Community Support Grants:Fulton County Community Foundation

227 East 9*'' Street, P.O. Box 807Rochester, Indiana 46975

(574) 223.2227 [ Toll Free (877) 432.6423

FULTON COUNTY

COMMUNITYFOUNDATIONA FUND AFFILIATE OF NICF

COMMUNITY SUPPORT GRANT APPLICATION

for smaller grant requests

Name: Fulton County Community Center Federal ID #: 35-1336270

Phone:

Email- fccoa(grtcol.com

Fax: 574-223-4962

Organization

Director of Organization: Georgia Moudy

Organization Mailing Address: 625 Pontiac Street

Rochester, Indiana 46975

Type of organization (please check):

i 501 (c) (3) - Attach a copy of the IRS determination letter. □ Governmental Entity

Director Signature: _

Board Officer Signatu(a person other than the person signing above)

re: ClDat

Dat

□ Other;

9 J 6 i ^ oju?e:

e:

Name and title of person making application: GsQFQia Moudy

Please specify the amount of your request: 6300.00

Brief summary of your request:

Phone: 574-223-6953

Fulton County Transpo is asking for 6300.00 to provide our new vans with our new logo. We have afleet of 9 mini vans and 2 buses. Our vehicles get a lot of exposure and we would like them to lookgood and stand out in the community. We also have other ads that we sell to put on the vans as well,and are going to be working on more in the future. We will have a local business do the decals. Also, asmall portion of the money would go to purchase jackets / shirts for winter with the new logo for ourdrivers. We like to look professional and think this will help with that. With the Covid epidemic and beingclosed we do not have funds to support this.

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1. Overview of organization:

Attachments:

m If you are a 501 (c) (3) organization, attach a copy of your IRS Determination letter.

Attach a list of names and addresses of your board of directors and staff if applicable. If you do not

have a board or staff, please attach a list of names and addresses of members of your organization.

H

(b) Organization's establishment date and brief history.

The Fulton County Council on Aging was established in 1974 as a small non-profit agency. Webegan by offering senior meals and senior transportation, but have since added senior programs andactivities. As a growing community center, we constantly strive to achieve our goal of adding moreand more senior life enrichment programs and services, as well as transportation.

(C) Principal services, purposes, and mission.

The purpose of the Fulton County Council on Aging is to provide services and programs that enableand encourage senior citizens, low income individuals, and disadvantaged persons to maintainindependent lifestyles as long as possible. We strive to add life enrichment programs and activitiesthat will appeal to the senior population and benefit their lives physically, emotionally, or socially.

(d) What population (age, geography, income level, other) does your organization serve?

We provide services to anyone over 60 and we do not discriminate on income level, geography orrace

(e) Corporate ownership and formal affiliations.

The Fulton County Council on Aging is a private, not for profit agency that is funded throughUnited Way, donations, rentals, and fundraisers. We are a member of the National Council onAging.

(f) Collaboration, partnerships, and joint ventures as it relates to this project.

United Way, donations, rental of our facilities and fundraisers.

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2. Describe your project in more detail:

Explain or describe the need for the project/program for which you are seeking funding. Also: What

sources of verification can you site to verify this need? (i.e. statistics, regulations, surveys, etc.)

I believe this is important and needed for the community, to show how much we value our vans. Welike to keep them in good shape, not only mechanically, but also keeping them clean and lookinggood. We have not been able to afford shirts/coats for the drivers in quite some time and would like todo that for them.

Describe how this project/program will address the identified need. (This is an opportunity for you to

explain how your program will work).

The vans will have new decals and make the public more aware of us out in the community. And itshows the pride we have in taking care of the vans.

(b)

Describe the organization's ability to carry out this project

We contract out to Chad Lewis from Rochester who does an amazing job for us on our vans. He willbe carrying out the project after we get the ok.

(C)

Your proposed timeline.

We are ready at any time to complete this.

(d)

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3. Please explain the expected benefits of this grant;

(a) How will you measure and assess the benefit and impact of your project? (i.e. A follow-up assessment,some benchmark by which you can chart your progress, etc.)

We do an annual survey with our riders and we could ask the question "how do you think our vanslook and do you think they are clean, etc;

(b) Who will be served, benefited or impacted? Quantify.

The citizens and riders of Fulton County. Pre-covid we have usually around 150 -175 average rides aday.

(c) How will your organization benefit?

By showing our community that we take care of what has been given to us, and to show pride in ourcommunity.

4. If application is for a new service, pilot project, survey or study, explain the source of funds to carry on

the project (if any will be needed) after any initial grant money is spent. Are there commitments or

guarantees for these funds? If funded, do you plan to ask the Foundation for support for this project again?

N/A

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5. Are you aware of any other organizations providing similar services? If so, will you be collaborating with other

organizations?

No

6. Describe past and current efforts within the community to address the identified needs.

We usually don't have to ask for help to do this. It Is usually 1 or 2 vans at a time. We would like toupdate all of our vans so our fleet all matches. We just recieved 3 new vans this year. At this time ourvans are all in good shape. We try to purchase 1-2 vans per year.

7. What public relations methods will be used to communicate to your donors/members/supporters any grant

support you receive from the Foundation?

The ads on the vans, word of mouth.

8. Do you have any legal issues associated with the project? If yes, briefly explain.

No

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SUMMARY OF HOW THIS PROJECT (ACTIVITY) WILL BE FINANCEDNote: We place a lower priority on projects where Fulton County Community Foundation is the sole funder.

1. Source of Funds

From federal, state, city or county government (specify)

Amount % of Total Project

From other foundations (specify if these are secured or pending)

N/A

Public contributions or donations

Loans

Your organization’s contributions

Other sources:.

$6,300.00Requested from Community Foundation

$6,300.00 100TOTAL SOURCES OF FUNDS

2. Project/Activity Expenses: How the project money will be spent.

Please place an * next to the items for which you are requesting funding from the Community Foundation.

Also list items from top to bottom in order of importance to the success of the project.Amount % of Total ProjectItem

All Transpo Van and Bus Logos $ 5,000.00 79

Transpo Shirts/Coats for Drivers $ 1,300.00 21

$6,300.00 100TOTAL PROJECT/ACTIVITY EXPENSES;

Attach copies of best estimates, contractor proposals or any information that will help the committee understand yourproject, (one copy)

3. Additional Information

● Please list other organizations where you have applied for funding:

None.

● If the Community Foundation is unable to provide your organizat|fifl with full funding, will you still be ableYesto provide this service or complete the project? _ No (check appropriate response)

REQUIRED ATTACHMENTS:

H Copy of your organization’s operating budget and copy of your program/project

budget if applicable.

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227 East 9^^ Street, P. O. Box 807Rochester, Indiana 46975

Phone: (574) 223-2227 ♦ Toll Free: (877) 432-6423Fax: (574) 224-3709 ♦ www.nicf.org

NORTHERN INDIANA

COMMUNITYFOUNDATIONSTARKE FULTON MIAMI

Verification of Charitable Use of Funds

We verify, that as a duly appointed representatives of an organization that is not a 501(c)(3)

corporation, we will use any and all funds received through the Northern Indiana Community

Foundation for charitable purposes.

If at any time, the Grant Committee or Board of the N orthern Indiana Community

Foundation, Inc. determines that the funds distributed to our organization were not used in a

charitable manner, we agree to repay those funds to the Northern Indiana Community

Foundation, Inc. for redistribution to an organization that will use them in a not-for-profit

manner.

Funds will be used for activities as outlined in the attached application.

Fulton County Council on AgingName of Organization

Diane Jones, Board PresidentPrinted name of duly appointed representative and title held within the organization

(UjJ M CnlA^7

Signature Date

Georgia Moudy, Executive DirectorPrinted name of duly appointed representative and title held within the organization

Signature 1) T f ! 6 j AOAODate

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FULTON COUNTY COUNCIL ON AGING

2020

BOARD MEMBERS

Chudzynski, Kendra 2009 Bessmore Park Road 223-0668 2018

Hudkins, Bob 1519 Briar Lane, Rochester, IN 720-469-7143 2020

Jones, Diane / President 1200 Rochester Blvd, Rochester IN 223-6601 2018

Olinger, Phil 530 Pontiac Street, Rochester IN 223-5316 2018

Shambarger, Julie 317-409-1438 20207010 W. 150 N. Rochester IN

Carla Smiley 1541 Audubon Ave. Rochester IN 574-835-2091 2023

Smith, Mart/VP 100 Arthur Street, Rochester, IN 223-2166 2020

4776 W Trails End Rd, Rochester, IN 224-2151 2020Smook, David

Sutton, Randy 1003 Arthur Street, Rochester IN 223-4489 2020

224-4600 2020Townsend, Jack 1330 Wabash Ave, Rochester, IN

President:

Vice-Pres.:

Secretary;Treasurer;

Diane Jones

Mart Smith

Phil Olinger

Randy Sutton

Dnterasil Bev@oy© Seruic© Departmen'c of the TreasuryV, 0. Box 2508

Cincinnatij Ohio 45201DistrictDirector

Person to Contact:

Harold Kirzner

Teiephono Number:513-684-3578

Refer Reply to:EP/EO:HK:efh

Date: OCT 5 197

j, Fulton County Council on Aging, InCo7th and Pontiac St.

Rochester, IN 46975

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CiN: EO; '800 0 2 3CERTIFIED MIL

“ Dear Sir or Madam;

, we determined your'July 23, 1979By our letter datedorganizatibn to be exempt from Federal income tax under section501(c)(3) of the Internal Revenue Code effective October 13, 1977

Under section 1.508-1(a)(2) of the Income Tax Regulations, an organization which seeks exemption under section 501(c)(3) of the Code must

file its exemption application within 15 months from the end of themonth in which it was organized. Since you did not file a complete

application until more than 15 months after the month you wereorganized, it is necessary for us to hold that the effective date of

, which is the date youOctober 13, 1977your exemption isfiled your completed application.

July 23, 1979 , you were givexi the oppor

tunity to protest this determination v/ith In 30 days from the date ofthe letter.

In our letter of

Since you did not protest in a timely manner, we have considered thisas a failure to exhaust available administrative x'emedies. Section

7428(b)(2) of the Internal Revenue Code provides in part that, "Adeclaratory judgment or decree under this section shall ixot be issuedin any proceeding unless the Tax Court, the Court of Claims, or thedistrict court of the United States for the District of Columbia

detennines that the organization involved has exhausted administrativeremedies available to it within the Internal Revenue Service."

Accordingly, this letter becomes our final determination.

Sincerely yours.

D.L. James, Jr.District Director

Fulton County Council on AgingPROPOSED Budget for 2020

TRANSPO (Direct

Costs) Indirect Costs

Department Number

EXPENSES

100 200

501 Labor

Operator's Salaries $215,000.00

Admin Salaries $33,000.00 $62,628.00

Dispatchers Salaries $30,000.00

RSVP

Total 501 Labor $278,000.00 $62,628.00

502 Fringe $0.00 $30,000.00

503 Services

Advertising Fees $1,400.00 $0.00

Custodial Services $2,800.00 $0.00

Legal Services $0.00 $0.00

Computer Services/Design/Program $1,000.00 $0.00

$0.00 $0.00Data Processing

$0.00 $0.00Payroll Services

$0.00 $14,000.00CPA Services

Administrative/Consulting $0.00 $0.00

$0.00 $0.00Temporary help Services

Automotive Repair/Labor $15,000.00 $0.00

$0.00Other $4,000.00

$24,200.00 $14,000.00Total 503 Services

504 Materials and Supplies

Fuel and Lubricants $55,000.00 $0.00

$5,510.00 $0.00Tires and Tubes

$0.00$7,000.00Auto Parts

$0.00 $0.00Medical/Safety Equipment

$0.00$0.00Fire Extinguishers

Office Supplies $3,000.00 $0.00

$0.00$2,000.00Janitorial Supplies

$1,000.00 $0.00Other

$73,510.00 $0.00Total 504 Materials and Supplies

505 Utilities

$6,300.00 $0.00Electric

$1,620.00 $0.00Gas

$3,370.00 $0.00Water/Sewers

$390.00 $0.00Garbage

$0.00 $4,800.00Telephone

$0.00$0.00Other

$11,680.00 $4,800.00Total 505 Utilities

506 Casualty and Liability Cost

$0.00 $0.00Facility and Property Insurance ?

$17,000.00 $0.00Vehicle Insurance

$0.00Other $0.00

$17,000.00 $0.00Total 506 Casualty and Liability Cost

507 Taxes

$50.00 $0.00Vehicle Licensing and Registration Taxes

$0.00Other $500.00

$550.00 $0.00Total 507 Taxes

508 Purchase Transportation

$0.00 $0.00Purchased Transportation Service

$0.00 $0.00Total 508 Purchase Transportation

509 Miscellaneous Expenses

Dues and Subscriptions $400.00 $0.00

$0.00Other $3,500.00

Travel and Meetings $950.00 $0.00

Fulton County Council on AgingPROPOSED Budget for 2020

TRANSPO (Direct

Costs) Indirect Costs

$450,00 $0.00Postage

Total 509 Miscellaneous Expenses $5,300.00 $0.00

512 Leases and Rentals

$6,000.00 $0.00Equipment

Facility $0.00 $0.00

Uniform/Clothing Allowance $0.00 $0.00

$0.00Other $0.00

$6,000.00 $0.00Total 512 Leases and Rentals

517 Equipment

$0,00 $0.00Equipment

$0.00 $0.00Total 517 Equipment

518 Indirect Expenses

$0.00 $0.00Indirect Expenses

$0.00 $0.00Total 518 Indirect Expenses

$111,428.00TOTAL EXPENSES $416,240.00

Fulton County Council on AgingPROPOSED Budget for 2020

TRANSPO (Direct

Costs) Indirect Costs

REVENUE

401 Passenger Fares

$54,000.00Passenger Fares

402 Special Transit Fares

$17,000.00Passenger Fares

406 Auxiliary Transportations

Advertising Services $0.00

$12,000.00Other

407 Non-Transit

$0.00Non-transit

RSVP reimbursement

Special Event income

Interest Income earned on Working Capital

Other $0.00

450 Other Contra-Expenses

proceeds from equipment sale $0.00

Cash Discounts and refunds $0.00

Insurance claims and reimbursements $0.00

State sales tax rebates $0.00

$0.00Interest Income earned on Working Capital

Other $0.00

FEDERAL

$210,822.00Federal

STATE

$122,405.00PMTF

LOCAL

General Fund Appropriations $35,000.00

Other, Unrestricted Federal/State/Local $76,441.00

$0.00n-Kind

TOTAL REVENUE $527,668.00