Senior Services Grant Program

Senior Services Grant Program is sponsored by McHenry County Senior Services Grant Commission. This program funds quality social and transportation services that encourage independent living, wellness, dignity, and quality of life for McHenry County seniors. Grant funds can be used to provide transportation vehicles or services for senior citizens.

Printed By: Shanika Forbes on 4/26/2023 1 of 17 Address: *No Address Assigned # McHenry County Senior Service Grant Program Department of Planning and Development Community Development Division 667 Ware Road Woodstock, Illinois 815-334-4560 McHenryCountyComDev@mchenrycountyil. gov About the Senior Services Grant Fund In April of 2003 a referendum was approved by the citizens of McHenry County to levy a tax rate not to exceed .

025% for the provision of providing social services for senior citizens as applicable under State Statutes 5/5 ILCS 5/5-1034, 5/5-1005 and 5/5-1091. To further this direction, the McHenry County Board created the Senior Services Grant Commission and Fund. Geographic Emphasis and Age of Clients Served Grants awarded from this Fund must be used for the exclusive benefit of McHenry County senior citizens.

In keeping with State Statute, grant funds shall be used for the following:  Provide supportive social services designed to prevent the unnecessary institutionalization of elderly residents  Provide for the operation of, and equipment for, senior citizen centers  Provide for transportation vehicles or services for senior citizens Additional Program Qualifications Printed By: Shanika Forbes on 4/26/2023 2 of 17  No one program can receive more than 25% of available grant funds in a given McHenry County fiscal year.

 Any not-for-profit charitable organization applying for Senior Services Grant Funding must have been in operation, with 501(c)(3) status, for at least one year prior to submittal of a Letter of Intent (LOI) to Seek Funding. Applicants not meeting this requirement may be considered for funding if affiliated with, and receiving support from, a nationally recognized parent organization.

 Priority will be given to those agencies and proposals which have an established and favorable track record of providing senior service within McHenry County.  It is strongly encouraged that at least 60% of the requested grant funding be directed toward individuals or senior citizen households with an income that is at or below 80% of the U.S. > Department of Housing and Urban Development’s (HUD) determined Area Median Income (AMI).

McHenry County’s Area Median Income by household size can be obtained below: : FY 2022 Income Limit Area FY 2022 Income Limit Category Chicago-Joliet-Naperville, IL HUD Metro FMR Area Very Low (50%) Income Limits ($) 36,500 41,700 46,900 52,100 56,300 60,450 Extremely Low Income Limits ($)* 21,900 25,000 28,150 31,250 33,750 37,190 Low (80%) Income Limits ($) 58,350 66,700 75,050 83,350 90,050 96,700 > Grants will not be made to fund: > Hospitals (for institutional programs and services) > Nursing Homes (for institutional programs and services) > Pass-through organizations Printed By: Shanika Forbes on 4/26/2023 3 of 17  Purely social organizations  Political parties or candidates  For-profit organizations  Advertising journals, booklets,  Construction or capital projects (unless funding is used to increase service capacity for which the non-profit organization has already been funded).

However, support may not be used as a bank  Non-direct service agencies (defined as agencies that provide administrative, technical, or facility management services to direct service agencies but which do not provide eligible services directly to seniors).

 Start-up agencies (defined as agencies that have not provided any services to any member of the public prior to submission of an application to the Senior Services Grant Fund)  Staff salaries/time devoted toward the preparation of grant applications Please refer to the Notice of Funding Availability (NOFA) for Fiscal Year (FY) 2023 Senior Services Grant funds, which can be found HERE .

For questions about categories of funding and where to include expenses categorically, please contact Aileen Zei at AMZei@mchenrycountyil. gov . For questions regarding content of the pre-application or full application, please contact Hans Mach at HDMach@mchenrycountyil.

gov . Printed By: Shanika Forbes on 4/26/2023 4 of 17 # A. Organization Information Address: *No Address Assigned A.

Organization Information > Click HERE to download the program guidelines A. 1. Name of Organization A.

2. Organization Address: A. 3.

Unique Entity Identifier (UEI) Number: A. 5. Contact Phone Number: A.

6. Contact Email Address: A. 7.

Name of Authorized Organization Signatory A. 8. Project Manager Name A.

9. Project Manager Address A. 10.

Program Manager Phone Number A. 11. Project Manager Email PLEASE FILL OUT THE OPTIONAL SECTION BELOW WITH THE CONTACT INFORMATION FOR ANY ADDITIONAL STAFF/PERSONNEL THAT YOU WOULD LIKE TO RECEIVE OFFICIAL CORRESPONDENCE REGARDING THIS GRANT APPLICATION A.

17. Title Printed By: Shanika Forbes on 4/26/2023 5 of 17 A. 27.

Phone Number Printed By: Shanika Forbes on 4/26/2023 6 of 17 Address: *No Address Assigned > If the program/project you are applying for was awarded FY 2021 or FY 2022 Senior Services Grant Funds, please complete the section below. If it did not, please SKIP this section. B.

1 If your project was awarded FY 2022 Senior Services Grant funding (12/01/2021-11/30/202), please provide the total number of unduplicated clients served by the project: B. 2 If your project was awarded FY 2022 Senior Services Grant funding (12/01/2021-11/30/2022), please provide the total number of service units provided by the project: B.

3 If your project was awarded FY 2023 Senior Services Grant funding (12/01/2022-11/30/2023), please describe if, how, and why the amount of your current FY2024 grant request may have changed since last year’s request: B. 4 What was the FY 2023 request amount: B. 5 What was the FY 2023 awarded amount: $0.

00 Printed By: Shanika Forbes on 4/26/2023 7 of 17 Address: *No Address Assigned > Please provide the following information. C. 2.

Total Cost of Project C. 4. Please provide a short description of the services your organization will offer McHenry County seniors: C.

5 For your FY 2023 grant project, how will your organization define a service unit? C. 6.

How many service units does your organization propose to provide with this grant project? C. 7.

How many unduplicated clients does your organization propose to serve with this grant project? C. 8.

Please provide a brief description of intended outcomes: C. 9. Please provide a brief description of your organization’s fundraising strategy: C.

10. What amount and what percentage of the project/program’s overall revenue is derived from fundraising (i.e. donations, appeals, giving campaigns, events)? C.

11 Are there any lingering effects to your organization related to COVID-19? C. 12.

Please upload the following documents: #  The most recent Illinois AG-990 and IRS 990 for any non-profit organization or equivalent information for Printed By: Shanika Forbes on 4/26/2023 8 of 17 government agencies *Required #  Goal and Outcome Reporting ( Click here to download instructions ) *Required #  The management and all other letters from the auditor who completed the non-profit organization’s most recent audit, or government entity that indicate any deficiencies, recommendations or findings *Required #  The most recent annual audit from the non-profit organization or government entity *Required #  Click HERE to download, complete, and upload a preliminary budget for the project using the Senior Services Grant Revenue Source and Expense excel sheet (NOTE: Please complete this by using the County fiscal year time period from December 1-November 30) *Required This is the end of the Pre-application.

When ready, please click “Complete & Submit” and your pre-application will be sent for review by both program staff and the Senior Services Grant Commission. You will receive email correspondence regarding whether your pre-application has been accepted/denied for moving forward to the full application. If your pre-application is accepted, the remainder of the full application will be unlocked for your completion at that time.

Printed By: Shanika Forbes on 4/26/2023 9 of 17 Address: *No Address Assigned If the applicant is not eligible, do not click "Complete & Submit". Please change status to "Application Denied" and add a note to Audit Log as to why the application is deemed Denied. Eligible/complete Pre-Application?

Approved to move forward to full application by the Senior Services Grant Commission? #  I certify that based on the Pre-Application, the applicant meets preliminary eligibility requirements for the McHenry County Senior Services Grant Program and was approved by the Senior Services Grant Commission to move forward to full application.  **Not signed Printed By: Shanika Forbes on 4/26/2023 10 of 17 # D.

Illinois State Statute Compliance Address: *No Address Assigned D. Illinois State Statute Compliance > Please provide the following information. (55 ILCS 5/5-1005) (from Ch.

34, par. 5-1005) Sec. 5-1005.

Powers. Each county shall have power: To appropriate funds from the county treasury to be used to provide supportive social services designed to prevent the unnecessary institutionalization of elderly residents, or, for operation of, and equipment for, senior citizen centers providing social services to elderly residents. (55 ILCS 5/5-1091) (from Ch.

34, par. 5-1091) Sec. 5-1091.

Transportation vehicles or services for senior citizens. A county board may expend funds or make grants or loans of funds derived either from taxes collected annually for county purposes or from funds received by the county pursuant to the "State and Local Fiscal Assistance Act of 1972" for the purposes of providing transportation vehicles or services for senior citizens.

Such transportation vehicles or services may be provided by the county or through a not-for-profit corporation.

If such transportation vehicles or services are provided by a not-for-profit corporation the county board shall enter into an appropriate contract or contracts to insure that such funds as may be made available by the county to the not-for-profit corporation are used for the purposes of providing transportation vehicles or services for senior citizens.

The Illinois state Statutes indicate that Senior Service Grant funding may be allocated to one of three types of programs. These programs are: 1. To provide supportive services designed to prevent the unnecessary institutionalization of elderly residents 2.

The operation of, and equipment for, a Senior Citizen Center providing services to elderly residents. 3. The provision of transportation vehicles or services for senior citizens.

D. 1. Please indicate which one of these three areas your proposed program is addressing how it is in compliance Printed By: Shanika Forbes on 4/26/2023 11 of 17 Address: *No Address Assigned > Please provide the following information.

BE AS SUCCINCT AND DIRECT AS POSSIBLE WITH ALL OF THE FOLLOWING RESPONSES E. 1. Program Mission: State your organization's mission.

E. 2. Program Participants: Identify the targeted senior population, specifying beneficiaries' income levels.

E. 3. Program Description: Provide a brief overview description of the program for which Senior Services Grant Funds are being requested.

E. 4. Program Delivery: Describe your agency's capacity, including its ability to continue the proposed program implementation in the event of staff vacancies or shortfall of requested funding.

Include specific resources the organization will contribute toward this program and the agency's total administrative costs and total cost ratio. Define your organization's strategy in the event of catastrophic financial shortfalls. E.

5. Levels of Accomplishment/Program Evaluation: Describe how you will evaluate your program. Program outcomes must be specifically stated, and they must be measurable and attainable; they must measure impact, not just activities.

Printed By: Shanika Forbes on 4/26/2023 12 of 17 # F. Summary of Request (Narrative) Address: *No Address Assigned F. Summary of Request (Narrative) Please provide the following information.

F. 1. Please provide an executive summary of your proposed grant project.

The Narrative summary should address all of the following areas:  Program Evaluation and Monitoring Note that this is a more comprehensive version of the information provided in the “Program Information” Section of this application. Printed By: Shanika Forbes on 4/26/2023 13 of 17 # G. Proposed Program Budget Address: *No Address Assigned G.

Proposed Program Budget > Please provide the following information. G. 1.

Download, complete, and upload an updated Senior Services Grant Revenue Source and Expense excel sheet. (NOTE: Please complete this by using the County fiscal year time period from December 1-November 30) #  Senior Services Grant Revenue Source and Expense spreadsheet *Required G. 2.

Budget Narrative: Based on your attached budget spreadsheet, please describe where funds will be spent, including any notable details/explanations. G. 3.

Describe your organization’s efforts to diversify its fundraising efforts in order to more effectively support ongoing operations and program. Printed By: Shanika Forbes on 4/26/2023 14 of 17 Address: *No Address Assigned Salaries and Fringes: Provide the proposed salary and fringes by position/employee for the program for which funds are being requested.

Please provide 2023 projected salary and FICA fringe for the overall proposed program and that portion of the program for which Senior Services Grant funds are being requested. H. 1.

Program salaries and fringes by position & employee Position 2023 - Total Project $0. 00 $0. 00 0.

00 % Printed By: Shanika Forbes on 4/26/2023 15 of 17 # I. Supporting Documents Address: *No Address Assigned Please provide the following information.

#  Conflict of Interest Disclosure *Required #  A list of the Board of Directors of the agency *Required The authorization to submit a Senior Services Grant Application does not have a specific format; however, the following information must be included in the authorization: o Identify key organizational person to submit the application on behalf of the organization o Signed/approved by key organizational signatories #  Copy of the Organization’s By-Laws *Required #  Copy of the IRS determination letter indicating 501(c)(3) tax-exempt status if applicant is a non-profit organization Municipal/governmental organizations should upload a page stating this is not applicable.

*Required **No files uploaded Printed By: Shanika Forbes on 4/26/2023 16 of 17 Address: *No Address Assigned > Please provide the following information.

Signature of Authorized Representative (Click HERE to download and re-upload below) #  Signature of Authorized Representative *Required By attaching the authorization above, the Authorized Signatory is certifying that the information submitted in this Senior Services Grant Program Project Application is true and correct to the best of their knowledge.

I also certify that the documented Conflicts of Interest are true and correct to the best of their knowledge. Printed By: Shanika Forbes on 4/26/2023 17 of 17 Address: *No Address Assigned Please provide the following information. Eligible/complete Full Application?

Approved to be funded by the Senior Services Grant Commission? #  I certify that based on the Full Application, the applicant meets eligibility requirements for the McHenry County Senior Services Grant Program and was approved by the Senior Services Grant Commission to be funded in the amount specified by the Commission during the applicable funding allocation meeting. 