,500. 00 -33. 71 % 32 Postage/Ship Postage/Shiping 559.00 750.00 750. 00 0.00% 33 Utilities 2 420.00 1 ,625.00 1 625.00 0.00% 34 Occupancy (Building & Grounds 16140.00 1440000 9000.00' 000.00 37. 50% 35 Printing & Publications 672.00 500.00 500.00 0. 00% 36 Subscription/Dues/Memberships 126.00 100.00 100.001 0.00% 37 Insurance 2J98.001 10000.00 11000.00 0.00% 38 Equipment: Rental & Maintenance 2,033,00 19500.00 1 , 500. 00 0.00% 39 Advertising 75.00 97.55 97. 55 0.00% 40 Equipment Purchases:Ca ital Expense 49439,001 0.00 0. 00 #DIV/01 41 Professional Fees (Legal, Consulting) 636000 190.00 190.00 0.00% 42 Books/Educational Materials 19896.00 500.00 500. 00 0. 00% 43 Food & Nutrition 0.00 0.00 0. 00 #DIV/01 44 Administrative Costs 23188.00 24P255. 10 29 498 . 50 21 .62% 45 Audit Expense 31498.001 39000.00 32000.00 0.00% 46 Specific Assistance to Individuals 609.00 1y500,00 19285. 00 -14.33% 47 Other/Miscellaneous 0.00 0.00 #DIV/0 ! 48 Other/Contract 0.00 0.00 #DIV/0! 49 TOTAL 389 932.00 350 481 .76 3529944. 05 0. 70% 5o REVENUES OVER/ UNDER EXPENDITURES 999.00 3.24 40.95 1163.89% 18 IRC Healthy Start Coalition, Inc. 2003-04 Healthy Families - IRC UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : IRC Healthy Start Coalition , Inc . - Healthy Families - IRC FUNDER : IRC BOCC - CSAC 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 2499882 . 00 51 , 090 .00 20 .45 % 23 FICA 19 , 116 . 00 3 ,908 . 39 20 .45% 24 Retirement 91000 .00 0 . 00 0 .00 % 25 Life/Health 6 , 000 .00 0 . 00 0 .00 % 26 Workers Compensation 29900 . 00 0 .00 0 . 00% 27 Florida Unemployment 0 . 00 0 .00 #DIV/0 ! 28 Travel -Dail 71500 . 00 0 . 00 0 . 00 % 29 Travel/Conferences/Trainin 3 ,500 . 00 0 . 00 0 . 00 % 30 Office Supplies 29500 .00 0 . 00 0 .00 % 31 Telephone 39500 .00 0 . 00 0 . 00 % 32 Postage/Shipping750 . 00 0 .00 0 . 00% 33 Utilities 1 ,625 . 00 0 .00 0 . 00 % 34 Occupancy ( Building & Grounds ) 90000 . 00 0 . 00 0 . 00 % 35 Printing & Publications 500 . 00 0 . 00 0 . 00 % 36 Subscription/Dues/Memberships 100 . 00 0 . 00 0 . 00 % 37 Insurance 1 , 000 . 00 0 . 00 0 . 00 % 38 E ui ment : Rental & Maintenance 10500 . 00 0 . 00 0 . 00 % 39 Advertising 97 . 55 0 . 00 0 . 00 % 40 Equipment Purchases : Capital Expense 0 .00 0 .00 #DIV/0 ! 41 Professional Fees ( Legal , Consulting ) 190 . 00 0 . 00 0 . 00 % 42 Books/Educational Materials 500 .00 0 . 00 0 . 00 % 43 Food & Nutrition 0 . 00 0 . 00 #DIV/0 ! 44 Administrative Costs 29 ,498 . 50 0 .00 0 .00 % 45 Audit Expense 31000 . 00 0 . 00 0 . 00% 46 S ecific Assistance to Individuals 11285 . 00 0 .00 0 . 00 % 47 Other/Miscellaneous 0 . 00 0 .00 #DIV/01 48 Other/Contract 0 . 00 0 .00 #DIV/0 ! 49 TOTAL $352 ,944. 05 $ 54 , 998 .39 $0 . 16 19 IRC Heamy Stmt Coalition, Inc. 2003-04 Healthy Famdies - IRC UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : IRC Healthy Start Coalition, Inc. = Healthy Families = IRC FUNDER: IRC BOCC-CSAC LINE ITEM EXPLANATION FOR VARIANCE #DN/0! #DN/01 #DIV/0! Local funding support from IRC BOCC-CSAC has been the same since 1998, at $40,000.00. These funds have been applied directly to the salaries and FICA for the Family Support Workers, and help with the madatory 25% local match, which last year brought in $294 ,985 to the community. In 2002-03, state funding from the parent HF agency, the Florida Ounce of Prevention, was cut by over 4.5 million dollars (due to the use of one time TANF funds the previous year, which was not replenished). This statewide Healthy Families funding deficit led to a local cut of $60,000.00 to the HF-IRC program. The Coalition was successful in securing an additional $ 14 ,000.00 in funding from the John's Island Community Service League (JICSL) and private donations for 2003/04 to enable the HF- IRC program to maintain the enfire staff, with no cuts that year. However, for 2003-04 , the State Healthy Families Florida (HFF) Advisory Committee-Indian River anticipated an increase in funding due to the expanded prevention services from the Florida Department of Children and Families. B-12 Continued: For this reason , the Coalition opted to not seek additional funding from JICSL for HF-IRC and instead applied for funding support for the TLC Newborn Program from John's Island. Unfortunately, due to the statewide budget shortfall, the increase in funds did not occur for HFF and the funding amount for HF-IRC is going to be the exact same as last year ($294,985.00). This is the reason for the funding increase of $ 15,000.00 from the IRC BOCC-CSAC, as well as increased salary expenses over the last two years #DN/01 for the HF-IRC staff, who have done a commendable job for the Fami Support Workers retention. #DN/01 #DN/0! #DN/0! #DN/01 #DN/0! #DN/0! #DN/0! #DIV/0! #DIV/01 #DNlO! #DIV/0 ! #DN/01 #DN/0! #DIV/0! #DIV/01 #DIV/0! As a means to help defer expenses for 2002-03 fiscal year, only nine percent administration fee of the Healthy Families Florida allocation was budgeted. For 2003-04 , the percentage administration fee is being increased by one percent to adequately support the Administrative Costs time and effort contributed by the IRC Healthy Start Coalition and CASTLE administration . #DN/0! #DIV/0! 20 IRC HeaBhy Slat CoaRm. ft. 2W304 Healthy Farrdms - IRC UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME : IRC Healthy Start Coalition, Inc. - Healthy Families = IRC FUNDER : IRC BOCCaCSAC UNE ITEM EXPLANATION FOR VARIANCE A greater amount of funds are being sought from the BOCC-CSAC to support the HF-IRC Family Support Workers, which leads to a Salaries greater percentage of sala being contributed by BOCC-CSAC. A greater amount of funds are being sought from the BOCC-CSAC to support the HF-IRC Family Support Workers, which leads to a FICA greater percentage of FICA being contributed by BOCC-CSAC. #DN/01 #DN/01 #DN/01 #DN/0! 21 c 00 (Policy Provisions : WC 0 0 0 0 0 0 A ) � 7 GD INFORMATION PAGE wEc WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER : HARTFORD UNDERWRITERS INSURANCE COMPANY low HARTFORD PLAZA , HARTFORD , CONNECTICUT 06115 NCCI Company Number: 1 n� THE it Company Code : 6 HARTFORD H VIP 0 Suffix HLARS RENEWAL C POLICY NUMBER : 1 91 wT?r �nn:770n 01 0 CD Previous Policy Number: 191 wEr rm n n HOUSING CODE : DV 1 . Named Insured and Mailing Address : INDIAN RIVER COUNTY HEALTHY N ( No . , Street, Town , State , Zip Code) ( SEE ENDT ) 0 0 `n 1603 10TH AVENUE * FEIN Number: 650363222 VERO BEACH , FL 32960 State Identification Number(s): The Named Insured is : CORPORATION Business of Named Insured: CIVIC ORGANIZATION Other workplaces not shown above : 1603 10TH AVENUE VERO BEACH , FL 32960 2. Policy Period : From 05 / 03 / 03 To 05 / 03 / 04 12 :01 a . m . , Standard time at the insureds mailing address . Producer's Name: SID BANACK INSURANCE / SCIC P . 0 . BOX 29611 CHARLOTTE , NC 28229 Producer's Code : 227667 Issuing Office : THE HARTFORD -- 8711 UNIVERSITY EAST DRIVE CHARLOTTE NC 28213 -- ( 866 ) 467 - 8730 Total Estimated Annual Premium . $ 916 Deposit Premium . Policy Minimum Premium : $ 236 FL Audit Period : ANNUAL, Installment Tenn : The policy is not binding unless countersigned by our authorized representative . Authorized Representative Foran WC 00 00 01 A (1 ) Printed in U .S .A. Page 1 (Continued on next page) Process Date : 03 / 08 / 03 Policy Expiration Date : 0 5 / 0 3 / 0 4 ORIGINAL ' • • 1 Y 14 F • • ■ r 1 1 1 1 1 1 • 1 111 111 • • r • • • ■ 'r 1 1 1 1 1 1 ` • 'r 111 111 • ' ` 1 • • � • ' • � • 11 • • � INSURANCE COMPANY BUSINESSOWNERS POLICY DECLARATIONS 6101 ANACAPRI BLVD . , LANSING , MI 48917 - 3999 Renewal Effective 03 - 10 - 2003 AGENCY SID BANACK INSURANCE 12 - 0119 - 00 MKT TERR 051 ( 772 ) 562 - 3369 POLICY NUMBER 93 - 211 - 127 - 00 INSURED INDIAN RIVER CO HEALTHY START INC Company Use 20 - 57 - FL - 9303 Company POLICY TERM ADDRESS 1603 10TH AVE Bill 12 : 01 a . m . 12 : 01 a . m . VERO BEACH FL 32960 - 6231 to 03 - 10 - 2003 03 - 10 - 2004 In consideration of payment of the premium shown below , this policy is renewed . Please attach this Declarations and attachments to your policy . If you have any questions , please consult with your agent . ENTITY : Corporation PROPERTY COVERAGES - ALL DESCRIBED LOCATIONS DED LIMITS PREMIUM Special Coverage Form Automatic Increases ) 6 . 0 % Building Limit $ 250 $ 5 , 000 $ 66 . 48 Employee Dishonesty BUSINESS LIABILITY PROTECTION LIMITS PREMIUM COVERAGES Liability and Medical Expense $ 1 , 000 , 000 Included Medical Expense - Per Person 5 , 000 Included Personal Injury Included Included Tenants Fire Legal 50 , 000 Included Hired Auto & Non - Owned Auto Liability 1 , 0001000 $ 35 . 53 F0BP0009A ( 01P87 )PLY TO ALL 5467gOCA06 � 92 ) 54709 C04 - 94 ) 593502 ( 11 - 02 ) 546566 ( 08 - 91 ) 54663 ( 09 - 91 ) Countersigned By : �" f/ f1/19/20J29: 11 AM SCHEDULE A Organization Exempt Under Section . 501 (c) ( 3 ) (Form 990 or 990-EZ) (Except Private Foundation) and Section 501 (e), 501 (f), 501 (k), OMB No. 1545-0047 501 (n) , or Section 4947(a)(1 ) Nonexempt Charitable Trust DepartmentottheTreasury Supplementary Informat(on4See separate instructions .) 2001 Internal Revenue service ► MUST be completed b the above organizations and attached to their Form 990 or 990-EZ Name of the organization Employer identification number I . R . C . HEALTHY START COALITION INC 65 - 0363222 Part 1 Compensation of the Five Highest Paid Employees Other Than Officers , Directors , and Trustees (Seepage 1 of the instructions . List each one. If there are none enter " None . " (a) Name and address of each employee paid more (b) Title and average hours (d) Contributions to (e) Expense than $50,000 per week devoted to position (c) Compensation employee ben. plans b account and other deferred compensation allowances NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 0 . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . rotal number of other employees paid overo 650 000 ► 0 Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services See page 2 of the instr. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )tat number of others receiving over $50,000 for ofessional services1 .�10 ► E:o::: )r Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ. Schedule A (Form 990 or 990-EZ) 2001 4 INTERNAL REVENUE SERVICE DEPARTifENT OF THE TREASURY DISTRICT DIRECTOR C - 1130 ATLANTA , GA 50301 Ciatr- : Enlptoyer Iden tificat ic: :; iilawii ; er : APR 2 9 1993 65 - 0 632 ' Contact Person & tt R GER T A VA N' ME T ER TND iia TOE`- i3OUNT `r V1 AL Ti `r' ' TAr{ � Cor, t � ct lelej: ;-; tin :_ Piur,l Li _• ;' : !� A ,_ I i 1 !i , { 1 ,•! r� i404SI - 01 Fs 1 .100 27TFi ailh, ET Hccvunt i nq Pear i od End i r, Q,w June zi Foundation Status Clas =. ification : F09 ( a ) ( 1 ) Advance Ruling Period ; egi : s. • - - October- 23 , 1992 Advance Ruling Period c. r; ds : June 30 , 1997 Addendum Appiies : Yes Dear Apr) i iicant : Ba ed !+ t informazlc; n YOU Supp I illi , and r p p - = 77 ill i n J your our c; p := r- ,. ._ is-ins stated I r, y _i (Ir app i icat iron i or recc; gr, i ti c; n .; t ei: empt i or„ jae tlivre deter ri) : ii ;_ d you are exempt from federal income tale Under section x; 01 ( a ) of the I n l. ern :': i Rte '.' n ue Code as an .; rganization described in section 5V1 ( c ) v 1 Esecause v .; u are a nettly created ccrganlzations rde are nest nc; i-, i, aking a f inaI eter :;iination Of your fi; uridati r, = tatU5 under se ti � ? " ! i 1 ' _ n 09 : a , Of the de . However , we have determined that yc; u can reasonably expect to be a publ iC supported organization described in sections 509 ( a '' and 1. 70 ( Accordingly , during an advance ruling period y .; u iiill be treated as a publicly supported organization , and not as a private foundation . This advance ruling period begins and ends on the dates shoe-in abCove . i+lithin 90 days after the end of your advance r- ul inq period , •you r.? u � t send us the information neede- til deti- reline r•jhether you have met- the i c- crl i F == - ments c: f the applicable support test durinq the advance ruling period . If you estab I i sh that you have been a pub I i c f y supported c; rgan i zat i on , s-je s-j i t i r I ': ss i - fy yriu as a ection 509 ( a ) ( 1 ) .; r F09 ( a) i2 ) organization as i .; ;lg as y .• „ con : inue . •-. tc; meet the req uireraents Of the appI icable suppc; rt test . If you dc; not meet the public support requirements during the advance Fuling period , we i'ri ; i classify you as a private foundation for futureperiods . AIS .; , if sle cIaC: f:. ify' you as a private foundation , i'je i'ri I i treat you as e private f ;iundatir_; n fruit, your beginning date for pur- pocPrsc; f section to ' ( d and 4940 . Grantors and contributcirs m8y i •_ ly on our detrarillination ': i; at you are nc; t a pr i ..• ate foursdatinrl until 90 da ' s at ter elle end c; ; % c; ur advaTlci_ ( l. i in4'_ oeri ; '; d - I f you •_ :- nd us the req u i r e ;_tt I r - inf nla .- ;ori ; ethers the � ,? da ',! ys ' Contributr! rc rilav continue to rr• I '✓ !in the a var.. 1- t'! . .• d t: er :,i i nat i .; il liji F l I 1.; v nj .zi ! r a final deteri)linatic; n .; f yc; ur f _ unda !; i ,; n st; atij i r11 ' ' 0 " TY ir_ :? i_ Tlit' 1 ij. � � . i1 Y' � 1 1jr LTri If : ie publish a notice in 1., tte ir. ; • rnaI F; evenac t: u let , n setting that It S i no iiia jf r trey [ ;ri1U as d , ? '` . = a _ � contributors r plt iC . . fid= p !irFeu !irft ,y111 ,'� atl • lTii grantors iino cont r _ fliay n _= . ely === n this de: tirminaticon after "r. e dat,. e ile oub l ish she n _.it lCe . LA cddlti !in ! If U� !i „ �� - } I e i� := ii " sidtus as s Ub i is C, P 1 V up _ � atlVn ! and ilrantc= r or c =-= r-: tribu+tC! r ::% ds res �ii� rlslUi =' tVrS !i - [ I . A , � "' tCl_ r� r1] dT1 ! — f : !, r aq awarE tyre a [: r fai Iure t ., act ; thi" res I riivy nr' s rely u teed in y '=' ur loss of such status_- , that peri_- cn : n this determination f 'rorn the i� f the date e _ act Aliar failure tc, act . s !i • ; a � rantc= r car contributor learned that we had given rr _, tice that vciu �; '== uld be reni ==• '.= ed from Cia' S � If It CaIC= 't d5 d publicly supported that person way not rely or, this deter rr. i not i ==qn as ;, pp = reed ' r gan i gat i on > then _ f the data= he == r- she acquired such knot-fledge . If you change your scources cif _. rlapnrtr yc• ur purp !ises , characters car a: Y {: hod !if c�peratlor, 5 Pied Se let us kric= t-! sc= i-le Car, cOnslder the effect cif the chancle on y =; ur eX * mpt status and f !iundation status , organ i zat i ona l If u .amend Your Ycl � - lr- d '; rument !• r " ylaias , please send its a c ,, py !if the amended dacume +- t Also , let us Kn !ii-i al I char, es in y !i • nu car I! V „ I { ;, . 9 U '- name car address . As !. f J nuary 1v i9 ^ �# , 0. are ; table for sc= cia ! recuri ; ses Sa ;: e > unfit: r t l-ie Federal Insurance Contributions f1c - =in arou. nt5 ., f y1s00 car more yciu. pay ti. each !if yc' ur pripIcoyees durina a calendar year . Yc= u are not liable fc= r the tar imposed under the Federal Unempi !iymerit Tax Act ( PUPA ) r< OrganiZatic• ns that are not private fc= undations are not SUi1 vate foundation excise tares under Chapter 42 of the Internal Revrttuelft 11C` ode .the � ri However ? yclu are ricat aut =? GidticallV exem t fro j ' p iii o � tt := r tedeaa , 6 %. ri = e tax e If you have any questicins about excise , em lc' menti !_ let us knownP Y ' r ==ether- fedora i [ arc: s , p lease Dc' nr, rs may deduct contributions to you as provided in s !_' [. tion 170 of the Internal Revenue Gide . Cequests , ieaacies , devises , transfers , car gifts to you ==' r- for your ;+ _ e are deductible for Federal estate and gift tax purpos :. s if they meet the applicable provisions cif sections 20551 2106 , and f the Code . Elconcirs may deduct contritjitilins you !only to the Xtent that their crontributl =; ns are gifts ! with ria conSideratii= n received . ' Ticket purchases and Similar payments In con junction !filth fundraising events may not necessarl ; !+ qualify as d :, ductible coritributic= ns , depending can the rirCumS `Lt* nCe _ : Ruling 67 - c^ 6 , published in CumulativeReyr t) ` . E: u I I et i n 1967 . 170ran Page 104v g i vies guidelines regarding i. hen taxpayers may deduct payments for adm i ss i cin t !i , Or !other- participati !in in ; fundraisina .activities for charity . You are not required to file Form 990 , Return _ - . ; !- f i; rgani . atic' n Exempt 1- Y === m Income i }: ) yirur gr 'iss receipts each Year are ni: rmal ly s1r= , C) (,) s_, i' i . css . If i !' U rer �:• 1ye F ;, rm `iso package 11: the niai I , slriply attach the label pr' avided • check the bi-= :; in the heading tri indirate that your- annual cir =.` ss recei ? t _ ar e nc' raia 1 1 ;, is r: 1000 ="= r less , and sign the return . 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