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Home My WebLink About2005-346B OCT 1 1 2005 INDIAN RIVER COUNTY J3 OT GRANT CONTRACT G `> -3 � This Grant Contract ("Contract" ) entered into effective this Jcp day of October 2005, by and between Indian River County, a political subdivision of the State of Florida ; 1840 25th Street , Vero Beach , Florida , 32960-3365 ; and Indian River County Healthy Start Coalition , Inc . ( Recipient) , of: Indian River County Healthy Start Coalition , Inc 1603 10th Avenue Vero Beach , Florida 32960 TLC Program Background Recitals A. The County has determined that 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 proposal 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 (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 the 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 2005/2006 ("Grant Period" ) . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - OCT 1 1 2005 INDIAN RIVER COUNTY J3 OT GRANT CONTRACT G `> -3 � This Grant Contract ("Contract" ) entered into effective this Jcp day of October 2005, by and between Indian River County, a political subdivision of the State of Florida ; 1840 25th Street , Vero Beach , Florida , 32960-3365 ; and Indian River County Healthy Start Coalition , Inc . ( Recipient) , of: Indian River County Healthy Start Coalition , Inc 1603 10th Avenue Vero Beach , Florida 32960 TLC Program Background Recitals A. The County has determined that 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 proposal 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 (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 the 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 2005/2006 ("Grant Period" ) . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : EIGHTEEN THOUSAND , FIFTY THREE DOLLARS ($ 18 , 053 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the 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 Obligation 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 to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative , 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 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 the 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 the Contract . 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A. M . Best, subject to approval by Indian River County' s Risk Manager, of the following types and amounts of insurance : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : EIGHTEEN THOUSAND , FIFTY THREE DOLLARS ($ 18 , 053 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the 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 Obligation 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 to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative , 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 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 the 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 the Contract . 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A. M . Best, subject to approval by Indian River County' s Risk Manager, of the following types and amounts of insurance : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - damage , including coverage for premises/operations , product/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 ) Worker's 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 the County. In addition , the County may request such other proofs and assurances as it may reasonable 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 Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities, losses , damage , or causes of action which may arise from any misconduct, negligent act , or omissions of the Recipient , its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract . 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By : C' el e5' /- �7Eomas S . Lowther, Chairman BCC Approved : /' d y O r Attest : J . K . Barton , Clerk By: Deputy Clerk Approved : Jose h A . Baird County Administrator Appn? vg4s to form and legal s fficiency: B : Manan E . Fel , s ' ant oun y Attorney RECIPIENT : Indian River County Healthy Start Coalition , Inc - 4 - damage , including coverage for premises/operations , product/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 ) Worker's 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 the County. In addition , the County may request such other proofs and assurances as it may reasonable 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 Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities, losses , damage , or causes of action which may arise from any misconduct, negligent act , or omissions of the Recipient , its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract . 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - f EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - w Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application PROGRAM COVER PAGE Organization Name : Indian River County Healthy Start Coalition Inc Executive Director: Leslie Spurlock Email : irchsc(a,aol. com Address : 1603 10th Avenue Telephone : (772) 563 -9118 Vero Beach, FL 32960 Fax : (772) 563 -9125 Program Director: Linda Roberts Email : Linda Roberts20Woh. state. fl us Address : IRC Health Department Telephone : (772) 794-7484 1900 27t11 Street Vero Beach, FL 32960 F • 7 794-7453 Program Title : TLC Newborn Pro Priority Need Area(s) 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 nurturingof f the newborn. PH-620 . 150 — Communication Training=helps parents communicate with children health professionals, and other parent/infant interaction skills focusing on positive growth and development The TLC (Touch, Love, Communicate) Newborn Program focuses on parent education infant health care information, bonding advice and brain development activities SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2005706 : $ "' V Total Proposed Program Budget for 2005 / 06 : $ 94 , 53 Percent of Total Program Budget : 2 Current Program Funding ( 2004 / 05 ) : $ 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 ,232 Unduplicated Number of Adults to be served Individually : 19132 Unduplicated Number to be served via Group settings : Total Program Cost per Client : 39 . 99 * *If request increased 5 % or more, briefly explain why: Due to the County' s growth and an expected increase in the number of births for the next fiscal year as well as our expanded breastfeeding program, we will have to increase the total number of staff hours from 92 a week to 117 a week If these funds are being used to match another source, name the source and the $ amount : Yes (partial) United Way of IRC ($46,000. 00) and John ' s Island Community Service League ($ 12 , 500) , The Organization 's Board of Directors has approved this appacano on (date). Debbie True Name of President/Chair of the Board Sign e Leslie S urlock C7 Name of Executive Director/CEO Signature 3 IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By : C' el e5' /- �7Eomas S . Lowther, Chairman BCC Approved : /' d y O r Attest : J . K . Barton , Clerk By: Deputy Clerk Approved : Jose h A . Baird County Administrator Appn? vg4s to form and legal s fficiency: B : Manan E . Fel , s ' ant oun y Attorney RECIPIENT : Indian River County Healthy Start Coalition , Inc - 4 - Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: LRC Board of County Commissioners — Children's Services Advisory Committee - 0546 Grant Application PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 %z" X 11 " paper and number each page. These directions and the graphic boxes may be deleted if space is needed. 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 partnerships 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 Care Coordination 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 all pregnant women, infants and children. The Coalition developed and put in place the TLC Newborn Program in 1998 , which serves more than 1 ,000 infants each year, as well as the parents of the newborns . The Coalition also serves as the lead agency for Healthy Families — IRC, which provides intensive case management to well over 120 families each year, with the primary goal of preventing child abuse in at-risk families. In addition, the Coalition oversees Healthy Start Care Coordination services in partnership with the Indian River County Healthy Department, which serves approximately 575 families each year. 4 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 0546 Grant Application Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change? b) Who has the need? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. What: 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 it 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 . This leads 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 had 1 ,213 births in 2003 . In 2002, almost half of all births are covered under Medicaid or indigent funding. Of all the births in 2002 (the latest year for complete birth data), 39 .2 % were to unwed mothers, with black unwed births at 70% . In terms of education status of the newborn ' s mother, 28 . 9% did not have a 12th grade education or GED . 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 throughout the entire county. Approximately 20 .3 % of the births were 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. The information reported above is derived from birth outcome data provided to Healthy Start from the Florida Department of Health — Vital Statistic Office. There are no programs or services that provide "universal" support for all families of newborns besides the TLC Newborn program in Indian River County. 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. The TLC Program is totally unique not only in Indian River County, but in the entire state of Florida. The program is unique due to its universal nature, and touches almost every family of newborns in Indian River County. Healthy Start Care Coordination and Healthy Families have similar target populations with regard to the infants and families of newborns , but they only serve those families who are scored "at-risk" on the Healthy Start/Families postnatal screen. They are primarily intensive home-based case management programs, with the majority of services beginning prenatally. In contrast,' TLC serves all pregnant moms regardless of risk. This is important because some risks do not appear until after the baby is delivered. Thus, TLC serves as a critical safety net for all pregnant moms . 5 f EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. The elimination of factors upon children 0 to 6 months which impede the child ' s mental, emotional or physical development or well-bein . 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 of every newborn last year either the day of delivery of the baby or the day after. 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 if the TLC Family Associate identifies a need for greater contact. In the second month, calls are generally made to the family every other week. From months three through six, phone contacts are made on a monthly basis. 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, depending on the age of the infant. At the TLC Newborn office, the TLC representative mails personalized and specific educational material to each family who has accepted the program. 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. The monthly newsletters also include educational and play ideas, as well as a "Dad ' s Corner", which provides tips on fatherhood issues relating to infant care. In 2005 , the program will serve its 7,000' baby. Referrals to community resources, such as the Healthy Start Care Coordination team, and concerns of individual families are reviewed by the TLC Newbom 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 and non-invasive means of education and support. Families receive TLC services in the comfort of their home that is not intrusive or disruptive. Mothers can also contact their TLC Family Associate at their convenience as questions or needs arise " regarding the care and well-being of their infant. 3 . Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates 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 96 percent over the last three years. As a comparison, the acceptance rate for the Healthy Start prenatal Screen was only 56% in 2003 and 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 risk factors and could potentially be missed in terms of 6 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 0546 Grant Application needing education and support. TLC fills this gap in care and services and provides a safety net for any families that were not screened. One new goal of the TLC program for 2005 -2006 will be to have the TLC staff trained as certified Lactation Counselors . Breastfeeding support accounts for 70% of the reasons mothers call the TLC Staff. This will be a perfect compliment to the VNA home breastfeeding component added in 2001 -2002 . 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 Program Manager — 32 hours per week (80% Full Time Equivalent - FTE) TLC Assistant Program Manager — 20 hours per week Three (3) TLC Family Associates - 15 hours per week each Administrative Assistant — 20 hours per week The TLC staff have nursing, psychology or child education backgrounds and all have college degrees . Their continuity and professionalism have been cornerstones for the program ' s success. 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. For 2005 , TLC will be highlighted monthly in the Florida Parenting News, a newspaper that is distributed to every family of a child in Indian River County. 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 more than 1 , 000 new moms and families the program serves each year, as well as from the grandparents and relatives of the newborn. The IRCHSC 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. 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 seen by TLC in Indian River County. 7 w Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application PROGRAM COVER PAGE Organization Name : Indian River County Healthy Start Coalition Inc Executive Director: Leslie Spurlock Email : irchsc(a,aol. com Address : 1603 10th Avenue Telephone : (772) 563 -9118 Vero Beach, FL 32960 Fax : (772) 563 -9125 Program Director: Linda Roberts Email : Linda Roberts20Woh. state. fl us Address : IRC Health Department Telephone : (772) 794-7484 1900 27t11 Street Vero Beach, FL 32960 F • 7 794-7453 Program Title : TLC Newborn Pro Priority Need Area(s) 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 nurturingof f the newborn. PH-620 . 150 — Communication Training=helps parents communicate with children health professionals, and other parent/infant interaction skills focusing on positive growth and development The TLC (Touch, Love, Communicate) Newborn Program focuses on parent education infant health care information, bonding advice and brain development activities SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2005706 : $ "' V Total Proposed Program Budget for 2005 / 06 : $ 94 , 53 Percent of Total Program Budget : 2 Current Program Funding ( 2004 / 05 ) : $ 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 ,232 Unduplicated Number of Adults to be served Individually : 19132 Unduplicated Number to be served via Group settings : Total Program Cost per Client : 39 . 99 * *If request increased 5 % or more, briefly explain why: Due to the County' s growth and an expected increase in the number of births for the next fiscal year as well as our expanded breastfeeding program, we will have to increase the total number of staff hours from 92 a week to 117 a week If these funds are being used to match another source, name the source and the $ amount : Yes (partial) United Way of IRC ($46,000. 00) and John ' s Island Community Service League ($ 12 , 500) , The Organization 's Board of Directors has approved this appacano on (date). Debbie True Name of President/Chair of the Board Sign e Leslie S urlock C7 Name of Executive Director/CEO Signature 3 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all o the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . Strengthening families through promotion 1 . Regular telephone calls to the home and and development of family values and family monthly development newsletters mailed to the structure . TLC Newborn families will reassure the parents in their roles. This will be reported GOAL : 85 % of TLC Newborn families who through parent surveys, which will be mailed respond to the survey will feel reassured as monthly to parents of 3 -month-old infants. ' a parent because of their involvement in TLC Newborn. 2 . Promotion of healthy individuals including 2 . Regular telephone calls to the home where medical, dental and mental health. the family associate staff member inquires about : the infants ' health; weight; GOAL : 90 % of TLC Newborn families who developmental milestones the infant should be respond to the survey will agree that they achieving; and visits to the pediatrician. This were provided necessary in on will be reported through parent surveys, which parenting and about their newborn from will be mailed monthly to parents of 3 -month- their involvement in TLC Newborn. old infants. 3 . Elimination of all factors upon children 3 . Regular telephone calls to the home, with a ages 0 to 6 months, which impeded the child ' s development newsletter mailed will reassure mental, emotional or physical developmental the parents in their role. This will be reported or well-being. through parent surveys, which will be mailed monthly to parents through the child' s first GOAL : 90 % of TLC Newborn families who birthday. respond to the survey will feel that their TLC Newborn Family Associate promoted understanding to them. * note: These first three Outcomes Goals were modified from the 2002-03 FY based on the recommendations provided at the 2003 United Way training on goal and objective development. The goals 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 previous year's progress reports and have been increased for FY '04-`05 based on '03- 04 mid-year outcomes. 8 organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee . - 05-06 Grant Application OUTCOMES ACTIVITIES Add all of the elements or your Measurable Outcomes Add the tasks to accomplish the Outcome(s) PROCESS OBJECTIVES 1 . GOAL : TLC Newborn staff will visit 1 . 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 . 2 . GOAL : 93 % of mothers who are visited 2 . 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. 3. GOAL : 90 % of families will be reached 3 . 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. 4. GOAL : 90 % of referrals will be followed 4. 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. 5. GOAL : 7.5 % of families will call 5 . 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 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: LRC Board of County Commissioners — Children's Services Advisory Committee - 0546 Grant Application PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 %z" X 11 " paper and number each page. These directions and the graphic boxes may be deleted if space is needed. 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 partnerships 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 Care Coordination 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 all pregnant women, infants and children. The Coalition developed and put in place the TLC Newborn Program in 1998 , which serves more than 1 ,000 infants each year, as well as the parents of the newborns . The Coalition also serves as the lead agency for Healthy Families — IRC, which provides intensive case management to well over 120 families each year, with the primary goal of preventing child abuse in at-risk families. In addition, the Coalition oversees Healthy Start Care Coordination services in partnership with the Indian River County Healthy Department, which serves approximately 575 families each year. 4 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 0546 Grant Application Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change? b) Who has the need? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. What: 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 it 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 . This leads 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 had 1 ,213 births in 2003 . In 2002, almost half of all births are covered under Medicaid or indigent funding. Of all the births in 2002 (the latest year for complete birth data), 39 .2 % were to unwed mothers, with black unwed births at 70% . In terms of education status of the newborn ' s mother, 28 . 9% did not have a 12th grade education or GED . 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 throughout the entire county. Approximately 20 .3 % of the births were 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. The information reported above is derived from birth outcome data provided to Healthy Start from the Florida Department of Health — Vital Statistic Office. There are no programs or services that provide "universal" support for all families of newborns besides the TLC Newborn program in Indian River County. 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. The TLC Program is totally unique not only in Indian River County, but in the entire state of Florida. The program is unique due to its universal nature, and touches almost every family of newborns in Indian River County. Healthy Start Care Coordination and Healthy Families have similar target populations with regard to the infants and families of newborns , but they only serve those families who are scored "at-risk" on the Healthy Start/Families postnatal screen. They are primarily intensive home-based case management programs, with the majority of services beginning prenatally. In contrast,' TLC serves all pregnant moms regardless of risk. This is important because some risks do not appear until after the baby is delivered. Thus, TLC serves as a critical safety net for all pregnant moms . 5 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application E . COLLABORATION (Entire Section E not to exceed one page) 1 . List your program' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters.) Collaborative Agency Resources provided to the program * Free office rent * Conference room access * Access to Indian River County Health Dept. office equipment such as computers, copier, postage, fax and telephone services. * Staff supervision * Storage space * Payroll services * Cleaning All these services are provided * Purchasing services * Personnel services * clerical in-kind, with no administrative fee. Support * outreach 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 All these services are provided respective Labor and Delivery areas. * Positive in -kind, with no administrative fee. promotion of TLC program to new mothers by all hospital staff. * Comfortable communication between medical providers and TLC staff. * Provides two books to newborn families that are given IRC Library — Born to Read to the family of the newborn by the Stork Club. The Program 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, * Provides home visitation for mothers of newborns Visiting Nurses Association of the experiencing breastfeeding difficulties or in need of Treasure Coast greater breastfeeding education. Breastfeeding home visitation charge is $50 . 00 per visit by the VNA * Overall program development, integration and Indian River County Healthy Start communication within all three IRCHSC programs Coalition (Healthy Start, Healthy Families, & TLC) . * Fundraising, PR and marketing of TLC program. (While the Coalition is the applying * In cooperation/collaboration with the IRC Health agency, many in-kind collaborative Department, TLC Program QA/QI, reports and efforts on behalf of the TLC program troubleshooting. * Provide TLC representation at take place . ) United Way and other public events. * Presentations to community groups regarding the TLC Program. * Development and presentation of TLC RFP/Grant(s) . All these services are provided in- * Fiscal oversight and reimbursement requests. kind, with no administrative ee. 10 Organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application 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 Bl ? - 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. 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. All data — client information is gathered at the time of the hospital visit and enrollment into the program. The birth of a newborn from an IRC resident is the sole requirement for participation. Decreasing support, both medical, educational and emotional, is a primary need that is filled by TLC for overall infant development and wellbeing. 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. 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 the benefits of the program in terms of the TLC family' s 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 holds a 11 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. The elimination of factors upon children 0 to 6 months which impede the child ' s mental, emotional or physical development or well-bein . 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 of every newborn last year either the day of delivery of the baby or the day after. 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 if the TLC Family Associate identifies a need for greater contact. In the second month, calls are generally made to the family every other week. From months three through six, phone contacts are made on a monthly basis. 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, depending on the age of the infant. At the TLC Newborn office, the TLC representative mails personalized and specific educational material to each family who has accepted the program. 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. The monthly newsletters also include educational and play ideas, as well as a "Dad ' s Corner", which provides tips on fatherhood issues relating to infant care. In 2005 , the program will serve its 7,000' baby. Referrals to community resources, such as the Healthy Start Care Coordination team, and concerns of individual families are reviewed by the TLC Newbom 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 and non-invasive means of education and support. Families receive TLC services in the comfort of their home that is not intrusive or disruptive. Mothers can also contact their TLC Family Associate at their convenience as questions or needs arise " regarding the care and well-being of their infant. 3 . Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates 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 96 percent over the last three years. As a comparison, the acceptance rate for the Healthy Start prenatal Screen was only 56% in 2003 and 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 risk factors and could potentially be missed in terms of 6 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 0546 Grant Application needing education and support. TLC fills this gap in care and services and provides a safety net for any families that were not screened. One new goal of the TLC program for 2005 -2006 will be to have the TLC staff trained as certified Lactation Counselors . Breastfeeding support accounts for 70% of the reasons mothers call the TLC Staff. This will be a perfect compliment to the VNA home breastfeeding component added in 2001 -2002 . 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 Program Manager — 32 hours per week (80% Full Time Equivalent - FTE) TLC Assistant Program Manager — 20 hours per week Three (3) TLC Family Associates - 15 hours per week each Administrative Assistant — 20 hours per week The TLC staff have nursing, psychology or child education backgrounds and all have college degrees . Their continuity and professionalism have been cornerstones for the program ' s success. 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. For 2005 , TLC will be highlighted monthly in the Florida Parenting News, a newspaper that is distributed to every family of a child in Indian River County. 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 more than 1 , 000 new moms and families the program serves each year, as well as from the grandparents and relatives of the newborn. The IRCHSC 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. 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 seen by TLC in Indian River County. 7 Organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application quarterly TLC committee meeting for the program, which reviews the reports as well as overall program issues and logistics . 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 the TLC Coordinator, Healthy Start Care Coordination Supervisor, and Healthy Families — IRC Program Manager is generally held every other month at the Coalition office . The purpose of the meeting is to address program issues individually, which includes updating each Program Manager on the programs status , as well as ensuring overall communication, collaboration and integration. 12 Organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections. Month/Period Activities 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: 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. Daily * 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 Associate within one week. st * Send customized mailing based on family' s needs . 1 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 monthly wks . * 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 12 month, appropriate program evaluation surveys are mailed. 13 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all o the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . Strengthening families through promotion 1 . Regular telephone calls to the home and and development of family values and family monthly development newsletters mailed to the structure . TLC Newborn families will reassure the parents in their roles. This will be reported GOAL : 85 % of TLC Newborn families who through parent surveys, which will be mailed respond to the survey will feel reassured as monthly to parents of 3 -month-old infants. ' a parent because of their involvement in TLC Newborn. 2 . Promotion of healthy individuals including 2 . Regular telephone calls to the home where medical, dental and mental health. the family associate staff member inquires about : the infants ' health; weight; GOAL : 90 % of TLC Newborn families who developmental milestones the infant should be respond to the survey will agree that they achieving; and visits to the pediatrician. This were provided necessary in on will be reported through parent surveys, which parenting and about their newborn from will be mailed monthly to parents of 3 -month- their involvement in TLC Newborn. old infants. 3 . Elimination of all factors upon children 3 . Regular telephone calls to the home, with a ages 0 to 6 months, which impeded the child ' s development newsletter mailed will reassure mental, emotional or physical developmental the parents in their role. This will be reported or well-being. through parent surveys, which will be mailed monthly to parents through the child' s first GOAL : 90 % of TLC Newborn families who birthday. respond to the survey will feel that their TLC Newborn Family Associate promoted understanding to them. * note: These first three Outcomes Goals were modified from the 2002-03 FY based on the recommendations provided at the 2003 United Way training on goal and objective development. The goals 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 previous year's progress reports and have been increased for FY '04-`05 based on '03- 04 mid-year outcomes. 8 organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee . - 05-06 Grant Application OUTCOMES ACTIVITIES Add all of the elements or your Measurable Outcomes Add the tasks to accomplish the Outcome(s) PROCESS OBJECTIVES 1 . GOAL : TLC Newborn staff will visit 1 . 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 . 2 . GOAL : 93 % of mothers who are visited 2 . 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. 3. GOAL : 90 % of families will be reached 3 . 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. 4. GOAL : 90 % of referrals will be followed 4. 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. 5. GOAL : 7.5 % of families will call 5 . 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 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Undu licated Clients by Location Last Fiscal Year Current Fiscal Year Ne Location Actual 2003/2004 Budget 2004/05 Proj 'otsJQt Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 938 893 950 S. Indian River County 13331 1 ,340 11414 Indian River Co. Total 2 ,269 29233 2,364 Greater Stuart - - - Hobe Sound - - - Indiantown - - - Jensen Beach - - - Palm City - - - Martin County Total - - - Fort Pierce - - - Port Saint Lucie - - - St. Lucie Co. Total - - - Other Locations - - - TOTAL SERVED 29269 2233 2,364 Number of Unduplicated Clients by Age Lasffiscal Year Current Fiscal Year Nett LocationActua120Q3/2004 Budget 2004/05 g . e . Individuals Group Individual Group Indi ` r+�up: 0 to 4 - (Pre-school) 11112 - 1 , 117 - 19142 - 5 to 10 - (Elementary) - - - - - - 11 to 14 - (Middle) - - - - - - 15 to 18 - (High School) 100 - 100 - 90 - Total Children 1 ,212 - 19217 - 1 ,232 - 19 to 59 - (Adults) 1 ,057 - 925 - 1 , 132 - 60 + (Seniors) - - - - - - Total Adults 1 ,057 - 925 - 1 , 132 - TOTAL SERVED 29269 - 29142 1 2,364 - 14 I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. 15 Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application E . COLLABORATION (Entire Section E not to exceed one page) 1 . List your program' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters.) Collaborative Agency Resources provided to the program * Free office rent * Conference room access * Access to Indian River County Health Dept. office equipment such as computers, copier, postage, fax and telephone services. * Staff supervision * Storage space * Payroll services * Cleaning All these services are provided * Purchasing services * Personnel services * clerical in-kind, with no administrative fee. Support * outreach 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 All these services are provided respective Labor and Delivery areas. * Positive in -kind, with no administrative fee. promotion of TLC program to new mothers by all hospital staff. * Comfortable communication between medical providers and TLC staff. * Provides two books to newborn families that are given IRC Library — Born to Read to the family of the newborn by the Stork Club. The Program 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, * Provides home visitation for mothers of newborns Visiting Nurses Association of the experiencing breastfeeding difficulties or in need of Treasure Coast greater breastfeeding education. Breastfeeding home visitation charge is $50 . 00 per visit by the VNA * Overall program development, integration and Indian River County Healthy Start communication within all three IRCHSC programs Coalition (Healthy Start, Healthy Families, & TLC) . * Fundraising, PR and marketing of TLC program. (While the Coalition is the applying * In cooperation/collaboration with the IRC Health agency, many in-kind collaborative Department, TLC Program QA/QI, reports and efforts on behalf of the TLC program troubleshooting. * Provide TLC representation at take place . ) United Way and other public events. * Presentations to community groups regarding the TLC Program. * Development and presentation of TLC RFP/Grant(s) . All these services are provided in- * Fiscal oversight and reimbursement requests. kind, with no administrative ee. 10 Organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application 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 Bl ? - 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. 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. All data — client information is gathered at the time of the hospital visit and enrollment into the program. The birth of a newborn from an IRC resident is the sole requirement for participation. Decreasing support, both medical, educational and emotional, is a primary need that is filled by TLC for overall infant development and wellbeing. 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. 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 the benefits of the program in terms of the TLC family' s 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 holds a 11 Type the Organization and Program Name Program Manager/32 hours 27,200.00 27,200.00 109000.00 36. 760/ Assistant Program Manager/20 hours 12, 500 .00 12,500. 00 0.000/C 3 Family Associates ( 15 hours each ) 21 , 750.00 21 ,750.00 89000.00 36. 78°/ Administrative Assistant/20 hours 8,250. 00 8,250.00 2,000.00 24 .24% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0 ! Remaining Positions outside TLC : #DIV/0! Healthy Families IRC (total annual) 330, 581 .00 0 . 00°/ --- IRCHSC Care Coordination (total annual) 241 ,000.00 0.00°/ IRCHSC (total annual ) 132, 000 .00 0.000/ #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Remaining positions throughout the agency Total Salaries $773281 .00 $699700.00 $20,000.00 2.59°/ FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B D E F Pension Worker's Unemployme Total Fringes Funder Column C only, from line 22 to 27) Specific FICA 7.65% A % Health Ins. Position Title / Total Hrs/wk Budget ( x ) Comperes. ret Comperes. Specift Example. Case Manager/ 40 hrs 5,000. 00 382.50 200.00 500.00 300.00 200.00 1,582,50 Program Manager/32 hours 10,000.00 765. 00 765. 0 Assistant Program Manager/20 hours 0. 00 0. 00 0. 0 3 Family Associates ( 15 hours each) 8,000.00 612.00 612.0 Administrative Assistant/20 hours 2,000.00 153.00 153,0 0 0.00 0.001 0. 0 0 0.00 0.00 0. 0 0 0. 00 0.00 0.001 0 0.00 0.00 0.001 0 0.00 0. 00 0.001 Remaining Positions outside TLC : 0. 00 0.00 0.001 Healthy Families IRC (total annual) 0.00 0.00 0.0 IRCHSC Care Coordination (total annual ) 0. 00 0.00 0 .001 IRCHSC (total annual ) 0.00 0 .00 0.001 0 0. 00 0. 00 0.0 0 0.00 0.00 0.001 0 0.00 0. 001 0. 0 0. 00 0.001 0 .0 0 0.00 0. 001 0.0 0 0.00 0. 001 0.0 0 . 1 0.001 0.001 0.0 Total Funder Request Fringe Benefits 1 $20 ,000. 00 $ 1 ,530.00 $0.001 $0.001 $0.00 $0.0q $19530.0 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCYUSE DUONLYrG Budget Budget Budget t7 27 Travel-Daily 11200.00 24,000.00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb. 28 Travel/Conferencesfrraining 21000.00 149000.00 5/13/2005 B-1 Type the Organization and Program Name • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel , lodging, registration , food) 29 Office Supplies 800.00 12,500.00 • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 0.00 18,000.00 # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 31 Postage/Shipping 61500.00 10,000.00 • Quarterly Mailing of Newsletter • Special events, etc. • Bulk mailings - appeals 32 Utilities 0.00 69000.00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds) 0.00 36,000.00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes 34 Printing & Publications 5,000.00 6 ,000.00 Quarterly Newsletter ($ x 4) Letterheads, Envelopes, etc. Fundraising materials Other 35 Subscription/Dues/Memberships 500.00 2,500.00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, etc. 36 Insurance 0.00 4 ,500.00 • Directors/Officers Liab. • Commercial/General Insurance • Bond Ins . • Auto Insurance 37 Equipment: Rental & Maintenance 0.00 50500.00 • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38 Advertising 500 .DO 3 ,000.00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases : Capital Expense 0.00 3 ,000.00 • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal , Consulting) 11500.00 12,000.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 1500.00 3 ,300.00 • Books/videos • Materials ($ x staff) 42 Food & Nutrition 0.00 5/13/2005 B-1 Organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application quarterly TLC committee meeting for the program, which reviews the reports as well as overall program issues and logistics . 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 the TLC Coordinator, Healthy Start Care Coordination Supervisor, and Healthy Families — IRC Program Manager is generally held every other month at the Coalition office . The purpose of the meeting is to address program issues individually, which includes updating each Program Manager on the programs status , as well as ensuring overall communication, collaboration and integration. 12 Organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections. Month/Period Activities 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: 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. Daily * 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 Associate within one week. st * Send customized mailing based on family' s needs . 1 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 monthly wks . * 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 12 month, appropriate program evaluation surveys are mailed. 13 Type the Organization and Program Name • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 0.00 40,000.00 Admin . Cost (% of total budget) 44 Audit Expense 0.00 20,000.00 Independent Audit Review 45 Specific Assistance to Individuals 0.00 5,000.00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 0.00 8,000.00 • Background check/drug test • Other 47 Other/Contract Sub-contract for program services 48 TOTAL EXPENSES $94,532.05 $21 ,530.001 $ 1 , 153,737.00 5/13/2005 B-1 IRCHSCRLC NwWvn 0506 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition , Inc./TLC Newborn 105 06] FY 03!04 FY 04/05 FY 05/06 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (ed. C•eol. eyed. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services Councll-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 70 000.00 74 500.00 75 000.00 0.67% 4 United Way-St Lucie County 0.00 #DIV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way-Indian River County 45 000.00 46 000.00 46 000.00 0.00% 7 DOH/State of Florida 366t963,00 366 963.00 945 315.00 157.60% 8 County Funds 32 500.00 2050000 0.00 -100.00% s Contributions-Cash 59705,001 129500.00 #DIV/01 10 Program Fees T 830.00 10 250.00 0.00 1 -100.00% 11 Fund Raising Events-Net 22 22200 24 250.00 12 500.00 48.45% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/01 14 Investment Income ' 0.00 #DIV/01 15 Miscellaneous 112 905.60 135198.00 501000.00 -63.02% 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 386 040.00 443v985,00 12,500.00 -97.18% 18 Reserve Funds Used for Operating 23 000.00 0.00 -100.000/0 1s in-Kind Donations (Not included In total) 75 000.00 #DN/01 20 TOTAL 1049,165.60 1 144 646.00 1 ,153 815.00 0.80% EXPENDITURES 21 Salaries 629 674.12 756 306.00 773,281 .00 2.24% 22 FICA 48170.07 57 857.00 59, 156.00 225% 23 Retirement Lines 23-26 are combined 91 966.01 80 599.26 8%000.00 9.18% 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Daily 17,107.232170600=== 249000.00 10.57% 28 Travel/Conferences/Training 14 944.47 129500.00 14 000.00 12.00% 29 Office Supplies 9,168.4410 700.00 12 500.00 16.82% 30 Telephone 15 636. 10 17 200.00 18 000.00 4.65% 31 Postage/Shipping 89241 .87 838400 10 000.00 19.27% 32 Utilities 79651 ,71 5156.00 600000 16.37% 33 Occupancy (Building & Grounds 30 509. 00 37 299.00 36 000.00 3.48% 34 Printing & Publications 69633.66 51700.00 61000.00 5.2690 35 Subscription/Dues/Memberships Z436.00 11500.00 29500.00 66.67% 36 Insurance 8r469.00 4100.00 450000 9.76% 37 Equipment: Rental & Maintenance 81050.00 49935,00 59500.00 11 .45% 38 Advertising 19211 .48 45800.00 39000,00 37.50% 39 Equipment Purchases:Ca ital Expense 562.00 2 500.00 39000,00 20.00% 40 Professional Fees (Legal, Consulting) 39 319.56 11 350.00 12 000.00 5.73% 41 Books/Educational Materials 41857.411 3 300.00 3,300.00 0.00% 42 Food & Nutrition 2 988.00 19300,00 0.00 400.00% 43 Administrative Costs 31 988.00 62 398.50 40j000.00 35.90% 44 Audit Expense 79975.00 18 840.0020 000.00 6.16% 45 Specific Assistance to Individuals 5271 .46 10 500.00 5r000.00 052.38% 46 Other/Miscellaneous 35 375.33 7o846,00 8,000.00 1 .96% 47 Other/Contract 10 953.95 0.00 #DIV/01 46 TOTAL 190391159,87 1 146p776.76 115373700 0.61 % 4s REVENUES OVER/ UNDER EXPENDITURES 10 005.73 -29130.76 78.00 -103.66% L/3 2005 BZ Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Undu licated Clients by Location Last Fiscal Year Current Fiscal Year Ne Location Actual 2003/2004 Budget 2004/05 Proj 'otsJQt Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 938 893 950 S. Indian River County 13331 1 ,340 11414 Indian River Co. Total 2 ,269 29233 2,364 Greater Stuart - - - Hobe Sound - - - Indiantown - - - Jensen Beach - - - Palm City - - - Martin County Total - - - Fort Pierce - - - Port Saint Lucie - - - St. Lucie Co. Total - - - Other Locations - - - TOTAL SERVED 29269 2233 2,364 Number of Unduplicated Clients by Age Lasffiscal Year Current Fiscal Year Nett LocationActua120Q3/2004 Budget 2004/05 g . e . Individuals Group Individual Group Indi ` r+�up: 0 to 4 - (Pre-school) 11112 - 1 , 117 - 19142 - 5 to 10 - (Elementary) - - - - - - 11 to 14 - (Middle) - - - - - - 15 to 18 - (High School) 100 - 100 - 90 - Total Children 1 ,212 - 19217 - 1 ,232 - 19 to 59 - (Adults) 1 ,057 - 925 - 1 , 132 - 60 + (Seniors) - - - - - - Total Adults 1 ,057 - 925 - 1 , 132 - TOTAL SERVED 29269 - 29142 1 2,364 - 14 I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. 15 IRCHSC/MC Neve an 05-M UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : Indian River ounty Healthy Start Coalition, Inc./TLC Newborn FY 03/04 FY 04105 FY 05/06 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (COL C-col. Bycoi. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Advisory Committee-Indian River 15 000.00 15 000.00 20,000.00 33.33% 4 United Way-St Lucie County0.00 #DN/O! 5 United Way-Martin County0.00 #DIV/0! 6 United Way-Indian River County 45 000.00 4600000 469000.00 0% 7 Department of Children & Families 0.00EE:i? a CountyFunds 0.00 9 Contributions-Cash Z350.00 0.00 #DIV/01 10 Program Fees 0.00 #DIV/01 11 Fund Raising Events-Net 21565.00 12 000.00 12,500.00 4. 17% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/O! 14 Investment Income 0.00 #DIV/01 15 Miscellaneous 0.00 #DIV/0! 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 10 000.00 129500.00 #DIV/01 1a Reserve Funds Used for Operating 5,000.00 5,000.00 0.00 0100.00% 19 In-Kind Donations (Not included In total 25 000.00 #DN/01 20 TOTAL 79 915.00 787000'(10 91 000.00 16.67% EXPENDITURES 21 Salaries 50 427.00 55 811 .00 69 700.00 24.89% 22 FICA 31857.67 4270,00 5,332.05 24.87% 23 Retirement 764.00 19954,00 0.00 -100.00% 24 Life/Health 0.00 #DIV/O! 25 Workers Compensation 0.00 #DIV/OI 26 Florida Unemployment 0.00 #DN/O! 27 TravekDaily 696.00 19200,00 1 200.00 0.00% 28 Travel/Conferences/Training 500.00 2 000.00 #DIV/OI 29 Office Supplies 750.00 700.00 800.00 14.29% 3o Telephone 0.00 #DN/01 31 Postage/Shipping 59304.00 45884,00 6 500.00 33.09% 32 Utilities 0.00 #DN/01 33 Occupancy Buildin & Grounds 0.00 #DIV/Ol 34 Printing & Publications 5000,00 #DN/01 35 Subscription/Dues/Memberships 3131 .00 250000 500.00 -80.00% 36 Insurance 0.00 #DIV/O! 37 Equipment: Rental & Maintenance 0.00 #DIV/01 38 Advertising500.00 #DN/01 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/0! 40 Professional Fees (Legal, Consulting) 11500.0 0 #DIV/O! 41 Books/Educational Materials 493.00 500.00 1500.00 200.00% 42 Food & Nutrition 0.00 #DIV/0! 43 Administrative Costs 0.00 #DN/0! 4a Audit Expense 0.00 #DIV/01 45 Specific Assistance to Individuals 1 580.00 1500,00 0.00 -100.00% 46 Other/Miscellaneous 206.00 175.00 0.00 0100.00% 47 Other/Contract 0.00 #DIV/01 48 TOTAL 67 708.67 739494,001 94 532.05 28.639%. 49 REVENUES OVER/ UNDER EXPENDITURES 12 206.33 49506.00 39532.05 478.39% 51732005 BJ IRCHSC/TLC Newborn 05.06 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Indian River County Healthy Start Coalition , Inc ./TLC Newborn FUNDER : IRC BOCC - Children 's Services A A B C FY 05/06 FY 05/06 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A) EXPENDITURES 21 Salaries 69,700 . 00 209000 . 00 28 . 69% 22 FICA 5,332 .05 19530 .00 28 .69% 23 Retirement 0 . 00 0200 #DIV/01 24 Life/Health 0 .00 0 .00 #DIV/Ol 25 Workers Compensation 0 . 00 0200 #DIV/01 26 Florida Unemployment 0 .00 0 .00 #DIV/01 27 Travel -Dail 1 ,200 .00 0 .00 0 .00% 28 Travel/Conferences/Training 29000 .00 0. 00 0.00% 29 Office Supplies 800.00 0 .00 0 .00% 30 Telephone 0 .00 0 .00 #DIV/0 ! 31 Postage/Shipping 6,500.00 0.00 0 .00% 32 Utilities 0 .00 0 .00 #DIV/01 33 Occupancy Building & Grounds 0 .00 0 .00 #DIV/01 34 Printing & Publications 51000 . 00 0 .00 0 .00% 35 Subscription/Dues/Memberships 500 .00 0 .00 0 .00% 36 Insurance 0 .00 0.00 #DIV/01 37 Equipment: Rental & Maintenance 0 .00 0 .00 #DIV/01 38 Advertising 500 .00 0.00 0 .00% 39 Equipment Purchases : Ca ital Expense 0. 00 10,00 #DIV/01 40 Professional Fees ( Legal , Consulting ) 19500 .00 0 .00 0.00% 41 Books/Educational Materials 11500 .00 0 .00 0 .00% 42 Food & Nutrition 0 .00 0.00 #DIV/01 43 Administrative Costs 0 .00 0 .00 #DIV/01 44 Audit Expense 0 .00 0 . 00 #DIV/0 ! 45 Specific Assistance to Individuals 0.00 0 .00 #DIV/01 46 Other/Miscellaneous 0.00 0 .00 #DIV/O ! 47 Other/Contract 0 .00 0 , 001 #DIV/01 48 TOTAL $94, 532 .05 $21 ,530 .00 22.78% 5/132005 Br/ Type the Organization and Program Name Program Manager/32 hours 27,200.00 27,200.00 109000.00 36. 760/ Assistant Program Manager/20 hours 12, 500 .00 12,500. 00 0.000/C 3 Family Associates ( 15 hours each ) 21 , 750.00 21 ,750.00 89000.00 36. 78°/ Administrative Assistant/20 hours 8,250. 00 8,250.00 2,000.00 24 .24% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0 ! Remaining Positions outside TLC : #DIV/0! Healthy Families IRC (total annual) 330, 581 .00 0 . 00°/ --- IRCHSC Care Coordination (total annual) 241 ,000.00 0.00°/ IRCHSC (total annual ) 132, 000 .00 0.000/ #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Remaining positions throughout the agency Total Salaries $773281 .00 $699700.00 $20,000.00 2.59°/ FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B D E F Pension Worker's Unemployme Total Fringes Funder Column C only, from line 22 to 27) Specific FICA 7.65% A % Health Ins. Position Title / Total Hrs/wk Budget ( x ) Comperes. ret Comperes. Specift Example. Case Manager/ 40 hrs 5,000. 00 382.50 200.00 500.00 300.00 200.00 1,582,50 Program Manager/32 hours 10,000.00 765. 00 765. 0 Assistant Program Manager/20 hours 0. 00 0. 00 0. 0 3 Family Associates ( 15 hours each) 8,000.00 612.00 612.0 Administrative Assistant/20 hours 2,000.00 153.00 153,0 0 0.00 0.001 0. 0 0 0.00 0.00 0. 0 0 0. 00 0.00 0.001 0 0.00 0.00 0.001 0 0.00 0. 00 0.001 Remaining Positions outside TLC : 0. 00 0.00 0.001 Healthy Families IRC (total annual) 0.00 0.00 0.0 IRCHSC Care Coordination (total annual ) 0. 00 0.00 0 .001 IRCHSC (total annual ) 0.00 0 .00 0.001 0 0. 00 0. 00 0.0 0 0.00 0.00 0.001 0 0.00 0. 001 0. 0 0. 00 0.001 0 .0 0 0.00 0. 001 0.0 0 0.00 0. 001 0.0 0 . 1 0.001 0.001 0.0 Total Funder Request Fringe Benefits 1 $20 ,000. 00 $ 1 ,530.00 $0.001 $0.001 $0.00 $0.0q $19530.0 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCYUSE DUONLYrG Budget Budget Budget t7 27 Travel-Daily 11200.00 24,000.00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb. 28 Travel/Conferencesfrraining 21000.00 149000.00 5/13/2005 B-1 IRCHSMLC N&hto 05-06 • UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME : Indian River County Healthy Start Coalition, Inc./TLC Newborn FUNDER: IRC BOCC - Children's Services Advisory Committee - 05-06 LINE ITEM EXPLANATION FOR VARIANCE #DN/0! #DIV/01 As the TLC Program touches nearly 98% of pregnant moms delivering babies in Indian River County, the TLC Program serves as a wonderful safety net of making sure that pregnant moms and infants are receving the care that is needed and that they are in touch with the appropriate services that may be needed. Due to the significant amount of growth in our community and an expected increase in the number of pregnant moms (especially in light of the fact our County had two major hurricanes hit our County - historical data shows that major disasters ususally results in an increase of pregnant moms) we are requesting an additional $5,000 to help offset our Advisory Committee-Indian River costs in increasing the number of hours that the TLC staff will need to continue successfully serving our community. #DN/O! #DIV/O! #DN/0! #DN/0! #DN/O! #DN10! #DIV/O! #DN/ol #DN/01 #DN/01 #DIV/0! #DIV/0! #DIV/0! In light of the fact that our County is experiencing a significant amount of growth and an increase in the number of babies bom in Indian River County, the total number of Staff hours worked in a single workweek will increase from 92 hours to 117 hours a workweek. In addition, there will be a raise for Staff since Staff have NEVER received a raise since the inception of the Program in the late 90's. This is important for tenure reasons and the fact that most Staff have college educations with nursing and educational degreees. It took Salaries months to fill one vacant position due to the low hourly rate. FICA Please see above explanation for increase in salary that impacts the increase in the FICA rate. #DN/01 #DN/0! #DN/01 #DN/0! #DIV/0! The TLC Program would like to expand the distribution of its newsletter to other members of the local community as a way of increasing donations to the Program. In addition, the U.S. Postal Service has announced that it may increase the postage rates within the next Postane/Shipping fiscal yeas #DN/0! #DN/01 #DN/0! #ON/01 #DN/0! #DN/01 #DIV/0! #DIV/01 Due to the increase of newborns from Spanish-speaking parents, there is a need to purchase more materials and other educational items that are in Spanish. In addition , in response to calls requesting breastfeeding information, the TLC Program needs to purchase Books/Educational Materials more books and educational items related to brea edin . #DN/0! #DIV/0! #DN/0! #DN/O! 5/132005 BS IRCHSGTIC Newborn 0598 UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 1S% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME : FUNDER: LINE ITEM EXPLANATION FOR VARIANCE Salaries Please see above. FICA Pleae see above. #DN/O! #DNIO! #DN/0! #DN/0! #DN/01 #DN/Ol #DN/01 #DIV/O! #DN/01 #DN/Ol #DIVIO! #DN/0! #DIV/O! #DIV/01 #DNIO! #DN/0! 5113r29o5 ea Type the Organization and Program Name • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel , lodging, registration , food) 29 Office Supplies 800.00 12,500.00 • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 0.00 18,000.00 # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 31 Postage/Shipping 61500.00 10,000.00 • Quarterly Mailing of Newsletter • Special events, etc. • Bulk mailings - appeals 32 Utilities 0.00 69000.00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds) 0.00 36,000.00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes 34 Printing & Publications 5,000.00 6 ,000.00 Quarterly Newsletter ($ x 4) Letterheads, Envelopes, etc. Fundraising materials Other 35 Subscription/Dues/Memberships 500.00 2,500.00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, etc. 36 Insurance 0.00 4 ,500.00 • Directors/Officers Liab. • Commercial/General Insurance • Bond Ins . • Auto Insurance 37 Equipment: Rental & Maintenance 0.00 50500.00 • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38 Advertising 500 .DO 3 ,000.00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases : Capital Expense 0.00 3 ,000.00 • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal , Consulting) 11500.00 12,000.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 1500.00 3 ,300.00 • Books/videos • Materials ($ x staff) 42 Food & Nutrition 0.00 5/13/2005 B-1 Type the Organization and Program Name • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 0.00 40,000.00 Admin . Cost (% of total budget) 44 Audit Expense 0.00 20,000.00 Independent Audit Review 45 Specific Assistance to Individuals 0.00 5,000.00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 0.00 8,000.00 • Background check/drug test • Other 47 Other/Contract Sub-contract for program services 48 TOTAL EXPENSES $94,532.05 $21 ,530.001 $ 1 , 153,737.00 5/13/2005 B-1 SUPPORTING DOCUMENTS CHECKLIST RFP 7052 Cover Page Application List of current officers and directors ✓ Latest Financial Audit Report & Management Letter that conforms with the AICPA Audit Guide v✓ Most recent IRS Form 990, including all schedules Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating Budget ✓ Staff Organizational Chart Nom_ Most Recent Annual Report (if available) 501 (C)(3 ) IRS Exemption Letter Articles of Incorporation Agency' s Bylaws Agency' s written policy regarding Affirmative Action V Nepotism Statement XV Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application ORGANIZATION : INDIAN RIVER COUNTY HEALTHY START COALITION INC. PROGRAM : TLC NEWBORN TABLE OF CONTENTS Please "X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information can be located. 1XI Section of the Proposal I Pa e # TABLE OF CONTENTS (check list) 1 COVER PAGE (with signatures) , I * * @ * , , I of * * * * 40 00 # * 1111000611 000000 see * 0 * 066000100119 3 A. ORGANIZATION CAPABILITY (one page maximum) 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 . Summary of expertise, accomplishments, and population served . . 4 B. PROGRAM NEED STATEMENT (one page maximum) 1 . Program Need Statement . . . . . . . " , * * * " If 0 6660 * 66 0009 , 6006 140 * 0 & 100000 5 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) 1 . Funding priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 3 . Evidence that program strategy will work . . . . . . . 0111 . 00 . . . . . . . . . . . . . . . . . . . . . . . . 00 . . . 6 4 . Staffing , . * . . . . . . . see 0 0 a 0 s 0 0 a a 0 6 0 9 0 9 0 0 7 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 . 9 . 8 . . . . . . . . . . . . . . . . . . . . . 7 D. MEASURABLE OUTCOMES (two pages maximum) , , 14 * 01060 * 0 06 1 * * & * wee * * * 8 E. COLLABORATION (one page maximum) 10 F. PROGRAM EVALUATION (two pages maximum) 1 . Demographics . . . " , . sees 0000 069006 * 86 goo 11 2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 9 0 9 . . . . . . . . . . . . . . . . . . . . . . . . 11 3 . Reporting , . . . . . . . 0 0 , , 0 0 0 0 9 0 6 0 6 , , 0 * a 0 0 a 0 a 0 a 0 0 e 6 0 0 0 * * a 0 0 0 0 11 G. TIMETABLE (one page maximum) 13 H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1 IRCHSCRLC NwWvn 0506 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition , Inc./TLC Newborn 105 06] FY 03!04 FY 04/05 FY 05/06 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (ed. C•eol. eyed. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services Councll-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 70 000.00 74 500.00 75 000.00 0.67% 4 United Way-St Lucie County 0.00 #DIV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way-Indian River County 45 000.00 46 000.00 46 000.00 0.00% 7 DOH/State of Florida 366t963,00 366 963.00 945 315.00 157.60% 8 County Funds 32 500.00 2050000 0.00 -100.00% s Contributions-Cash 59705,001 129500.00 #DIV/01 10 Program Fees T 830.00 10 250.00 0.00 1 -100.00% 11 Fund Raising Events-Net 22 22200 24 250.00 12 500.00 48.45% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/01 14 Investment Income ' 0.00 #DIV/01 15 Miscellaneous 112 905.60 135198.00 501000.00 -63.02% 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 386 040.00 443v985,00 12,500.00 -97.18% 18 Reserve Funds Used for Operating 23 000.00 0.00 -100.000/0 1s in-Kind Donations (Not included In total) 75 000.00 #DN/01 20 TOTAL 1049,165.60 1 144 646.00 1 ,153 815.00 0.80% EXPENDITURES 21 Salaries 629 674.12 756 306.00 773,281 .00 2.24% 22 FICA 48170.07 57 857.00 59, 156.00 225% 23 Retirement Lines 23-26 are combined 91 966.01 80 599.26 8%000.00 9.18% 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Daily 17,107.232170600=== 249000.00 10.57% 28 Travel/Conferences/Training 14 944.47 129500.00 14 000.00 12.00% 29 Office Supplies 9,168.4410 700.00 12 500.00 16.82% 30 Telephone 15 636. 10 17 200.00 18 000.00 4.65% 31 Postage/Shipping 89241 .87 838400 10 000.00 19.27% 32 Utilities 79651 ,71 5156.00 600000 16.37% 33 Occupancy (Building & Grounds 30 509. 00 37 299.00 36 000.00 3.48% 34 Printing & Publications 69633.66 51700.00 61000.00 5.2690 35 Subscription/Dues/Memberships Z436.00 11500.00 29500.00 66.67% 36 Insurance 8r469.00 4100.00 450000 9.76% 37 Equipment: Rental & Maintenance 81050.00 49935,00 59500.00 11 .45% 38 Advertising 19211 .48 45800.00 39000,00 37.50% 39 Equipment Purchases:Ca ital Expense 562.00 2 500.00 39000,00 20.00% 40 Professional Fees (Legal, Consulting) 39 319.56 11 350.00 12 000.00 5.73% 41 Books/Educational Materials 41857.411 3 300.00 3,300.00 0.00% 42 Food & Nutrition 2 988.00 19300,00 0.00 400.00% 43 Administrative Costs 31 988.00 62 398.50 40j000.00 35.90% 44 Audit Expense 79975.00 18 840.0020 000.00 6.16% 45 Specific Assistance to Individuals 5271 .46 10 500.00 5r000.00 052.38% 46 Other/Miscellaneous 35 375.33 7o846,00 8,000.00 1 .96% 47 Other/Contract 10 953.95 0.00 #DIV/01 46 TOTAL 190391159,87 1 146p776.76 115373700 0.61 % 4s REVENUES OVER/ UNDER EXPENDITURES 10 005.73 -29130.76 78.00 -103.66% L/3 2005 BZ IRCHSC/MC Neve an 05-M UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : Indian River ounty Healthy Start Coalition, Inc./TLC Newborn FY 03/04 FY 04105 FY 05/06 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (COL C-col. Bycoi. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Advisory Committee-Indian River 15 000.00 15 000.00 20,000.00 33.33% 4 United Way-St Lucie County0.00 #DN/O! 5 United Way-Martin County0.00 #DIV/0! 6 United Way-Indian River County 45 000.00 4600000 469000.00 0% 7 Department of Children & Families 0.00EE:i? a CountyFunds 0.00 9 Contributions-Cash Z350.00 0.00 #DIV/01 10 Program Fees 0.00 #DIV/01 11 Fund Raising Events-Net 21565.00 12 000.00 12,500.00 4. 17% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DIV/O! 14 Investment Income 0.00 #DIV/01 15 Miscellaneous 0.00 #DIV/0! 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 10 000.00 129500.00 #DIV/01 1a Reserve Funds Used for Operating 5,000.00 5,000.00 0.00 0100.00% 19 In-Kind Donations (Not included In total 25 000.00 #DN/01 20 TOTAL 79 915.00 787000'(10 91 000.00 16.67% EXPENDITURES 21 Salaries 50 427.00 55 811 .00 69 700.00 24.89% 22 FICA 31857.67 4270,00 5,332.05 24.87% 23 Retirement 764.00 19954,00 0.00 -100.00% 24 Life/Health 0.00 #DIV/O! 25 Workers Compensation 0.00 #DIV/OI 26 Florida Unemployment 0.00 #DN/O! 27 TravekDaily 696.00 19200,00 1 200.00 0.00% 28 Travel/Conferences/Training 500.00 2 000.00 #DIV/OI 29 Office Supplies 750.00 700.00 800.00 14.29% 3o Telephone 0.00 #DN/01 31 Postage/Shipping 59304.00 45884,00 6 500.00 33.09% 32 Utilities 0.00 #DN/01 33 Occupancy Buildin & Grounds 0.00 #DIV/Ol 34 Printing & Publications 5000,00 #DN/01 35 Subscription/Dues/Memberships 3131 .00 250000 500.00 -80.00% 36 Insurance 0.00 #DIV/O! 37 Equipment: Rental & Maintenance 0.00 #DIV/01 38 Advertising500.00 #DN/01 39 Equipment Purchases:Ca ital Expense 0.00 #DIV/0! 40 Professional Fees (Legal, Consulting) 11500.0 0 #DIV/O! 41 Books/Educational Materials 493.00 500.00 1500.00 200.00% 42 Food & Nutrition 0.00 #DIV/0! 43 Administrative Costs 0.00 #DN/0! 4a Audit Expense 0.00 #DIV/01 45 Specific Assistance to Individuals 1 580.00 1500,00 0.00 -100.00% 46 Other/Miscellaneous 206.00 175.00 0.00 0100.00% 47 Other/Contract 0.00 #DIV/01 48 TOTAL 67 708.67 739494,001 94 532.05 28.639%. 49 REVENUES OVER/ UNDER EXPENDITURES 12 206.33 49506.00 39532.05 478.39% 51732005 BJ • Organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application I. BUDGET FORMS 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . , . , . . 999 . 6 . 15 J. FUNDER SPECIFIC/ADDITIONAL SHEETS K. APPENDIX 2 - 8 - 1181HX3 „ *Ajessaoau poweap se asuadxa Aue aol juawasangwlaa auiloap of Jy61J ayJ sanJosai Aluno0 a41 - uoileoildde 6uipunl s,Aouabe ay; ui peuillno Jou asuadxa Auy ( p • 6uipunl papienne sey AJunoo ay; yolynn jol weibo.id ay; to uoisino,id 9141 ylinn paleloosse lou sasuadxa Auy (o oseomos jayJo woal papinoid eq ;snw asayl ' saloilod Aed u01leoen pue dols snolaen aney Aew s9loua6e eoulg • seaAoldwa aol sluawAed uoileoen ao �oiS ( q - algennoile sl (Alunoo Janib uelpul ulylinn) lane; leool aol Juawasingwiaa obealiW • silo; pue ' walp jad ' seouennolle leaw ' sleaw ' swooi leloy ' } uawasingwlei a6eaiiw : ol pepwil lou Jnq 6uipnloui �(Junoo eqj apislno IaneJj sol sasuadxa Ianeal ( e •Molaq palsll aje sadAl ajnlipuedxa asayl • saanlipuadxe to sadAl uleliao asingwiaj lou lllnn Aluno0 JaniZl uelpul - algellene swjol tiewwns sey J96pn8 V JuawabeuelN to eoill0 9y1 -Ajewwns aqj uo pasolosip aq pinoys uorpod sigj jol poylaw aqj uayJ ' ( aaAoldwe ue to Ajeles - 6 - 9) asuadxa ue to uopod a Aluo aol Aouabe ue 6uisingwiaj sl AJunoo a9ni2i uelpul ll ' ole ' saoimas lenloeiluoo ' sailddns 'lllauaq ' sopeles olid unnop ua� ojq aq pinoys sauewwns asa41 • adAl Aq asuadxa to Aaewwns a apnloui Jsnw lsanbaa luawasingwiaj y3e3 - Julod Jegj puoAaq aeaA leosil joud aqj aol spayo sseoo,id lou scop luawlaedaQ eoueu13 ay} aouis 'aagolo0 piw of Apee AlleoidAl sl auilpeep s141 • aeaA leosil ayl jol slsenbai Juewasingwiaj aol auilpeap ayJ 10 6uisinpe s913ua6e l!laduou Ile of aallal a puss IIIM 196pn8 pue Juawebeuew to eol.40 eqj 'aeaA yoe3 - siseq Alawil a uo pappgns aq Jsnw (,,O£ aagwaldag ) pue jean( leosil le Juewasingwiaj aol slsenbai Iib' • sjauoissiwwo0 to paeo8 eqj Aq pazuoylne Alssajdxe ssalun aeaA lxau ayJ of JOAO palaaeo lou we spunl esayl 'jean( leosil a to pue aqj le popuadxeun aje spunl Aue l! `Alleuolllppv 'jeaA 6uinnollol eqj wal spunl yl! nn pasingwiaa aq Aew 3S 6 jagolo0 of aoud sajnlipuedxa ou ' aidwexe X03 • papienne seen 6uipunl yolynn aol jean( Ieosil ayl woal posingwiaa aq Aluo Aew sajnlipuedx3 - slsenbai buipunl ajnlnl belle AIasaanpe Aew siyl 'Alleuoilippy -Aleleipawwi penupoosip eq Aew buipunl ' siseq lualsisuoo e uo uoiJeluawnoop alenbapeui sapinojd Aoua6e ue Juana ayJ ul - sjauoissiwwo0 to pjeo8 aqj of papodaj aq Aew siyl ' uoileluawnoop alenbape apinoid of sl1el AIPaleadaa Aouabe ue 11 • posingwiaa aq lou Aew jolelsiuiwpy Aluno0 ayl jo/pue 196pn8 V Juawa6eueVI to 9oill0 ayl to uoiloelsiles eqj of Apedoid paluawnoop lou asuadxa Auy - � oayo palaoueo eqj to Adoo a jo/pue aolonuI ue Aq paluawnoop aq Jsnw sasuadxa algesingwiaa IIV - Aluo siseq Juawasingwiaj a uo saloua6e Jiloaduou Ile of 6uipunl sapino,id /(Junod a9ni2j uelpul Buipun3 paemV aa;jd saililigisuodsoN AouaBV I !IojduoN • a „ ( ZOOZ ' 66 Ajenaga=I uo saauoissiwwoo AJunoo to paeo8 AJunoo JGAIH uelpul Aq poldope Aoilod woa3 ) 91181HX3 IRCHSC/TLC Newborn 05.06 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Indian River County Healthy Start Coalition , Inc ./TLC Newborn FUNDER : IRC BOCC - Children 's Services A A B C FY 05/06 FY 05/06 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A) EXPENDITURES 21 Salaries 69,700 . 00 209000 . 00 28 . 69% 22 FICA 5,332 .05 19530 .00 28 .69% 23 Retirement 0 . 00 0200 #DIV/01 24 Life/Health 0 .00 0 .00 #DIV/Ol 25 Workers Compensation 0 . 00 0200 #DIV/01 26 Florida Unemployment 0 .00 0 .00 #DIV/01 27 Travel -Dail 1 ,200 .00 0 .00 0 .00% 28 Travel/Conferences/Training 29000 .00 0. 00 0.00% 29 Office Supplies 800.00 0 .00 0 .00% 30 Telephone 0 .00 0 .00 #DIV/0 ! 31 Postage/Shipping 6,500.00 0.00 0 .00% 32 Utilities 0 .00 0 .00 #DIV/01 33 Occupancy Building & Grounds 0 .00 0 .00 #DIV/01 34 Printing & Publications 51000 . 00 0 .00 0 .00% 35 Subscription/Dues/Memberships 500 .00 0 .00 0 .00% 36 Insurance 0 .00 0.00 #DIV/01 37 Equipment: Rental & Maintenance 0 .00 0 .00 #DIV/01 38 Advertising 500 .00 0.00 0 .00% 39 Equipment Purchases : Ca ital Expense 0. 00 10,00 #DIV/01 40 Professional Fees ( Legal , Consulting ) 19500 .00 0 .00 0.00% 41 Books/Educational Materials 11500 .00 0 .00 0 .00% 42 Food & Nutrition 0 .00 0.00 #DIV/01 43 Administrative Costs 0 .00 0 .00 #DIV/01 44 Audit Expense 0 .00 0 . 00 #DIV/0 ! 45 Specific Assistance to Individuals 0.00 0 .00 #DIV/01 46 Other/Miscellaneous 0.00 0 .00 #DIV/O ! 47 Other/Contract 0 .00 0 , 001 #DIV/01 48 TOTAL $94, 532 .05 $21 ,530 .00 22.78% 5/132005 Br/ IRCHSMLC N&hto 05-06 • UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME : Indian River County Healthy Start Coalition, Inc./TLC Newborn FUNDER: IRC BOCC - Children's Services Advisory Committee - 05-06 LINE ITEM EXPLANATION FOR VARIANCE #DN/0! #DIV/01 As the TLC Program touches nearly 98% of pregnant moms delivering babies in Indian River County, the TLC Program serves as a wonderful safety net of making sure that pregnant moms and infants are receving the care that is needed and that they are in touch with the appropriate services that may be needed. Due to the significant amount of growth in our community and an expected increase in the number of pregnant moms (especially in light of the fact our County had two major hurricanes hit our County - historical data shows that major disasters ususally results in an increase of pregnant moms) we are requesting an additional $5,000 to help offset our Advisory Committee-Indian River costs in increasing the number of hours that the TLC staff will need to continue successfully serving our community. #DN/O! #DIV/O! #DN/0! #DN/0! #DN/O! #DN10! #DIV/O! #DN/ol #DN/01 #DN/01 #DIV/0! #DIV/0! #DIV/0! In light of the fact that our County is experiencing a significant amount of growth and an increase in the number of babies bom in Indian River County, the total number of Staff hours worked in a single workweek will increase from 92 hours to 117 hours a workweek. In addition, there will be a raise for Staff since Staff have NEVER received a raise since the inception of the Program in the late 90's. This is important for tenure reasons and the fact that most Staff have college educations with nursing and educational degreees. It took Salaries months to fill one vacant position due to the low hourly rate. FICA Please see above explanation for increase in salary that impacts the increase in the FICA rate. #DN/01 #DN/0! #DN/01 #DN/0! #DIV/0! The TLC Program would like to expand the distribution of its newsletter to other members of the local community as a way of increasing donations to the Program. In addition, the U.S. Postal Service has announced that it may increase the postage rates within the next Postane/Shipping fiscal yeas #DN/0! #DN/01 #DN/0! #ON/01 #DN/0! #DN/01 #DIV/0! #DIV/01 Due to the increase of newborns from Spanish-speaking parents, there is a need to purchase more materials and other educational items that are in Spanish. In addition , in response to calls requesting breastfeeding information, the TLC Program needs to purchase Books/Educational Materials more books and educational items related to brea edin . #DN/0! #DIV/0! #DN/0! #DN/O! 5/132005 BS 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 : Indian River County Healthy Start Coalition , Inc . 1603 10th Avenue Vero Beach , Florida 32960 Attention : Leslie Spurlock , Director 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 provision and term 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 context indicates otherwise , words importing the singular number include the plural number, and vise 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. EXHIBIT - C - 11 / 04 % 2005 14 : 54 FAX 772 562 3466 SID BANACK INS . 10001 ), 001 ACORD DATE WDD/YYYY) ---T�. CERTIFICATE OF LIABILITY INSURANCE 7 NOV 4os • PRODUCER THIS CERTIFICATE IS *SUED AS A MATTER OF INFORIAATION HILB ROGAL & HOBBS OF FLA, INCJ31D BANACK INS. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2045 114TH AVE. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O BOX 130 ALTER E AFFORDED BY THE POLIC!13 BELOW. VERO BEACH FL 32981 INSURERS AFFORDING COVERAGE NAIL 1k INSURED INSURER A: AU TO.OWNERS INSURANC COMPANY + INDIAN RIVER COUNTY HEALTHY START, INC. I INSURERS: HARTFORD UNDERWRITERS INSURANCE COMP Y VERO BEACH FL 32960 1003 19TH DVH. INSURERC: UNITED STATES LIABILITY INSURANCE COMPAN VERO INSURER D: f INSURER E: COVERAGES THE POLICIES OF INSURANCE LISfEC BELOW MAVB BEEN 1SSUE0 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NGTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEIN7 WITH RESPECT TONRIICH THIS CERTIFICATE MAY 0E ISSUEO OR MAY PERTAIN, THE P[SURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN 16 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOJTIONS OF SUCH POUCIER AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAiD CLAW. "M` rotor INSURANCE—�POLICY - LTM IN NUMBER �YM�CTNE FDATELM ooffn/1 LIALTS GENERAL LIABILITY NDo1005544G AUG 105 ALIG 8 00 �+ Occu Ice L 1 , 00,0 COMWRCIAL GENERAL LW ICI p�MACA TO RENTED I s a- •,�.., s 50,000 C t I t;LwMs MADE�� OCCUR MUD, EXP (Arty one p&wm) s _ 5V000 PERSONAL A AOV INJURY S 11000, 000- 1I GENERALAOGREGATE S _ 190004000 cEJNLAGGREGATE UMrrAPPLrsPER 1 , , I ' PROOUCrS.COMP/0J' AcG, S 000 000 POL Cr .R r `1 Loc f -- I 1OJT 0a10rLE �� COMSINEN#SINGLE LIMIT 7 (Ee accJd.n!I s ALL aWNFo AUTOS BODILY INJURY SCHEOULEDAuros I (Perper7on) �— HIREDAU7011 I BODILY INJURY IS NON-0WM® AUTOS (Per amidam) FPROPERTY DAMAGE j3 Dv xrldent) GARAGE LJAOLJTY AUTO ONLY - EA ACCIDENT S —� ANY AUTO j OTHER THAN EA ACC , S AUTO ONLY. s EXCESS I UMBRELLA LIABLITY EACH OCCURRENCi ! I� OCCUR 17CLAIiASMADE I AGGREGATE T is IIDEDUCTIBLE F------ RETENTION S I g . S WORKAM COMPENSATION AND 21 WEC ODY700 MAY 3 05 MAY 3 06 rrc arAfv OTHER EMWLoYE119' LIAMILM WHINE _. B ; My �AIT� i IE.LEACH ACCIDENT 4 100, 000 OFFICtRansm 11 in, auNft wdwSEI L.DISEABE-EA EMPLOYEE $ 100, 000 aPECIALPRovEtnrq ~1oM E.L. DJSUSE-PoUCV LMT S 5000000 OTHER; DIRECTORS AND OFFICERS ND0100MS"G I AUG a O5 AUG 8 OB ;110000000 C ' I DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLESJEXCLUSIONS ADDED BY ENDORSEIIIENTI SPECIAL PROVISIONS CERITIFICATE HOLDER NAMED AS AN ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY AS PER POLICY FORM AND PROVISIONS .CIERTIFICATE H0LQgR — CANC ON SW)ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL t0 DAYS WRITTEN NOTICE TD THE CERTIFICATE HOLDER NAMED TO THE LBF', BUT INDIAN RIVER COUNTY FALURE INSURER, O 0S0 90 S OR IMPOSE M PR$Et o OgU ATION OR LMLIrV CF ANY KIND 'UPON THE 1840 25TH STREET VERO BEACH FL 32960 AUTHORIZED REPRESENTATIVE At6xltlon_ 470.179a IdRdy a c , air *d* 14 ACORD 25 (2001108) CertlriCrts 4 90762 0 ACORD CORPORATION 1988 IRCHSGTIC Newborn 0598 UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 1S% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME : FUNDER: LINE ITEM EXPLANATION FOR VARIANCE Salaries Please see above. FICA Pleae see above. #DN/O! #DNIO! #DN/0! #DN/0! #DN/01 #DN/Ol #DN/01 #DIV/O! #DN/01 #DN/Ol #DIVIO! #DN/0! #DIV/O! #DIV/01 #DNIO! #DN/0! 5113r29o5 ea SUPPORTING DOCUMENTS CHECKLIST RFP 7052 Cover Page Application List of current officers and directors ✓ Latest Financial Audit Report & Management Letter that conforms with the AICPA Audit Guide v✓ Most recent IRS Form 990, including all schedules Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating Budget ✓ Staff Organizational Chart Nom_ Most Recent Annual Report (if available) 501 (C)(3 ) IRS Exemption Letter Articles of Incorporation Agency' s Bylaws Agency' s written policy regarding Affirmative Action V Nepotism Statement XV 11 / 07 / 2005 110^1 16 : 41 FAX 561 563 9125 IRt' HEALTHY START 2001 / 001 Nit 4tY •,eIeyn . Indian River County Healthy Stan: Coalition , Inc . B ' i/ 1603 10�'' Avenue, Vero Beach Florida . 32960 kiri� u.; , >- Phone 772 . 563 . 9118 Fax 772 . 563 . 9125 ",,tilt �q } 0 1111 ,e&all ., Z Email : info a irche l h ., d. .� .a� , , rt. r Web address : =&virchgalthystartqrc k I t {L November 7 , 2005 Children 's Services Advisory Committee Indian River County Human Services 18402 Sth Street Vero Beach, FL 32960 - 3365 Attention : Marion Masterson Re : Transportation Dear Ms . Masterson , I am writing per request to inform you that neither of our children 's programs Healthy Families IRC nor TLC Newborn Is required to transport children . Thank you for the opportunity to provide services to the families of Indian River County . Sincerely , Gw�O Leslie Spurlock, Executive Director "The Mission of the Indian River County Healthy Start Coalition is to estawish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote normat growth and development. Organization: Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application ORGANIZATION : INDIAN RIVER COUNTY HEALTHY START COALITION INC. PROGRAM : TLC NEWBORN TABLE OF CONTENTS Please "X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information can be located. 1XI Section of the Proposal I Pa e # TABLE OF CONTENTS (check list) 1 COVER PAGE (with signatures) , I * * @ * , , I of * * * * 40 00 # * 1111000611 000000 see * 0 * 066000100119 3 A. ORGANIZATION CAPABILITY (one page maximum) 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 . Summary of expertise, accomplishments, and population served . . 4 B. PROGRAM NEED STATEMENT (one page maximum) 1 . Program Need Statement . . . . . . . " , * * * " If 0 6660 * 66 0009 , 6006 140 * 0 & 100000 5 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) 1 . Funding priority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 3 . Evidence that program strategy will work . . . . . . . 0111 . 00 . . . . . . . . . . . . . . . . . . . . . . . . 00 . . . 6 4 . Staffing , . * . . . . . . . see 0 0 a 0 s 0 0 a a 0 6 0 9 0 9 0 0 7 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 . 9 . 8 . . . . . . . . . . . . . . . . . . . . . 7 D. MEASURABLE OUTCOMES (two pages maximum) , , 14 * 01060 * 0 06 1 * * & * wee * * * 8 E. COLLABORATION (one page maximum) 10 F. PROGRAM EVALUATION (two pages maximum) 1 . Demographics . . . " , . sees 0000 069006 * 86 goo 11 2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 9 0 9 . . . . . . . . . . . . . . . . . . . . . . . . 11 3 . Reporting , . . . . . . . 0 0 , , 0 0 0 0 9 0 6 0 6 , , 0 * a 0 0 a 0 a 0 a 0 0 e 6 0 0 0 * * a 0 0 0 0 11 G. TIMETABLE (one page maximum) 13 H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1 • Organization : Indian River County Healthy Start Coalition, Inc. Program: TLC Newborn Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application I. BUDGET FORMS 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . , . , . . 999 . 6 . 15 J. FUNDER SPECIFIC/ADDITIONAL SHEETS K. APPENDIX 2 - 8 - 1181HX3 „ *Ajessaoau poweap se asuadxa Aue aol juawasangwlaa auiloap of Jy61J ayJ sanJosai Aluno0 a41 - uoileoildde 6uipunl s,Aouabe ay; ui peuillno Jou asuadxa Auy ( p • 6uipunl papienne sey AJunoo ay; yolynn jol weibo.id ay; to uoisino,id 9141 ylinn paleloosse lou sasuadxa Auy (o oseomos jayJo woal papinoid eq ;snw asayl ' saloilod Aed u01leoen pue dols snolaen aney Aew s9loua6e eoulg • seaAoldwa aol sluawAed uoileoen ao �oiS ( q - algennoile sl (Alunoo Janib uelpul ulylinn) lane; leool aol Juawasingwiaa obealiW • silo; pue ' walp jad ' seouennolle leaw ' sleaw ' swooi leloy ' } uawasingwlei a6eaiiw : ol pepwil lou Jnq 6uipnloui �(Junoo eqj apislno IaneJj sol sasuadxa Ianeal ( e •Molaq palsll aje sadAl ajnlipuedxa asayl • saanlipuadxe to sadAl uleliao asingwiaj lou lllnn Aluno0 JaniZl uelpul - algellene swjol tiewwns sey J96pn8 V JuawabeuelN to eoill0 9y1 -Ajewwns aqj uo pasolosip aq pinoys uorpod sigj jol poylaw aqj uayJ ' ( aaAoldwe ue to Ajeles - 6 - 9) asuadxa ue to uopod a Aluo aol Aouabe ue 6uisingwiaj sl AJunoo a9ni2i uelpul ll ' ole ' saoimas lenloeiluoo ' sailddns 'lllauaq ' sopeles olid unnop ua� ojq aq pinoys sauewwns asa41 • adAl Aq asuadxa to Aaewwns a apnloui Jsnw lsanbaa luawasingwiaj y3e3 - Julod Jegj puoAaq aeaA leosil joud aqj aol spayo sseoo,id lou scop luawlaedaQ eoueu13 ay} aouis 'aagolo0 piw of Apee AlleoidAl sl auilpeep s141 • aeaA leosil ayl jol slsenbai Juewasingwiaj aol auilpeap ayJ 10 6uisinpe s913ua6e l!laduou Ile of aallal a puss IIIM 196pn8 pue Juawebeuew to eol.40 eqj 'aeaA yoe3 - siseq Alawil a uo pappgns aq Jsnw (,,O£ aagwaldag ) pue jean( leosil le Juewasingwiaj aol slsenbai Iib' • sjauoissiwwo0 to paeo8 eqj Aq pazuoylne Alssajdxe ssalun aeaA lxau ayJ of JOAO palaaeo lou we spunl esayl 'jean( leosil a to pue aqj le popuadxeun aje spunl Aue l! `Alleuolllppv 'jeaA 6uinnollol eqj wal spunl yl! nn pasingwiaa aq Aew 3S 6 jagolo0 of aoud sajnlipuedxa ou ' aidwexe X03 • papienne seen 6uipunl yolynn aol jean( Ieosil ayl woal posingwiaa aq Aluo Aew sajnlipuedx3 - slsenbai buipunl ajnlnl belle AIasaanpe Aew siyl 'Alleuoilippy -Aleleipawwi penupoosip eq Aew buipunl ' siseq lualsisuoo e uo uoiJeluawnoop alenbapeui sapinojd Aoua6e ue Juana ayJ ul - sjauoissiwwo0 to pjeo8 aqj of papodaj aq Aew siyl ' uoileluawnoop alenbape apinoid of sl1el AIPaleadaa Aouabe ue 11 • posingwiaa aq lou Aew jolelsiuiwpy Aluno0 ayl jo/pue 196pn8 V Juawa6eueVI to 9oill0 ayl to uoiloelsiles eqj of Apedoid paluawnoop lou asuadxa Auy - � oayo palaoueo eqj to Adoo a jo/pue aolonuI ue Aq paluawnoop aq Jsnw sasuadxa algesingwiaa IIV - Aluo siseq Juawasingwiaj a uo saloua6e Jiloaduou Ile of 6uipunl sapino,id /(Junod a9ni2j uelpul Buipun3 paemV aa;jd saililigisuodsoN AouaBV I !IojduoN • a „ ( ZOOZ ' 66 Ajenaga=I uo saauoissiwwoo AJunoo to paeo8 AJunoo JGAIH uelpul Aq poldope Aoilod woa3 ) 91181HX3 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 : Indian River County Healthy Start Coalition , Inc . 1603 10th Avenue Vero Beach , Florida 32960 Attention : Leslie Spurlock , Director 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 provision and term 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 context indicates otherwise , words importing the singular number include the plural number, and vise 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. EXHIBIT - C - 11 / 04 % 2005 14 : 54 FAX 772 562 3466 SID BANACK INS . 10001 ), 001 ACORD DATE WDD/YYYY) ---T�. CERTIFICATE OF LIABILITY INSURANCE 7 NOV 4os • PRODUCER THIS CERTIFICATE IS *SUED AS A MATTER OF INFORIAATION HILB ROGAL & HOBBS OF FLA, INCJ31D BANACK INS. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2045 114TH AVE. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O BOX 130 ALTER E AFFORDED BY THE POLIC!13 BELOW. VERO BEACH FL 32981 INSURERS AFFORDING COVERAGE NAIL 1k INSURED INSURER A: AU TO.OWNERS INSURANC COMPANY + INDIAN RIVER COUNTY HEALTHY START, INC. I INSURERS: HARTFORD UNDERWRITERS INSURANCE COMP Y VERO BEACH FL 32960 1003 19TH DVH. INSURERC: UNITED STATES LIABILITY INSURANCE COMPAN VERO INSURER D: f INSURER E: COVERAGES THE POLICIES OF INSURANCE LISfEC BELOW MAVB BEEN 1SSUE0 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NGTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEIN7 WITH RESPECT TONRIICH THIS CERTIFICATE MAY 0E ISSUEO OR MAY PERTAIN, THE P[SURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN 16 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOJTIONS OF SUCH POUCIER AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAiD CLAW. "M` rotor INSURANCE—�POLICY - LTM IN NUMBER �YM�CTNE FDATELM ooffn/1 LIALTS GENERAL LIABILITY NDo1005544G AUG 105 ALIG 8 00 �+ Occu Ice L 1 , 00,0 COMWRCIAL GENERAL LW ICI p�MACA TO RENTED I s a- •,�.., s 50,000 C t I t;LwMs MADE�� OCCUR MUD, EXP (Arty one p&wm) s _ 5V000 PERSONAL A AOV INJURY S 11000, 000- 1I GENERALAOGREGATE S _ 190004000 cEJNLAGGREGATE UMrrAPPLrsPER 1 , , I ' PROOUCrS.COMP/0J' AcG, S 000 000 POL Cr .R r `1 Loc f -- I 1OJT 0a10rLE �� COMSINEN#SINGLE LIMIT 7 (Ee accJd.n!I s ALL aWNFo AUTOS BODILY INJURY SCHEOULEDAuros I (Perper7on) �— HIREDAU7011 I BODILY INJURY IS NON-0WM® AUTOS (Per amidam) FPROPERTY DAMAGE j3 Dv xrldent) GARAGE LJAOLJTY AUTO ONLY - EA ACCIDENT S —� ANY AUTO j OTHER THAN EA ACC , S AUTO ONLY. s EXCESS I UMBRELLA LIABLITY EACH OCCURRENCi ! I� OCCUR 17CLAIiASMADE I AGGREGATE T is IIDEDUCTIBLE F------ RETENTION S I g . S WORKAM COMPENSATION AND 21 WEC ODY700 MAY 3 05 MAY 3 06 rrc arAfv OTHER EMWLoYE119' LIAMILM WHINE _. B ; My �AIT� i IE.LEACH ACCIDENT 4 100, 000 OFFICtRansm 11 in, auNft wdwSEI L.DISEABE-EA EMPLOYEE $ 100, 000 aPECIALPRovEtnrq ~1oM E.L. DJSUSE-PoUCV LMT S 5000000 OTHER; DIRECTORS AND OFFICERS ND0100MS"G I AUG a O5 AUG 8 OB ;110000000 C ' I DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLESJEXCLUSIONS ADDED BY ENDORSEIIIENTI SPECIAL PROVISIONS CERITIFICATE HOLDER NAMED AS AN ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY AS PER POLICY FORM AND PROVISIONS .CIERTIFICATE H0LQgR — CANC ON SW)ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL t0 DAYS WRITTEN NOTICE TD THE CERTIFICATE HOLDER NAMED TO THE LBF', BUT INDIAN RIVER COUNTY FALURE INSURER, O 0S0 90 S OR IMPOSE M PR$Et o OgU ATION OR LMLIrV CF ANY KIND 'UPON THE 1840 25TH STREET VERO BEACH FL 32960 AUTHORIZED REPRESENTATIVE At6xltlon_ 470.179a IdRdy a c , air *d* 14 ACORD 25 (2001108) CertlriCrts 4 90762 0 ACORD CORPORATION 1988 11 / 07 / 2005 110^1 16 : 41 FAX 561 563 9125 IRt' HEALTHY START 2001 / 001 Nit 4tY •,eIeyn . Indian River County Healthy Stan: Coalition , Inc . B ' i/ 1603 10�'' Avenue, Vero Beach Florida . 32960 kiri� u.; , >- Phone 772 . 563 . 9118 Fax 772 . 563 . 9125 ",,tilt �q } 0 1111 ,e&all ., Z Email : info a irche l h ., d. .� .a� , , rt. r Web address : =&virchgalthystartqrc k I t {L November 7 , 2005 Children 's Services Advisory Committee Indian River County Human Services 18402 Sth Street Vero Beach, FL 32960 - 3365 Attention : Marion Masterson Re : Transportation Dear Ms . Masterson , I am writing per request to inform you that neither of our children 's programs Healthy Families IRC nor TLC Newborn Is required to transport children . Thank you for the opportunity to provide services to the families of Indian River County . Sincerely , Gw�O Leslie Spurlock, Executive Director "The Mission of the Indian River County Healthy Start Coalition is to estawish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote normat growth and development.