Board of Trustees — Skokie, IL
Date: 2013-01-07

MONDAY, JANUARY 7, 2013 – 8:00 P.M.

 1. Pledge of Allegiance led by Cub Scout Pack #85 from Middleton School.

 2. Call meeting to order and roll call.

 3. Approve Consent Agenda.

* 4. Approve, as submitted, minutes of regular meeting held December 17, 2012.

* 5. Approve Voucher List #16-FY13 of January 7, 2013.

* 6. Proclamations and Resolutions.
 A. Proclamation:
 Martin Luther King Day – January 21, 2013

 7. Recognition, Presentations and Awards.

* 8. Appointments, Reappointments and Resignations.
 A. Appointments:
 Fire Pension Board: George Van Geem, Director of Finance, Michael M. Lorge,
 Corporation Counsel
 Human Relations Commission (Three-Year Term): Dr. David Y. Ko
 B. Resignation:
 Sustainable Environmental Advisory Commission: Ben Harris

 9. Report of the Village Manager.
 A. Request for Executive Session.

 10. Report of the Corporation Counsel.
 CONSENT:
 * A. An ordinance amending Chapter 2, Article VII, of the Skokie Village Code pertaining
 to the creation of the Economic Development Commission. This item is on the
 consent agenda for second reading and adoption.
 * B. An ordinance amending Chapter 2, Article VII, Sections 2-896 and 2-902 of the
 Skokie Village Code pertaining to the Cable Television Advisory Commission. This
 item is on the consent agenda for second reading and adoption.

 11. Unfinished Business.

 12. New Business.

 13. Plan Commission.

 14. 2013-14 Community Development Block Grant Public Hearing #2.

 15. Citizen Comments.

 16. Adjournment.




421187
 WHEREAS, Martin Luther King, Jr. devoted his life to the advancement of civil
rights and public services; and


 WHEREAS, Dr. King recognized that greatness can be achieved through the
service of his or her fellow man; and


 WHEREAS, during his lifetime, Dr. King encouraged all Americans to serve
their neighbors and work to better their communities through peace and harmony; and


 WHEREAS, the citizens of Skokie honor Dr. King’s legacy each year with a
day of remembrance in January that focuses on bringing people together to break down
the barriers that divide our state and nations; and


 WHEREAS, thousands of Illinois citizens use Martin Luther King Day as a day
dedicated to community service and fulfilling Dr. King’s dream.


 NOW, THEREFORE, I, GEORGE VAN DUSEN, Mayor of the Village of
Skokie, do hereby proclaim January 21, 2013, as


 “MARTIN LUTHER KING DAY”


in the Village of Skokie, and do urge every resident of this Village to observe this week
in honor of Dr. Martin Luther King.


 Passed this 7th day of January 2013


 ___________________________________
 George Van Dusen
 Mayor

_________________________________
Marlene Williams
Village Clerk




59338
 MML: 12/17/12 1st reading
 A
 *1/7/13


 THIS ORDINANCE MAY BE CITED AS
 VILLAGE ORDINANCE NUMBER

 13-1-C-

 AN ORDINANCE AMENDING CHAPTER 2, ARTICLE VII, OF THE
 SKOKIE VILLAGE CODE PERTAINING TO THE CREATION OF THE
 ECONOMIC DEVELOPMENT COMMISSION

1 WHEREAS, Chapter 2, Article VII, of the Skokie Village Code (hereinafter “Code”)
2 provides for the establishment and regulation of Village Boards and Commissions; and

3 WHEREAS, there are 13 Mayoral Commissions serving the Village. Although the
4 scope and purpose of each Commission varies, most of them operate in the capacity of
5 advising the Mayor and Board of Trustees and making recommendation for action or policy.
6 From time to time, the Mayor reviews the status of the commission as set forth in Chapter 2 of
7 the Code; and

8 WHEREAS, pursuant to such a review, the Mayor has determined a need for a
9 Commission to make such recommendations to the Mayor and Board of Trustees and to work
10 with staff on Village matters regarding economic development in the Village; and

11 WHEREAS, the establishment of the Economic Development Commission
12 (hereinafter “EDC”) has been recommended by the Mayor. This new Commission would
13 provide input from all aspects of the Skokie business community and be representative of the
14 business community. The members would provide a sounding board, researching and
15 analyzing issues affecting economic development in the Village; and

16 WHEREAS, the duties of the EDC shall include:
17 - Make recommendations on matters relating the improvement of sound economic
18 growth and business development in the Village,

19 - Examine opportunities for fostering an attractive climate for businesses within the
20 Village with respect to both existing and potential new business establishments,

21 - Recommend additional steps and measures to promote economic growth by
22 retaining businesses and attracting new commerce and industry,

23 - Cooperate with Village elected officials and staff to realize appropriate goals and
24 objectives relating to sound business practices and better employment
25 opportunities; and

26 WHEREAS, the Mayor recommended to the Board of Trustees that Chapter 2, Article
27 VII, of the Skokie Village Code be amended accordingly; and




 Page 1 of 4
 VOSDOCS-#418749-v1-Ordinance__Code_Amendment__Chapter_2__Creation_of_Economic_Development_Commission
1 WHEREAS, the Board of Trustees at a public meeting duly held on January 7, 2013,
2 concurred in the aforesaid recommendation of the Mayor; and

3 NOW, THEREFORE, BE IT ORDAINED, by the Mayor and Board of Trustees of the
4 Village of Skokie, Cook County, Illinois;

5 Section 1: That Chapter 2, Article VII, of the Skokie Village Code be and the same
6 is hereby amended in the manner hereinafter indicated. The new material is highlighted in
7 bold and the material to be deleted is highlighted and stricken through.

8 Chapter 2 ADMINISTRATION
9 …
10 ARTICLE VII. BOARDS AND COMMISSIONS
11 …
12 DIVISION 18. ECONOMIC DEVELOPMENT COMMISSION

13 Sec. 2-950. Creation.
14 There is hereby created an Economic Development Commission for the Village
15 for the purpose of: (i) providing input from all aspects of the Skokie business
16 community, (ii) acting as a resource for elected officials and staff to explore new
17 economic development ideas and changes to Village policies, and (iii) considering and
18 introducing new economic development ideas for consideration to elected officials
19 and staff. The word “Commission”, when used in this division, shall mean the
20 Economic Development Commission for the Village.

21 Sec. 2-951. Membership.
22 The Mayor, with the advice and consent of the Board of Trustees, shall appoint
23 all members of the Commission. The Commission shall consist of 12 members. The
24 persons appointed to the Commission shall be residents of the Village or persons
25 employed within the Village or persons whose business, occupational or professional
26 activities are carried on in a substantial degree within the Village. When such
27 residence, employment or substantial activity within the Village no longer exists, such
28 members shall be deemed to have resigned from the Commission. However, the
29 Mayor may, in the Mayor’s discretion, refrain from nominating a replacement for such
30 resigned member for a period of 60 days and may submit such resigned member’s
31 name for reappointment within this 60-day period.

32 Sec. 2-952. Vacancies
33 The Mayor, with the advice and consent of the Board of Trustees, is authorized
34 to fill any vacancy on the Commission which may arise for any unexpired term.

35 Sec. 2-953. Chair and Vice Chair.
36 The Mayor, with the approval of the Board of Trustees, shall appoint one of the
37 members of the Commission to serve as chair and one to serve as vice chair, each for
38 a term of 1 year and until such person’s successor is appointed and shall take office.


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 VOSDOCS-#418749-v1-Ordinance__Code_Amendment__Chapter_2__Creation_of_Economic_Development_Commission
1 Sec. 2-954. Term of members.
2 The term of office of each member of the Commission shall be for 2 years and
3 until such member’s successor shall be appointed and shall qualify.

4 Sec. 2-955. Attendance at meetings.
5 Any member of the Commission who during any 6-month period is not present
6 throughout 50 percent or more of the regularly scheduled meetings shall be presumed
7 to have resigned form the Commission. This presumption shall be absolute,
8 irrespective of the reasons for the lack of attendance. However, the Mayor may, in the
9 Mayor’s discretion, refrain from nominating a replacement for a period of 60 days and
10 may submit such resigned member’s name for reappointment during such period.

11 Sec.2-956. Meeting schedule.

12 Commission meetings shall be shall be scheduled and held every 60 days. The
13 Chairman may schedule and hold meetings on a more frequent basis, if he or she
14 believes it is warranted.

15 Sec. 2-957. Quorum.
16 A quorum of the Commission shall consist of a simple majority of the members
17 appointed.

18 Sec. 2-958. Compensation of members.
19 The members of the Commission shall serve without compensation.

20 Sec. 2-959. Payment of expenses.
21 Expenses for the operation and conduct of the affairs of the Commission shall
22 be paid from funds provided for that purpose in the annual appropriation ordinance
23 and budget for the Village.

24 Sec. 2-960. Annual report.
25 The Commission, through its chair or other designated member, shall report in
26 writing, during the Village’s annual budget process, to the Mayor and Board of
27 Trustees. The report shall cover the activities of the Board for the preceding year.

28 Sec. 2-961. Duties.
29 It shall be the duty of the Commission to:
30 (1) Make recommendations on matters to the improvement of sound
31 economic growth and business development.
32 (2) Examine opportunities for fostering an attractive climate for business
33 within the Village with respect to both existing and potential new business
34 establishments.
35 (3) Recommend additional steps and measures to promote economic growth
36 by retaining businesses and attracting new commerce and industry.


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 VOSDOCS-#418749-v1-Ordinance__Code_Amendment__Chapter_2__Creation_of_Economic_Development_Commission
1 (4) Cooperate with Village elected officials and staff to realize appropriate
2 goals and objectives relating to sound business practices and better
3 employment opportunities.

4 Section 2: That this Ordinance shall be in full force and effect from and after its
5 passage, approval and publication in pamphlet form as provided by law.

 ADOPTED this day of January, 2013.

 Ayes:
 Nays: Village Clerk
 Absent:

 Attested and filed in my office Approved by me this day of
 this day of January, 2013; January, 2013.
 and published in pamphlet form
 according to law from January
 , 2013 to January , 2013.
 Mayor, Village of Skokie


 Village Clerk
6
7




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 VOSDOCS-#418749-v1-Ordinance__Code_Amendment__Chapter_2__Creation_of_Economic_Development_Commission
 B
 MML: 12/17/12 1st reading
 *1/7/13


 THIS ORDINANCE MAY BE CITED AS
 VILLAGE ORDINANCE NUMBER

 13-1-C-

 AN ORDINANCE AMENDING CHAPTER 2, ARTICLE VII, SECTIONS
 2-896 AND 2-902 OF THE SKOKIE VILLAGE CODE PERTAINING
 TO THE CABLE TELEVISION ADVISORY COMMISSION

1 WHEREAS, Chapter 2, Article VII, of the Skokie Village Code (hereinafter “Code”)
2 provides for the establishment and regulation of Village Boards and Commissions; and

3 WHEREAS, there are currently 14 Mayoral Commissions serving the Village.
4 Although the scope and purpose of each Commission varies, they all operate in the capacity
5 of advising the Mayor and Board of Trustees and making recommendation for action or
6 policy. From time to time, the Mayor reviews the status and duties of these commissions set
7 forth in Chapter 2 of the Code; and

8 WHEREAS, pursuant to such a review, the Mayor has determined a need to revise
9 the name and duties set forth for the Cable Television Advisory Commission. Its purpose to
10 advise the Mayor and Board of Trustees and to work with staff on Village action or policies
11 regarding telecommunications matters in the Village will remain the same. However, the
12 cable television and telecommunications industry, generally, has evolved so extensively since
13 the inception of the Cable Communications Advisory Commission that the duties of the
14 Commission should be revised to reflect these changes; and

15 WHEREAS, the Mayor has determined that since the field of communications is not
16 limited to cable anymore, a broader name for the Commission should be utilized, such as the
17 Telecommunications Advisory Commission; and

18 WHEREAS, the duties of this renamed Commission should include revised duties,
19 such as;

20 (1) Advise the Mayor and Board of Trustees on matters pertaining to telecommunications
21 and broader technology issues affecting the Village residents.
22 (2) Pursue telecommunications education for the benefit of Village residents.
23 (3) Act as a venue for public input regarding telecommunications related matters in order
24 to advise the Mayor and Board of Trustees.
25 (4) To work with Village staff, on Village actions or policies as they may relate to
26 telecommunications matters.
27 (5) Perform such other duties and functions as may be requested by the Mayor and Board
28 of Trustees.
29




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 VOSDOCS-#419191-v1-Ordinance__Code_Amendment__Chapter_2__Cable_Television_Advisory_Commission
1 WHEREAS, Mayor has recommended to the Board of Trustees that Chapter 2, Article
2 VII, Sections 2-896 and 2-902, of the Code be amended accordingly; and

3 WHEREAS, the Mayor and Board of Trustees at a public meeting duly held on
4 January 7, 2012, concurred in the aforesaid recommendation of the Mayor; and

5 NOW, THEREFORE, BE IT ORDAINED, by the Mayor and Board of Trustees of the
6 Village of Skokie, Cook County, Illinois;

7 Section 1: That Chapter 2, Article VII, Sections 2-896 and 2-902 of the Skokie
8 Village Code be and the same is hereby amended in the manner hereinafter indicated. The
9 new material is highlighted in bold and the material to be deleted is highlighted and stricken
10 through.

11 Chapter 2 ADMINISTRATION
12 …
13 ARTICLE VII. BOARDS AND COMMISSIONS
14 …
15 DIVISION 17. CABLE TELEVISION ADVISORY COMMISSION
16 Sec. 2-891. Creation.
17 There is hereby created a Cable TelevisionTelecommunications Advisory Commission for
18 the Village. The word "Commission," when used in this division, shall mean the Cable
19 Television Telecommunications Advisory Commission for the Village.
20 …
21 Sec. 2-902. Duties.
22 It shall be the duty of the Commission to:
23 (1) Advise the Mayor and Board of Trustees on matters pertaining to
24 telecommunications and broader technology issues affecting the Village
25 residents.
26 (2) Pursue telecommunications education for the benefit of Village residents.
27 (3) Act as a venue for public input regarding telecommunications related matters in
28 order to advise the Mayor and Board of Trustees.
29 (4) To work with Village staff on Village actions or policies as they may relate to
30 Telecommunications matters.
31 (5) Perform such other duties and functions as may be requested by the Mayor and
32 Board of Trustees.
33 (1) Advise the Mayor and Board of Trustees on matters pertaining to cable
34 communications within the Village.
35 (2) Promote educational and governmental  access programming. Make
36 recommendations to the Mayor and Board of Trustees regarding grants that may be
37 available from a cable operator.


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 VOSDOCS-#419191-v1-Ordinance__Code_Amendment__Chapter_2__Cable_Television_Advisory_Commission
1 (3) Recommend to the Mayor and Board of Trustees any proposed changes in the cable
2 communications franchise ordinances and agreements, and any amendments thereto,
3 or, if deemed necessary, the revocation of any cable communication franchise.
4 (4) Review applications for cable television franchises, and conduct public hearings as
5 necessary on such applications, and make recommendations thereon to the Mayor
6 and Board of Trustees concerning such applications.
7 (5) Administer any sections of the cable communications franchise ordinance and
8 agreements, and any amendments made thereto, which the Village Board shall so
9 delegate.
10 (6) Perform such other duties and functions as may be requested by the Mayor and Board
11 of Trustees.

12 Section 2: That this Ordinance shall be in full force and effect from and after its
13 passage, approval and publication in pamphlet form as provided by law.
14
 ADOPTED this day of January, 2013.

 Ayes:
 Nays: Village Clerk
 Absent:

 Attested and filed in my office Approved by me this day of
 this day of January, 2013; January, 2013.
 and published in pamphlet form
 according to law from January
 , 2013 to January , 2013.
 Mayor, Village of Skokie


 Village Clerk
15
16




 Page 3 of 3
 VOSDOCS-#419191-v1-Ordinance__Code_Amendment__Chapter_2__Cable_Television_Advisory_Commission
Overview of CDBG Proposals for FY14
Village of Skokie Community Development Block Grant (CDBG) Program
December 27, 2012
 FY13 FY14
 Award Request
 ($) ($)
Administration
  Program Funding to administer the Village’s CDBG Program, implement and monitor all projects, submit all 85,000 85,000
  Administration required documentation to HUD, and coordinate all planning activities relative to the Village’s community
 development efforts. (Activity subject to 20% administrative cap.)


Housing
 Home Improvement The Property Standards Division is seeking funding to continue the Village's program of repairing single- 110,000 95,000
 Program family homes. This program began in 1983. Low-income households (less than 50% of area median
 family income) are eligible to receive grants up to $8,000 to pay for building materials or contractors'
 services, and moderate-income households (50-80% of median family income) can receive loans up to
 $8,000 from local banks with the entire interest charges being subsidized through the program. In cases
 of emergency and life safety repairs, the Village has the ability to increase any grants to a level of
 $12,000.
 Connections for the Connections for the Homeless is seeking funding to make capital improvements to its 4840 Hull Street n/a 3,559
 Homeless property, one of the locations for the organization's Family Housing program. Proposed improvements
 include: the replacement of a damaged sidewalk that slopes towards and runs along the side of the
 home, the installation of fencing to provide safety and security for its residents, and the replacement of
 bricks in the chimney to make it stable. Connections would match the CDBG funding with $1,186 from
 other sources.




 VOSDOCS-#420412-v1-CDBG_PY13_Public_Hearings_-_Proposal_Summaries 1
 FY13 FY14
 Award Request
 ($) ($)
Infrastructure
 Street and Alley The Engineering Division is seeking funding to resurface 2 streets and an alley in a designated 150,000 150,000
 Resurfacing low/moderate-income mixed-use and multi-family residential area northeast of the Skokie Boulevard and
 Oakton Street intersection. The streets are Keating and Knox Avenues, both from Oakton Street north to
 Keeney Street. The alley is between Knox and Kilpatrick Avenues, from Cleveland Street north to
 Madison Street. The proposed improvements are located in Census Tract 8074 and Block Group #3,
 which according to the 2000 U.S. Census had a 61.1% low/moderate income population. Street and
 alley resurfacing is a high priority of the Village’s Capital Improvement Program (CIP) budget.


 Sidewalk The Engineering Division is seeking funding to provide grants to homeowners meeting low/moderate 2,000 3,000
 Replacement Program income eligibility who are required to participate in the Village’s mandatory 50/50 sidewalk replacement
 program. As the Village implements its Mandatory Sidewalk Replacement Program each year,
 low/moderate-income property owners are able to apply on an individual basis for CDBG funds to cover
 their 50% share. A simple application form is used and proof of income status is based on our Home
 Improvements Program guidelines (i.e. most recent federal tax return or proof of current earnings and
 signed affidavit).




 VOSDOCS-#420412-v1-CDBG_PY13_Public_Hearings_-_Proposal_Summaries 2
 FY13 FY14
 Award Request
 ($) ($)
Public Facilities
 CJE SeniorLife CJE is seeking funding to expand emergency generator coverage for extended power outages that 10,000 15,000
 impact the Lieberman Center for Health and Rehabilitation at 9600 Gross Point Road. During a 23-hour
 power outage in June 2011, additional critical areas were identified for emergency generator coverage,
 including: the meat freezer, fruit and vegetable cooler, meat and dairy coolers, hot boxes to keep cooked
 food at safe temperatures, and additional outlets on each floor to ensure access to medical records and
 critical medical equipment remains in continuous use. In addition, the additional coverage would ensure
 that meals, for both Lieberman residents and participants of the Home Delivered Meals program, can be
 produced during a power outage. CJE will provide $5,000 in matching funds from other sources.


 Turning Point Turning Point is seeking funding to construct a green space therapeutic playground for family and 5,000 9,750
 children's therapy for physically and mentally disabled children 0-8 years old. In addition, the playground
 is expected to be used by disabled veterans and their children to retrain wounded veterans in family play
 support. Turning Point will provide $13,035 in matching funds from other sources.


 SHORE SHORE is seeking funding to replace deteriorating carpeting/padding and vinyl sheet flooring with a 4,500 13,541
 commercial-grade tile at the Karger House CILA at 4324 Church Street. The selected tile will create a
 more safe and sanitary environment for the residents and staff, and be easier to maintain. SHORE will
 provide $4,513 in matching funds from other sources.
 Search Search is seeking funding to replace windows and doors in a group home for women with developmental 15,000 24,750
 disabilities located at 8707 Keeler. These capital improvements would increase the energy-efficiency of
 the home. Search would match the CDBG funding with $8,250 from other sources.

 Orchard Village 13,000 n/a




 VOSDOCS-#420412-v1-CDBG_PY13_Public_Hearings_-_Proposal_Summaries 3
 FY13 FY14
 Award Request
 ($) ($)
Public Services
 Social Worker The Human Services Division is seeking funding to offset the costs for a Village Social Worker position. 31,190 37,920
 The Social Worker works exclusively with low/moderate-income residents who need various types of
 case management, financial assistance, counseling, and referrals. Residents seeking financial aid are
 required to prove their income status prior to receiving any assistance from Human Services. The
 activity is designed to solely benefit low/moderate-income clientele. (Activity subject to 15% public
 service cap.)
 Metropolitan Family Metropolitan Family Services (MFS) is seeking funding to cover a portion of a counselor and intake 5,000 5,000
 Services worker/program supervisor who provides information and referral services, including grief, trauma,
 family/couple and/or parent/child relationships, child and adolescent school performance and behavior
 problems, work performance, substance abuse, individual and family development, and family violence.
 These employees support and strengthen families and individuals through counseling services that are
 offered in MFS' community-based centers, clients' homes, and school settings. MFS utilizes a solution-
 focused, time-limited approach to counseling interventions that build on clients' strengths, capacity for
 change and growth, and relationships within their families, community, work, and school settings.
 Counseling services are available to low/moderate-income clients. Each client fee is determined by the
 agency's sliding fee scale. Each client goes through financial registration at the time of intake. (Activity
 subject to 15% public service cap.)

 Center for Enriched The Center for Enriched Living (CEL) is seeking funding to provide scholarships to enable low-income 2,000 5,000
 Living Skokie residents with developmental disabilities to be fully included in the community, achieve personal
 success, and enjoy a good quality of life. While programs are fun and of great interest to participants, the
 primary objective is to alleviate the isolation and loneliness experienced by people with developmental
 disabilities. CEL accomplishes this through varied programs and activities that teach new skills and
 expose them to new activities all while enhancing their abilities to communicate with and relate to others.
 CEL programs are offered seven days a week throughout the year at its Riverwoods campus and in local
 communities, including Niles North High School. CDBG funding provides scholarship assistance for
 Skokie residents to participate in CEL programs. (Activity subject to 15% public service cap.)




 VOSDOCS-#420412-v1-CDBG_PY13_Public_Hearings_-_Proposal_Summaries 4
 FY13 FY14
 Award Request
 ($) ($)
Maine-Niles M-NASR is seeking funding to provide financial aid to enable extremely low- to low-income children and 2,000 3,000
Association of Special adult Skokie residents with developmental disabilities to opportunity to participate in therapeutic
Recreation (MNASR) recreation activities and providing their caregivers much needed respite. Program fees are reduced by
 35% to 85% for such residents. (Activity subject to 15% public service cap.)

Access to Care The Access to Care Program, sponsored by the Suburban Primary Health Care Council located in 5,000 7,000
 Westchester, Illinois, is seeking funding to provide primary medical services to low-income residents of
 suburban Cook County and northwest Chicago. This program serves low-income, suburban Cook
 County residents who are uninsured but not eligible for Medicare or Medicaid. Members of Access to
 Care may have an unlimited number of visits to their Access to Care physician, routine lab and x-ray
 services, and prescription drugs for nominal co-payments. Members pay $5 per physician office visit, lab
 specimen, and x-ray, and pay $15-$40 for prescription drugs. The requested funding would enable
 Access to Care to enroll 10 Skokie residents in the program. Funding would be used to offset the costs
 of a staff function. (Activity subject to 15% public service cap.)

PEER Services PEER Services is seeking funding to offset the costs associated with employing a half-time treatment 6,500 12,000
 engagement and retention specialist to provide outreach, clinical assessments, drug education, early
 intervention, treatment, and recovery services to Skokie teens, families, and single adults who are
 experiencing problems related to substance abuse. (Activity subject to 15% public service cap.)

Children's Advocacy The Children's Advocacy Center is seeking funding to support child victims of abuse, and their non- 2,500 3,500
Center offending family members, through expert child interviews, medical evaluations and crisis intervention
 services during the investigation of the alleged abuse. Following the completion of the investigation, the
 Center provides on-going advocacy, court support and trauma-focused counseling services to help
 children and families heal from the abuse. Services are available 24 hours a day and are offered to
 children and families free of charge. Funding is specifically being sought to help offset the costs of a
 Child and Family Advocate/Counselor position in the Child Abuse Services program. (Activity subject to
 15% public service cap.)




VOSDOCS-#420412-v1-CDBG_PY13_Public_Hearings_-_Proposal_Summaries 5
 FY13 FY14
 Award Request
 ($) ($)
The Harbour The Harbour, Inc. is seeking funding to serve the needs of homeless youth (including locked-out, 6,000 8,000
 runaway, and abandoned) ages 12-21 in the north and northwest Chicago suburbs. Agency programs
 include a Safe Harbour Emergency Shelter, Transitional Living Program (TLP), Independent Living
 Program (ILP), and Successful Teens/Effective Parents (STEPs). The funds will be disbursed among the
 four programs to offset the costs associated with staff functions. (Activity subject to 15% public service
 cap.)
North Shore Senior The NSSC is seeking funding to offset the staffing costs associated with providing long-term case 8,000 10,000
Center (NSSC) management and counseling services to Skokie’s homebound, low-income elderly and their families.
 These services are carried out by the Evanston/Skokie Valley Senior Services, a satellite operation of
 North Shore Senior Center. Services include formal assessments, assistance in applying for public
 entitlements, arranging medical appointments, counseling services, case management, and follow-up
 home visits. (Activity subject to 15% public service cap.)

JCFS Jewish Child and Family Services (JCFS) is seeking funding to support a Financial Assistance Case n/a 10,000
 Manager position. The overall goal of the financial assistance program is to empower low-income
 Skokie residents to create more stable environments. The position was created in 2009 to address the
 outcomes of the current economic climate. Such workers assist clients in accessing resources they
 need to regain and maintain financial stability. Services include a complete financial assessment, an
 understanding of causes and conditions that lead to a financial crisis, an increase in access to resources,
 and financial assistance. (Activity subject to 15% public service cap.)


 FY13 FY14
 Total Total
 Award Request
 462,690 501,020




VOSDOCS-#420412-v1-CDBG_PY13_Public_Hearings_-_Proposal_Summaries 6
Funding Analysis of CDBG Proposals for FY14
Village of Skokie Community Development Block Grant (CDBG) Program
December 27, 2012
 Amount ($)

 Estimated Entitlement from HUD 425,000
 Unallocated Funds from FY12 76,235 unallocated FY12 balance (actual amount: 76,235.34)
 Unallocated Funds from FY13 1,521 unallocated 50/50 sidewalk balance
 Program Income during FY13 2,240 income from 2 Home Improvement Program home sales
 Subtotal 504,996

 Recommended Minimum Balance to be Retained 41,310

 Estimated Budget 463,686

 Village Proposals 370,920
 Other Proposals 130,100
 Total 501,020

 Administrative Activities 85,000
 Public Service Activities 101,420
 Other Activities 314,600
 Total 501,020

 Administrative Activities 85,000
 Administrative 20% Cap (estimate) 85,000
 Surplus/Reduction 0

 Public Service Activites 101,420
 Public Service 15% Cap (estimate) 64,086
 Surplus/Reduction -37,334 Reduction required.

 Other Activities 314,600
 Estimated Budget Available (1) (2) 314,600
 Surplus/Reduction 0

 Notes:
 (1) Assumes full funding of the administrative activities and public service activities caps.
 (2) Dependent upon projects meeting CDBG eligibility requirements and meriting funding.
Community Development Block Grant (CDBG) Program
Fiscal Year 2014


Village of Skokie Proposals
Memorandum
Community Development Department, Property Standards Division

TO: Tom Thompson
 Economic Dcvelo~~i·r
 rect 1 ,

FROM: Terry Oline ~
 Property Standards S upe r

DATE: December 3, 2012

SUBJECT: CDBG Home Improvements Program
 ReviewFY13
 Funding Request FY 14

Year to date the Program has funded grants to ten homeowners for approved repairs. Tills
represents a slight decrease in Program activity from last year. It is anticipated that additional
applications will be approved this fiscal year.

A total of fifteen projects have been completed. Projects completed include private lateral sewer
line repairs and replacement roofs and windows.

I request a funding allocation of$95,000 for FYI4. Please contact me if you need any additional
information.




 VOSDOCS.-#419121-v !-Hip_Fy _13 ]unding_

 1 of I
Memorandum
Engineering Division

To: Thomas L. Thompson, Economic Development/CDBG Coordinator


From:


Date: December 3, 2012

Subject: CDBG Program
 FY14 Request
 Street Resurfacing



Tire Engineering Division has updated the analysis of existing pavements in the Village and has
identified the FY14 CDBG Street Resurfacing Program based on the condition of the streets and
alleys. The following street and alley sections are in census tracts eligible for Community
Development Block Grant Funding.

TRACT STREET LENGTH(FTl SY COST

8074-3 Keating Ave.- Oakton St. to Keeney St. 558 1,984 $51,000

8074-3 Knox Ave. - Oakton St. to Keeney St. 724 2,707 $70,000

8074-3 Alley west of8200 Knox Ave. 600 I 070 $29 000

 Total= 1,882 FT 5,761 $150,000
 (0.36 mi)

I request that CDBG Funding in the amount of$150,000 be allocated to this resurfacing project in
FY14. Please contact me if you have any questions.




PWR

cc: Max Slankard, Director of Public Works
 Frederick Schattner, Director of Engineering
 Pete Peyer, Community Development Director
 Paul W. Ryan, Civil Engineer




 Doc.# 85902v14
.-------~~~~----·-··········· ------




 2013 CDBG STREET RESURFACING
 PROGRAM




i STREETS FOR RESURFACING
 KEATING AVE. ....... OAKTON ST. TO KEENEY ST. LEG EN D: AIIfl1lllllnrun
 KNOX AVE ......... OAKTON ST. TO KEENEY ST. ~RESURFACING NORTH

 ALLEY FOR RESURFACING
 ALLEY: 8200 BLOCK, W. OF KNOX AVE.


 - ----------····-···--- -- --------· - ----·
Memorandufl!
Engineering Division

TO: Thomas L. Thompson, Economic Development/CDBG Coordinator

FROM:
 Erik P. Cook, P .E., Senior Civil Engineer


SUBJECT: FY14 CDBGAPPLICATION -SIDEWALK REPLACEMENT PROGRAM

DATE: December 3, 2012

Public Works will continue its Sidewalk Replacement Program in FY14 and anticipates
low/moderate-income households needing assistance with their 50% share ofthe sidewalk
replacement costs. Replacement activities will be focused in an area bound by Church Street to
the north, Dempster Street to the south, and the eastern and western Village limits. There are also
areas of sidewalk within the limits of The Village of Skokie that will be replaced upon property
owners request at a 50% share cost.

I request CDBG funding in the amount of$3,000 be allocated for our Sidewalk Replacement
Program. Please contact me if you have any questions.

CC: Bonnie Hennelly




 VOSDOCS-#41883 7 -vl-FY 14_CDBG_ S1dewalk __ mcmo _to .. rom__ ·-r·hompson
MEMORANDUM
HUMAN SERVICES



TO:


FROM:
 r11~n N. Murphy '
 Director, Human Services

DATE: November 30, 2012

SUBJECT: 2012 CDBG Funding Request


The Human Services Division provides social work services to some of Skokie's
most vulnerable residents. This fiscal year, the CDBG program provided 50%
funding in the amount of $30,074 for one of the full time Human Services social
work positions. From May 1, 2012 through October 31, 2012, 162 low income
residents were assessed for emergency financial assistance. The number of
hours spent consulting with these residents represents approximately 60% of the
social worker's hours on the job. As the number of low income residents seeking
service is anticipated to increase, I respectfully request funding in the amount of
$37,920 to continue to fund this position at 60%.

Please do not hesitate to contact me should you have any additional questions.
Community Development Block Grant (CDBG) Program
Fiscal Year 2014


Public Facility/Construction Proposals
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SHEET


Project Title: Hull St. Residence Improvements

Project Description (150 words maximum): Connections seeks funding to (a) replace a sidewalk
 that runs along the house, as it is badly sloped and
 forces rain and snow melt waters into the house's
 basement; {b) install two fences and gates in the
 backyard of the property to curtail trespassers using the
 house's yard as a cut-though from the alley to Hull St,
 thus providing improved security for the proprty and its
 residents; and (c) replace 50 bricks on the house's
 chimney to stabilize it.

Project Address: 4840 Hull Street, Skokie, IL


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $1,186
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $ 3,559

 Total Estimated Project Cost: $4745


 Public Services:
 Total CDBG Funding Request: $




 Contact Information
 Organization Name:
 Contact Name, Title:


 Signature:


 Mailing Address 1: 2121 Dewey Avenue
 Mailing Address 2:
 City, State, Zip: Evanston, IL 60201
 Telephone Number: 847-475-7070
 Fax Number: 847-864-6558
Skokie CDBG FY13 Applicationv3.doc
Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


 Email Address: ps@cfthinc.org




Skokie CDBG FY13 Applicationv3.doc
Page2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 0 (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 0 (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 ~ (C) Benefits Housing (go to #5)
 0 (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 0 Prevents or Eliminates Blight on an Area Basis (go to #7)
 0 Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%) $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members18 years old or older that contribute to the household. The
 extremely low, very low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birlh, marriage, or adoption.



3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)




Skokie CDBG FY13 Applicationv3.doc
Page3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting from
 the project or program for which you are requesting funding. The totals in the blue cells must match. The totals in the orange cells must match.


 """·-· · · ---·· ~~~-~~--.,
 -. . . - 31%to . --------Above ········---------------·- .~-t~-~-~~~l.b.~~-~~~--- --·-· ··-------------· --- "'"' •·-----------· · -· · ~~~-~------- . --- ------- -· -Mixed
 ------------· ___________Total
 ,._,.______ _ Female-
 Below 51%to Total Yes · No · Total White Blacker Native Asian · American · Headed
 30% 50% 80% 80% African- Hawaiian Indian or Race Households
 (all others) American or Other Alaskan
 Pacific Native
 Islander
 People

 Skokie
 Residents




5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the bluegells must match.


 s·eiOW .. """"" .. 31 %to
 Income
 5Hrto: -····-··Asov·e ·-r·-- -TOi8"1"···' r.
 Hispanic I Latino
 y·es. . ·-·"·""""""""Na····r. . . . --·"··Totai··-·t . . . .--White··· BiaCkor
 Race
 Natrve·-···,··· --·;;:sran· . . Amerrcan·. . MiXed·'""" Total
 Female-
 Headed
 30% 50% so% \ so% African- Hawaiian Indian or Race Households
 (all others) American or Other Alaskan
 Paciftc NaUve

 l Households
 5i 5 5 i 5 51
 Islander
 5 2


6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or prcgram for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.

 Total Full-Time Total Part-Time Total Part-Time Expected low- Expected low-
 Jobs Jobs Weekly Hours Income Full-Time lrtcome Part-Time
 Hires Hires




Skokie CDBG FY13 Applicationv3.doc
Page4
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project. (Please select only one.)

 Anti-Crime Programs Senior Programs
 D Crime Awareness D Senior Centers
 D Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 D Micro-Enterprise Assistance D Youth Centers
 D Child Care Centers
 Non-Homeless Housing D Youth Services
 D Renter- Elderly D Child Care Services
 D Renter- Small Family
 D Renter- Large Family Homeless Individuals
 D Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 D Sidewalks D Housing Placement
 D Tree Planting D Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical improvement Projects) D Emergency Shelter
 D General Public Facilities D Transitional Housing
 D Handicapped Centers D Job Training
 D Parks/Recreational Facilities D Case Management
 D Parking Facilities D Child Care
 D Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Services (8] Housing Placement
 (Administrative Support Activities) D Life Skills Training
 D General Public Services
 D Handicapped Services
 D Transportation Services
 D Employment Training
 D Health Services
 D Mental Health Services
 D Screening for Lead-Based Paint




Skokie CDBG FY13 Applicationv3.doc
Page5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


8. Special Needs
 Check below if the proposed programming is seliling any of these Special Needs Populations:
 (Please select all that apply.)

 0 Elderly
 0 Frail Elderly
 0 Severe Mental Illness
 0 Developmentally Disabled
 ~ Physically Disabled
 ~ Substance Abusers
 ~ Persons with HIV/AIDS
 ~ Victims of Domestic Violence

 Comments: The housing units at hand in this proposal are used as supportive housing for families in
 Connections' Family Housing program. Families in this program are headed by single mothers who
 are victims of Domestic Violence and suffer PTSD as a result. From time to time, depending on the
 families living there, individuals may also be physically disabled, suffer from substance abuse, and
 have HIV/AIDS, as these conditions are all prevalent in our family housing client population.


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 The mission of Connections is to provide housing, employment and supportive selilices to move individuals and
 families out of the shadow of homelessness. We prevent people from losing their homes and house those who
 have already lost it, while providing selilices to promote maximum self·sufficiency.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 Connections seeks funding for three housing improvments on a property that we own and use for families in our
 Family Housing program. (1) The sidewalk that runs along the side of the building is badly damaged, and tilts in
 towards the building. This forces water from rain and melting snows to drain into the basement, creating fiooding,
 water damage, and negatively impacting livability for residents. We want to replace the entire sidewalk with level
 concrete. (2) There is no fencing for the backyard of the building and people use this as an invitation to walk
 from the alley to Hull St (and vice-versa), damaging the yard and jeopardizing the safety and security of the
 residents who often are confronted with strangers cutting through the yard. We would like to build two fences -
 one from the side of the building to the existing fence along the property line with a gate and one from the side of
 the garage (behind the building) to the existing fence along the property line, also with a gate- to create a fenced
 in backyard that keeps trespassers out by removing access between the alley and Hull St. (3) The chiminey is in
 disrepair and requires 50 bricks to be replaced and to shore up its stability.

 All three of these activities will increase the livability and long-term stability of the building. By eliminating
 flooding, livability is increased by providing a dry basement no longer susceptable to water and mold damage
 and contaminations. By stabilizing the chimney, the chimney and surrounding roof are made secure by
 preventing the chimney from collapse. And by installing a fence to create a fenced in yard with gates, security for


Skokie COBG FY13 Applicationv3.doc
Page5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 the property and its residents is increased by eliminating trespassers who currently use the property's lack of
 fencing as a route between the alley and Hull St.


11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 The project meets the CDBG objectives by providing necessary funding to maintain two livable housing units as
 residences for families with extremely low income (below 30% MFI). These residences provide supportive
 housing for populations specifically identified in Skokie's 2010-2014 Consolidated Plan: all families are headed
 by single mothers who are victims of domestic violence and the population that this housing serves includes
 residents with mental and/or physical disabilities.

 Connections has been providing supportive housing/homeless prevention services for extremely low income
 Skokie residents for over two decades, providing hundreds of thousands of dollars in rent/utility subsidies to
 residents living in the Village. Connections works to solve homelessness through a "housing first" model (of
 which this project plays a role); by keeping people housed, supportive services such as employment/job-training
 have been shown to be more successful in alleviating homelessness by raising income and providing a path to
 long-term housing security.




Skokie CDBG FY13 Applicationv3.doc
Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How manv people are Skokie residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 Determining residency for homeless people can be difficult, as they are transient due to lack of permanent
 housing. All clients housed through this residence will be Skokie residents upon being housed. The two
 units each can hold up to 4 people, for a total of 8. Connections manages a Homeless Management
 Information System that tracks all case management interventions and records goals and case plans. We
 have a property manager and finance department that track all housing improvements and collect rent.

 B. What do you consider to be a unit of service? (Please select only one.)

 D One client, many times
 !:><:] One client, one time
 D Multiple clients, one time
 D Other (Please describe.)
 C. What types of service(s) are included? (Please select all that apply.)

 D Phone counseling
 !:><:] In-office counseling
 D Nights of service
 !:><:] Home visits
 !:><:] Other (Please describe.) Connections provides clients, including those in Family Housing
 (which is the client population being addressed through this
 proposal) extensive case management services designed to address
 each client's specific set of barriers that prevent achieiving long-term
 housing stability. These include, but are not limited to, addressing
 health (mental and physical), educational, legal, children's
 educational issues, and other issues. Connections operates a broad
 Employment Services program and a Job Training program designed
 to find living-wage employment for its clients, including those living
 at the Hull St. property. Connections also provides short-
 term/stabilizing health services and linkages to longer-tenn public
 and private health care providers for all of its clients.

 D. What types of tangible services are provided? (Please select all that apply.)

 !:><:] Food
 !:><:] Housing/shelter
 !:><:] Clothing
 !:><:] Emergency Funds
 !:><:] Other (Please describe.) Connections provides Employment Services (resume development, job
 search skills, assistance, and strategies, job interview skills building,
 financial education, to clients in Family Housing (including those at the Hull
 St. residence). Connections subsidizes their housing (rent, utilities) while
 they work with case managers to address their edcuational and employment

Skokie CDBG FY13 Applicationv3.doc
Page 7
Village of Skokie
Community Development Block Grant (COBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 issues, and provides all clients with access to healthcare either through our
 own services (short-term stabilization health services) or through linking
 clients to long-term healthcare provision in both the public and private health
 arenas.




Skokie COBG FY13 Applicationv3.doc
Page 8
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 D Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 ~ Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 wourd be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)
 ----------------,---,.----:-:-::-~------=-----:------:-:------:-----:-:--::,.------------,

 When selecting an outcome, ask: What type of change or result am I seeking?


 ~ Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 D Affordability
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook~ups, or services such as transportation or day care.
 Affordability is an appropriate objective whenever an activity is lowering lhe cost, improving the quality, or increasing lhe affordability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 low/moderate-income microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of the loan, enabling entrepreneurs to slart businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 D Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




Skokie CDBG FY13 Applicationv3.doc
Page9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 Q1 May: Solicit contracts from identified contractors (bids are already received)
 June: Begin work
 July Complete Work
 Q2 August:
 September:
 October:
 Q3 November:
 December:
 January:
 Q4 February:
 March:
 April:


16. other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 Connections has some reserves which are in part from IHDA and part from rent set asides. If funds are not
 provided through CDBG for this request .we will have to use the reserves and will return to CDBG for the next
 major system improvement


17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 Connections has never done a project in Skokie using CDGB funding.




Skokie CDBG FY13 Applicationv3.doc
Page 10
Village of Skokie
Communily Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 ~ Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 ~ Budget (including REVENUE and EXPENSE line items for the proposal)
 ~ Latest Agency Budget
 ~ Latest Agency Independent Financial Audit
 ~ Blank Income Verification Form
 ~ Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 0 Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 0 Activity Programs Brochure with Fee Schedule (scholarship, public service activities only)
 0 Other (Please describe.)




Skokie CDBG FY13 Applicationv3.doc
Page 11
For Office Use Onl ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT form AG990-IL
 Revised 3/05
 PMT# Attorney General LISA MADIGAN State of Illinois
 Charitable Trust Bureau, 100 West Randolph CO# 01-021140
 11th Floor, Chicago, Illinois 60601 Check all items attached:
 AMT Report for the Fiscal Period: [X] Copy of IRS Return
 Make Checks [X] Audited Financial Statements
 Beginning 07/01/2011 Payable to D Copy of Form IFC
 INIT the Illinois [X] $15.00 Annual Report Filing Fee
 & Ending Charity
 06/30/2012 Bureau Fund D $100.00 Late Report Filing Fee
federaiiD# 36-3346917 MD  DAY YR MD DAY YR
Are contributions to the organization tax deductible? [X] Yes D No wsreatd·
 ae Drgamza f1on a c
 Dt e. 12/17/1985
 LEGAL Year-end
 NAME CONNECTIONS FOR THE HOMELESS, INC. amounts
 MAIL A) ASSETS A)$ 1,501 881.
 ADDRESS 2121 DEWEY AVENUE B) LIABILITIES B)$ 247,981.
 CITY, STATE EVANSTON, IL C) NET ASSETS C)$ 1 253 900.
 ZIPCODE 60201
 I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR: PERCENTAGE AMOUNT
 D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.) 31.712% D)$ 1 296 342.
 E) GOVERNMENT GRANTS & MEMBERSHIP DUES 68.004% E) $ 2 779 916.
 f) OTHER REVENUES 0.284% f) $ 11 612.

 G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, & f) 100% G)$ 4 087 870.
 II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H) OPERATING CHARITABLE PROGRAM EXPENSE 79.281% HI$ 2 492 089.
 I) EDUCATION PROGRAM SERVICE EXPENSE % I) $

 J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H& I) 79.281% J) $ 2 492 089.
 J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): $

 K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS % Ki $

 L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) 79.281% L) $ 2 492 089.

 M) MANAGEMENT AND GENERAL EXPENSE 11. 581% M)$ 364 045.

 N) FUNDRAISING EXPENSE 9.138% ~) $ 287 245.

 0) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N) 100% 01$ 3 143 379.
Ill. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
 (Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.)
 PROFESSIONAL FUNDRAISERS:
 P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS 100% P) $ 0.

 0) TOTAL FUNDRAISERS FEES AND EXPENSES % Q) $

 R) NET RECEIVED BY THE CHARITY (P MINUS Q"R) % R) $
 PROFESSIONAL FUNDRAISING CONSULTANTS:
 S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS S) $ 0.
IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
 T) NAME, TITLE:PAUL SELDEN, EXECUTIVE DIRECTOR T) $ 91 850.
 U) NAME, TITLE:DAN CHEN COMPTROLLER U) $ 64 890.
 V) NAME, TITLE:SUSANNE LOELLBACH DIRECTOR OF DEVELOPMENT V) $ 60 000.
v. CHARITABLE PROGRAM DESCRIPTION: g~~~rb~~~~6~?E~RAM (3 HIGHEST BY$ EXPENDED) List en bacl1 side of Instructions

7
 CODE
9 W) DESCRIPTION: PROVIDE SHELTER FOR THE HOMELESS W)# 131
" X) DESCRIPTION: PROVIDE SERVICES FOR THE HOMELESS X)# 126
- Y) DESCRIPTION: ADVOCACY FOR THE HOMELESS Y) # 300
 IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: YES I NO


 1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? 1. I X
 2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY
 COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY? 2. lx
 3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY Of ITS OffiCERS,
 DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE
 ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. I X
 4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OffiCER, DIRECTOR OR TRUSTEE OWNS MORE
 THAN 10% Of THE OUTSTANDING SHARES? 4. lx
 5. IS ANY PROPERTY Of THE ORGANIZATION HELD IN THE NAME Of OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON
 OR ORGANIZATION? 5. lx
 6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC) .. 6. lx
 la. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS
 BETWEEN PROGRAM SERVICE AND fUNDRAISING EXPENSES? 7. I X
 lb. IF 'YES', ENTER (i) THE AGGREGATE AMOUNT Of THESE JOINT COSTS$ ; (ii) THE AMOUNT
 ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND
 GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $

 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? .. 8. lx
 9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR
 REVOKED BY ANY GOVERNMENTAL AGENCY? . 9. lx
 10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANYTHEFT, DEFALCATION, MISAPPROPRIATION,
 COMMINGLING OR MISUSE Of ORGANIZATIONAL FUNDS? 10. lx
 11. LISTTHE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
 THREE LARGEST ACCOUNTS:

 FIRST BANK & TRUST OF EVANSTON 820 CHURCH STREET, EVANSTON, IL 60201

 URBAN PARTNERSHIP BANK P 0 BOX 19260 CHICAGO IL 60619

 NORTH SHORE COMMUNITY BK & TRUST, 1145 WILMETTE AVE WILMETTE IL 60091

  12. NAME AND TELEPHONE NUMBER Of CONTACT PERSON: DANI CHEN - (847)475-7070

  ALL ATTACHMENTS MUST ACCOMPANYTHIS REPORT- SEE INSTRUCTIONS

UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED
DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE
ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE Of ILLINOIS RELY TH E PON. I HEREB~ FURTHER AUTHORIZE AND
AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION Of THE STATE OF ILLINOI .

  BE sURE To I NC LUD EAlL FEEs oUE: aco.l!AJJ1
 f3;J:(..Lf!ci1'-'t-eo:" _ ,L: : .: :ec: co:._Yl~()C.' r__,(l::__(_ _ _+-'""-''llLl1..13E--':'-fli:JJE,1L:-~-.J..L,f-J.7-/./Li"J-.=.
  1.) REPORTS ARE DUE WITHIN SIX PRESIDENT or TRUSTEE (PRINT NAME) DATE
 MONTHS Of YOUR FISCAL YEAR END.
  2.) FOR FEES DUE SEE INSTRUCTIONS.
  3.) REPORTS THAT ARE LATE OR
 INCOMPLETE ARE SUBJECT TO A
 $100.00 PENALTY.
 KAREN OLSON
198101
05·01-11 PREPARER (PRINT NAME) SIGNATURE DATE
Connections for the Homeless Budget for Housing Repair: Skokie CDBG



Expense



Remove & replace existing sidewalk 2850
Remove & replace 50 bricks from chimney 590
Install 51 feet of 4 foot high galvanized fence w/ 2 gates 1305

Total Expense: 4745




Revenue:

Skokie CDBG (75% of project expense) 3559
Organizational Match (25% of project expense) 1186

Total Revenue 4745
 ~ V\ €6{1 QY\0
 Budget Budget Budget Budget Budget Budget Budge! Budget
 Family Developmen
 FY13 Re-Housing Prevent PSH Housing Com. Ed HMIS G&A . t

Support and Revenues
 Government $ 1,785,900 58%
 Foundations $3 17,800 10%
 Religious Community $50,200 2%
 Individuals $615,100 20%
 Organizations $59,800 2%
 Corporations and business $150,100 5%
 United Way $60,000 2%
 Fund raising events -$70,000 -2%
 Gifts in Kind $44,200 1% $10,200 $1,000 $32,000 $1,000
 Contracted Revenue $0 0%
 Miscellaneous $57,000 2%
 Interest $0 0%
 Other Income (IHDA NSP credit) lQ. 0% ill iQ iQ iQ iQ iQ 10. iQ
 Total Support and Revenue $3,070,100 $10,200 $0 $1,000 $32,000 $0 $0 $1,000 $0


Expenditures
 Salaries $1,422,500 47% $590,200 $88,900 $93,500 $225,000 $59,000 $25,300 $162,700 $177,900
 Fringe $307,200 10% $127,500 $19,200 $20,200 $48,600 $12,700 $5,500 $35,100 $38,400
 Professional Fees $103,600 3% $24,600 $600 $2,100 $10,100 $0 $4,800 $50,500 $10,900
 Occupancy $497,400 16% $62,000 $5,400 $144,100 $230,000 $0 $900 $37,000 $18,000
 Repair and Maintenance $17,600 1% $8,600 $0 $400 $6,400 $0 $0 $2,000 $200
 Telephone $32,200 1% $6,300 $600 $1,400 $3,700 $200 $11,000 $5,900 $3,100
 Insurance $20,400 1% $4,700 $0 $1,800 $4,900 $0 $200 $8,300 $500
 Supplies $24,600 1% $15,300 $0 $3,200 $5,700 $0 $0 $0 $400
 Assistance to Individuals $398,900 13% $219,300 $152,200 $10,500 $16,900 $0 $0 $0 $0
 Transportation $32,400 1% $26,600 $200 $0 $5,600 $0 $0 $0 $0
 Office Supplies $17,200 1% $4,800 $400 $300 $800 $200 $1,100 $3,100 $6,500
 Equipment $22,600 1% $5,700 $0 $1,500 $8,800 $0 $500 $1,800 $4,300
 Recruiting $600 0% $100 $0 $100 $200 $0 $0 $100 $100
 Interest Expense $2,800 0% $0 $0 $0 $0 $0 $0 $2,800 $0
 Training, Conferences, Meetings $10,300 0% $2,600 $300 $700 $2,200 $0 $500 $2,000 $2,000
(){)nVI€-C;\l'tl't0
Postage $10,100 0% $300 $300 $700 $300 $0 $0 $1,000 $7,500
Printing $17,200 1% $300 $0 $0 $100 $0 $0 $1,100 $15,700
Miscellaneous $80,500 3% $12,100 $800 $2,100 $52,100 $0 $0 $4,500 $8,900
Total Expenses $3,018,100 $1,111,000 $268,900 $282,600 $621,400 $72,100 $49,800 $317,900 $294,400
Depreciation $45,800
Expenses with Depreciation $3,063,900
 HYNEKCONSTRUCTION
9101 Oak Park, Morton Grove, 60053 Cell: 773 339 7326 Fax: 847 5811639
  e-mail: hynek75@msn.com Please visit the website: www.hynekconstruction.net


July 29, 2012 Costumer# 1875


David Moreno
4840 Hull St
Skokie IL 60077


We, the undersigned, agree to do the following work on the building located at:
4840 Hull St, Skokie

Buss tell:847 492 4313 Email:drn@cfthinc.org Cell tell:847 630 3335

$2850,- Remove existing side sidewalk ( 3' x 114'), Install from and pour with min
4000psi concrete mix new 4 inch thick concrete sidewalk on 4 inch compacted stone
base.
Concrete will have brushed finish for slip resistance
Concrete will be sealed with a two part cure and se>al
$590,- Replace 50 bricks on middle part of back chimney.


To Start sign contract, down payment of 50% must be paid on the first day of the job.

Mortar will by mixed by hands using: sand, cement, lime and latex with right proportion
for extra strength and longer life. Color of mortar will be mixed to better blend in to
original, or any palette of customer request. All rubbish and debris will be hauled away.
All work to be done in fine workmanship manner.

This agreement shall become binding only upon the written acceptance hereof, of the
property owner or his duly authmized agent.

 FULLY INSURED MEMBER OF ANGIE'S LIST

HYNEK SEDLACEK PROPERTY OWNER OR AGENT



 Date._ _~+--
 FAX COVER SHEET


 DATE:----~8_-~1~4_-~1~2-


CONTACT PERSON_______M_R__D_A_V_E__M_O_R_E_N_o__________________________


SENT FROM~___P_E_R_R_Y__R_A_U_P_P-------------------------------------




PROJECT__~5~1~'~0~F~4~'~H~I~G~H~A~L~L~G~A=L~V~A~N~I~Z=E~D_C~,L~F~E~N~C~E~W~I~T~H~-------


COMMENTS____2_-__
 4_'_G__
 AT E_S__T_E_R_M_I_N_A_L__P_o_S_T_s_'_2~~~·-'_L_I_N_E__P_o__
 __ ST__s__z_"_________



 TOTAL PRICE IS $1305.00 THANK YOU VERY
 MUCH.,




 .. ;·· ·- ..... ~~
FAX SENT FROM RAUPP FENCE COMPANY 847-253-6545.
THANK YOU VERY MUCH,




 000000000000 "ON 3NOHd
 !+ I I ,




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 sAck~e.;T/
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SHEET


Project Title: Expansion of Emergency Generator Coverage

Project Description (150 words maximum): Liebenman Center has an emergency generator that
 activates during power outages and provides
 emergency power to many areas throughout the
 building. During an extended power outage in June
 2011, additional critical areas were identified for
 emergency generator coverage. The goal of this project
 is to expand the emergency generator coverage to allow
 key operations and resident/patient care to continue
 seamlessly during a power outage.

Project Address: Lieberman Center for Health and Rehabilitation
9700 Gross Point Road
Skokie IL 60076


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $ 5,000
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $15,000

 Total Estimated Project Cost: $20,000


 Public Services:
 Total CDBG Funding Request: $ 15,000




 Contact Information
 Organization Name: Council for Jewish Elderly, doing business as CJE Seniorlife
 Contact Name, Title: ive Director of Lieberman Center


 Signature:


 Mailing Address 1: 9700 Gross Point Road
 Mailing Address 2:
 City, State, Zip: Skokie IL 60076

 CDBG_FY13_Application_FINAL
 Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 Telephone Number: 847.929.3211
 Fax Number: 847.929.3290
 Email Address: ron. benner@cje. net




 CDBG_FY13_Application_FINAL
 Page 2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)



CDBG PROPOSAL- APPLICATION
All items must be addressed to receive any consideration for funding,

1, National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 L8J (B) Benefits Specific and Limited Low-Income Clientele (goto#4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 D Prevents or Eliminates Blight on a Spot Basis (go to #7)


2, Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members18 years old or older that contribute to the household. The
 extremely low, very low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birth, marriage, or adoption.



3, Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)




 CDBG_FY13_Application_FINAL
 Page 3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


4, Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers to.be listed below are the numbers of unduplicated individuals benefiting from
 the project or program for which you are requesting funding. The totals in the blue cells must match. The totals in the orange cells must match.


 "_" ______ ". . . . . ........... ______ . . . . ..!~-~-~-'!1-~---···· ...............----------- .. . . . . . . . . . . . . . __ "-···· . ~.!.~.P.~-~i_~L~-~1.!.~-~. -- "" . ._. . . ------· -· · · · · ·--· --------------"·"·"·"· · . . . . . . . . -----" """ ..... R.~~-~--"·"···· . . . . . . . . . . .------"-· . . . . . . . . . . . . . . . ____ ."'"'". . . . . . . . Female-
 Below i 31%to i 51%1o i Above i Total Yes ! No 1 Total White i Blacker ! Native : Asian i American ! Mixed ! Total Headed
 30% i 50% 80% i 80% African- ' Hawaiian i Indian or i Race : Households
 (all others) J American ' or Other j Alaskan ! ·
 · Pacific : Native !
 Islander ;
 500*
 Ooes
 not
 includ
 [ .e~3 175"
 i ' ~Jeber Lieberman
 . c
 'c":enman
 ter
 ,. . enter
 People I 339 i 82 i 36 i 43 ! shc>rt 8 525 533 423 93 0 16 1 0 resJdents/p
 . ·~. ~n

 ~In
 rt i~~~
 ~
 s or
 . ~~~ .
 .Whom

 I ~(t:~
 the
 payer,
 268 ' 36 " See
 SkoWe 1 : , See
 ""'dents 192 : 18 15 ; 43 note 3 298 301 288 4 0 9 0 0 301 note
 above: above.



5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to be listed.below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the blue cells must match.


 !..... Income '" ....".................. .! ......". ___ "t!~.~.P.?..I!!~J-~.~.!.t~.~ ..........."."...J-·-·-·"·"..:.... Race ."................ J Female- I
CDBG_FY 13_Application_FINAL
Page4
 Village of Skokie
 Community Development Block Grant (CDBG) Program
 Program Year 2013Application (Term: May 1, 2013, through Apri130, 2014)


 51
 "i0:~ io~ A~~~
 Yee Headed
 ~~~~~ Ha~:i:~~
 Below Tote! No Iota! White Iota!
 ~~~~~~~ ~~~~
 ASian
 30% Households
 (all others) American or Other Alaskan
 Pacific Native
 Islander
 i
 j Households .·.· ... > ..••
 _.:.:_ __:
 6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.

 Total Full-Time Total Part-Time Total Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time Income Part-Time
 Hires Hires




CDBG_FY 13_Application_FINAL
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project (Please select only one.)

 Anti-Crime Programs Senior Programs
 D Crime Awareness D Senior Centers
 [81 Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 D Micro-Enterprise Assistance D Youth Centers
 D Child Care Centers
 Non-Homeless Housing D Youth Services
 D Renter- Elderly D Child Care Services
 D Renter- Small Family
 D Renter- Large Family Homeless Individuals
 D Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 D Sidewalks D Housing Placement
 0 Tree Planting D Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) D Emergency Shelter
 D General Public Facilities D Transitional Housing
 D Handicapped Centers D Job Training
 D Parks/Recreational Facilities D Case Management
 D Parking Facilities D Child Care
 D Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Services 0 Housing Placement
 (Administrative Support Activities) D Life Skills Training
 D General Public Services
 D Handicapped Services
 D Transportation Services
 0 Employment Training
 D Health Services
 0 Mental Health Services
 0 Screening for Lead-Based Paint




CDBG_FY 13_Application_FINAL
Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 1:8:1 Elderly
 1:8:1 Frail Elderly
 D Severe Mental Illness
 D Developmentally Disabled
 D Physically Disabled
 D Substance Abusers
 D Persons with HIV/AIDS
 D Victims of Domestic Violence
 Comments:


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 The mission of CJE Seniorlife is to facilitate independence of older adults and to enhance quality of life by
 advocating on their behalf and by offering programs and services throughout the continuum of care for
 individuals, families and the community. Residential services range from independent housing to assisted living
 to skilled nursing. In-home and community-based services include transportation, home-delivered meals,
 personal care, home health care, adult day services and counseling. CJE also operates a consumer assistance
 department, a research arm, and a healthy aging center.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 Lieberman Center for Health and Rehabilitation's emergency generator currently provides coverage to a limited
 number of essential functions in the building in the event of a power outage. The emergency generator powers
 emergency lighting in hallways and work areas, selected outlets on each residential floor, one elevator, one
 electronic medical record touchscreen per residential floor and a few computer work stations throughout the
 building. During a power outage, staff use extension cords to plug in key pieces of equipment in the red,
 generator-powered outlets so that, for example, feeding pumps continue to work,diagnostic equipment can be
 used and the facility's full-electric beds can be raised and lowered per each resident's needs.

 The current scope of the emergency generator suffices for short power outages, lasting a few hours or less. For
 extended power outages, the facility needs additional services added to the emergency generator's coverage in
 order to continue services to the residents. During the 23 hour power outage that affected much of Skokie in
 June 2011, the facility felt the impact of the generators limited coverage. Although lighting, an elevator and
 limited access to input documentation in the electronic medical record were helpful, Lieberman's food supply for
 resident meals as well as CJE's Home-Delivered Meal (HDM) program was affected. The facility was able to get
 a refrigerated truck to transfer some of the food supply, but that solution may not always be available.

 Funding from the Village of Skokie CDBG program will allow Lieberman Center to expand the coverage of the
 emergency generator. The meat freezer, fruit and vegetable cooler, meat cooler and dairy cooler would be

 CDBG _FY 13_Application_FINAL
 Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


 added to the generator. This will allow food to be maintained at appropriate temperatures and ensure that meals
 can be produced during a power outage. (Note that the kitchen cooking equipment is gas powered. ) It will also
 ensure that the HOM program operates without interruption. Additionally, by powering multiple units, it ensures
 that rules of Kashruth are maintained. Additionally, hot boxes that hold cooked food at safe temperatures would
 also be powered on the generator. Finally, additional outlets on each floor will be converted to generator
 coverage, ensuring that electronic medical record documentation continues without interruption and critical
 medical equipment remains in continuous use.

 Lieberman Center staff are involved in the Village of Skokie's long-term care facility emergency planning efforts.
 As the largest long-term care facility in Skokie, increasing the generator coverage would allow the facility to be a
 resource in the community and potentially accept patients from other facilities affected by a power outage.
 Lieberman Center is a member of CHUG (Collaborative Healthcare Urgency Group) and staff have received
 CHUG training at Lieberman and through the Village of Skokie. Lieberman Center is committed to disaster
 preparedness for the safety of residents, staff and visitors and to being a partner with the Village and other
 healthcare providers to support them in the event of disasters in their locations. Expansion of the emergency
 generator coverage would amplify the Center's ability to do this.


11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 Skokie's Consolidated Plan for CDBG (Program Years 201 0-2014) states that 15.6% of the population is over 65
 (2005-2007 American Community Survey), and in 2007, 2.9% of residents were age 85+, representing an
 increase from 2000. This local trend in Skokie is also seen nationally; the fastest growing population group is
 persons 85+.

 The Consolicated Plan lists housing as a high priority. In addition, support of home-delivered meal programs is a
 strategy of Objective SN3. The proposed project matches priority objectives since it serves the low-income
 (majority Medicaid resdients), frail, older adult residents of Skokie's Lieberman Center, as well as CJE's home-
 delivered meals clients in Skokie.

 Lieberman Center's operations require an increasing number of capital expenditures, challenging the budget.
 CJE Seniorlife seeks to partner with outside sources to obtain additional resources required to meet the capital
 needs such as the emergency generator project, and, in turn, continue much-needed services without
 interruption.




 CDBG_FY 13_Application_FINAL
 Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How manv people are Skokie residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 Statistics will be compiled using Liebermau Center's electronic medical record system. By virtue
 of admission to Liebermau, the senior is a resident of Skokie; all226 residents are Skokie
 residents. In addition, approximately 24% of the 307 seniors who received meals in the last year
 were from Skokie.

 Liebermau collects income data for all residents except those receiving care covered by Medicare
 Part A. Participation in this program prohibits Liebermau from collecting income information.
 This missing data is indicated by a note in our statistics. At present, approximately 66% of
 Lieberman residents are low-income. The vast majority of home-delivered meals clients are
 referred by IDOA or Evauston Valley Senior Services. These entities determine income eligibility
 before referring clients. We do not have access to income information for patients at the hospital
 aud nursing home facilities where we provide meals.

 B. What do you consider to be a unit of service? (Please select only one.)

 D One client, many times
 0 One client, one time
 0 Multiple clients, one time
 ~ Other (Please describe.) For the purposes of the Skokie CDBG program, a unit of service is
 considered to be a resident admission to Lieberman Center (this can
 be a duplicated number). A unit of service for the home-delivered
 meals program is a meal.

 C. What types of service(s) are included? (Please select all that apply.)

 D Phone counseling
 0 In-office counseling
 D Nights of service
 D Home visits
 ~ Other (Please describe.) Lieberman Center is a skilled nursing facility that provides skilled
 care, Alzheimer's care, short term rehabilitation and hospice/end of
 life care. All care is provided on a 24-hour basis. CJE also delivers
 meals to frail, low-income seniors living in the community.

 D. What types of tangible services are provided? (Please select all that apply.)

 ~Food
 0 Housing/shelter
 0 Clothing
 0 Emergency Funds
 ~ Other (Please describe.) Liebermau Center is a skilled nursing facility that provides skilled
 care, Alzheimer's care, short term rehabilitation aud hospice/end of
 life care on a 24-hour basis. The services include nursing care,

 CDBG_FY13_Application_FINAL
 Page 7
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


 meals, private rooms, laundry services, linens, activities, social
 services, housekeeping and maintenance, to name a few. CJE also
 provides home-delivered meals to frail, low-income seniors.




 CDBG_FY13_Application_FINAL
 Page 8
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


13, Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 [8J Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 D Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 D Affordability
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Afford ability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the afford ability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 low/moderate-income microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 [8J Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




 CDBG_FY13_Application_FINAL
 Page 9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 Q1 May:
 June: Develop bid specifications for expansion of emergency generator coverage
 July: Solicit bids from vendors
 Q2 August: Review bids and award project
 September: Schedule project work
 October: Install necessary power equipment for expansion of emergency generator coverage
 Q3 November: Project complete
 December:
 January:
 Q4 February:
 March:
 April:


16. Other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 In CJE Seniorlife's FY13 capital budgeting process, funds were reserved for emergency generator work and
 matching funds will be utilized from the Center's annual budget for this project. If CDBG funds are not granted for
 this project, CJE Seniorlife would need to utilize capital replacement reserve funds for 100% of the project,
 diminishing the facility's ability to address emergency capital repairs.


 17. Previous CDBG Funding
 Briefiy describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 During the 2012-2013 program year, CJE Seniorlife was awarded $10,000 for the replacement of two 40-gallon
 capacity kitchen kettles at Lieberman Center. The kettles are anticipated to be installed before the end of this
 year. During the 2011-2012 program year, CJE Seniorlife was awarded $12,350 to refurbish a walk-in produce
 cooler at Lieberman Center. This project was completed in December 2011. During the 2010-2011 program
 year, CJE was awarded up to $10,000 to replace rooftop exhaust fans at Lieberman. This project was completed
 in February 2011.




 CDBG_FY13_Application_FINAL
 Page 10
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 k2:] Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 k2:] Budget (including REVENUE and EXPENSE line items for the proposal)
 k2:] Latest Agency Budget
 k2:] Latest Agency Independent Financial Audit
 D Blank Income Verification Fomn
 k2:] Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 D Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 D Activity Programs Brochure with Fee Schedule (scholarship, public service activities only)
 D Other (Please describe.)




 CDBG_FY13_Application_FINAL
 Page 11
For Office Use Only ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT Form AG990-IL
 Revised 3/05
 PMT# Attorney General LISA MADIGAN State of Illinois
 Charitable Trust Bureau, 100 West Randolph co # 01-0 0 8 '914
 11th Floor, Chicago, Illinois 60601 Check all items attached:
 AMT Report for the Fiscal Period: IX] Copy of IRS Return
 Make Checks IX] Audited Financial Statements
 Beginning 0 7 I 01 I 2 010 Payable to D Copy of Form IFC
 the Illinois
 INIT
 & Ending Charity D $15.00 Annual Report Filing Fee
 0613012011 Bureau Fund D $100.00 Late Report Filing Fee
FederaiiD # 36-2 7 27 59 7 MD DAY YR MD DAY YR
Are contributions to the organization tax deductible? IXJ Yes D No Date Organization was created· 0110111972
 LEGAL Year~end

 NAME Council for Jewish Elderly amounts 1- t . : ' : i! .ii /·····-·-····;
 MAIL A) ASSETS A)$ 61,483,147.
 ADDRESS 3003 West Touhy Avenue B) LIABILITIES B)$ 70,107,292.
 CITY, STATE Chicago, IL C) NET ASSETS C)$ -8,624,145.
 ZIP CODE 60645 i <'.[:..,.•. ·····< I • .................. ., -···-··
  L SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR: PERCENTAGE AMOUNT
 D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.) 97.796% D)$ 52,670,034.
 E) GOVERNMENT GRANTS & MEMBERSHIP DUES % E) $
 F) OTHER REVENUES 2.204% F) $ 1,186,740.

 G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, & F) 100% G)$ 53,856,774.
  II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H) OPERATING CHARITABLE PROGRAM EXPENSE
 ,i/', ·.. "
 .,,, 8 5 .3 57% ·~; i_ . ·- - 4-~.
 ••. •.. ,;,: .....
 ioo .'6~X:
 I) EDUCATION PROGRAM SERVICE EXPENSE % I) $
 J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I) 85.357% J) $ 47,100,096.
 J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): $ i' Jtc• _ .--_i.-,•,T
 K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS % K) $
 L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) 85.357% L) $ 47,100,096.

 M) MANAGEMENT AND GENERAL EXPENSE 13.350% M)$ 7,366,802.

 N) FUNDRAISING EXPENSE 1. 292% N) $ 713,200.

 0) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N) iOO% 01 $ 55,180,098.

 IlL SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES: I .. .-......-------._. -. I • . :!_·•·--••- < >····--- - ·- •.•
 (Attach Attorney General Report of Individual Fundraising Campaign· Form IFC. One for each PFR.) ; '

 PROFESSIONAL FUNDRAISERS:
 P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS 100% P) $ 0.

 Q) TOTAL FUNDRAISERS FEES AND EXPENSES % Q) $
 % R) $
 R) NET RECEIVED BYTHE CHARITY (P MINUS D=R)
 PROFESSIONAL FUNDRAISING CONSULTANTS: -·
 .. :,:• ...:-: .:·

 S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS S) $ 0.
 IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
 T) NAME, TITLEMark Weiner, President & CEO T) $
 :.
 "9{' ·, ' - - :
 29 ,785.
 U) NAME, TITLE:Joseph Atkln, ExecutJ.ve VIP & CFO U) $ 249,579.
 V) NAME, TITLE:WJ.llJ.am Casper, VIP ResJ.dentJ.al ServJ.ces V) $ 198,256.
 v. CHARITABLE PROGRAM DESCRIPTION: g8~%~~~6~?E~RAM (3 HIGHEST BY$ EXPENDED) list on back side of instructions
 CODE
 ~


 ~ W) DESCRIPTION: Services for the Aged W)# 117
 X) DESCRIPTION: Nurs J.ng ServJ.ces X) # 113
 0 Y) DESCRIPTION: Hous J.ng for the Aged Y) # 132
1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT?

2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY
 COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?

3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE
 ANYTHING OF VALUE NOT REPORTED AS COMPENSATION?

4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE
 THAN 10% OF THE OUTSTANDING SHARES?

5. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON
 OR ORGANIZATION?

6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATIACH FORM IFC) ..

?a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS
 BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?


 7b. IF 'YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$  ==,-,-:-==c--,-,:-:-c= ; (ii) THE AMOUNT
 ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND
 GENERAL $ ; AND (1v) THE AMOUNT ALLOCATED TO FUNDRAISING $_ _ _ _ _ _ __

 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? ..

 9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR
 REVOKED BY ANY GOVERNMENTAL AGENCY? .

 10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION, MISAPPROPRIATION,
 COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. c_--'-~-j

 11. LISTTHE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
 THREE LARGEST ACCOUNTS:

 JP Illinois




 ALL ATIACHMENTS MUST ACCOMPANY THIS REPORT- SEE INSTRUCTIONS

UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFYTHAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATIACHED
DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE
ILLINOIS ATIORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS REL YTHEREUPDN.I HEREBY FURTHER AUTHORIZE AND
AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.

 BE SURE TO INCLUDE ALL FEES DUE: Mark Weiner
 1.) REPORTS ARE DUE WITHIN SIX PRESIDENT or TRUSTEE (PRINT NAME) SIGNATURE DATE
 MONTHS OF YOUR FISCAL YEAR END.
 2.) FOR FEES DUE SEE INSTRUCTIONS. Joseph Atkin
 3.) REPORTS THAT ARE LATE OR
 TREASURER or TRUSTEE (PRINT NAME) SIGNATURE DATE
 INCOMPLETE ARE SUBJECT TO A
 $100.00 PENALTY.
 Zack Fortsch
098101
05-01-10 PRE PARER (PRINT NAME) SIGNATURE DATE
  Council for Jewish Elderly 36-2727597


Form AG990-IL Explanation for Activities Statement 1
 Described on Page 2


 CJE collects and holds refundable security deposits from its residents
 to cover expenses of any repairs or damages to the premises greater
 than normal "wear and tear." In addition, CJE holds and manages
 spending funds for some of its residents.




 Statement(s) 1
 Village of Skokie
 Community Development Block Grant (CDBG) Program
 2013-2014 Program Year Application

 ATIACHMENT

 CJE Seniorlife
 Lieberman Center for Health and Rehabilitation
 Budget

For illustrative purposes only for creating the budget, a quote was obtained from
Electro Force LLC. The estimated project budget follows:

EXPENSES

Install all necessary power equipment including transformers,
distribution panels, safety switches, conduit and cable to
connect the following electrical equipment to the emergency
generator power system.
 Meat freezer
 Fruit and vegetable cooler
 Meat cooler
 Dairy cooler
 Home-delivered meals and Lieberman hot box power panel
 Power receptacles for computer stations and medical equipment

Total: $20,000


REVENUE

CJE Seniorlife- Lieberman Center for Health and Rehabilitation
25% match $ 5,000
Village of Skokie CDBG Program 2013-2014 Request $15,000

Total: $20,000
CJe Senior life

 Operating Budget Fiscal Year Ending 6/30/2013

REVENUES

 Private Pay $ 16,439,533
 IL Community Care Weinberg 840,000
 IL Donated Fund Initiative 132,387
 Endowment Income 2,379,428
 Grants 1,365,526
 HUD 4,410,084
 HUD Interest Rebate 46,200
 IL Managed Community Care 3,468,850
 Medicaid 7,112, 797
 Medicare 8,545,473
 Donations 1,343,852
 Other Income 833,197
 Other Government 273,252
 Scholarships 1,239,000
 Jewish Federation Allocation 5,199,576
 Total Revenues $ 53,629,155

EXPENDITURES
 Salaries $ 24,499,033
 Employee Benefits 6,146,170
 Payroll Taxes 1,865,942
 Contractual Services 3,002,778
 Debt Service 3,025,915
 Reserve & Replacement 355,000
 Marketing 400,177
 Occupancy Expenses 4,121,000
 Program Expenses 5,653,472
 Rent to Jewish Federation 2,929,288
 Office Expense 751,120
 Other Expense 879,260
 Total Expenditures $ 53,629,155
®Electro Force LLC ESTIMATE
 3285 Overland Pass DATE ESTIMATE NO.
 Northbrook TL 60062 11121/2012 3916


 NAME I ADDRESS ELECTRO FORCE PHONE NUMBERS
 CJE SeniorLife Phone# 84 7 254-5559
 3003 WTonhy
 Chicago IL 60645 Fax# 84 7 998-8569
 e-mail electroforce@comcast.net
 Web Site www.electroforceweb.com


 P.O. NUMBER PHONE FAX


 DESCRIPTION QTY TOTAL

ATTN: Anna-Liisa LaCroix, MPH, LNHA
Assistant Director
CJE SeniorLife
Lieberman Center for Health and Rehabilitation
9700 Gross Point Road
Skokie IL 60076
p. 847.929.3220
f. 847.929.3290
e. anna-liisa.lacroix@cje.net

JOB NAME: CJE SeniorLife
LOCATION: Lieberman Center

PROJECT: Infrastructure Upgrade to the Emergency Power System

RE: Estimate for Electrical Work
DESCRIPTION:
Install all necessary power equipment including transformers, distribution panels, safety
switches, conduit and cable to connect the following electrical equipment to the emergency
generator power system.
1) Qty. 1- Meat Freezer
2) Qty. 1- Fruit & Vegetable Cooler
3) Qty. 1- Meat Cooler
4) Qty. 1- Dairy Cooler
5) Qty. 1- Home Delivered Meals & Lieberman Rolling Hot Boxes Power Panel
6) Qty. 3- Emergency Power Receptacles for Computer Stations and Medical Equipment
Total Estimate Cost 20,000.00


TOTAL ESTIMATE COST: 20,000.00


 TOTAL $20,000.00
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SHEET


Project Title: Turning Point Behavioral Health Care- Therapeutic
 Playground forChildren with Physical and/or Mental
 Disabilities

Project Description (150 words maximum):

Project Address:


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $ 13,035
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $ 9,750

 Total Estimated Project Cost: $ 22,785


 Public Services:
 Total CDBG Funding Request: $ 9,750




 Contact Information
 Organization Name: Turning Point Behavioral Health Care Center
 Contact Name, Title: Ann Fisher Raney


 Signature:


 Mailing Address 1: 8324 Skokie Boulevard
 Mailing Address 2:
 City, State, Zip: Skokie, IL 60077
 Telephone Number: 847 933-0051 X 414
 Fax Number: 84 7 933-0058
 Email Address: araney@tpoint.org




CDBGJY13_Appllcation.DOC
Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 [8] (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 D Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members18 years old or older that contribute to the household. The
 extremely low, very low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birth, marriage, or adoption.



3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)




CDBG_FY13 _Application. DOC
Page2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers.to b~ listed below are the numbers of unduplicated individuals benefiting from
 the project or program for which you are requesting funding. The totals in the bju~'l::l)ll¢ must match. The totals in the orange cells must match.


 ----- - ----- -------.......... --------- ............................................... ______________ --~-i-7-.P~-~-i-~.L~-~!.i,~.'? ____ . . . . . . . .---
 ----------------------- -----Income Race Female-
 Below 31%to 51%to Above Total Yes No Total White Black oc Nati" Asian American Mixed lotal Headed
 30% 50% 80% 80% African- Hawaiian Indian or Race Households
 (all others) American or Other Alaskan
 Pacific Native
 Islander
 People
 882 161 81 36 113 1047 .:.;:11M 753 155 2 85 4 161 iCH6o N/A
 Skokie
 Residents 384 i 73 39 12 ! . ·: 508 55 i 453 508 315 77 1[ 48 3 64 508 N/A



5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to be li~tedbelow are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the blllecells must match .


 Income
 -- ··Ei'810'W ··· ·· ··· ··· j'{o/~·-·ia···· ·. · ·"ST%"(0" .. · ........ AbOVe Total
 .".. "....~.!-~P.~-~-~-~J. ~~"~,tno Race Female·
 Yes No Total White Black or Native Asian American Mixed Total Headed
 30% 50% 80% 80% African- Hawaiian Indian or Race Households
 (all others) American or Other Alaskan
 Pacific Native

 l Households
 Islander




6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.

 Total Full-Time Total Part-Time To!al Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time Income Part-Time
 Hires Hires




CDBGJY13_Application .DOC
Page 3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project. (Please select only one.)

 Anti-Crime Programs Senior Programs
 D Crime Awareness D Senior Centers
 D Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 D Micro-Enterprise Assistance D Youth Centers
 D Child Care Centers
 Non-Homeless Housing D Youth Services
 D Renter- Elderly D Child Care Services
 D Renter- Small Family
 D Renter- Large Family Homeless Individuals
 D Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 D Sidewalks D Housing Placement
 D Tree Planting D Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) D Emergency Shelter
 D General Public Facilities D Transitional Housing
 D Handicapped Centers D Job Training
 D Parks/Recreational Facilities D Case Management
 D Parking Facilities D Child Care
 [8] Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Services D Housing Placement
 (Administrative Support Activities) D Life Skills Training
 D General Public Services
 D Handicapped Services
 D Transportation Services
 D Employment Training
 D Health Services
 D Mental Health Services
 D Screening for Lead-Based Paint




CDBG_FY13_Application.DOC
Page 4
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013Application (Term: May 1, 2013, through April30, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 D Elderly
 D Frail Elderly
 [8J Severe Mental Illness
 [8J Developmentally Disabled
 [8J Physically Disabled
 D Substance Abusers
 0 Persons with HIVIAIDS
 [8J Victims of Domestic Violence

 Comments:


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 At Turning Point, our mission statement, "Solid Support When you need it most," is a promise to our community.
 Our mission is to serve people with mental illness, regardless of their ability to pay, with the same respect,
 compassion and professionalism we would expect for ourselves. We provide our expert support to people during
 some of the most difficult times of their lives.
 We believe in recovery. We believe that each person who walks through our doors has the capacity to recover
 from his or her mental illness. We believe the services provided by our professionally-trained clinicians combined
 with our clients' own strengths, hopes and dreams create an environment where recovery is not just a goal, but
 an expectation. Turning Point has been providing essential mental health services to the Skokie community for
 more than forty years and has consistently added capacity to serve increased client numbers suffering from the
 current economic crisis.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 Turning Point proposes to build a "Green Space Therapeutic Playground" that will be used for family and
 children's therapy for physically and mentally disabled children from 0-8 years old. The playground is also
 projected to be used by disabled veterans and their children in order to retrain wounded veterans in family play
 support.
 The playground for children's therapy will be built on the south section of Turning Point's large parking lot at
 8320-24 Skokie Boulevard. A 40' x 20' section of asphalt will be demolished and hauled away. Barricades will
 be erected and a cleanup site area will be established. After the site is cleared, 800 square foot of rubber
 surfacing which is 4" deep will be applied. The family therapy playground will be adjacent to the national Lekotek
 Center for developmentally disabled children to be established at Turning Point in 2013. This request is for the
 first key element of the proposal which is site preparation and special surfacing for the therapeutic playground.
 The second element is the placement of special playground equipment which will be funded from another
 source.



CDBG_FY 13_Application, DOC
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)




11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 Since 2007, the number of low-income clients choosing Turning Point has steadily increased. Today, almost
 sixty-five percent of our clients fall below133% of the federal poverty level, and hundreds of clients benefit from
 our sliding fee scale. The current direction in health care reform is to offer comprehensive health care services in
 one "medical home".

 Turning Point intends to expand its services to children and families by partnering with the national Lekotek
 Center in Turning Point's new building. A therapeutic playground will be added in the parking lot to be used by all
 child and adolescent clients and families. The playground area will assist Turning Point therapists and family
 members to better diagnose and care for children 0- 8 years old. This capital expansion will help Turning Point
 become a center for treating mentally disabled children along with Lekotek which treats developmentally
 disabled children. Creative play therapy is one of the most promising treatments for children who suffer with
 developmental disabilities and/ or mental illness. The Turning Point facility will become a state of the art center
 for treating our most vulnerable children in Skokie, North Chicago and the northern suburbs.

 Turning Point requests $9,750 to prepare the surface and build the base for the Turning Point therapeutic
 playground which will provide family play and therapy support to children who desperately need to learn play
 skills which will exponentially aid their physical and mental developmental potential. The therapeutic playground
 will also be used for family therapy and for wounded veterans relearning new play skills with their children.




CDBG _FY13_Application. DOC
Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How manv people are Skok1e residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 Statistics will be compiled using our CIS billing/data system. The CIS system tracks the income
 status of all clients. Participants in the Lekotek program and the Turning Point clients will be
 tracked. Best practices in both physical and mental health therapy require baseline and income
 data.

 B. What do you consider to be a unit of service? (Please select only one.)

 D One client, many times
 I2:(J One client, one time
 D Multiple clients, one time
 I2:(J Other (Please describe.) Home Visits

 C. What types of service(s) are included? (Please select all that apply.)

 I2:(J Phone counseling
 I2:(J In-office counseling
 I2:(J Nights of service
 D Home visits
 I2:(J Other (Please describe.) 1. Psycho-Social Rehab services are available to clients of Turning
 Point. These services assist clients in improving basic skills for
 living independently. 2. Case Management services assist clients in
 accessing housing, jobs, training and other baseline needs for
 independent living.


 D. What types of tangible services are provided? (Please select all that apply.)

 I2:(J Food
 D Housing/shelter
 D Clothing
 D Emergency Funds
 I2:(J Other (Please describe.) The Living Room Psychiatric Respite Center provides emergency
 services for one-tenth the cost of a hospital emergency room visit.
 The Living Room Pilot Project includes the services of a nurse
 practitioner for primary health care. In 2013, substance abuse
 services will be added to the health care service areas available at
 Turning Point.




CDBG_FY13_Application. DOC
Page 7
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013Application (Term May 1, 2013, through April30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 [8J Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 0 Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 0 Creating Economic Opportunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 l:8l Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 0 Affordability
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Affordability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the affordability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 low/moderate-income microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 0 Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




CDBG _FY 13_Application .DOC
Page 8
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 Q1 May: Sign construction contract
 June: Begin site preparation, build barricades and designate cleanup site area
 July: Demolish the asphalt and remove all debris
 Q2 August: Install 800 square feet of rubber surfacing with a maximum of 4" deep
 September:
 October:
 Q3 November:
 December:
 January:
 Q4 February:
 March:
 April:


16. Other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 Turning Point will provide the balance of the $22,785 for the Therapeutic Services Playground Project out of
 indidual donor contribution revenues from the 2013 Turning Point Annual Appeal currently in process. It is also
 anticipated that expansion of children's mental health service capacity at Turning Point will result in increased
 billing revenues from Medicaid for low-income client families with children.


17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 2012 CDBG funding- $5,000 for building 3 additional offices at Turning Point for a primary care nurse and two
 additional therapy offices.

 2010 CDBG funding - $6,665. for a Building and Maintenance Project which included roof maintenance, exterior
 wall tuckpointing, chimney repair and a new office door.

 In 2008 and 2009, Turning Point did not receive CDBG funding.




CDBG_FY13_Application.DOC
Page 9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)




CDBG_FY13_Application.DOC
Page 10
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 [g] Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 [g] Budget (including REVENUE and EXPENSE line items for the proposal)
 [g] Latest Agency Budget
 [g] Latest Agency Independent Financial Audit
 D Blank Income Verification Form
 [g] Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 D Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 D Activity Programs Brochure with Fee Schedule (scholarship, public service activities only)
 D Other (Please describe.)




CDBG _FY13_Application .DOC
Page 11
For Office Use Only ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT form AG990-IL
 Revised 3/05
 PMT# Attorney General LISA MADIGAN State of Illinois
 Charitable Trust Bureau, 100 West Randolph co# 01-005617
 11th Floor, Chicago, Illinois 60601 Check all items attached:
 AMT Report for the Fiscal Period: [X] Copy of IRS Return
 Make Checks [X] Audited Financial Statements
 Beginning 0 7 I 01 I 2 010 Payable to D Copy of form IFC
 the Illinois [X] $15.00 Annual Report filing fee
 INIT Charity
 & Ending
 06/3012011 Bureau Fund D $100.00 Late Report filing fee
federaiiD # 3 6-2 3 27 294 MO DAY YR MD DAY YR
Are contributions to the organization tax deductible? [X] Yes 0No Date Organization was created' 0310511952
 LEGAL TURNING POINT BEHAVIORAL HEALTH Year-end
 NAME CARE CENTER amounts
 MAIL A) ASSETS A) $ 2,628,102.
 ADDRESS 8324 SKOKIE BOULEVARD B) LIABILITIES B)$ 391,210.
 CITY, STATE SKOKIE, IL C) NET ASSETS C)$ 2,236,892.
 ZIP CODE 60077
 I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR: PERCENTAGE AMOUNT
 D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.) 65.197% D)$ 1,778,763.
 E) GOVERNMENT GRANTS & MEMBERSHIP DUES 27.488% E) $ 749,965.
 f) OTHER REVENUES 7.315% f) $ 199,581.
 G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADO D, E, & f) 100% G) $ 2,728,309.
 II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H) OPERATING CHARITABLE PROGRAM EXPENSE 91.305% H) $ 2,327,843.
 I) EDUCATION PROGRAM SERVICE EXPENSE % I) $

 J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I) 91.305% J) $ 2,327,843.
 I .



 J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): $ .


 K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS % K) $
 L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) 91.305% L) $ 2,327,843.

 M) MANAGEMENT AND GENERAL EXPENSE 8.191% M)$ 208,826.

 N) fUNDRAISING EXPENSE 0.504% N) $ 12,862.

 D) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N) 100% 0) $ 2,549,531.
 .
 Ill. SUMMARY OF ALL PAID FUND RAISER AND CONSULTANT ACTIVITIES:
 (Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.)
 PROFESSIONAL FUNORAISERS:
 P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS 100% P) $ 0.
 Q) TOTAL fUNDRAISERS FEES AND EXPENSES % Q) $
 R) NET RECEIVED BY THE CHARITY (P MINUS O=R) % R) $
 PROFESSIONAL FUNDRAISING CONSULTANTS:
 S) TOTAL AMOUNT PAID TO PROFESSIONAL fUNDRAISING CONSULTANTS S) $ 0.
 ..
 IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
 T) NAME, TITLEANN FISHER RANEY, CEO T) $ 116 '131.
 U) NAME, TITLE:KIRK ERICKSON, coo U) $ 76,873.
 V) NAME, TITLERICHARD BAS OF IN, CFO V) $ 74,549.
 v. CHARITABLE PROGRAM DESCRIPTION: g~~~~b~~~6~?E~RAM (3 HIGHEST BY$ EXPENDED) List on back side of instructions
 CODE
 W) DESCRIPTION: FAMILY AND INDIVIDUAL SERVICES W)# 111
 X) DESCRIPTION: X)#
 Y) DESCRIPTION: Y) #
 IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: YES I NO

  1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? 1. IX

 2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY
 COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY? 2. IX

 3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE .·· .



 ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. IX

 4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE
 THAN 10% OF THE OUTSTANDING SHARES? 4. IX

  5. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON
 OR ORGANIZATION? 5. IX

  6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC) .. 6. IX

  ?a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS
 BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? 7. IX

  ?b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$ ; (ii) THE AMOUNT
 ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND
 GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $


  8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? .. B. IX

  9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR
 REVOKED BY ANY GOVERNMENTAL AGENCY? 9. IX

  10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION, MISAPPROPRIATION,
 COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. IX

  11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
 THREE LARGEST ACCOUNTS:

 FIRST BANK & TRUST, 820 CHURCH ST, EVANSTON, IL 60201

 EDENS BANK, 3245 w. LAKE AVE., WILMETTE, IL 60091



  12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: RICHARD BASOFIN - 847-933-0051

  ALL ATTACHMENTS MUST ACCOMPANYTHIS REPORT· SEE INSTRUCTIONS

UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFYTHAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED
DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE
ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND
AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.

  BE SURE TO INCLUDE ALL FEES DUE: MICHAEL BLAND, PRESIDENT
  1.) REPORTS ARE DUE WITHIN SIX PRESIDENT or TRUSTEE (PRINT NAME) SIGNATURE DATE
 MONTHS OF YOUR FISCAL YEAR END.
  2.) FOR FEES DUE SEE INSTRUCTIONS. ANN FISHER RANEY, CEO
  3.) REPORTS THAT ARE LATE OR
 TREASURER or TRUSTEE (PRINT NAMEl SIGNATURE DATE
 INCOMPLETE ARE SUBJECT TO A
 $100.00 PENALTY.
 HARRY STEINDLER
098101
05-01-10 PREPARER (PRINT NAME) SIGNATURE DATE
CDBG PROPOSAL- FY 13



ITEM #18 PROJECT BUDGET for Turning Point Therapeutic Playground for Children
with Physical and/or Mental Disabilities




REVENUE:

CDBG grant $9,750
Turning Point match 13,125
Total: $22,785


EXPENSE:

1. Barricade and create cleanup area
2, Demolish & haul away asphalt
in a 40' x 20' section
3. Surface 800 sf with rubber to
a maximum of 4" deep
Total: $22,785
 x3
 -:-1
 TURNING POINT
 Final FY13 Budget




 FY13 FY12 FY13 vs. Est. Actual FY12 FY13 vs. Budget FY12
 FY12 Est.
 FY13 Budget Actual FY12 Budget Amount % Amount %
Revenue
 DMH FEE FOR SERVICE $1,429,924.00 $1,335,510.00 $1 ,310,000.00 $94,414.00 107% $119,924.00 109%
 DMH GRANTS $650,961.00 $623,839.00 $631,000.00 $27,122.00 104% $19,961.00 103%
 MEDICARE PAYMENTS $95,000.00 $67,754.24 $60,000.00 $27,245.76 140% $35,000.00 158%
 CLIENT PAYMENTS $105,000.00 $107,322.19 $125,000.00 ($2,322 19) 98% ($20,000.00) 84%
 PRIVATE INSURANCE PAYMENTS $75,000.00 $89,458.15 $60,000.00 ($14,458.15) 84% $15,000.00 125%
 US PROBATION OFFICE $91,000.00 $99,630.67 $80,000.00 ($8,630.67) 91% $11,000.00 114%
 RECEIPTS TO PAY CLIENT EXPENSES $60,000.00 $74,997.24 $55,000.00 ($14,997.24) 80% $5,000.00 109%
 FUNDRAISING AND EVENTS $118,000.00 $117,767.58 $73,000.00 $232.42 100% $45,000.00 162%
 OTHER GRANTS $80,000.00 $228,800.00 $33,000.00 ($148,800.00) 35% $47,000.00 242%
 NILES TOWNSHIP $107,000.00 $114,999.96 $115,000.00 ($7,999.96) 93% ($8,000.00) 93%
 UNITED WAY $40,000.00 $39,996.00 $40,000.00 $4.00 100% $0.00 100%
 Total INVESTMENT INCOME $22,000.00 $28,175.24 $15,000.00 ($6, 175.24) 78% $7,000.00 147%
 Total MISCELLANEOUS OTHER INCOME $5,200.00 $5,072.43 $0.00 $127.57 103% $5,200.00 n/a
 INCOME FROM CELL TOWER $140,000.00 $140,000.00 $140,000.00 $0.00 100% $0.00 100%
 Total Revenue $3,019,085.00 $3,073,322.70 $2,737,000.00 ($54,237.70) 98% $282,085.00 110%
Expense
 HUMAN RESOURCES $2,037,588.00 $1,842,118.00 $1 ,805,000.00 $195,470.00 111% $232,588.00 113%
 MD CONSULTANT $298,700.00 $261 ,233.28 $250,000.00 $37,466.72 114% $48,700.00 119%
 FUNDRAISING/EVENTS $54,300.00 $61,698.44 $70,000.00 ($7,398.44) 88% ($15, 700.00) 78%
 OCCUPANCY $169,380.00 $189,778.67 $165,000.00 ($20,398.67) 89% $4,380.00 103%
 OFFICE EXPENSE $120,760.00 $115,503.17 $140,000.00 $5,256.83 105% ($19,240.00) 86%
 PROGRAM SUPPLIES $18,000.00 $14,521.36 $0.00 $3,478.64 124% $18,000.00 n/a
 PROFESSIONAL FEES $164,460.00 $157,485.21 $140,000.00 $6,974.79 104% $24,460.00
 117~1
 RESIDENTIAL EXPENSE $120,200.00 $120,255.60 $130,000.00 ($55.60) 100% ($9,800.00) 92%
Total Expense $2,983,388.00 $2,762,593.73 $2,700,000.00 $220,794.27 108% $283,388.00 110%
Net Revenue -----~35,697 .OQ_ _____l3_:1__Q.!?8_.97 $37,000.00 ($275,031.97) 11% ($1 ,303.00) 96%
JE Distributors, LLC
 JE Distributors, LLC
 QUOTE
7302 Torrington Way DATE 11/27/2012
Springfield IL, 62711 QUOTE# 110912
Phone: 217-414-1763 ln\NJ\j~ Invoice#
 Valid Until:
 c\\sa1~
jed istri butors2011 @yahoo .com 90 Days
Prepared by: Jim


Customer: (~ c"to V'- ~ W"NA-
Turning Point Behavioral Health Care Center /C
8324 Skokie Boulevard
Skokie IL, 60077
Mary Laura Jones
m ljones2022 @gma il.com


 DESCRIPTION TAXABLE AMOUNT


 1. Sawcut Smooth edges, demolition and haul away of existing $22,785.00
 asphalt in a 40' x 20' section
 2. Barricades and cleanup site area
 3. 800 sq ft of rubber surfacing maximum 4" deep
 75% color and 25% black

 **price includes prevailing wages




 Subtotal $22,785.00
TERMS AND CONDITIONS Taxable $0.00
1. After you accept this quote you will be billed after installation. Tax Rate 0.00%
2. Payment: Terms TBD Tax Due $0.00
3. Send original signed price quote to our address above Shipping $0.00
Customer Acceptance {Please Sign Below): TOTAL DUE $22,78S.OO


x__________________________________
Print Name:



 If you have any questions regarding this price quote, please contact us immediately
 Jim Edison- jedistributors2011@yahoo.com


 THANK YOU FOR YOUR BUSINESS!
JKS JK-FIVE CONSTRUCTION, INC.
 Asphalt, Concrete and Excavating
 2160 E. ENTERPRISE
 )')V,:w;,'U..,~·\ w~eM," .
 SPRINGFIELD, ILLINOIS 62702
 (217)391-2656 FAX(217)726-9472
 Coy(t\o.-OaA ,A ~-~"
 PROPOSAL FOR CONTRACTING SERVICES

CLIENT/AGENT: Turning Point Behavioral Health Care Center ProposalNo:P-20121302

PROJECT: Asphalt Pavement Removal Date: November 19,2012

LOCATION: Skokie, IL

SCOPE OF WORK:

JK-Five Construction, Inc. (JK5) proposes to furnish all labor, material and equipment necessary to
complete the following scope of work in accordance to the plans provided. We propose to complete the
below scope of work for the lump sum price of $23,300.00.

General:

• Price is good for 90 days.
• Work to be performed in Spring of2013 Construction season.
• Price includes prevailing wages for labor.

Scope of Work
JK5 proposes to provide the following services in order to achieve the proper asphalt pavement removal
and surfacing as required for the 40 foot by 20 foot area.

• Sawcut smooth edges, Demolition and haul away existing asphalt pavement 40 foot x 20 foot area.

• Barricades and Cleanup site area.

• 800 sq ft of 4" rubber surfacing. 75% color and 25% black




Payment and Fees
Our total fees for this project as described above are based on the above scope. We have estimated our
cost to be $23,300.00. No additional services in excess of the above fee would be performed without your
prior authorization. Payment is due within 30 days of invoice date for work completed. A finance charge
will be computed using a single periodic rate of 1.5% per month after 30 days, which is an mmual
percentage rate of 18%.
JKS JK-FIVE CONSTRUCTION, INC.
 Asphalt, Concrete and Excavating
 2160 E. ENTERPRISE
 SPRINGFIELD, ILLINOIS 62702
 (217) 391-2656  FAX (217) 726-9472




Please review the above scope of work and fee structure. If you agree and except our proposal as stated
above please have an Authorized Owner or Agent sign where indicated below and return it to our office as
soon as possible. We appreciate the opportunity to serve you and your associates.




 Agreement

The terms and conditions outlined in this proposed Scope of Services defined in the above are accepted
and JK-Five Construction, Inc. is hereby awarded the work.

Submitted for Acceptance: Acceptance:

JK-Five Construction, Inc. Turning Point Behavioral Health Care Center

By: Michael R. Keebler By: - - - - - - - - - - - - - - - -

Title: Vice-President Title: ________________

Signature:------------- Signature: _ _ _ _ _ _ __

Date: November 19, 2012 Date: ________________
 QUOTE
 Date Quote#
 11/28/2012 UNSAVED




  Turning Point Behavioral Center Turning Point Behavioral Center Turning Point Behavioral Center
  Mary Laura Jones Mary Laura Jones Mary Laura Jones
  8324 Skokie Blvd 8324 Skokie Blvd 8324 Skokie Blvd
  Skokie, IL 60077 Skokie, IL 60077 Skokie, IL 60077

 P: P: P:
 F: F: F:




 50% Deposit Required.
 See Terms and Conditions




 PPRS Installation of Rubber Surface and Removal of $23,995.00 $23,995.00
 Asphalt

 Rubber Surface: 800 sq ft
 ** 6' Fall Height
 ** 4" Thickness
 **75% Color 25% Black

 Prep work for Rubber:
 Sawcut Smooth Edges, Demolition and Haul away of
 existing asphalt- 40'x20' - 800 sq ft
 Barricad and clean up site

 Pricing Includes Prevailing Wages

 SubTotal $23,995.00
 Tax Rate 0.00%
 Sales Tax $0.00
 Shipping $0.00




**Please contact your Playworld Preferred Sales Representative if any of the foregoing information is incorrect.**
**Order Acknowledgement will be sent within 48 hours after your Purchase Order has been processed. Order Acknowledgement will include
the estimated Ship Date. Shipping notification and documentation will be sent once the product ships.**
**Please note, due to market variables outside of our control, certain items such as commodity material price fluctuations, freight surcharges,
sales tax rates, and additionally requested re-consigned delivery location fees may change the final amount invoiced from the amount
originally provided on this quote. **




 Page 1
 Terms and Conditions
CONTROLLING TERMS: THIS QUOTATION IS LIMITED TO THE TERMS AND CONDITIONS CONTAINED HEREIN. ANY ADDITIONAL OR
DIFFERENT TERMS PROPOSED BY CUSTOMER IN ANY PURCHASE ORDER OR OTHER DOCUMENTS ARE DEEMED TO BE MATERIAL
ALTERATIONS AND NOTICE OF OBJECTION TO THEM IS HEREBY GIVEN. ANY SUCH PROPOSED TERMS SHALL BE VOID, AND THE TERMS
HEREIN SHALL CONSTITUTE THE COMPLETE AND EXCLUSIVE STATEMENT OF THE TERMS AND CONDITIONS OF THE CONTRACT BETWEEN
THE PARTIES. NEITHER SELLER'S ACKNOWLEDGMENT OF A PURCHASE ORDER NOR SELLER'S FAILURE TO OBJECT TO CONFLICTING,
DIFFERENT, OR ADDITIONAL TERMS AND CONDITIONS IN A PURCHASE ORDER SHALL BE DEEMED AN ACCEPTANCE OF SUCH TERMS AND
CONDITIONS OR A WAIVER OF THE PROVISIONS HEREOF.
PRICES: Prices in this Quote are good for thirty (30) days. Unless otherwise stated in writing, all prices are F.O.B. Origin, and shall be exclusive of transportation, insurance, taxes,
license fees, customs fees, duties, premiums, fees, site preparation, installation expenses and other charges, unless specifically stated.

Tax exempt Customers shall provide Playworld Preferred with a copy of its valid tax-exempt certificate at time the order is placed.

CANCELLATION: Orders become final forty-eight (48) hours from Order Acknowledgement. Orders for play structures may NOT be cancelled or returned under any
circumstances. Items which may be cancelled or returned are subject to a twenty (20%) percent restocking fee, plus the cost of return freight. Returned items must be in original
packaging, in new condition, and returned within thirty (30) days. Authorization for the return must be obtained in writing from Playworld Preferred. Orders for products, other than
those from Playworld Systems, may NOT be cancelled or returned.

TERMS OF PAYMENT: For orders in an amount of $100 or less, payment in full is required at the time of the order. For all olher orders, a fifty (50%) percent deposit is required,
unless expressly waived by Playworld Preferred. (Orders from governmental entities are excluded from the deposit requirement.)

UNLESS CREDIT IS SPECIFICALLY GRANTED IN WRITING BY PLAYWORLD PREFERRED, PAYMENT IN FULL IS DUE WITHIN TEN (10) DAYS OF INVOICE. For orders
without installation, the invoice will be issued on the date the order ships. For orders which include installation by Playworld Preferred or its authorized sub-contractor,
the invoice will be issued upon the completion of the project.

Past due balances are subject to a one and one-half (1.5%) percent monthly finance charge, but in no event will the late payment finance charge be greater than the maximum
rate permitted by law. Customer shall pay all fees and expenses (including attorneys' fees) incurred by Playworld Preferred in the enforcement of its rights hereunder.
WARRANTIES and DISCLAIMERS: Manufacturers' limited warranties are available upon request.

THE MANUFACTURER'S WARRANTY IS EXCLUSIVE AND IS IN LIEU OF ALL OTHER REPRESENTATIONS AND WARRANTIES OF ANY KIND, WHETHER EXPRESS,
IMPLIED OR STATUTORY, INCLUDING BUT NOT LIMITED TO ANY WARRANTY OF CONDITION, DESCRIPTION, MERCHANTABILITY, FITNESS FOR A PARTICULAR
PURPOSE OR NON-INFRINGEMENT OR ANY REPRESENTATIONS OR WARRANTIES IN ANY BROCHURES, MANUALS, CATALOGS, LITERATURE OR OTHER
MATERIALS OF PLAYWORLD PREFERRED. FURTHER, NO REPRESENTATION, WHETHER ORAL OR WRITTEN, OF PLAYWORLD PREFERRED MAY BE
SUBSTITUTED OR ALTER THE EXCLUSIVE MANUFACTURER'S LIMITED WARRANTY.

LOSS or DAMAGE in TRANSIT: Playworld Preferred is not responsible for loss or damage in transit. Our responsibility ends when the carrier signs the Bill of Lading, which is our
receipt that the products were complete and in good condition when shipped. It is the customer's responsibility to check the number of pieces shown on the freight bill and our Bill
of Lading. Any shortages or damages must be noted on the freight bill before it is signed.

DELIVERY: Delivery, shipment and installation dates are estimates only, and do not guarantee shipment, delivery or installation on or by such dates. If shipment is made per the
estimated ship date, and you are unable to accept delivery, then storage, demurrage or extra unloading charges may be incurred and billed to your account

INSPECTION: All products must be inspected upon receipt, and claims must immediately be filed with the carrier and Playworld Preferred when there is evidence of shipping
damage, either concealed or external. All shipments are FOB Origin, unless quoted FOB Destination. FOB Destination does not change the terms of receiving and inspection of
the products as set forth herein.

INSTALLATION: Installation is not included in the purchase price of the products, unless expressly noted on the quote and invoice. IT IS CUSTOMER'S RESPONSIBILITY TO
ASSEMBLE, INSTALL AND USE THE PRODUCTS SAFELY AND IN ACCORDANCE WITH THE MANUFACTURER'S INSTALLATION INSTRUCTIONS, UNLESS
EXPRESSLY AGREED OTHERWISE BY PLAYWORLD PREFERRED.

LIABILITY EXCLUSIONS: TO THE EXTENT PERMITTED BY LAW, PLAYWORLD PREFERRED SHALL NOT BE LIABLE IN CONNECTION WITH A PRODUCT OR SERVICE
FOR (A) ANY INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, BASED ON TORT, CONTRACT OR OTHER LEGAL THEORY, WHETHER OR NOT
ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, OR (B) ANY DAMAGES WHATSOEVER IN EXCESS OF AN AMOUNT EQUAL TO THE PURCHASE PRICE OF
PRODUCT PROVEN TO BE DEFECTIVE. THE RIGHT TO RECOVER DAMAGES WITHIN THE LIMITATIONS SPECIFIED IS CUSTOMER'S EXCLUSIVE ALTERNATIVE
REMEDY IN THE EVENT THATTHE REMEDY PROVIDED HEREIN FAILS OF ITS ESSENTIAL PURPOSE.

FORCE MAJEURE: Playworld Preferred shall not be liable because of unforeseen circumstances or causes beyond its control, including, without limitation, strike, lockout,
embargo, riot, war, act of terrorism, fire, act of God, accident, failure or breakdown of components necessary for order completion, subcontractor, supplier or Customer caused
delays, inability to obtain labor, materials or manufacturing facilities, or compliance with any law, regulation or order.

SAVINGS CLAUSE: If any part of the terms and conditions stated herein is held void or unenforceable, such part, to the extent void or unenforceable will be treated as severable,
leaving valid the remainder of the terms and conditions which shall be deemed revised so as to remain enforceable to the greatest extent possible consistent with such holding.


  Turning Point Behavioral Center UNSAVED Page 2
 IF INSTALLATION IS INCLUDED WITH THIS ORDER, THE FOLLOWING ADDITIONAL PROVISIONS APPLY:

SCHEDULE: Playworld Preferred will provide Customer with a shipment and installation schedule. Playworld Preferred will take the commercially reasonable steps necessary to
complete installation on schedule and without delay. However, Playworld Preferred does not guarantee the start or completion of the project in strict accordance with the
installation schedule provided. Installation may be delayed by weather conditions, fire, Act(s) of God or other casualty for which Playworld Preferred is not responsible.

CHANGES: Playworld Preferred reserves the right to change, modify or alter installation terms. INSTALLATION PRICE IS BASED ON NORMAL DIGGING CONDITIONS. IF
ROCKS OR OTHER CONDITIONS ATTHE SITE BEYOND THE CONTROL OF PLAYWORLD PREFERRED ARE ENCOUNTERED, THERE MAY BE ADDITIONAL
CHARGES. If Playworld Preferred deems a change is necessary, it will provide Customer with a Change Order request, including an estimate of the commercially reasonable
cost for the additional work required for proper installation of the equipment Playworld Preferred will not continue with the installation until approval of the Change Order in
writing by customer. If Playworld Preferred and Customer cannot agree upon the additional cost for the extra work within fifteen (15) days of the Change Order request,
Playworld Preferred may immediately invoice Customer for the equipment, and Customer agrees to pay the equipment invoice in accordance with the payment terms set forth
above (NET 10 days).

In the event that Customer requests changes to the installation or installation schedule which results in delays in excess of thirty (30) days, from the date of the original
installation schedule, Playworld Preferred may immediately invoice Customer for the equipment, and Customer agrees to pay the equipment invoice in accordance with the
payment terms set forth above (NET 10 days).

UTILITIES: Playworld Preferred will locate and mark public utilities on the site. Customer shall locate and mark any private utility lines, such as irrigation lines or local
telecommunication lines. Customer's failure to do this may result in damage to its private utility lines and costs associated thereto, and additional installation charges and delays.

PERMITS: Customer is responsible for the cost of all installation-related permits and fees not expressly included in the quotation.

REFUSE: Trash and packaging materials will be consolidated and stacked neatly on Customer's site or placed in Customer's dumpster on site. Upon customer's written
request, Playworld Preferred will arrange for the trash and packaging materials to be removed from the site and disposed of for an additional fee.

FINAL INSPECTION: Customer agrees to inspect the project with the lead installer and/or sales representative within five (5) days of completion of the project. If project has
been satisfactorily completed, Customer will note acceptance of the project on Playworld Preferred's Client Acceptance Form. Playworld Preferred will then invoice Customer,
and Customer agrees to pay the invoice in accordance with the payment terms set forth above (NET 10 days). Signing the client acceptance form does not relieve Playworld
Preferred from its on going warranty obligations as they relate to the product shipped or installation work.

 I f Customer notes defects in the materials or workmanship ("punch list"), Playworld Preferred will remedy them in a timely manner. However, Playworld Preferred may
immediately invoice Customer for the project, less ten (10%), and Customer agrees to pay the invoice in accordance with the payment terms set forth above (NET 10 days).
Upon completion of the "punch list," Playworld Preferred shall invoice Customer for the remaining ten (1 0%) due, and Customer agrees to pay the invoice in accordance with the
payment terms set forth above (NET 10 days).

SUPERVISED INSTALLATION: In the event that Playworld Preferred is contracted by Customer to supervise the installation of the equipment subject to this Quotation,
Customer shall complete Playworld Preferred's "Supervised Installation Requirements" Form. Said form sets forth the details of the supervised build and the parties' respective
responsibilities. The Quotation may be subject to change based upon Custome~s responses on the "Supervised Installation Requirements" Form. Within five (5) days of the
completion of the supervised installation, the Parties shall comply with the FINAL INSPECTION provisions set forth above.


 I acknowledge that I have read, understand, and accept the terms and conditions of this quotation and that I am authorized to do

  Print Name _ _ _ _ _ _ __ Customer PO#

 Title


 Signature Date


 Playworld Preferred Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Date

 Send Signed Quote & Deposit To:
 Playworld Preferred
 Attn: Signed Quote
 13504G South Point Blvd
 Charlotte, NC 28273


  Turning Point Behavioral Center UNSAVED Page 3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SHEET


Project Title: New Floor Covering at the Karger House CILA ··

Project Description (150 words maximum): SHORE is seeking funding to replace 12-year old
 carpeting and vinyl sheet floor covering throughout the
 Jean F. Karger House CILA with a more durable tile.
 The carpet is showing its age with fraying,
 pulling away from the tack strips, deteriorating padding,
 heavy stains and the start of ripples, which can create a
 safety hazard for slips and falls caused by the
 impediments in the walking surface if it continues to
 buckle. The vinyl floors are also scuffed from
 wheelchairs and walkers and are starting to curl along
 the baseboards. The new tile is a commercial grade
 product that is easy to maintain and will create a more
 sanitary environment for the residents and staff.

Project Address: 4324 Church Street, Skokie, IL 60076


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $ 4,513
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $13,541

 Total Estimated Project Cost: $18,054


 Public Services:
 Total CDBG Funding Request: $0




 Contact Information
 Organization Name: SHORE Community Services, Inc.
 Contact Name, Title: Debora K. Braun, Executive Director


 Signature:


 Mailing Address 1: 4232 Dempster Street
 Mailing Address 2:
CDBG _FY 13_Application .DOC
Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


 City, State, Zip: Skokie, IL 60076
 Telephone Number: (847) 982-2030 ext 22
 Fax Number: (847) 982-2039
 Email Address: dkb.shore@sbcglobal.net




CDBG_FY13_Application.DOC
Page 2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL - APPLICATION
All items must be addressed to receive any consideration for funding,

1, National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 ~ (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 D Prevents or Eliminates Blight on a Spot Basis (go to #7)


2, Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members 18 years old or older that contribute to the household. The
 extremely low, very tow, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birth, marriage, or adoption.



3, Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project)




CDBG _FY 13_Application. DOC
Page 3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers to b,e listed below are the numbers of unduplicated individuals benefiting from
 the project or program for which you are requesting funding. The totals in the ~1\!i~;P,~Ii~; must match. The totals in the orange cells must match.

 Female·
 Headed
 Households




 0


5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to b~ Ji~ted below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the ~lu$ggll~ must match.

 Income Hisoanic I Latino Race Female-
 Below 31%\o 51% to Above Total Total White Black or Native Asian American Mixed Total Headed
 30% 50% 80% 80% African- Hawaiian Indian or Race Households
 (all others) American or Other Alaskan
 Pacific Native
 I Islander
 c::olds I




6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.

 Total Full-Time Total Part Tim~ ;~ Total Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time Income Part-Time
 Hires Hires
 !




CDBG_FY 13_Application .DOC
Page 4
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project. (Please select only one.)

 Anti-Crime Programs Senior Programs
 0 Crime Awareness D Senior Centers
 0 Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 D Micro-Enterprise Assistance D Youth Centers
 D Child Care Centers
 Non-Homeless Housing D Youth Services
 D Renter- Elderly D Child Care Services
 D Renter- Small Family
 D Renter- Large Family Homeless Individuals
 0 Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 D Sidewalks D Housing Placement
 D Tree Planting D Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) D Emergency Shelter
 D General Public Facilities D Transitional Housing
 J:2J Handicapped Centers D Job Training
 D Parks/Recreational Facilities D Case Management
 0 Parking Facilities 0 Child Care
 D Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Services D Housing Placement
 {Administrative Support Activities) D Life Skills Training
 D General Public Services
 D Handicapped Services
 D Transportation Services
 D Employment Training
 D Health Services
 D Mental Health Services
 D Screening for Lead-Based Paint




CDBG_FY13_Application.DOC
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 D Elderly
 D Frail Elderly
 D Severe Mental Illness
 k2J Developmentally Disabled
 D Physically Disabled
 D Substance Abusers
 D Persons with HIV/AIDS
 D Victims of Domestic Violence
 Comments:


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 SHORE's mission is to improve the quality of life for persons with developmental disabilities through educational,
 residential, vocational and related programs provided with community integrated supports and services. Helping
 children and adults reach their full potential and, thus, lead them to more independent and productive lives is
 fundamental to the process.

 In 1951, a group of Evanston parents formed SHORE School. By 1953, the school operated as one of six
 statewide research projects to determine if children with developmental disabilities could benefit from public
 education. The school's success led to incorporation in 1954 into the Evanston-Skokie School District. SHORE
 grew and established programs as inclusion moved to the forefront and institutional care diminished.

 Today, SHORE provides the following services: small group homes, CILAs (Community Integrated Living
 Arrangements), Supported Living Arrangements, a Training Center, a Senior and Adult Services Program, Early
 Intervention, Service Facilitation and Respite Care to nearly 400 children and adults with intellectual and other
 developmental disabilities.



10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 SHORE is seeking funding to replace 12-year old carpeting and vinyl sheet floor covering throughout the Jean F.
 Karger House CILA with a more durable tile. There are six men that reside in the CILA and two use wheelchairs
 and walkers to manuevar, which scuffs the floors and pulls on the vinyl and carpeting. The vinyl floors are
 difficult to keep clean from the daily scuffing and it is starting to curl up towards the baseboards. The carpeting
 is pulling away from the tack strips and has a few ripples, which can create a safety hazard for slips and falls
 caused by the impediments in the walking surface if it continues to buckle. It is beginning to fray in areas and
 the padding is deterioraing from regular wear and tear. In addition, the carpet is heavily stained, despite
 constant cleaning. This is as a result of the residents spilling and dropping food on the floor especially in the
 dining room where meals are served, incontinence and other past illinesses.

 CDBG_FY 13_Application.DOC
 Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)




 The preferred product replacement is a Luxury VinyiTile that is a commercial grade with a 25 year warranty for
 residential use. It is made of recycled material and has an advanced ceramic-infused wear layer that provides
 increased protection throughout the life of the floor. Other features include: Nano-Silver, which is the most
 sophisticated antimicrobial defense used in floors that provides greater protection against bacteria, viruses and
 molds; vinyl is resistent to water; has two coats of advanced UV-cured polyurethane that makes it scratch and
 scuff resistent; and the product has met or exceeded the most stringent VOC (Volatile Organic Compound)
 emissions requirements. The tile is slip resistent and easy to maintain, which will reduce annual cleaning costs
 and would create a more sanitary environment for the residents and staff.

 The tile would be installed in the front entrance, living and dining room at a price of $5,453.00; rear entrance, two
 stairs and hallway for $3,631.00, and the five resident bedrooms for $8,91 0.00. Removal of debris is $60.00
 rounding the total project cost to $18,054.00. However, if the entire project is unable to be funded, then the
 priority would be to replace the commom areas (front and rear entrances, front room, dining room, stairs and
 hallway) at a cost of $9,144.00 with the debris removal included.




11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 The repairs requested for the Jean F. Karger House GILA (Community Integrated Living Arrangement) supports
 what use to be Objective H2, Strategy A, which supported efforts of agencies that supply and maintain housing
 for the developmentally disabled. SHORE's residential programs have 54 low-income participants with
 intellectual and other developmental disabilities. Twenty-seven reside in Skokie including six men with moderate
 to severe disabilities at the Karger House.

 The philosopy of the State of Illinois is to reduce the number of individuals with intellectual and other
 developmental disabilities on waiting lists and living in large state operated facilities by moving them into smaller
 community based residential facilities. The Karger House, like most facilities, needs constant improvements to
 maintain a safe and attractive home environment.




CDBG _FY13 _Application .DOC
Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How manv people are Skokre resrdents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 The target population consists of six men who reside at the Jean F. Karger House CILA
 (Community Integrated Living Arrangement) in Skokie. These residents have moderate to severe
 intellectual and other developmental disablisabilities and require 24-hour supervision when at
 home or at a day program. All the individuals at the CILA are low-income and receive a
 Medicaid Waiver as a term to their residency.

 Services provided to the residents include: shelter, meal preparation, toileting and grooming
 assistance, activities of daily living skills, recreational and healthy living activites.

 B. What do you consider to be a unit of service? (Please select only one.)

 D One client, many times
 D One client, one time
 D Multiple clients, one time
 ~ Other (Please describe.) One person is considered a unit of service and the count is not
 duplicated even if served 365 days a year.

 C. What types of service(s) are included? (Please select all that apply.)

 D Phone counseling
 D In-office counseling
 D Nights of service
 D Home visits
 ~ Other (Please describe.) 24-hour care (See A for more details.)

 D. What types of tangible services are provided? (Please select all that apply.)

 ~Food
 ~ Housing/shelter
 ~ Clothing
 ~ Emergency Funds
 ~ Other (Please describe.) Transportation, training/job search, education and recreational
 activities




CDBG _FY 13_Application .DOC
Page 7
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 [:1 Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunities
 This objective applies to activities related to economic development. commercial revltallzation, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 [:1 Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 D Affordability
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Afford ability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the affordability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 low/moderate-income microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 D Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




 CDBG_FY13_Application.DOC
 Page 8
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 Q1 May:
 June:
 July:
 Q2 August: Invitation to bid will be put out to contractors.
 September: Bid accepted, reviewed by the Village of Skokie and contract signed.
 October: Materials selected and ordered and work begins.
 Q3 November: Project completed.
 December:
 January:
 Q4 February:
 March:
 April:


16. other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 No other funding for this project has been sought. SHORE's required match for the CDBG project is estimated at
 $4,513.50 and would be available through agency resources. If no CDBG funding is granted, the project would
 be deferred until such time other funding is obtained.


17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 . The last three projects that received CDBG funding from the Village of Skokie are complete. This year, four
 energy efficient windows and three storm doors were installed at the Laura House GILA, 8900 Central Park in
 Skokie with a $4,500.00 CDBG grant. In 2011, the CDBG grant of $11,300.00 was used to make improvements
 at the Laura House GILA, which included: replacing the kitchen and dining room floors with commercial grade
 tile, replacing the shower pan, walls, faucet and plumbing in one bathroom shower, and four energy efficient
 thermal pane windows were installed. The 2010 project received $12,000.00 in CDBG funding to purchase and
 replace two furnaces and two air conditioners at the Regenstein Administration Center, 4232 Dempster Street in
 Skokie.




CDBG_FY13_Application. DOC
Page 9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 k2J Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 k2J Budget (including REVENUE and EXPENSE line items for the proposal)
 k2J Latest Agency Budget
 k2J Latest Agency Independent Financial Audit
 k2J Blank Income Verification Form
 k2J Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 D Job Description, Compensation, Benefits, and Position Duration (non-scholarship. public service activities only)
 D Activity Programs Brochure with Fee Schedule (scholarship. public service activities only)
 k2J Other (Please describe.) SHORE Residential Services Preliminary Admissions Application, CILA Provider
 Award Letter, 24 Hour Shift CILA Support Rate Determination, 24 Hour Shift
 Staff CILA Support Rate Determination, 24 Hour and Foster Care "HF" CILA
 Support Turnaround & Rate Review Form,

 Used for Blank Income Verification Form -Community Reimbursement
 Subsystem Financial Questionnaire from the State of Illinois Department of
 Mental Health and Developmental Disabilities & Illinois Department of Human
 Services Community Reporting System Client Income Information




 CDBG_FY 13_Application .DOC
 Page 10
 Form AG990-IL
;-cFo"--r""-bffc.c-1'"'
 8
 -"'u""se__,o""niL__y_, Illinois Charitable Organization Annual Report Revised 3/05 10: 2BN

 PMT# _ _ _ _ _~
 Attorney General Lisa Madigan State of Illinois
 Charitable Trust Bureau, 100 West Randolph
 11th Floor, Chicago, Illinois 60601 CO# 01033533
 AMT Check all items attached:




 ~
 Report for the Fiscal Period: Copy of IRS Return
 INIT Beginning 7/01/11 Audited Financial Statements
 Make Checks
 & Ending 6/30/12 Payable to
 the Illinois
 Copy of Form IFC
 MO DAY YR Charity
 Bureau Fund
 $15.00 Annual Report Filing Fee
 $100.00 Late Report Filing Fee
 MO DAY YR



 LEGAL
 NAME SHORE COMMUNITY SERVICES INC.
 MAIL
 ADDRESS 4232 DEMPSTER
  CITY, STATE
 ZIP CODE SKOKIE, IL 60076


 I SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:
 D PUBLIC SUPPORT, CONTRIBUTIONS AND PROGRAM SERVICE REVENUE
 (GROSS AMOUNTS).
 E GOVERNMENT GRANTS AND MEMBERSHIP DUES ..
 F OTHER REVENUES .. . . . . .SEE . .STATEMENT . .1.
 G TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, AND F)..
 II SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H OPERATING CHARITABLE PROGRAM EXPENSE ..
 I EDUCATION PROGRAM SERVICE EXPENSE ..
 J TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (AOD HAND 1) ..
 Jl JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J).. . ... $---.-----.JS"'
 K GRANTS TO OTHER CHARITABLE ORGANIZATIONS .
 L TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J AND K}.
 M MANAGEMENT AND GENERAL EXPENSE ..
 N FUNDRAISING EXPENSE ..
 0 TOTAL EXPENDITURES THIS PERIOD (ADD L, M, AND N).
 Ill SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
 (Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.)
 PROFESSIONAL FUNDRAISERS:
 P TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS.
 Q TOTAL FUNDRAISERS FEES AND EXPENSES .
 R NET RECEIVED BY THE CHARITY (P MINUS o~R) ..
 PROFESSIONAL FUNDRAISING CONSULTANTS:
 S TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS..
 IV COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:


 U NAME, TITLE:
 T NAME, TITLE:
 V NAME, TITLE:
 ~~E~RA~L~D~~~~~~~~~~~============================tJ~====~jtij~tj
 V CHARITABLE PROGRAM DESCRIPTION: CHARITABLE PROGRAM (3 HIGHEST BY$
 EXPENDED) COD£ CA TEGOR!ES



 DESCRIPTION: ~
 X DESCRIPTION:
 W
 y
 ~~~~~~~~~~~~~~~~~~~~i======i~~==~~=~
 ILVA0212L 12129/08
s
IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATIACH A DETAILED EXPLANATION:


 1 WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT'. 1
 2 HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN
 CONVICTED BY ANY COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS
 OR ANY FELONY?.. 2

 3 DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH
 ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY
 TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL
 INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED
 AS COMPENSATION?... .. .. .. .. .. 3
 4 HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR
 TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES?. 4

 5 IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF
 ANY OTHER PERSON OR ORGANIZATION 7 .. 5 f-----+~-4
 6 DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER7 (ATIACH FORM IFC).. 6

 7a DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR
 LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?.. 7
 7b IF 'YES', ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$ ; (ii) THE
 AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (ii) THE AMOUNT ALLOCATED TO
 MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO
 FUNDRAISING $ _ _ _ _ _ __

 8 DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN
 RESTRICTED PURPOSES?. . 8

 9 HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION
 SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY?. . 9

10 WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION
 MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?.. 10

 11 LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE
 LARGEST ACCOUNTS:




 12 NAME AND TELEPHONE NUMBER OF CONTACT PERSON: 82-2030

ALL ATIACHMENTS MUST ACCOMPANY THIS REPORT- SEE INSTRUCTIONS


UNDER PENALTY OF PERJURY, I ('HE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I ('HE) HAVE EXAMINED THIS ANNUAL
REPORT AND THE ATIACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED
ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATIORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE
STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT
HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.



BE SURE TO INCLUDE ALL FEES DUE:

 1 REPORTS ARE DUE WITHIN SIX
 MONTHS OF YOUR FISCAL YEAR END.
 2 FOR FEES DUE SEE INSTRUCTIONS. DATE
 3 REPORTS THAT ARE LATE OR
 INCOMPLETE ARE SUBJECT TO A WAYNE E. SILVERMAN
 $100.00 PENALTY. PREPARER (PRINT NAME) DATE
 MANNING SILVERMAN & COMPANY
 175 OLDE HALF DAY ROAD, #290
 LINCOLNSHIRE, IL 60069




 ILVA0212L 12129/08
 SHORE Community Services, Inc.
 Budget for Jean F. Karger House CILA Project


Capital Improvements $18,054.00



Income

Village of Skokie Community Development Block Grant $13,540.50

Match from SHORE Community Services $4,513.50

Total $18,054.00




Expenses

Karger House Project (As outlined under Project Description
and Cost and Design Assistance Estimates) $18,054.00

Total $18,054.00
 SHORE Community Services, Inc.
 Cost and Design Assistance Estimates
 Jean F. Karger House CILA Project



The project involves the removal of existing carpeting, padding, tackless strips, and vinyl floor
covering with the replacement of Luxnry Vinyl Tile. A 114" plywood underlayment will be
installed below the tile and a primed pine baseboard \viii be added throughout the house. Below
is a breakdown of the costs for the different areas in the house:

Front Entrance, Living and Dining Room $5,453.00

Rear Entrance, Two Stairs and Hallway $3,631.00

Five Bedrooms $8,910.00

Debris Removal $60.00

Total $18,054.00
 SHORE
 COMMUNITY SERVICES INC.

 Proposed Budget 2012 - 2013

INCOME:
 Contributions - Net 581,200
 SHORE Lois Lloyd Center 1,005,700
 SHORE Training Center 1,841,400
 SLA Services 117,400
 SHORE Homes 726,500
 SHORE GILA 917,100
 SLS Services #55A 13,100
 DHS Training 29,200
 Respite Care (In Home) 54,100
 Sub Total General Operating Fund 5,285,700

 HUD Account- SHORE Homes
 Rent Income- Clients 90,400
 Rent Supplement- HUD 245,800
 Interest Income
 Sub Total HUD Account 336,200
 Total Operating Funds Income 5,621,900

EXPENSES:
  Administration 700,600
  lnterdepartment 45,600
  Second Time Around 55,800
  SHORE Lois Lloyd Center 904,700
  SHORE Training Center 1,549,800
  SLA Services 97,300
  SHORE Homes 798,400
  SHORE GILA 665,600
  SLS Services #55A 7,200
  DHS Training 55,300
  Respite Care (In Home) 42,600
  Occupancy - Church Street 78,100
  Occupancy - Brummel Street 25,600
  Occupancy- 8035 Austin Avenue 166,600
  Occupancy - Dempster Street 26,900
 Occupancy - 727 Brown 11,100
 Occupancy- 4324 Church St. - Karger House 14,500
 Occupancy- 511 Judson Scattered Site 7,500
 Occupancy - 4125 Oakton - ECI Center 18,900
 Occupancy - 4123 Oakton - STA 4,000
 Occupancy - 8900 Central Park - Laura House 9,600
 Sub Total General Operating Fund 5,285,700 5,285,700
 HUD Account- SHORE Homes
 Administration 27,260
 Occupancy 308,940
 Sub Total HUD Account 336,200 336,200
 Total Operating Funds Expense 5,621,900 5,621,900




 APPROVED 9/1/11
PHONE: (847)677-1774 Date: 11/19/12
 PROPOSAL
FAX: (847)677-1775 Dallia Floor & Wall Co., Inc. No:l2527
Email: Sales@Dalliafloors.com 9946 Crawford Avenue Phone:847-982-2030 x2l
Shore Homes Skokie, Illinois 60076 Fax:
Attn. Marv Matz Email:
4232 Dempster Vinyl Tile Ceramic
Skokie, IL 60076 Wood Marble
 Linoleum Sheet Goods


We propose to fumish all materials and labor to install _ _ _ _ _ _ _ _ areas below,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
At 4324 Church Ave., Skokie_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
as follows:
ENTRY. LIVING ROOM, AND DINING ROOM:
 1.  Remove and reset furniture as needed.
 2.  Remove existing carpet, padding, and tackless strip, placing outside for your scavenger service.
 3.  Furnish and install 1/4" multi~ply underlayment plywood stapled 1 to 2 inches around perimeter and 4 to 6 inches through center of
 boards.
 4. Furnish and install Adore's Nature lie 18xl8 solid vinyl tile#·_ _ _ _ , laid square to walls.
 5. Furnish and install primed pine base shoe at walls to finish.
 6. Furnish and install metal reducer at doorway to kitchen as needed.
 Total material and labor: $5,453.00
REAR ENTRY, TWO STAIRS, AND HALLWAY:
 1.  Remove existing underlayment and tile, placing outside for your scavenger service.
 2.  Furnish and installl/4" multi-ply underlayment plywood stapled 1 to 2 inches around perimeter and 4 to 6 inches through center of boards.
 3. Furnish and install Adore's Naturelle 18xl8 solid vinyl tile# , laid square to walls.
 4. Furnish and install primed pine base shoe at walls to finish.
 5. Furnish and install metal reducers at doonvays or stairs as needed.
 Total material and labor: $3,631.00
FIVE BEDROOMS:
 1.
 Remove and reset furniture as needed.
 2.
 Remove existing carpet, padding, and tackless strip, placing outside for your scavenger service.
 Furnish and installl/4" multi-ply underlayment plywood stapled 1 to 2 inches around perimeter and 4 to 6 inches through center ofboards.
 3.
 4.
 Furnish and install Adore's Naturelle 18xl8 solid vinyl tile# , laid square to walls.
 5.
 Furnish and install primed pine base shoe at walls to finish.
 Total material and labor: $8,910.00
NOTE: Job figured as non-taxable. If incorrect, tax will be added to above numbers.

 If we are required to remove debris from job site, add $60.00
 Thank you
We have our own in-house employees;
there is no subcontracting of work.
 PROPOSAL GUARANTEED FOR 30 DAYS For the sum of _ _ _ _ _ _ __
 WORK GUARANTEED FOR ONE YEAR UPON
 Terms: 50% Deposit, COMPLETION OF JOB
 Balance Upon Completion 50% Deposit Requested-·-- . __
 Price includes State Sales
 PLEASE SIGN AND
 Tax on Material Only Extras
 RETURN ORIGINAL
There is a 2 hour minimum charge on all jobs. Total Balance~_ _ _ _ _ _ __
 Purchaser agrees to pay any expenses incurred by
 Dallia Floor & Wall Co., Inc. in collecting amounts
1% interest per month will be added to all accounts due, including attorney's fees.
30days past due



 This proposal is submitted in behalf ofDallia Floor & Wall Co. Signature of customer and dealer constitutes a contract.


x___________________________ 2o X~----------~~~~~----~---20
 Customer Acceptance Acceptance by Dallia Floor & Wall Co.


o Moving of appliances, furniture and materials at owner's risk c 7Qo room temperature is essential for satisfactory installation of all resilient floors
o Expansion and contraction due to atmospheric conditions is beyond "Not responsible for cutting down any doors unless specifically stated in contract
 control
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 3D, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SHEET


Project Title: Window and Door Replacement

Project Description (150 words maximum): Search, Inc. is requesting CDBG funding for the
 replacement of windows and doors at a group home for
 six women with intellectual disabilities. CDBG funding
 for this project would support Search's efforts to
 respond effectively to rising energy costs related to
 maintaining supported housing for adults with
 intellectual and physical disabilities.

Project Address: 7807 N. Keeler


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $ 8,250
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $24,750

 Total Estimated Project Cost: $ 33,000


 Public Services:
 Total CDBG Funding Request: $




 Contact Information
 Organization Name: Search, Inc.
 Contact Name, Title: Donna Catalano - Executive Director/Chief Operating Officer


 Signature: ~~-=;
 -~
 Mailing Address 1: 1925 N. Clyboum Ave., Suite 200
 Mailing Address 2:
 City, State, Zip: Chicago, IL. 60614
 Telephone Number: 773-305-5000
 Fax Number: 773-305-0739
 Email Address: dcatalano@search-inc.org
cdbg application 13-14
Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)




cdbg application 13-14
Page 2
Village of Skokie
Community Development Block Grant (COBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 [8J (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 D Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members 18 years old or older that contribute to the household. The
 extremely low, vel}' low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birth, marriage, or adoption.



3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)




cdbg application 13-14
Page3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers!o be listed below are the numbers of unduplicated individuals benefiting from
 the project or program for which you are requesting funding. The totals in the blu!l'Bei~ must match. The totals in the orange .cells must match.


 -------··selow--"----31%to·-· ---51-%i0-r··-·p;tiove·r---·rotar ·"·"---------~-!~.P.-~~!~L~~!l~-~----------------
 Income Race Female·
 Yes i No i Total ----- whire··· ··--aTaCk"Or·-r-·-NaiiVe--r----·-ASian··· ""American·r----MIXe;r:·----·-· Totar- Headed
 30% 50% 80% j 80% j African- : Hawaiian ! Indian or  ! Race ! Households
 i
 ! (all others) 1
 ;
 i
 i
 I : i
 American i or Other !
 i Pacific !

 l ''''"'" i
 Alaskan !
 Native i i
 People
 6 ! l; ';,;•:';'1.0 l 6  :<·).6. 4 1 i 1- 6
 Skokie
 6 ! 6 6! 6 4 1i j 1 i '. ' 6
 Re:!ii!l!~ts - !
 '

5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to b~ listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the bluec'ells must match.


 ·----·-aerow ·T·-- ·-·31%-to-·r··-!~~f~-io·-r·----A-bOve- T-·-·--rotar ·-·-·- · -· -ves~·Lr-e.~~.LC?.L~~!-f."-~-----Toiarj··-· ·v~rt;iteT·-·-slack-or··r---N~~ve··r·---·~j,;sfan ·-~- Am~rican ·-~---Mixe;rrT·-···-··--rotal-· Female·
 Headed
 30% 50% : 80% ~ 80% i ! i i Afrlcan- i Hawauan i ; Jnd1an or j Race i Households
 ! ! (all others) j 1 1 1 American orp~~~ ! ! A~:~~~ j !
 1
 Islander [ ' ·
 j Households




6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.
 Total Full-Time Total Part-Time Total Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time Income Part-Time
 Hires Hires




cdbg application 13-14
Page4
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project (Please select only one.)

 Anti-Crime Programs Senior Programs
 0 Crime Awareness D Senior Centers
 D Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 0 Micro-Enterprise Assistance D Youth Centers
 D Child Care Centers
 Non-Homeless Housing D Youth Services
 D Renter- Elderly D Child Care Services
 0 Renter- Small Family
 0 Renter- Large Family Homeless Individuals
 .rzl Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 0 Sidewalks 0 Housing Placement
 D Tree Planting 0 Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) D Emergency Shelter
 0 General Public Facilities 0 Transitional Housing
 0 Handicapped Centers 0 Job Training
 0 Parks/Recreational Facilities D Case Management
 D Parking Facilities D Child Care
 D Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Services 0 Housing Placement
 (Administrative Support Activities) D Life Skills Training
 D General Public Services
 0 Handicapped Services
 D Transportation Services
 0 Employment Training
 D Health Services
 D Mental Health Services
 0 Screening for Lead-Based Paint




cdbg application 13-14
Page5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 D Elderly
 D Frail Elderly
 D Severe Mental Illness
 ~ Developmentally Disabled
 D Physically Disabled
 D Substance Abusers
 D Persons with HIV/AIDS
 D Victims of Domestic Violence
 Comments:


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 Search's mission is to empower persons with intellectual disabilities to achieve their full potential, accept a
 valued role in their community, and lead rich, rewarding lives.

 Search, Inc. is a private, non-profit organization which provides life skills training, residential group homes, job
 training and placement services, medical services, and recreation services to over 400 persons with disabilities
 annually in Chicago and the northern suburbs. Of Search's 38 program sites, 14 of the sites are group homes
 located in Skokie. Search opened it's first Skokie group home in 1990.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 Search is seeking CDBG funding to complete capital improvements related to energy efficiency. Specifically,
 Search proposes to replace the doors and windows to increase energy efficiency at a home for six women with
 disabilities. The project also includes the internal trim finishing work related to the replacements. Priority order
 for the job componants is external windows, external doors, and then internal doors/trim.


11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 The housing Search provides for adults with disabilities is high quality, however, the exterior of this home
 requires urgently needed capital improvements to improve energy efficiency. CDBG funding for this project
 would support Search's efforts to respond effectively to rising energy costs related to maintaining supported
 housing for persons with disabilities. Search has been unable to address this need previously due to the
 unavailability of a funding source.


cdbg application 13-14
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)




 cdbg application 13-14
 Page6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How many people are Skokie residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 Six (6) persons with intellectual disabilities will benefit from the window and door replacement at this home.
 Of this number, 100% are between very low and low income, receiving income from a combination of Social
 Security, SSI, and/or food stamps. Four of the six women are white (non-Hispanic), one is black, and one is
 of mixed race. Finally 100% of the persons who would benefit are residents of Skokie.

 B. What do you consider to be a unit of service? (Please select only one.)

 D One client, many times
 D One client, one time
 !?SI Multiple clients, one time
 D Other (Please describe.)
 C. What types of service(s) are included? (Please select all that apply.)

 D Phone counseling
 D In-office counseling
 D Nights of service
 D Home visits
 D Other (Please describe.)
 D. What types of tangible services are provided? (Please select all that apply.)

 D Food
 D Housing/shelter
 D Clothing
 D Emergency Funds
 D Other (Please describe.)




 cdbg application 13-14
 Page 7
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 [2'J Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 D Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 [2'J Affordability
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Affordability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the affordability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 low/moderate-income microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 D Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




cdbg application 13-14
PageS
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed time line identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 Q1 May:
 June:
 July: Complete design, identify products, prepare scope and sequence of project
 Q2 August: Conduct contractor open house, secure bids, identify low bidder, secure approval by
 CDBG Administrator
 September: Order and receive materials
 October: Complete installation of windows and doors
 Q3 November:
 December:
 January:
 Q4 February:
 March:
 April:


16. Other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 No other viable funding sources have been identified for this project. The Illinois Department of Human Services
 provides funds to Search for general maintenance of the group homes but does not provide funding for capital
 improvements such as the one requested in this application.

 The Illinois Department of Human Services does provide up to $15,000 per property for home modifications for
 accessibility. Search reached this maximum award amount for this home in 2011 when we installed an
 automatic sprinkler system and thus, Search does not qualify for additional financial support for this home from
 this source.

 If CDBG funds are not awarded, this capital improvement project will be deferred until funding is obtained.


17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 Program Year 2010: Bathroom accessibility improvements at one group home. Project complete.




cdbg application 13-14
Page 9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 3D, 2014)


 Program Year 2011: Window and door replacement for increased energy efficiency at one group home. Project
 complete.

 Program Year 2012: Accessibility improvements in two bathrooms within one group home. Project completion
 expected by 12/31/12.




cdbg application 13-14
Page 10
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 I:8J Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 J:8J Budget (including REVENUE and EXPENSE line items for the proposal)
 J:8J Latest Agency Budget
 J:8J Latest Agency Independent Financial Audit
 0 Blank Income Verification Fonm
 0 Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 0 Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 0 Activity Programs Brochure with Fee Schedule (scholarship, public service activities only)
 0 Other (Please describe.)




 cdbg application 13-14
 Page 11
For Office Use Only
 ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT FormAG990-IL
 PMT# Attorney General LISA MADIGAN State of Illinois Revised 3/05
 Charitable Trust Bureau, 100 West Randolph
 11th Floor, Chicago, Illinois 60601 CO# o1-005506
 AMT Check all items attached:




 §
 Report for the Fiscal Period: Copy of IRS Return
 Make Checks Audited Financial Statements
 Beginning 71 1 I 2010 Payable to Copy of Form IFC
 thellfinois
 I NIT Charity $15.00 Annual Report Filing Fee
 & Ending 61 30 I 2011 Bureau Fund $100.00 Late Report Filing Fee
FederaiiD# 23-7058758 MO DAY YR MO DAY YR
Are contributions to the organization tax deductible? [Jf}es Date Organization was created· 9! 22 1969

 Year-end ·.
 LEGAL amounts
 NAME SEARCH, INC. A) ASSETS A)$ 23,514,844.
 MAIL
 ADDRESS1925 N. CLYBOURN, SUITE 200 B) LIABILITIES B)$ 15,619,361.
  CITY, STATE CHICAGO, IL C) NET ASSETS C)$ 7,895,483.
 ZIPCODE60614


  I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR: PERCENTAGE AMOUNT
 D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE R~I9ROSS AMTS.) 95% D)$ 15,086,239.


 E) GOVERNMENT GRANTS & MEMBERSHIP DUES 4% E)$ 693,601.
 F) OTHER REVENUES 1% F)$ 91,385.


 G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, & F) 100% G)$ 15,871,225.
  II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H) OPERATING CHARITABLE PROGRAM EXPENSE 91% H)$ 13,373,870.


 I) EDUCATION PROGRAM SERVICE EXPENSE % I)$
 J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I) 91% J) $ 13,373,870.


 J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): $
 K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS 0% K) $ 0.


 L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) 91% L) $ 13,373,870.
 M) MANAGEMENT AND GENERAL EXPENSE 9% M) $ 1,279,962.

 N) FUNDRAISING EXPENSE % N) $
 0) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N) 100% 0)$ 14,653,832.

 Ill. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
 (Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.)
 PROFESSIONAL FUNDRAISERS:
 P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS 100% P) $
 Q) TOTAL FUNDRAISERS FEES AND EXPENSES % Q) $


 R) NET RECEIVED BY THE CHARITY (P MINUS Q=R) % R) $
 PROFESSIONAL FUNDRAISING CONSULTANTS:
 S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS S) $

  IV. COMPENSATION TO THE {3) HIGHEST PAID PERSONS DURING THE YEAR:
 T) NAME, TITLE: JOHN LIPSCOMB, PRESIDENT/CEO T) $ 198,000.
 U) NAME, TITLE: DONNA CATALANO, coo U) $ 107,080.
 V) NAME, TITLE: GREG PETERSEN, CAO V) $ 115,269.
 v. CHARITABLE PROGRAM DESCRIPTION~HARITABLE PROGRAM (3 HIGHEST BY$ EXPENDED) CODE CATEGORIES List on back side of instructions
 CODE
 W) DESCRIPTION: SERVICES FOR DEVELOPMENTALLY DISABLED ADULTS W)# 121
 X) DESCRIPTION HOUSING FOR DISABLED X)# 134
 Y) DESCRIPTION: Y)#


 OJ15141.000
 IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: YES NO

  1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMEI;J"f?. . . . .... 1 X

  2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF,
 EVER BEEN CONVICTED BY ANY COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR
 MISAPPROPRIATION OF FUNDS OR ANY FELONY?
 . . . . . . " ....................... . . . . . . . 2 . X

  3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH
 ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACT! N
 IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID
 ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATIC?N? 3. X
 ·. .


  4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR
 TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? . . . . . . . . . . . . . . . . . . . . . . . . . . 4. X

  5. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE
 PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " ... 5 . X

  6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM If<;)_ . . . . 6. X

 7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR
 LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? . . . . . . . . . . . . . . . " .. 7. X

 7b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$ ; (ii) THE AMOUNT
 ALLOCATED TO PROGRAM SERVICES$ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT
 AND GENERAL$ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $


  8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED
 PURPOSES? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. X

  9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION
 X
 SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY?
 .. . . . . . . . . " . " ................. 9 .
 10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION
 MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUND?? . . . . . . . . . . . . . . . . . 10. X

 11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
 THREE LARGEST ACCOUNTS:
 JP MORGAN CHASE, 10 s. DEARBORN, CHICAGO, IL
 BANK OF NEW YORK MELLON, 2 NORTH LASALLE ST., CHICAGO, IL

 12. NAME AND TELEPHONE NUMBER OF CONTACT PERSONMARK FRANCIK, COMPTROLLER 773/305-5000


  ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT- SEE INSTRUCTIONS

UNDER PENALTY OF PERJURY,! (WE) THE UNDERSIGNEDDECLAREAND CERTIFYTHAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT
AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE
TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE
STATE OF ILLINOIS RELY THEREUPON.! HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT
HEREBYTO THE JURISDICTIONOF THE STATE OF ILLINOIS.




BE SURE TO INCLUDE ALL FEES DUE: PRESIDENT or TRUSTE~RINT NAME) SIGNATURE DATE
1.) REPORTS ARE DUE WITHIN SIX
 MONTHS OF YOUR FISCAL YEAR END.
2.) FOR FEES DUE SEE INSTRUCTIONS. TREASURER or TRUSTE~RINT NAME) SIGNATURE DATE
3.) REPORTS THAT ARE LATE OR
 INCOMPLETE ARE SUBJECT TO A
 $100.00 PENALTY.
 PREPARERPRINT NAME) SIGNATURE DATE
OJ15151.000
Community Development Block Grant (CDBG) Program
2013-2014 Program Year Application

Project Budget:

Window and Door Replacement -7807 N. Keeler Ave., Skokie

Revenue:

CDBG request $24,750
Search fundraising $8,250
 Project Total: $33,000

Expenses:

Furnish and install whole house, brick to brick, replacement windows such
as Pella Architect Series, pine interior and white aluminum exterior, double
hung and one picture window , inclusive of staining/finishing of windows
and pine colonial trim $20,000

Replace existing exterior doors with white fiberglass inclusive trim and with
standard nickel finish hardware and Schlage locks and two white storm
doors with hardware
 $2,800

Replace interior base boards to match interior door and window trim
including finishing
 $2,000

Replace interior doors including double track sliding door closet doors
with six panel colonial and door jams and trim in pine including finishing
 $8,200

 Project Total: $33,000
SEARCH, INC.
FY 2013 OPERATING BUDGET


 TOTAL



ILLINOIS DEPT OF HUMAN SERVICES 9,526,835
ILLINOIS DEPT OF HEALTH & FAMILY SERVICES 2,128,945
CLIENT/FAMILY THIRD PARTY 1,634,825
SALES OF SERVICES 1,887,009
INVESTMENT & INTEREST INCOME 5,000
MISCELLANEOUS REVENUE 695,556
TOTAL SUPPORT 15,878,170




SALARIES AND WAGES AND RELATED EXPENSES 9,946,165
MANAGEMENT FEE 981,408
CONSULTANTS 472,498
CONSUMABLE SUPPLIES 495,938
OCCUPANCY 1,040,185
TRANSPORTATION 592,467
DEPRECIATION AND AMORTIZATION 634,671
INTEREST 407,688
MISCELLANEOUS 1,271,665
TOTAL EXPENSES 15,842,685

TOTAL SUPPORT 15,878,170
Community Development Block Grant (CDBG) Program
Fiscal Year 2014


Public Service Proposals
 ,,.

Village of Skokie
Community Development Block Grant (CDBG) Program
 /; '~ .J~;:.
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SfiEEt ~,~ ., ..'\~;~''>/ i
 ,-~,~~~~:~·J~ls~
 ' " \ \ 1

 \\r;),.)\\ '\~,:\ 1P,)rj.)r // , ~n;
 ' ·~~
 \ .J>,
 General Counseling Progr~m~ ·\._ ···-...... · · .,
 >. . r-. ..L /:;E}.
 / , .., •
Project Title:
 -~ (' ~ ~"'•,. ' f' r-"'"// ' \. ,.' /
 '<" t I;'>· ~-"'\;: ..•~· ·· \ \; ;/
Project Description (150 words maximum): The goal of MFS' General Couns·efin§rt~'rogliart( is .to>"
 support and strengthen families and indiViaTia1sthrough
 counseling services that are offered in our community-
 based centers, clients' homes, and school settings.
 MFS utilizes a solution-focused, time-limited approach
 to counseling interventions that build on clients'
 strengths, capacity for change and growth, and their
 relationships within family, community, work and school
 settings. MFS counseling services are available to low
 and moderate income clients. Each client fee is
 determined by the agency's sliding fee scale. Each
 client goes through financial registration at the time of
 intake.

Project Address: 521 0 Main Street Skokie IL 60077


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $

 Total Estimated Project Cost: $


 Public Services:
 Total CDBG Funding Request: $5,000




 Contact Information
 Organization Name: Metropolitan Family Services
 Contact Name, Title: A Fernando Freire, Executive Director


 Signature:


 Mailing Address 1: 5210 Main St.
 Mailing Address 2:
 CDBG_FY13_Application
 Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


 City, State, Zip: Skokie, IL 60077
 Telephone Number: 84 7-825-7 407
 Fax Number: 847-676-8135
 Email Address: freiref@metrofamily.org




CDBG_FY 13_Application
Page 2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL - APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 0 (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 C2J (B) Benefits Specific and Limited Low-Income Clientele (goto#4)
 0 (C) Benefits Housing (go to #5)
 0 (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 0 Prevents or Eliminates Blight on an Area Basis (go to #7)
 0 Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members18 years old or older that contribute to the household. The
 extremely low, very low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birth, marriage, or adoption.



3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)




 CDBG_FY 13_Application
 Page 3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers to listed below are the numbers of unduplicated individuals benefiting from
 the project or program fer which you are requesting funding. The totals in the must match. The totals in the orahgi!:c@fls must match.


 Female-
 Headed
 Households



 60
 60


5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to be listedbelow are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the ~l!l\fi,~~~J~ must match.


 Female-
 Headed
 Households




6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.

 Total Full-Time Total Part-Time Total Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time Income Part-Time
 Hires Hires




CDBG_FY13_Application
Page4
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project. (Please select only one.)

 Anti-Crime Programs Senior Programs
 D Crime Awareness D Senior Centers
 D Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 D Micro-Enterprise Assistance D Youth Centers
 D Child Care Centers
 Non-Homeless Housing D Youth Services
 D Renter- Elderly D Child Care Services
 D Renter- Small Family
 D Renter- Large Family Homeless Individuals
 D Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 D Sidewalks D Housing Placement
 D Tree Planting D Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) D Emergency Shelter
 D General Public Facilities D Transitional Housing
 D Handicapped Centers D Job Training
 D Parks/Recreational Facilities D Case Management
 D Parking Facilities D Child Care
 D Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Se!Vices D Housing Placement
 (Adminislrative Support Activities) D Life Skills Training
 D General Public Services
 D Handicapped Services
 D Transportation Services
 D Employment Training
 D Health Services
 ~ Mental Health Services
 D Screening for Lead-Based Paint




CDBG_FY13_Application
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term May 1, 2013, through April 3D, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 0 Elderly
 D Frail Elderly
 D Severe Mental Illness
 D Developmentally Disabled
 D Physically Disabled
 D Substance Abusers
 0 Persons with HIV/AIDS
 0 Victims of Domestic Violence
 Comments:


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 Founded in 1857, Metropolitan Family Services (MFS) is the oldest and largest non-sectarian family service
 organization in metropolitan Chicago. As a multiple service agency MFS brings a breadth of programs to the
 community. The mission of the agency is to provide and mobilize the services needed to strengthen families and
 communities.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (§QQ words maximum)

 The goal of MFS' General Counseling Program is to support and strengthen families and individuals through
 counseling services that are offered in our community-based centers, clients' homes, and school settings. MFS
 utilizes a solution-focused, time-limited approach to counseling interventions that build on clients' strengths,
 capacity for change and growth, and their relationships within family, community, work and school settings. MFS
 counseling services are available to low and moderate income clients. Each client fee is determined by the
 agency's sliding fee scale. Each client goes through financial registration at the time of intake. We also serve
 non-registered Skokie clients through our Intake serivce by providing them with information and referrals to
 appropriate services or agencies when we do not provide the service they need. An example would be clients
 needir1g tangible assitance like food or shelter.

 Issues commonly presented by General Counseling Program clients include: grief, trauma, family/couple and/or
 parenUchild relationship problems, child and adolescent school performance and behavior problems, work
 performance concerns, substance abuse, individual and family developmental concerns, and family violence.
 The five most common presenting problems by percentage of clients are: Couple relationships 20%, Domestic
 Violence 12%, Family Relationships 12%, Stress 12% and Grief and Loss 10%. Our clients continue to
 experience multiple life stresses that include job loss, financial problems, and family relationship upheaval, often
 due to farnily anger management problems, legal issues, separation and divorce. Family stresses greatly impact
 a child's social and emotional learning, which in turn plays an important role in a child's ability to benefit from
 their academic education.


 CDBG_FY 13.. Application
 Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term May 1, 2013, through April30, 2014)


 To help support our General Counseling Program we are requesting $5,000.00. The funding will be used to
 cover part of the salary of a counselor and an intake worker who provides information and referral services.


11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 Issues commonly presented by General Counseling Program clients include: grief, trauma, family/couple and/or
 parent/child relationship problems, child and adolescent school performance and behavior problems, work
 performance concerns, substance abuse, individual and family developmental concerns, and family violence. By
 addressing these issues with the help of training counselors, clients can avoid unnecessary individual or family
 turmoil that may negatively impact their ability to keep or find gainful employment and keep stable housing.




 CDBG_FY13_Application
 Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12, Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How manv oeople are Skok1e residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (l§O_words maximum)

 Detail records will be kept for all counseling cases. Clients are required to sign the progress notes
 made by counselors when counseling services are provided. MFS has a client information system
 capable of producing detailed reports of services provided. Phone inquiries are logged and
 tracked.

 B. What do you consider to be a unit of service? (Please select only one.)

 [2J One client, many times
 D One client, one time
 D Multiple clients, one time
 D Other (Please describe.)
 C. What types of service(s) are included? (Please select all that apply.)

 D Phone counseling
 [2J In-office counseling
 D Nights of service
 [] Home visits
 [2J Other (Please describe.) Phone information and referral

 D. What types of tangible services are provided? (Please select all that apply.)

 D Food
 D Housing/shelter
 D Clothing
 D Emergency Funds
 [2J Other (Please describe.) Counseling and case management services




 CDBG_FY 13_Application
 Page 7
Village of Skokre
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term May 1, 2013, through April30, 2014)


13, Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger communffy need that I am seeking to address?

 [8J Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 tllGir living environment.

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation,



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When soloctmg an outcome, ask: What type of change or result am I seeking?


 ~ Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 llvo.

 0 Affordabi!lty
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. lt can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Affordability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the afford ability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 lmvimodcrate-incomo microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of tile loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidiwd day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 0 Sustainabllity
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 acl.ivitios or services that sustain communities or neighborhoods.




CDBG_FY13_Arclcetion
Page 8
Village of Skokrc
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 01 May:
 June:
 July:
 02 i\ugust:
 September:
 October:
 03 November:
 December:
 January:
 04 February:
 March:
 Apnl


16. Other Fu:1cling Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 This project will be mostly paid by MFS' own monies to provide counseling services in Skokie. If this grant is not
 approved, MFS will absorved its full cost However, when MFS does fund raising many donors want to see how
 much local support is available. This grant will help MFS in showing to have local support.


 17, Previous CDBG Funding
 Briefly de sui be the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these pmJects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 $5,000 last year. In 2010 we received a grant to replace our A/C unit




 CDBG_FY13_Application
 Page 9
Village of Skokio
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public scrvtce activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 [81 Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 [81 Budget (including REVENUE and EXPENSE line items for the proposal)
 [81 Latest Agency Budget
 [81 Latest Agency Independent Financial Audit
 [81 Blank Income Verification Form
 [J Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 [81 Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 [81 1\ctivily Programs Brochure with Fee Schedule (scholarship, public service activities only)
 D Other (Please describe.)




 CDBG_FY13_Application
 Page 10
 '
~ For Office U~n1y ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT Form AG990·1L
 Revised 3/05
 PMT# Attorney General LISA MADIGAN State of Illinois
 Charitable Trust Bureau, 100 West Randolph co# 01-001 '290
 11th Floor, Chicago, Illinois 60601 Check all items attached:
 -\MT Report for the Fiscal Period: lXJ Copy of IRS Return
 Make Checks [X] Audited Financial Statements
 Beginning 07/01/2010 Payable to D Copy of Form lfC
 the Illinois
  IINIT
 & Ending Charity D $15.00 Annual R•port Filing Fee
 06/30/2011 Bureau Fund D $100.00 Late Report Filing fee
 MD DAY YR MO DAY YR
 02 15/1857

 NAME Metropolitan Family Services
 MAIL
 ADDRESS One North Dearborn, No. 1000
 CITY,STATE Chicago, IL

 I.
 0) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.)
 E) GOVERNMENT GRANTS & MEMBERSHIP DUES
 F) OTHER REVENUES

 G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADO D, E, & F)
 II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H) OPERATING CHARITABLE PROGRAM EXPENSE

 I) EDUCATION PROGRAM SERVICE EXPENSE

 J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & i)

 J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J):

 K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS

 l) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)

 M) MANAGEMENT AND GENERAL EXPENSE

 N) fUNDRAISING EXPENSE

 0) TOTAL EXPENDITURES THIS PERIOD (ADO L, M, & U)

 Ill. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT Al"•rnaTJt::<>·
 (Attach Attorney General Report of Individual Fund raising Campaign- Form IFC. One for each PFR.)
 PROFESSIONAL FUNDRAISERS:
 P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS 0.

 Q) TOTAL FUNDRAISERS FEES ANO EXPENSES

 R) NET RECEIVED BY THE CHARITY (P MINUS U=R)
 PROFESSIONAL FUN ORA ISING CONSULTANTS:
 S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS
 IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
 L. Jones President


 ••.. cHARITABLE PRoGRAM oEscRIPTION: ~~n'ilii!I,6~~-~"'GiiESTBY$EXPENDED)

 and Individual
  IF ANSWER TO ANY OF THE FOLLOWING IS YES, ATIACH A
 see
  1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT?

  2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY
 COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY? ....

  3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE
 ANYTHING OF VALUE NOT REPORTED AS COMPENSATION?

  4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE
 THAN 10% OF THE OUTSTANDING SHARES?

  5. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON
 OR ORGANIZATION?

  6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC)

  7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS
 BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?

  7b. IF 'YES', ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$ ; (ii) THE AMOUNT
 ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND
 GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNORAISING $ _ _ _ _ _ _ _.c._

  8. OlD THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRlCTED PURPOSES? ......

  9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRAT!ON OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR
 REVOKED BY ANY GOVERNMENTAL AGENCY?.. . .............. ................ .. .............................. ..

  10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANYTHEFT, DEFALCATION, MISAPPROPRIATION,
 COMMINGLING OR MISUSE Of ORGANIZATIONAL FUNDS? ...................................... _......... ..

  11. UST THE NAME AND ADDRESS OFTHE FINANCIAL INSTITUTIONS WHERETHE ORGANIZATION MAINTAINS ITS
 THREE LARGEST ACCOUNTS:

 The Northern Trust

 us Bank IL

 Citibank Chic IL



  ALL ATIACHMENTS MUST ACCOMPANY THIS REPORT- SEE INSTRUCTIONS

UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED OEClAREAND CERTIFYTHAT I (WE) HAVE EXAMINED THIS ANNUAL REPOR1 AND THE ATTACHED
DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WIT YHE
ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE Of HAVING THE PEOPLE OF THE STATE Of ILLINOIS RELY1HEREUPON.I HEREBY FU THO IZEAND
AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBYTO THE JURISDICTION Of THE STATE OF ILLINOI .

  BE SURE TO INCLUDE ALL FEES DUE: Ricardo Estrada
  1.) REPOR1S ARE DUE WITHIN SIX PRESIDENT or TRUSTEE ~RINT NAM
 MONTHS OF YOUR FISCAL YEAR END.
  2.) FOR FEES DUE SEE INSTRUCTIONS.
  3.) REPORTS THAT ARE LATE OR
 SIGNA E
 INCOMPLETE ARE SUBJECT TO A


098101
05-0HO
 $10D.OO PENALTY.
 David Faje
 PREPARER (PRINT NAME)
 Dc:;J'*-
 SIGNATURE DATE
 r --tf----l
VILLAGE ()F SKOKIE  __ j I __ _ __


COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM ! \



PROPOSED 12 ~ONTH BUDGET :- __ _ _ _ _
 1




 --~-
 ~ :,: ;' I'::;~,.. I I:;;;:~"' f:;::,
 1




 -- r_T_ _ itle

 1
Perso-nnel _ ------ -

 Sr. Counselor
  -------+·~P~,rogram Supervisor . $
 l- f$, -~ $ 4. .5, 129_;____
 .. 50.0···0--"-_X___
 50,6921TotaliP5e.rOs0 'Xno-ne-l
 $ 22,565
 7,604
 $ 3,337
 $ 500

 . 0 30,l68J $ 3,837

 -~ - ----__
~-;o;-;------- - ---- --+----
Fringe Benefits
 Percent I --r----+----
~-~:0-~c-p--Jo-ym-en-t--t-=,--'-' ------:c~cc:~c:~cc~t ·:-·:--:_--:_--:_--:_--:_-.::-.::tl- -- 2,~~! ' ~ z;~
C_at__a____ _str____onhic
-
 --~~------- 0.62%1 187 $ 24
 o_._95_~~- I -~, $
Worker;c:::Cc-com-p.---t·--
Life & Disability
Health Insur.
 0  28
 "
 13.05%1
 - -~,
 __ . _
 --
 . - $
 287
 84
 _ - $ - 3,937
 $
 $ II
 36
 $ ____20_1__
Pension/Retirement 7.10% I '$ 2,142 $ 272

l-~--====='----="t___-_---~--3ccc0.3io/, 1---:- __-_-_-_-:___ Total Fringe ),lenefits ] $ 9,144 $_1_,1_§__
 --


iooT;c;OcoT;-;A-oL--:Bo-.:Uc-:D;:cG;ccE:ocToo·L-c-D-B~G-R-E-Q--UE-S-T--+---- -ll----j$ 39,312 ' $ 5,000
 METROPOLITAN FAMILY SERVICES FY13 PRELIMINARY BUDGET
···-·----··-·----~----------+-----1----+----t------1

1-------------+--·-·-······· + --·-----1-·---------- - ·-- - -

 ... - - - - - - - - - - - - - - - - + - - - - - + - - - - + - - - t - - - - - i
 --·--·---· ·-- + --------+----- -I
 13
Revenue Budget*
 -+----- 2_6,801 __
1--'G~o_v~er_n_m~e_n~t~C_on_t~ra_c~ts_ _ _ _ _ _

  Fees For Service Contracts 6,661
 ---·-- ·-- -- ----+-------1
  MFS Annual Campaign 5,460

1--'Uc:.n"'it=-ed=-:.Wc.:a,.y___________________ -·--·- ___1,...,8c=8,7___' _____ -+-----+------l

  End()wment Payout 2,273
!--::-----:---::-::-:;------------ .. - ·----- ---- -- -------c=+-----+--------1
f--'T,.ru._sc-ls-.:&....-:0:--thc-e.,r_ _ _ _ _ _ _ _ _l-_ _ _7:_:9-_-5+-----,--- ____1_______ _

Total Revenue 43,877 !
1 - - - - - - - - - - - - - - 1 - - - - - - 1 - - - - - + - - - - - 1-------i

 ... -· ---------+------+-----!
 Expenses
  Salaries 25,130
 -· ---------·-------+------'='-'-=-t-----+---1------1
 -·---~-




_f'!if1fl_e _____________--+---=-8..::,0.=_36=--t'·-----+----+-------1

  Occupancy
 _______,_ --· -.-=--------+----::-::-:-:-t--------1------1
1---P_ro~~~es~s~io~n~a_l_Fe_e_s__________+------ _2,~14_ -~


 _!'rogram §)(pe'-'n~s~es~-------j---~1~,9~1~8-·r----r----t---------i
~--=-----------+---- ---- - -----·--- '"
  Telephones/Network 497

  Financial Assistance 607
1--'-==~=="-=-------1----__;--!-- ------- ··---·--+----!
  Equip Purchase/Loa11__f3e:.<pc:ayy_"'m"'e::n,t'--------l------=2=5c:.7+---+---+----i
f--::occthc-e-r------------l----c2"',o:o:o"'2:+---+-- ·-------r-------------
 Total Expenses 43,877

 Surplus (Deficit) _ _ _ _ _ _ _ _--j======'o'=ji-----t----t-----1

 *Ammounts in OOO's




 11/29/2012
 METROPOLITAN FAMILY SERVICES GRADE 16
 ssocw
 POSITION DESCRIPTION EXEMPT


TITLE: SENIOR SOCIAL WORKER

ESSENTIAL
FUNCTION: At an advanced level of skill and with a high degree of independence,
 provides direct services. Provides leadership in area of expertise and
 creative thrust to program development. Works with diverse staff and
 service population.

 Under general supervision of the Program Supervisor or Team Leader.

RESPONSIBILITIES:

 I. Using expert skills, provides direct services to clients and the community
 using a range of methodologies.

 2. Maximizes opportunities within specialty/service areas to expand own
 knowledge and skills, and to experiment with new techniques and practice.

 3. Provides consultation to agency staff and the community. Utilizing expert
 skills provides training, conducts seminars and works on special projects.

 4. Carries administrative responsibilities in areas of own expertise including
 proposal writing, program planning, and coordination.

 5. Carries appointments to program and agency-wide committees, often in
 leadership roles.

 6. Represents and interprets programs of agency in community, including to
 leaders within foundations and local, state, and federal entities.

 7. May be responsible for meeting or coordinating contractual requirements,
 including 24-hour coverage and reporting requirements.

 8. Under special circumstances may provide supervision to a limited number
 of staff in own area of expertise.

 9. Other duties as assigned by supervisor.

 l 0. Works effectively with diverse staff and service population.
TITLE: SENIOR SOCIAL WORKER (continued)

QUALIFICATIONS:

 Master's Degree in Social Work from an accredited college or university
 and at least eight years of post-graduate social work experience. Must be
 Licensed Clinical Social Worker (LCSW) if program requires.
 Demonstrated superior skills with families or communities. Demonstrated
 competence in consultation, teaching, or writing. Requires mobility to
 work in the community with assigned caseload. Ability to work
 effectively with diverse individuals and groups.




06/05/02
08/03/92
 METROPOLITAN FAMILY SERVICES GRADE 18
 SUPV2
 POSITION DESCRIPTION EXEMPT


TITLE: PROGRAM SUPERVISOR 2

ESSENTIAL
FUNCTION: Administers all aspects of a program/s. Works with diverse staff and
 service population.

 Under general supervision of the Team Leader or Executive Director.

RESPONSIBILITIES:

 !. Supervises and coordinates all aspects of the program.

 2. Responsible for maintaining quality and quantity of services. Keeps
 abreast of client service needs and participates in planning for them.

 3. Responsible for all personnel matters within program including hiring,
 assigning, and terminating of staff. Identifies for manager, leadership
 potential of program staff.

 4. Writes program's annual and long range plans. Participates in developing
 unit's annual and long range plan.

 5. Recommends program budget to the Director.

 6. Assures appropriate integrations of multi-service, multi-disciplinary, and
 systems approach to program.

 7. Develops and maintains contacts with community groups relating to
 program needs.

 8. Works co!laboratively with community agencies, organizations, and
 institutions.

 9. Works collaboratively with other program supervisors in unit to carry out
 unit goals.

 I 0. Works effectively with diverse staff and service population.
TITLE: PROGRAM SUPERVISOR2 (continued)

QUALIFICATIONS:

 Five years experience with increasing levels of responsibility. Supervisors
 who supervise Social Workers must have an LCSW or LCPC and five
 years post masters experience. Other certification or licensure as required.
 Mobility for travel. Ability to work effectively with diverse individuals
 and groups.




06/06/02
06/15/93
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)



CDBG PROPOSAL - APPLICATION SUMMARY SHEET


Project Title: Life Enrichment Programs for People with
 Developmental Disabilities

Project Description (150 words maximum): The Center for Enriched Living (CEL) provides skill
 development and social enrichment programs within a
 community where everyone feels accepted and valued;
 it is this emphasis on belonging that explains why we
 call our clients "members." Program topics (such as
 independent living, communication , relationship
 building, etc.) are always relevant to members' lives, but
 content is determined by them-one of the fundamental
 ways CEL fosters independent thought. Through
 diverse programs, CEL offers members a place to
 practice the skills necessary for happy, successful lives.
 We are open 7 days a week, and provide day,
 afternoon, afterschool, even ing, and weekend
 experiences at our Riverwoods campus, as well as at
 various satellites (including Niles North High School).
 CDBG funding assists Skokie residents in affording our
 program fees.

Project Address: 280 Saunders Road , Riverwoods, IL 60015


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $
 Total CDBG Funding Req uest (75% maximum of Total Estimated Project Cost): $

 Total Estimated Project Cost: $


 Public Services:
 Total CDBG Funding Request: $5,000




 Contact Information
 Organization Name: The Center for Enriched Living
 Contact Name, Title: Randi Frank,~~cto~opment


 Signature:
CEL FY13 Application.doc
 ~Q.~.
Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)




 Mailing Address 1: 280 Saunders Road
 Mailing Address 2:
 City, State, Zip: Riverwoods, IL 60015
 Telephone Number (847) 948-7001
 Fax Number: (847) 948-7621
 Email Address: Randi@CenterForEnrichedliving.org




 CEL FY13 Application.doc
 Page 2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Aprll30, 2014)



CDBG PROPOSAL- APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 [;8J (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 D Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%) $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members 18 years old or older that contribute to the household. The
 extremely low, very low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birlh, marriage, or adoption.



3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)




CEL FY13 Application.doc
Page 3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term May 1, 2013, through April 30, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting from
 the project or program for which you are requesting funding. The totals in the blue cells must match. The totals in the orange cells must match.


 Income Hi ;panic I Lat no Race Female-

 51 i;!~ • A~~~ Total /~xed Total Headed
 B~~oZ 31i;!~ Y8'
 Total No White Black oc H Nah" A' lac Am:rtcac '
 Afncan- awa11an lnd1an or Race Households
 (all others) American or Other Alaskan
 Pacific Native
 Islander
 People
 0 442 0 60 502 23 479 502 450 27 0 21 0 4 502 25
 Skokie
 Residents 0 62 0 8 70 2 68 70 56 5 0 7 0 2 70 7


5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the blue cells must match.


 Income Hispanic I Latino ...Ra_c_e___ Female-
 Total Y8' lotal A' <an
 31~;~ 51;;;~ A~~~
 Below No Whrte elock oc Headed
 ~~d~~~~~~ ~~~~
 H Na1"e total
 30% Afncan- awm1an Households
 (all others) American or Other Alaskart
 Pacific Native
 Islander
 f Households




6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.

 Total Full-Time Total Part-Time Total Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time lr1come Part-Time
 Hires Hires




CEL FY13 Application.doc
Page 4
Village of Skokie
Community Development Block Grant (COBG) Program
Program Year2013 Application (Term: May 1, 2013, through Apri130, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project (Please select only one.}

 Anti-Crime Programs Senior Programs
 0 Crime Awareness 0 Senior Centers
 0 Senior Services
 Economic Development
 0 Commercial Rehabilitation Youth
 0 Micro-Enterprise Assistance 0 Youth Centers
 0 Child Care Centers
 Non-Homeless Housing 0 Youth Services
 0 Renter- Elderly 0 Child Care Services
 0 Renter- Small Family
 0 Renter- Large Family Homeless Individuals
 0 Other Housing 0 Emergency Shelter
 0 Owner-Occupied 0 Transitional Housing
 0 Job Training
 Infrastructure 0 Case Management
 0 Street Improvements 0 Mental Health Care
 0 Sidewalks 0 Housing Placement
 0 Tree Planting 0 Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) 0 Emergency Shelter
 0 General Public Facilities 0 Transitional Housing
 0 Handicapped Centers 0 Job Training
 0 Parks/Recreational Facilities 0 Case Management
 0 Parking Facilities 0 Child Care
 0 Health Facilities 0 Substance Abuse Treatment
 0 Mental Health Care
 Public Services 0 Housing Placement
 (Administrative Support Activities) 0 Life Skills Training
 0 General Public Services
 ~ Handicapped Services
 0 Transportation Services
 0 Employment Training
 0 Health Services
 0 Mental Health Services
 0 Screening for Lead-Based Paint




GEL FY13 Application.doc
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 ~ Elderly
 D Frail Elderly
 D Severe Mental Illness
 ~ Developmentally Disabled
 ~ Physically Disabled
 D Substance Abusers
 0 Persons wilh HIV/AI OS
 D Victims of Domestic Violence
 Comments: Our target population is people with developmental disabilities. This is an umbrella term that
 describes individuals with physical, intellectual, or sensory difficulties (in isolation or in any
 combination) that present before age 22. While all of our members have a developmental disability,
 many of these include physical handicaps. In recent years, we've served a growing elderly
 contingent, too.


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 The Center for Enriched Living exists so that people with developmental disabilities can be fully included in the
 community, achieve personal success, and enjoy a good quality of life.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 Skokie CDBG funding is used exclusively to fund scholarships for Skokie residents who cannot afford the fees
 associated with afternoon, evening, and weekend programs. (We also offer two day programs, ELA and REACH,
 which run five days/week, six hours/day). What makes our programs so unique is that content is member-
 determined; depending on the program, staff may offer class parameters (technology, life skills, movement,
 cooking, and community are staple topics of afternoon program TCP, for example), but members suggest
 specific activities, debate cost and time, and vote their favorites.

 Our overarching goal is to offer members the same opportunities for personal growth and achievement as exist
 for non-developmentally disabled persons. For this reason, we emphasize choice, empowerment, self-advocacy,
 and community. We provide job readiness and leadership skill training to interested members, and within
 programs themselves, strive always to introduce new experiences while practicing old skills. For this reason,
 programs are divided into three sessions per year (plus summer camp for youth), with different options each
 session. Every program has extensive opportunities to leave our campus, which may mean museum or movie
 trips, volunteer work, group employment (such as our leaf-raking service this fall), or restaurant visits.

 Programs for youth and teens encompass cooking, sports and recreation, arts and crafts, relationship building
 and maintenance, health, and other areas. Specific activities include bowling, yoga, music therapy, Wii fitness,


GEL FY13 Application.doc
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 blogging how-to sessions, book and game clubs, and satellite programs with area schools. In the summer, we
 offer camp, including programs in therapeutic horseback riding, swimming, and drama.

 Day, evening, and weekend programs target young adults and adults. Many of the same umbrella topics are
 featured (such as recreation, arts, nutrition, and social clubs) as for youth, but these programs also emphasize
 independent living, employment, and leadership. Skills practiced in this regard include current events, handling
 money, apartment safety, or career training. Fitness is a critical component to every program, from yoga to
 dance to walking at the mall.

 The social aspect of programs is what makes CEL truly special. Activities are members' vehicle to make new
 friends, behave appropriately, and communicate better. We have several partnerships with local organizations,
 including residential facilities, which allow our members to interact with other groups. In Skokie, we currently run
 a satellite after school program at Niles North High School.


11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 CEL provides a place of acceptance and belonging to people who are often denied those feelings. Research
 indicates that people with disabilities are twice as likely to report feeling lonely or isolated than the general
 population. While there are numerous facilities in the Chicago metropolitan area that address physical needs,
 CEL is unique in emphasizing social needs. Being empowered and supported, having a place to practice new
 skills without ridicule, is essential to a healthy and fulfilling life-for our members, CELis that place.

 Since 84% of our members are low-income, including about 89% of Skokie residents, paying programs fees is a
 challenge. Moreover, in a sluggish economy, scholarship requests have only risen; in fiscal year 2012, CEL
 increased scholarship giving by 11%. We want to ensure that interest is a member's only prerequisite to
 participation, and CDBG funds are a key part of that.




CEL FY13 Application.doc
Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project How many people are Skokie residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 Scholarships are awarded based on program type and demonstrated need. To determine
 eligibility, CEL gathers information about an individual's living situation and income, which
 includes providing a current I 040 tax return fonn and salary information. The application does
 vary by living situation; copies of both blank fonns are attached.

 Cognitive and physical impairments, not to mention limited access to transportation, make full-
 time employment a serious challenge for our members. I 00% of adult members live at or below
 federal poverty guidelines, have part or full-time minimum wage employment, are enrolled in
 workshops, and/or receive SSI and Medicaid income. Further, 30% of youth members are from
 low-income families. All ofthe Skokie scholarship recipients in fiscal year 2012 are very low or
 extremely low income.

 Our statistics on service delivery are compiled monthly through attendance rosters. We record the
 number of individuals in our programs and the number oftimes they attend a specific program.
 From this, we are able to produce duplicated and unduplicated counts of participation.

 B. What do you consider to be a unit of service? (Please select only one.)

 D One client, many times
 D One client, one time
 D Multiple clients, one time
 ['><:! Other (Please describe.) A unit of service is based on the length of a program; 60 minutes of
 programming equals 1 unit. To ensure the socialization aspect,
 multiple people are present in one unit of service.

 C. What types of service(s) are included? (Please select all that apply.)

 D Phone counseling
 D In-office counseling
 D Nights of service
 D Home visits
 ['><:! Other (Please describe.) In addition to programs themselves, CEL consults with caregivers
 and teachers to allow content consistency and reinforcement. We
 also provide more specialized care to those requesting it (about 5%
 of our membership).

 D. What types of tangible services are provided? (Please select all that apply.)

 D Food
 D Housing/shelter
 D Clothing
 D Emergency Funds

CEL FY13 Application.doc
Page 7
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)


 C:3J Other (Please describe.) CEL operates a fleet of vans. We provide transportation to and from
 our facility for many evening and weekend programs.




CEL FY13 Application.doc
Page 8
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 [8] Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate~income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 [8] Avai/ability!Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facillties, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 D Affordabi/ity
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Affordability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the affordability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans ava11able to
 low/moderate-income microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 D Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




GEL FY13 Appl10ation.doc
Page 9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 Q1 May: CEL programs are ongoing. Our year begins in September and is divided in quarters
 (including the summer session). Summer scholarships are awarded
 in May, and the rest of the year is awarded in September.
 June:
 July:
 Q2 August:
 September:
 October:
 Q3 November:
 December:
 January:
 Q4 February:
 March:
 April:


16. Other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 word.s maximum)

 We strive to extend the accessibility aspect of our mission in all we do. This covers everything from providing
 transportation to keeping program costs low. Because such a majority of our members are extremely low to low-
 income, we charge only a fraction of prograrn costs.

 Member fees account for only 28% of our $2.1 MM budget, a three percent decrease from last year; we rely on
 contributions and grants for 72% of expenses. We receive no federal or state funding. Our fund raising strategy
 includes an annual fund (both individual and direct mail solicitation); foundation, municipal, and corporate grants;
 individual gifts; United Way funding; and special events (including our golf outing, Chefs' Night, and car raffle).
 Since scholarship requests continue to increase, funding sources like CDBG are essential to the health of our
 organization.


17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 Last fiscal year, CEL gratefully accepted a CDBG grant totalling $2,000; the previous two fiscal years we
 accepted $4,000. While this is apportioned quarterly, we could exhaust the amount over even just 3 applications

CEL FY13 Application.doc
Page 10
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 3D, 2014)


 to year-round evening program membership. All CDBG funds, including those for this year, have already been
 awarded.

 Our programs continue to be dynamic, relevant, and necessary to members' lives. This is best demonstrated by
 the fact that we've gained 13 new members over the past year. Since any economic hardships hit the
 disenfranchised hardest, we've seen a huge increase in scholarship requests. In fiscal year 2012, 26% of
 members received aid totaling nearly $50,000-- an 11% increase over fiscal year 2011. We expect requests to
 continue to rise in the coming year.




CEL FY13 Application.doc
Page 11
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


18, Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 ~ Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 ~ Budget (including REVENUE and EXPENSE line items for the proposal)
 ~ Latest Agency Budget
 ~ Latest Agency Independent Financial Audit
 ~ Blank Income Verification Form
 D Cost and Design Assistance Estimates (construction/rehabilitation projects only}
 D Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only}
 ~ Activity Programs Brochure with Fee Schedule (scholarship, public service activities only}
 D Other (Please describe.)




CEL FY13 Application.doc
Page 12
For Office Use Only ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT Form AG990-IL
 PMT# Revised 3/05
 Attorney General LISA MADIGAN State of Illinois
 Charitable Trust Bureau, 100 West Randolph co# 01-016-023
 11th Floor, Chicago, Illinois 60601
 Check all items attached:
 AMT Report for the Fiscal Period: lXI Copy of IRS Return
 Make Check!- CXJ Audited Financial Statements
 Beginning 07/01/2010 Payableto D Copy of Form IFC
 IN IT thell!ioois r--z.' $15.00 Annual Report Filing Fee
 & Ending Gh arity l.£'.,J
 06/30/2011 Bureau furld D $100.00 Late Report Filing Fee
FederaiiD # 3 6- 3 3 3 9 0 0 9 MO DAY YR MD DAY YR
Are contributions to the organization tax deductible? IXJ Yes D No Date Organization wa' 'treated· 09/17/1984
 LEGAL Year-end
 NAME THE CENTER FOR ENRICHED LIVING, INC. amounts
 MAIL A) ASSETS A)$ 4,021,744.
 ADDRESS 280 SAUNDERS ROAD 8} LIABILITII'S B)$ 141,385.
 CITY, STATE RIVERWOODS, IL C) NET ASSETS C) $ 3,880,359.
 ZIP CODE 60015-3835 ..
 I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR: PERCENTYlE AMOUNT
 D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.) 98.47<!% 0) $ 2,082,087.
 E) GOVERNMENT GRANTS & MEMBERSHIP DUES 1. 34ll% E) $ 28,500.
 F) OTHER REVENUES 0.178% F) $ 3,760.

 G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADO 0, E, & F) 1({1% G)$ 2,114,347.
 II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H) OPERATING CHARITABLE PROGRAM EXPENSE 79.280% H) $ 1,484,148.

 I) EDUCATION PROGRAM SERVICE EXPENSE % I) $

 J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H& I) 79.280% J} $ 1,484,148.

 J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): $
 -
 K} GRANTS TO OTHER CHARITABLE ORGANIZATIONS % K) $

 L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) 79.280% L) $ 1,484,148.

 M} MANAGEMENT AND GENERAL EXPENSE 4.45:3% M)$ 83,453.

 N} FUNDRAISING EXPENSE 16.26:2% N) $ 304,433.

 0) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N) 10(1 l(o 0) $ 1,872,034.
 ,, •.. ,,
 Ill. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
 (Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.) ... ,...
 i .

 PROFESSIONAL FUNDRAISERS:




 l~'
 P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS P) $ 0.

 Q) TOTAL FUNDRAISERS FEES AND EXPENSES •;, 0)$

 R} NET RECEIVED BYTHE CHARITY (P MINUS O=R) % R} $
 PROFESSIONAL FUNDRAISING CONSULTANTS:
 S) TOTAL AMOUNT PAlO TO PROFESSIONAL FUNDRAISING CONSULTANTS S) $ 46,500.
 IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
 T) NAME, TITLE:HARRIET LEVY, EXECUTIVE DIRECTOR T) $ 95,280.
 U} NAME, TITLERANDI FRANK, DIRECTOR OF DEVELOPMENT
 - U) $ 76,898.
 V} NAME, TITLE:MELISSA JUAREZ EHLERS, DIRECTOR OF PROG svcs V) $ 68,428.
 v. CHARITABLE PROGRAM DESCRIPTION: g~~~~b~~~~~~~RAM p HIGHEST BY$ EXPENDED) List on back side of instructions
 CODE

 ~
 W) DESCRIPTION: SERVICES FOR DEVELOPMENTALLY DISABLED ADULTS W)# 121
 X) DESCRIPTION: SERVICES FOR DEVELOPMENTALLY DISABLED CHILDREN X) # 122
I Y) DESCRIPTION: Y) #
IF T HE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: YES I NO
1. wAS THE ORGANIZATION THE SUBJECT Of ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? 1. IX
2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY
 cOURT Of ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION Of FUNDS OR ANY FELONY? 2. IX
 3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY Of ITS OFFICERS,
 DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANYTRANSACTION IN WHICH ANY Of ITS OFFICERS,
 DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECI'IVE
 ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. IX
 4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWN:; MORE
 THAN 10% Of THE OUTSTANDING SHARES? 4. IX
 5. IS ANY PROPERTY Of THE ORGANIZATION HELD IN THE NAME Of OR COMMINGLED WITH THE PROPERTY Of ANY OTHC!l PERSON
 OR ORG.A,NIZATION? 5. IX
 6. DID THE ORGANIZATION USE THE SERVICES Of A PROFESSIONAL fUNDRAISER? (ATTACH FORM IFC) ... 6. X I
 ?a. DID THE ORGANIZATION ALLOCATE THE COST Of ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE C051S
 BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? 7. IX
 ?b. If 'YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$ ; (ii) THE AMOU~ 1
 ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND
 GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $
 ---
 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? .. 8. IX
 g_ HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR
 REVOKED BY ANY GOVERNMENTAL AGENCY? .. g_ IX
 10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE Of ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION, MISAPPRD'RIATION,
 COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. IX
  11. LIST THE NAME AND ADDRESS Of THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
 THREE LARGEST ACCOUNTS:

 FIRST BANK OF HIGHLAND PARK 1835 FIRST STREET HIGHLAN~ PARK IL 60035

 NORTHSIDE COMMUNITY BANK 1155 MILWAUDEE AVE RIVERWOO~S IL 60015

 NORTHBROOK BANK & TRUST 1100 WAUKEGAN ROAD NORTHBROOK IL 60062

  12. NAME AND TELEPHONE NUMBER Of CONTACT PERSON: HARRIET LEVY - 847-948-7001

  All ATTACHMENTS MUST ACCOMPANYTHIS REPORT -SEE INSTRUCTIONS
 -
UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFYTHAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED
DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPloTE AND FILED WITH THE
ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE Of HAVING THE PEOPLE OF THE STATE Of ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND
AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION Of THE STATE OF ILLINOIS.

  BE SURE TO INCLUDE ALL FEES DUE: HARRIET LEVY
  1.) REPORTS ARE DUE WITHIN SIX PRESIDENT or TRUSTEE (PRINT NAME) SIGNATURE DATE
 MONTHS OF YOUR FISCAL YEAR END.
  2.) FOR FEES DUE SEE INSTRUCTIONS.
  3.) REPORTS THAT ARE LATE OR
 TREASURER or TRUSTEE (PRINT NAME) SIGNATURE DATE
 INCOMPLETE ARE SUBJECT TO A
 $1DO.OO PENALTY.
 ROY GROESBECK
098101
05-01-10 PREPARER (PRINT NAME) SIGNATURE DATE
 The Center For Enriched Living - Budget FY13
INCOME
CONTRJBUTIONS $379,000
IN-KIND CONTRJBUTIONS $93,000
OTHER SOURCES OF INCOME (rental, business, etc,) $65,000
SPECIAL EVENT(S) (golf, Chefs niaht & car raffle) $800,000
  Golf ($286,000)
  Car Raffle ($70,000)
  Chefs Niaht ($444,000)
FOUNDATIONS/GROUPS/ TOWNSHIPS $180,000
MEMBERSHIP $601,000
  Youth ($73,000)
  Adult ($179,000)
  REACH ($349,000)
INVESTMENT INCOME $3,000
UNITED WAY $10,000
BOARD ACCOUNT $4,500
TOTAL INCOME $2,135,500

EXPENSES
PROFESSIONAL SALARJES $301,500
DEVELOPMENT DEPT. SALARJES $219,500
CLERICAL SALARJES $106,000
MAINTENANCE SALARJES $43,500
PROGRAM SALARIES $475,000
EMPLOYEE BENEFITS/TAXES $224,000
EMPLOYEE EXPENSES $12,000
UNEMPLOYMENT RESERVE $10,000
MARKETING AND PUBLIC RELATIONS . $9,500
OTHER PURCHASED SERVICES $81,500
SUPPLIES $33,000
TELEPHONE $10,000
POSTAGE/SHIPPING $13,000
BUILDING MAINTENANCE- Contracts & Repairs $35,000
UTILITIES $30,000
TECHNOLOGY EQUIPMENT- Contracts & Repairs $28,000
EQUIP. RENTAL AND REPAIR $4,000
OUTSIDE PRINTING $6,000
STAFF PARKING & MILEAGE $4,000
AGENCY VEHICLE-REPAIRS $9,000
PROGRAM TRANS.-VAN $25,000
CONFERENCES AND TRAINING $6,000
SUBSCRJPTIONS/BOOKS, ETC. $3,500
MEMBERSHIP DUES $2,500
SMALL EQUIPMENT $4,000
CC PROCESSING FEES $17,000
INSURANCE $33,500
OTHER SOURCES OF INCOME (ELA CONTRIB) $42,000
SCHOLARSHIPS $51,000
MEMBER /ACTIVITY FEES $29,000
SPECIAL EVENTS EXPENSES $145,000
BOARD ACCOUNT $4,500
 IN-KIND EXPENSES $30,000
 CONTINGENCY $25,000
 TOTAL EXPENSES $2,072,500
 SURPLUS/DEFICIT $63,000
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SHEET


Project Title: Financial Aid for Skokie Residents with Developmental
 Disabilities Proving Extremely Low Income

Project Description (150 words maximum): We strive to help your residents with disabilities who
 prove they live on extremely low to low household
 incomes to pay for our municipal therapeutic recreation
 activities by giving them financial assistance that pays
 35% to the preferred 85% of our program fees.

Project Address: 6820 West Dempstrer Street, Morton Grove IL


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $

 Total Estimated Project Cost: $


 Public Services:
 Total CDBG Funding Request: $ 3,000




 Contact Information
 Organization Name: Maine-Niles Association of Special Recreation
 Contact Name, Title: Suzanne Bear, Executive Director


 Signature:


 Mailing Address 1: 6820 West Dempster Street
 Mailing Address 2:
 City, State, Zip: Morton Grove, IL 60053-2631
 Telephone Number: (847) 966-5522
 Fax Number: (847) 966-8340
 Email Address: sbear@mnasr.org or jruemmele@mnasr.org


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 Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL - APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 [8J (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 D Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members18 years old or older that contribute to the household. The
 extremely low, vel)' /ow, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birlh, marriage, or adoption.



3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)




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Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers to b~ listed below are the numbers of u.n?~8~~~ individuals benefiting from
 the project or program for which you are requesting funding. The totals in the bJlier:ceJis must match. The totals in the orange"c must match.

 Female·
 Headed
 Households
 (all others) American
 Pacific Native ,
 Islander

 59 32 2 3 12 84 64 10 0 9 30
 25 9 0 1 35 5 30 35 17 5 0 6i 0 10



5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to be ,listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the bliiehceli§ must match.

 Female-
 Yes T American Headed
 Indian or Households
 Alaskan
 Native




6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.
 Total Full-Time Total Part-Time Total Part-Time _  Expected Low- Expected Low-
 Jobs Jobs Weekly Hours i Income Full-Time Income Part-Time
 Hires Hires




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Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project. (Please select only one.)

 Anti-Crime Programs Senior Programs
 0 Crime Awareness 0 Senior Centers
 0 Senior Services
 Economic Development
 0 Commercial Rehabilitation Youth
 0 Micro-Enterprise Assistance 0 Youth Centers
 0 Child Care Centers
 Non-Homeless Housing 0 Youth Services
 0 Renter- Elderly 0 Child Care Services
 0 Renter-Small Family
 0 Renter- Large Family Homeless Individuals
 0 Other Housing 0 Emergency Shelter
 0 Owner-Occupied 0 Transitional Housing
 0 Job Training
 Infrastructure 0 Case Management
 0 Street Improvements 0 Mental Health Care
 0 Sidewalks 0 Housing Placement
 0 Tree Planting 0 Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) 0 Emergency Shelter
 0 General Public Facilities 0 Transitional Housing
 0 Handicapped Centers 0 Job Training
 0 Parks/Recreational Facilities 0 Case Management
 0 Parking Facilities 0 Child Care
 0 Health Facilities 0 Substance Abuse Treatment
 0 Mental Health Care
 Public Services 0 Housing Placement
 (Administrative Support Activities) 0 Life Skills Training
 0 General Public Services
 [81 Handicapped Services
 0 Transportation Services
 0 Employment Training
 0 Health Services
 0 Mental Health Services
 0 Screening for Lead-Based Paint




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Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 1Zl Elderly
 IZl Frail Elderly
 IZl Severe Mental Illness
 1Zl Developmentally Disabled
 IZl Physically Disabled
 D Substance Abusers
 D Persons with HIV/AIDS
 D Victims of Domestic Violence
 Comments:


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 The Maine-Niles Association of Special Recreation (M-NASR) is dedicated to improving the quality of life and,
 through advocacy and awareness, promoting a successful leisure lifestyle for individuals with disabilities.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 Your donation would help us fund financial assistance provided to Skokie residents in 2013 who prove that they
 and their household live on low, very low or extremely low incomes. Receiving our financial aid means we will
 strive to pay 35% to the preferred 85% of our registration fees for qualifying applicants. Recipients of aid are
 given assistance in paying for only two of our eight-week long programs in any season. We do not provide aid to
 help someone attend a special event or one of our vacation trips. Recipients of aid must pay their balance before
 they are allowed to register for future M-NASR activities.


11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 CDBG monies are mandated to support services for people with low incomes, handicaps, and those who are
 elderly. M-NASR's Financial Aid Service assists people falling within all of those categories. All recipients of our
 financial aid must prove they have very low to low annual incomes. There may never be a remedy to poverty.
 Indeed, some say the gap between those with livable incomes and those with low to very low incomes is
 growing. A segment of the population will forever struggle to make ends meet. That is especially true for people
 who have impairments. Studies say daily living expenses of people who are disabled are higher than average
 due to high, life-long costs of health care, clothing, transportation and personal care. Another contributing factor
 to financial woes: many employers shy away from hiring people with disabilities.


M CDBG_FY13_Application completed
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Village of Skokie
Community Development Block Gran I (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)




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Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through Apri130, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How many people are Skokie residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 People proving they live on low to extremely low household incomes are the population eligible
 to receive our financial aid for one year.

 Thirty-six of the 91 unduplicated people receiving our financial aid in 2012 were Skokie
 residents.

 To determine the income status of those seeking aid, once a year applicants must provide
 M-NASR an updated Financial Aid Application form and official financial documents proving
 their houshold's annual income and how many people live on that income. Applicants also must
 sign an annual statement that the information they provide M-NASR is truthful and assures these
 facts: they reside in Skokie, they have provided full, annual household income documents,
 statement of their ethnicity, race and whether the head of household is female.


 B. What do you consider to be a unit of service? (Please select only one.)

 [8:1 One client, many times
 D One client, one time
 D Multiple clients, one time
 D Other (Please describe.)
 C. What types of service(s) are included? (Please select all that apply.)

 [8:1 Phone counseling
 [8:1 In-office counseling
 [8:1 Nights of service
 D Home visits
 D Other (Please describe.)
 D. What types of tangible services are provided? (Please select all that apply.)

 D Food
 D Housing/shelter
 D Clothing
 D Emergency Funds
 [8:1 Other (Please describe.) Our Financial Aid Service helps assure access to municipal
 therapeutic recreation programs that give Skokie residents proving
 very low to low household incomes the chance to exercise,
 participate in sports as well as accessing other of their city's
 recreation and socially-oriented activities. We also cannot impress
 enough the value of respite caregivers gain while their loved ones are
 in our programs. We are often thanked for this side-benefit.


AA CDBG_FY13_Application completed
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Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)




AA CDBG_FY13_Application compleled
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Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Applicalion (Term: May 1, 2013, through April30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 l8l Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 l8l Availability!Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 l8l Affordability
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Affordability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the affordability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 low/moderate-income microenterprise businesses at 1% interest, which is far below the market rate. Th'ls program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 D Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




AA CDBG_FY13_Application completed
Page 9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of 02, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 01 May:
 June:
 July:
 02 August:
 September:
 October:
 03 November:
 December:
 January:
 04 February:
 March:
 April:


16. Other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 M-NASR greatly depends on many funding sources to meet growing financial aid requests with a meaningful
 level of help. Funds to respond to 2013 requests for financial aid are being sought from family, community and
 corporate foundations, municipal entities. Funds are also generated through our fundraising events. Most funds
 for our Financial Aid Service come from foundations. No source of "matching funds" has yet responded favorably
 to our appeals for support. Should CDBG funds not be granted, we reduce the amount of aid given Skokie
 residents. Reduction of financial aid award amounts would mean that some Skokie residents with disabilitieis
 who pay taxes for recreational services might not be able to participate in their municipality's therapeutic
 recreation activities. Such activities provide Skokie residents a critically-needed chance to exercise, participate in
 sports or to enjoy many leisure-time activities such as getflng out and about in their community and socializing
 with peers.


17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 Our last three projects funded by Village of Skokie were all Financial Aid for Skokie residents. Two of those
 projects are completed. The status of the current project (2012 Program Year) is that we've received one-quarter
 of our award of $2,000. With regard to how this year's request represents an increase or change in service from
 the present year, we cannot predict how many residents will seek help paying registration fees in 2013. In 2012,

AA CDBG_FY13_Application completed
Page 10
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 we received more requests than ever from Skokie residents, 36 qualified and received $14,028. In 2011, 34
 Skokie residents received a total of $12,424. In 2010, 29 Skokie residents received $18,059. That high amount
 for fewer people was due to more summer campers receiving aid. A week of therapeutic summer camp costs
 from $190 to $340 depending on whether the youth needs transprtortation. Many single mothers have children in
 our camps all summer long.




M CDBG_FY13_Application completed
Page 11
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Applicalion (Term: May 1, 2013, through April 30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 [8J Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 [8J Budget (including REVENUE and EXPENSE line items for the proposal)
 [8J Latest Agency Budget
 [8J Latest Agency Independent Financial Audit
 [8J Blank Income Verification Form
 0 Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 0 Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 [8J Activity Programs Brochure with Fee Schedule (scholarship, public service activities only)
 0 Other (Please describe.)




AA CDBG_FY13_Application completed
Page 12
 1 Form AG990~1L
~Fo"-'""
 0
 "-'ff'c""e-"u"'secco"'n2
 Y-___, Illinois Charitable Organization Annual Report Revrsed 3/05 :D: 2BN
 Attorney General Lisa Madigan State ot Illinois
PMT # - - - - - - - - Charitable TI"USt Bureau, 100 West Randolph
 11th Floor, Chicago, Illinois 60601 CO# 01014568
AMT Check all items attached:
 Repmt for the Fiscal Perrod: Copy of IRS Return
 Beginnrng 1/01/11
 U
INIT Audrted Financrai Siatements
 Make Checks
 & End 1ng l 2 /3};';/c;l~l-:;;;-- Payable to
 the/1/molt;
 Copy of Form IFC
 MO DAY YR Charity
 Bureau Fund
 :~ $15.00 Annual Report Filrrt'J Fee
 LJ $100.00 Late Reporl Filing Fee
FederaiiD # 36-3106698 MO DAY YR

Are contributrons to the organization tax deductible? [Xl Yes nNo Date Organization was created: 12/31/1972
 LEGAL MAINE-NILES ASSOCIATION OF SPECIAL Year-end
 NAME RECREATION amounts

 MAIL A ASSETS A$ 637,073.
 ADDRESS 6820 w. DEMPSTER B LIABILITIES 8$ 115,575.
 CITY, STATE
 ZIP CODE MORTON GROVE, IL 60053 c NET ASSETS C$ 521' 49_~


  I SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR: PERCENTAGE
 ------· AMOUNI_,~
 D PUBLIC SUPPORT. COI~TRIBUTIONS AND PROGRAM SERVICE REVENUE
 (GROSS AMOUNTS) . 3. 77 % D$ 73,759.
 E GOVERNMENT GRANTS AND MEMBERSHIP DUES 96.13% E$ 1,883,070.
 F OTHER REVENUES. . SEE .. STATEMENT. 1 0. 10 % F$ 2' 03 9.
 G TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D. E. AND F) 100% G$ 1,958,868.
  II SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H OPERATING CHARITABLE PROGRAM EXPENSE .. 87 . 21 % H$ l, 704,25l.c
 I EDUCATION PROGRAM SERVICE EXPENSE % 1$
 j TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD HAND 1).. 87 . 21 % J$ 1, 704,251.
 Jl JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J) $

 K GRANTS TO OTHER CHARITABLE ORGANIZATIONS % K$

 L TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J AND K) .. 87.21% L$ 1, 704,251.
 M MANAGEMENT AND GENERAL EXPENSE. 10.99% M$ 214,710.
 N FUNDRAISING EXPENSE ... 1. 81 % N$ 35,299,
 0 TOTAL EXPENDITURES THIS PERIOD (ADD L, M, AND N) 100% 0$ 1, 954,260.
 Ill SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
 (Attach Attomey Ger>eral Report o11ndivrdual Funaraising Campaign- Form IFC. One lor eilch PFR.)
 PROFESSIONAL FUNDRAISERS:
 p TOTAL AMOUNT RAISED BY PAID PROFESSIONAL i'LJNDRAISERS 100% P$ 0.
 Q TOTAL FUNDRAISERS FEES AND EXPENSES 9,; Q$ 0.
 R NET RECEIVED BY THE CHARITY (P MINUS O=R) % R$ 0.
 PROFESSIONAL FUNDRAISING CONSULTANTS:

 s TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISII'G CONSULTANTS S$ D.
 IV COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
 T NAME, TITLE SUZANNE BEAR, EXECUTIVE DIREC T$ 98,996.
 u NAME, TITLE: JENNIFER GEBECK, SUPERINTENDENT U$ 68,790.
 v NAME, TITLE JEAN GROSS, BUSINESS MGR V$ 59,157.
  v CHARITABLE PROGRAM DESCRIPTION: CHARITABLE PROGRAM (3 HIGHEST BY$ See instructions for list
 CODE
 :
 EXPENDED) CODE CA T£GORI£S
 w DESCRIPTION ONGOING PROGRAMS FOR HANDICAPPED INDIVIDUALS W# 124
 X DESCRIPTION: SERVICES FOR DEVELOPMENTALLY DISABLED ADULTS X# 121
 y DESCRIPTION SERVICES FOR DEVELOPMENTALLY DISABLED CHILDREN Y# 122
 1:... VA0212~ 12/29108
MAINE - NILES ASSOCIATION OF SPECIAL 36-3]06698 Page 2
IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:
 YES NO

 1 WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT' 1 ~-
 2 HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN
 CONVICTED BY ANY COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS
 OR ANY FELONY'. 2 I X
 3 DID THE ORGANIZATION MA"E A GRANT AWARD DR CONTRIBUTION TO ANY ORGANIZATION II' WHICH
 ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY
 TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL
 INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED
 AS COMPEI"SATION' 3 X
 4 HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR
 TRUSTEE OWNS MORE TH.AN 10% OF THE OUTSTANDING SHARES' 4 I X
 5 IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF
 ANY OTHER PERSON OR ORGANIZATION' 5 X
 6 DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER' (ATIACH cORM IFC) 6 X
 7a DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR
 LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?. 7 X
 7b IF 'YES', ENTER (1) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$ , (11) THE
 AMOUNT ALLOCATED TO PROGRAM SERVICES$ ; (11) THE AMOUNT ALLOCATED TO
 MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO
 FUNDRAISING $

 8 DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN
 RESTRICTED PURPOSES'. 8 X
 9 HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION
 I
 SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY' 9 X
10 WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, uEFALCATION
 MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10 I X
11 L.IST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE
 LARGEST ACCOUNTS:


 SEE STATEMENT 2



12 NAME AND TELEPHONE NUMBER OF CONTACT PERSOhL SUZANNE BEAR 84'1-966-5522
 --
ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT- SEE INSTRUCTIONS


UNDER PENALTY OF PERJURY, I [CNE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I [CNE) HAVE EXAMINED THIS ANNUAL
REPORT AND THE AITACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED
ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ADORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE
STATE OF ILLINOIS RELY THEREUPON, I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT
HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.



BE SURE TO INCLUDE ALL FEES DUE: DATE

 REPORTS ARE DUE WITHIN SIX
 MONTHS OF YOUR FISCAL YEAR END.
 2 FOR FEES DUE SEE INSTRUCTIONS. TREASURER or TRUSTEE (PRim NAMCJ SIGNATURE DJ\TC:

 3 REPORTS THAT ARE LATE OR
 INCOMPLETE ARE SUBJECT TO A 5/10/12
 $100.00 PENALTY PREPAR:::R (PRINT NAMi:) SIGNATURE OAT:::
 KNIJTTE & ASSOCIATES P.C.
 7900 S CASS AVE STE 210
 DARIEN, IL 605615066




 ILVA0212L 12/29/08
2011 ILLINOIS STATEMENTS PAGE1
 MAINE-NILES ASSOCIATION OF SPECIAL
 RECREATION 36-3106698


  STATEMENT 1
  FORM AG990-IL, PAGE 1, LINE F
  OTHER REVENUES

  MISCELLANEOUS INCOME $ 1, 771.
  INTEREST INCOME. 2 68.
 TOTAL ~$==~2"",~03'"=9~.


  STATEMENT 2
  FORM AG990-IL, PAGE 2, QUESTION 11
  NAME AND ACCOUNT NUMBER OF INSTITUTIONS HOLDING THREE LARGEST ACCOUNTS

  THE ILLINOIS FUNDS
  P.O. BOX 2088 SPRINGFIELD, IL 62705
  MB FINANCIAL BANK
  801 WEST MADISON STREET CHICAGO, IL 60607




 I
 Maine-Niles Association of Special Recreation




 2012 Financial Aid Budget Actual

 Financial Aid Service Revenues 2012 Financial Aid Service Expenses 2012
 Liponi Foundation $30,000 Aid to qualified applicants $42,519
 Blowitz-Ridgeway Fdn 5,000 Staff salaries and Benefits 10,000
 Village of Skokie 2,000
 M-NASR Annual Appeal 1,555 Computer equipment I software and maintenance 200
 Optimist Club of Des Plaines 700
 Muslim Community Center 200
 Anonymous Donor 1000
 TOTAL REVENUES $35,787 TOTAL EXPENSES $52,719

File:Judy/Fin Aidll3udget Actual2012
 MAINE-NILES ASSOCIATION OF SPECIAL RECREATION
 2013 PROPOSED BUDGET


REVENUE



General Revenues 2013 Budget
413037 Pub/Priv Foundations & Grants 63,000

413075 Fundraising 6,700

413200 Interest Earned 350

413350 Donations/Other Income 7,600

 Total General Revenues 77,650


Park District Contributions
440100 Des Plaines
440200 Golf-Maine
440300 Lincolnwood
440400 Morton Grove
440500 Niles
440600 Park Ridge
440700 Skokie
 Total District Contributions 1,276,139

Member District Inclusion Contributio
 Inclusion Wages 404,187
 FICA 30,920
 Workmen's Compensation 2,586
 Total Inclusion Contributions 437,693

Program Revenue
 490720 Ongoing Youth Programs 48,000 I
 490721 Special Events for Youth 13 500
 490722 Youth Day Camp 51,000

 490723 Leisure Education 1,600
 490730 Ongoing Adult Programs 95,000

 490731 Special Events for Adults 49,500

 490733 Found Sponsored Events 14,000

 Total Program Revenue 2n,6oo 1
 TOTAL REVENUE 2,064,082 1




 Page 1
 MAINE-NILES ASSOCIATION OF SPECIAL RECREATION
 2013 PROPOSED BUDGET



EXPENSES




Salaries Expense 2013 Budget
514120 Administrative Staff

 514250 Clerical Part Time

 514360 Special Recreation Mana.gers
 514363 Development Coordinator
 514365 Specialists
 514368 Business Manager
 Liponi Liaison
 Inclusion Wages
 Total Salaries Expense 1,135 679

Insurance Expense
 525125 Group Employee Health 89,199 1
 525150 Group Employee Life 1,288
 525175 Worker's Compensation 8,954
 525200 Liability 24,374
 Total Insurance Expense 123,815 1




 Page 2
 MAINE-NILES ASSOCIATION OF SPECIAL RECREATION
 2013 PROPOSED BUDGET




Contractual Service Expense 2013 Budget
 536000 Advertising 2,675

 536025 Association Dues 3,900


 Website Maintenance 1,500

 536050 Periodicals 300
 536200 Postage 8,800

 536210 Bulk Mail Postage 900
 536240 Telephone 9,000

 536300 Printing 19,500

 536410 Building Rental 57,306
 536500 Professional Services 5 000
 536550 Pension - IMRF 91,761


 536575 Pension - FICA 109,121
 536590 Unemployment Compensation 2,000
 Total Contractual Service 311,763

Utilities Expense
I 546610 !Electricity 6 ooo I
I 546620 Natural Gas 2 000
 Total Utilities Expense s,ooo 1




 Page 3
 MAINE-NILES ASSOCIATION OF SPECIAL RECREATION
 2013 PROPOSED BUDGET




Materials & Supplies Expense 2013 Budget
557000 Printed Supplies 2,400
557025 Office Supplies 4,000
 Safety and Training Supplies 3 500
 Computer Suonlies 2,000
 557030 Copy Machine Supplies 2,000
 557150 Gas Oil & Lubricants 23 000
 Total Materials & Supplies 36,900

M'
 amt. &Reoa1rs
 ' Exoense
567700 M & R - Office EQuipment 8,500
567725 M & R- Vehicles 17,000


 Total Maint & Repairs 25,500


Capital Expenditures
 578075 Program Equipment 1 ooo 1
 578110 Office Eouioment 5 800
 578200 Vehicles -
 Total Caoital Exoenditures 6 800




 Page 4
 MAINE-NILES ASSOCIATION OF SPECIAL RECREATION
 2013 PROPOSED BUDGET




Other Expenses 2013 Budget
589100 Travel Expense 4,500


589125 Personnel Expense 10,000




 589175 Educational Training 9,000




 589200 Board Expense 750


 589225 Photography 875
 589226 Fundraising 7,300


 589240 Bank Charges 3,000
 589245 Inclusion Expenses 1,500
 Total Other Expenses 36,925




 Page 5
 MAINE-NILES ASSOCIATION OF SPECIAL RECREATION
 2013 PROPOSED BUDGET




Program Expenses 2013 Budget
 590720 Ongoing Youth Programs 71,000

590721 Special Events for Youth 22,000

 590722 Youth Day Camp 118,500

 590723 Leisure Education 1,200

 590730 Ongoing Adult Programs 96,000

 590731 Special Events for Adults 56,000

 590733 Found Sponsored Events 14,000

 Total Program Expenses 378,7oo 1
 TOTAL EXPENSES 2,064,082




 TOTAL FUND REVENUE 2 064 082
 TOTAL FUND EXPENSE 2,064 082
 NET FUND -
 WSS




 Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SHEET


Project Title: Access to Care

Project Description (150 words maximum): Access to Care provides access to primary medical care
 to low icome residents of suburban Cook County and
 northwest Chicago. Members of Access to Care may
 have an unlimited number of physician off1ce visits to
 their Access to Care physician, routine lab and x-rays
 and prescription drugs for nominal co-payments.
 Members pay $5 per doctor visit, lab specimen and x-
 rays. They pay $15-$40 for prescription drugs.

Project Address: 2225 Enterprise Drive, Suite 2507, Westchester, Illinois
 60154


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum ofTotal Estimated Project Cost): $
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $ 7,000

 Total Estimated Project Cost: $ 3,833,000


 Public Services:
 Total CDBG Funding Request: $ 7,000




 Contact Information
 Organization Name: Suburban Primary Health Care Council
 Contact Name, Title: Victoria Bigelow, President

 I ""'"") I .
 Signature: f,riiiJ~ lJjh{O"/)-vo>loA-v-
 Mailing Address 1: 2225 Enterprise Drive, Suite 2507
 Mailing Address 2:
 City, State, Zip: Westchester, Illinois 60154
 Telephone Number: (708) 531-0680
 Fax Number: (708) 531-0686
 Village of Skokie CDBG FY13 Application
 Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 Email Address: victoriab@sphcc.org




Village of Skokie CDBG FY13 Application
Page 2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


CDBG PROPOSAL -APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 [8] (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 D Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members 18 years old or older that contribute to the household. The
 extremely low, very low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birth, marriage, or adoption.



 3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from th"1s project.)




 Village of Skokie CDBG FY13 Application
 Page 3
 Village of Skokie
 Community Development Block Grant (CDBG) Program
 Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers lobe listed below are the numbers of unduplicated individuals benefiting from
 the project or program for which you are requesting funding. The totals in the ~\~~~~1.1$ must match. The totals in the orangec~ll~ must match.

 Female-
 Headed
 Households
 (allolhers) ! I I ! American
 Paciilc
 Islander

 5,928 I 2,306 1,641 6,593 5,607 1,367 ! 1'194 N/A
 149 67 216 8 208 102 21 90 N/A



5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the !!l~e.J;i)Jis must match.

 Income I Lat no Race Female-
 Headed
 B~~;, "i;~ 51;;~ No Total Asiac Total
 A~~~ ~~~~~~~ Ha~:::~~ ~:~~i~~~ ~~~~
 Totel Yes White
 Households
 (all others) American or Other Alaskan
 Pacific Native
 Islander
 I Households
 ~···
 ()>;.:·.·.
 0•····
6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.

 Total Full-Time Total Part-Time ! Total Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time Income Part-Time
 Hires Hires
 I I



Village of Skokie CDBG FY13 Application
Page4
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term May 1, 2013, through April30, 2014)


7, Priority Needs
 Check the highest priority need to be addressed by the project. (Please select only one,)

 Anti-Crime Programs Senior Programs
 D Crime Awareness D Senior Centers
 D Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 D Micro-Enterprise Assistance D Youth Centers
 D Child Care Centers
 Non-Homeless Housing D Youth Services
 D Renter- Elderly D Child Care Services
 D Renter- Small Family
 D Renter- Large Family Homeless Individuals
 D Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 D Sidewalks D Housing Placement
 D Tree Planting D Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) D Emergency Shelter
 D General Public Facilities D Transitional Housing
 D Handicapped Centers D Job Training
 D Parks/Recreational Facilities D Case Management
 D Parking Facilities D Child Care
 D Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Services D Housing Placement
 (Administrative Support Activities) D Life Skills Training
 D General Public Services
 D Handicapped Services
 D Transportation Services
 D Employment Training
 ~ Health Services
 D Mental Health Services
 D Screening for Lead-Based Paint




Village of Skokie CDBG FY13 Application
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 D Elderly
 D Frail Elderly
 D Severe Mental Illness
 D Developmentally Disabled
 D Physically Disabled
 D Substance Abusers
 D Persons with HIV/AIDS
 D Victims of Domestic Violence
 Comments:


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 To provide access to primary medical care to low income, medically indigent residents of Cook County who lack
 access to such care due to financial barriers.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 A grant of $7,000 would allow us to enroll about 10 residents of Skokie into the Access to Care program for one
 year. They would be assigned to a primary care physician and would be allowed an unlimited number of
 physician office visits to that physician for a $5 co-payment per visit. Additionally, they can have an unlimited
 number of routine laboratory tests and x-rays for $5 a co-payment per specimen or x-ray. They can fill their
 prescriptions written by their Access to Care physician at any local Walgreens for $15 per generic medication,
 $30 for preferred brand name prescriptions and $40 for non-preferred brand name medications. Access to Care
 will facilitate appointments for specialty care at Stroger Hospital clinics.


 11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 Access to Care provides access to primary health care services to low income, medically indigent residents of
 suburban Cook County and northwest Chicago. The Cook County Department of Public Health estimates that
 there are approximately 151,000 individuals eligible for Access to Care in our territory and over 5,000 of them
 are from Skokie. These individuals either have no health insurance or have such a high deductible that they are
 still unable to see a doctor for illness. They are not eligible for public programs such as Medicare or Medicaid.
 Over the past year, Access to Care served 8,234 residents of Cook County and 216 of them were from the
 Village of Skokie.


 Village of Skokie CDBG FY13 Application
 Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)




 Village of Skokie CDBG FY13 Application
 Page6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How many people are Skokie residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 Our unit of service is client enrolled. We compile information on program utilization based on
 program utilization as well as actual utilization. For example, Access to Care members
 historically have visited their physician an average of 1.8 times a year. Our two most frequent
 diagnoses are hypertension and diabetes and our most frequently prescribed medications by
 therapeutic class are diabetic therapy and lipotropics.

 B. What do you consider to be a unit of service? (Please select only one.)

 D One client, many times
 ~ One client, one time
 D Multiple clients, one time
 D Other (Please describe.)
 C. What types of service(s) are included? (Please select all that apply.)

 D Phone counseling
 D In-office counseling
 D Nights of service
 D Home visits
 ~ Other (Please describe.) physician office visits, lab tests, x-rayss

 D. What types of tangible services are provided? (Please select all that apply.)

 D Food
 D Housing/shelter
 D Clothing
 D Emergency Funds
 ~ Other (Please describe.) prescription medications




 Village of Skokie CDBG FY13 Application
 Page 7
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 ~ Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate·income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does-not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunffies
 This objective applies to activities related to economic development, commercial revilalization, or 10b creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 ~ Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate·income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate·income people where they
 live.

 D Affordabi/ity
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate·income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Affordability is an appropriate obtective whenever an activity is lowering the cost, improving the quality, or increasing the afford ability
 of a product or service to benefit a low·income household. Example #1: A low interest loan program might make loans available to
 low/moderate·income microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate·income persons/families at lower cost than unsubsidized day
 care.

 0 Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate·income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




 Village of Skokie CDBG FY13 Application
 Page 8
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 Q1 May:
 June:
 July:
 Q2 August:
 September:
 October:
 Q3 November:
 December:
 January:
 Q4 February:
 March:
 April:


16. Other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 The program's largest funding source is Cook County. The program is also funded by several townships,
 including Niles Township, corporations and foundations and individuals.


 17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 The Village of Skokie granted the Access to Care program $5,000 for the 2012/13 fiscal year. That amount
 funded 7 residents of Skokie into the Access to Care program. This was accomplished in the first quarter of the
 fiscal year.




 Village of Skokie CDBG FY13 Application
 Page9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 0 Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 0 Budget (including REVENUE and EXPENSE line items for the proposal)
 0 Latest Agency Budget
 0 Latest Agency Independent Financial Audit
 0 Blank Income Verification Form
 0 Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 0 Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 0 Activity Programs Brochure with Fee Schedule (scholarship. public service activities only)
 0 Other (Please describe.)




Village of Skokie CDBG FY13 Application
Page 10
For Offioe Use Only ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT Form AG990-IL
 Revised 3/05
 PMT# Attorney General LISA MADIGAN State of Illinois
 Charitable Trust Bureau, 100 West Randolph co# 01-019759
 11th Floor, Chicago, Illinois 60601 Check all items attached:
 AMT Report for the Fiscal Period: 00 Copy of IRS Return
 Make Checks 00 Audited Financial Statements
 Beginning 01 I 01 I 2 011 Payable to D Copy of Form IFC
 the Illinois
 INIT
 & Ending Charity 00 $15.00 Annual Report Filing Fee
 1213112011 Bureau Fund D $100.00 Late Report Filing Fee
FederaiiD# 36-3590295 MO DAY YR MD DAY YR
Are contributions to the tax deductible? 00Yes 0No Date 0512011987
 Year-end
 NAME SUBURBAN PRIMARY HEALTH CARE COUNCIL
 MAIL
 ADDRESS 2225 ENTERPRISE DRIVE, NO. 2504
 CITY. STATE WESTCHESTER, IL
 60154-5821

 D) PUBLIC SUPPORT. CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.)
 E) GOVERNMENT GRANTS & MEMBERSHIP DUES
 F) OTHER REVENUES

 G) TOTAL REVENUE. INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, & F)
 II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H) OPERATING CHARITABLE PROGRAM EXPENSE

 I) EDUCATION PROGRAM SERVICE EXPENSE

 J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)

 J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J):

 K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS

 L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) 90.638% 2 548 235

 M) MANAGEMENT AND GENERAL EXPENSE 208 778

 N) FUNDRAISING EXPENSE 54 428.

 0) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)

  Ill. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT A("'•miiTI<=&>·
 (Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.)
 PROFESSIONAL FUNDRAISERS:
 P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS 0•

 Q) TOTAL FUNDRAISERS FEES AND EXPENSES

 R) NET RECEIVED BY THE CHARITY (P MINUS O=R)




  v. CHARITABLE PROGRAM DESCRIPTION: g~~'11'-IE~~f,~RAM(3HIGHESTBY$EXPENOEO)

 TO CARE
 1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT?

 2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY
 COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?

 3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANYTRANSACTION IN WHICH ANY OF ITS OFFICERS,
 DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE
 ANYTHING OF VALUE NOT REPORTED AS COMPENSATION?

 4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE
 THAN 10% OF THE OUTSTANDING SHARES?

 5. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON
 OR ORGANIZATION?

 6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATIACH FORM IFC) ..

 7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS
 BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? .

 7b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$ ; (ii) THE AMOUNT
 ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND
 GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $_ _ _ _ _ __

  8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? ...

  9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR
 REVOKED BY ANY GOVERNMENTAL AGENCY? .

  10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION, MISAPPROPRIATION,
 COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?

  11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
 THREE LARGEST ACCOUNTS:

 JP MORGAN CHASE 14 SOUTH LAGRANGE ROAD LAGRANGE IL 60525




  12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: VICTORIA BIGELOW - 70 8-531-0 6 8 0

  ALL ATIACHMENTS MUST ACCOMPANY THIS REPORT- SEE INSTRUCTIONS

UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATIACHED
DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE
ILLINOIS ADORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS REL YTHEREUPON.I HEREBY FURTHER AUTHORIZE AND
AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF IL INOIS.

  BE SURE TO INCLUDE ALL FEES DUE: VICTORIA BIGELOW
  1.) REPORTS ARE DUE WITHIN SIX PRESIDENT or TRUSTEE (PRINT NAME)

 ~
 MONTHS OF YOUR FISCAL YEAR END.
  2.) FOR FEES DUE SEE INSTRUCTIONS.
  3.) REPORTS THAT ARE LATE OR
 ROB TANNENBAUM K,t,, 7(; 3£.2c7112-/
 TREASURER or TRUSTEE (PRINT NAME) SIGNATURE ATE
 INCOMPLETE ARE SUBJECT TO A
 $100.00 PENALTY.
 MARGARET MCGINNIS
J~~J~-\ 1 PREPARER (PRINT NAME)
 36-2985770 SELDEN FOX, LTD., 619 ENTERPRISE DRIVE, OAK BROOK, IL 60523
Suburban Primary
Health Care 2012
 Budget
Revenue
Cook County $ 3,000,000
State $
Corps & Founds $ 750,000
Twps & Munis $ 120,000
Dinner Dance $ 110,000
Other Income $ 10,000
Service contracts $ 15,000
Sponsor a Family $ 3,000
Individuals $ 5,000
Carryforward $
Deferred revenue $
Cashflow reserves $
Enrollment fees $ 90,000

Total $ 4,103,000

Expenses

Personnel (incl. taxes)
Salaries $ 756,567
Temporary labor $
Benefits $ 164,316
Taxes $ 57,877

 Subtotal Personnel $ 978,760

Operating Expense
Board Development $
Auto Lease $ 3,900
Travel $ 6,500
Telephone $ 6,600
Postage $ 25,500
Printing $ 27,000
Audit $ 18,000
Consultant $ 27,000
Equipment lease/maint. $ 11,000
Fund raising $ 60,000
Insurance $ 27,000
Legal $ 1,000
Publications $ 500
Publicity $ 5,000
Office Supplies $ 7,000
Meetings $ 500
Rent & utilities $ 93,000
Storage $ 4,000
Bank fees/office exp. $ 4,000
Intake $ 1,500
Working capitaiiWD $ 2,000
Loan interest expense $ 2,500
Other $ 5,000

 Subtotal Oper. Exp $ 338,500

Providers
  Physicians $404,696
  Specialty care $0
  Lab $441,357
  Xray $275,670
  Pharmacy $1,664,016

 Subtotal $ 2,785,740

Total $ 4,103,000

average monthly capacity 5951
cost per person 689.42
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION SUMMARY SHEET


Project Title: Substance Abuse Outreach & Tre~tment

Project Description (150 words maximum): PEER Services will employ a half-time treatment
 engagement and retention specialist to proviae
 outreach, clinical assessments, drug education, early
 intervention, treatment and recovery services to teens,
 families and single adults in the Village of Skokie who
 are experiencing problems related to substance abuse.

Project Address: NA


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $

 Total Estimated Project Cost: $


 Public Services:
 Total CDBG Funding Request: $12,000




 Contact Information
 Organization Name: PEER Services, Inc.
 Contact Name, Title: Kate Mahoney - Executive Director


 Signature:


 Mailing Address 1: 906 Davis Street
 Mailing Address 2:
 City, State, Zip: Evanston, IL 60201
 Telephone Number: (847) 702-4126 Director's Cell
 Fax Number: (847) 492-0320
 Email Address: kmahoney@peerservices. org


 Skokie CDBG 2013-14 Application - KH
 Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 ~ (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 D Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26,400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members18 years old or older that contribute to the household. The
 extremely low, very low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birth, marriage, or adoption.



3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)

 NA




Skokie CDBG 2013-14 Application- KH
Page 2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers!? b~ listed below are the numbers of unduplicated individuals benefiting from
 the project or program for which you are requesting funding. The totals in the 6iil~C'eii$ must match. The totals in the orange cells must match.

 Female·
 Headed
 Households
 American or Other Alaskan
 Pacific Native
 Islander
 60 20 10 20 1 10 0 9 35
 60 20 10 20 1 10 0 9 35



5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to ?e !i~t~d below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the llllle.telis must match.

 Female-
 Headed
 Households


 Households




6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.

 Total Full-Time Total Part-Time Total Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time Income Part-Time
 Hires Hires




Skokie CDBG 2013-14 Application- KH
Page 3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project (Please select only one.)

 Anti-Crime Programs Senior Programs
 D Crime Awareness D Senior Centers
 D Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 D Micro-Enterprise Assistance 0 Youth Centers
 D Child Care Centers
 Non-Homeless Housing LSI Youth Services
 D Renter- Elderly D Child Care Services
 D Renter- Small Family
 D Renter- Large Family Homeless Individuals
 D Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 D Sidewalks D Housing Placement
 D Tree Planting D Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical Improvement Projects) D Emergency Shelter
 D General Public Facilities D Transitional Housing
 D Handicapped Centers D Job Training
 D Parks/Recreational Facilities D Case Management
 D Parking Facilities D Child Care
 D Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Services D Housing Placement
 (Administrative Support Activities) D Life Skills Training
 D General Public Services
 D Handicapped Services
 D Transportation Services
 D Employment Training
 D Health Services
 D Mental Health Services
 D Screening for Lead-Based Paint




 Skokie CDBG 2013-14 Application- KH
 Page 4
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


8. Special Needs
 Check below if the proposed programming is seiVing any of these Special Needs Populations:
 (Please select all that apply.)

 D Elderly
 D Frail Elderly
 D Severe Mental Illness
 D Developmentally Disabled
 D Physically Disabled
 ~ Substance Abusers
 D Persons with HIV/AIDS
 D Victims of Domestic Violence
 Comments: All of the clients will be impacted by substance abuse. Some of these may also be ederly, have a
 severe mental illness, be living with HIV/AIDS and/or be victims of domestic violence.


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 PEER SeiVices is a non-profit community-based agency which was established in 1975. Our mission is to
 improve the quality of life in local communities by working to eliminate substance abuse. This is best
 accomplished by educating the community and preventing substance abuse problems from developing,
 inteiVening in emerging substance abuse problems, and providing treatment for those teens and adults who are
 struggling with dependence.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 We will employ a half-time counselor to provide outreach, assessment, and treatment seiVices to teens, families,
 and single adults in the Village of Skokie who are experiencing substance abuse problems. These three
 components are outlined below:

 Outreach: According to a 2001 study by the Robert Woods Johnson Foundation, less than one-fourth of the
 individuals who are in need of substance abuse abuse treatment actually receive treatment. Two significant
 barriers to receiving treatment will be effectively addressed through our outreach program.

 The first barrier is that substance abusers and their families often do not know where to turn for help. The word-
 of-mouth advertising that works for many other social seiVice providers rarely works for substance abuse
 treatment. Because of the stigma connected to substance abuse, individuals who have had successful
 experiences in a treatment program rarely 'advertise it" to others who may need similar treatment. We will reach
 out to other social seiVices providers, the police, the courts, employers, local religious leaders, schools, and
 other institutions to facilitate referrals to treatment and the appropriate coordination of seiVices.

 We will also use the local media and public library as ways to inform Skokie citizens that treatment seiVices are
 simply a phone call away.


 Skokie CDBG 2013-14 Application- KH
 Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 A second barrier is lack of education about substance abuse and denial that a problem even exists. Our
 outreach strategies include educational components to help individuals and families identify risks and recognize
 problems. The earlier a substance abuse problem can be identified and treated, the better the prognosis. Early
 identification and treatment also reduces the costs to others in the community, family members, police and fire
 services, employers, schools and neighbors.

 Assessment: Our current resources generally only allow us to conduct assessments in our offices. Our
 outreach program will allow us to bring a counselor out into the community to conduct emergency assessments.
 The assessment will identify the type of treatment, if any, that the individual may need. If the individual needs
 more intensive care than our outpatient program is designed to provide, the counselor will work to get the
 individual into a hospital for detoxification or a residential treatment program if needed.

 Treatment: PEER Services is a licensed treatment program. All services are delivered in compliance with the
 regulations of the Illinois Department of Human Services Division of Alcoholism and Substance Abuse.

 The counselor will provide individual and family counseling services. If, based on the assessment, it is
 determined that an individual would also benefit from group treatment, group treatment will also be available.
 For individuals with severe dependence, we can provide our Intensive Outpatient Program (lOP). lOP interrupts
 the pattern of substance abuse by providing the client with a minimum of nine hours of treatment per week
 spread out over four days. Individuals learn new skills and interact with others who are striving to live drug-free
 lives.



11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is
 addressing and any previous efforts to remedy it. (150 words maximum)

 Our program meets the national objective of increasing access to services to benefit low-income persons. By
 increasing access to services and addressing substance abuse problems impacting this population, we will be
 contributing to making Skokie a suitable living environment for low-to moderate-income citizens. Substance
 abuse is a problem that seriously impacts life in the community. Not only is the substance abuser's life
 dramatically impacted by the substance abuse problem, but the lives of children and other family members,
 neighbors, and coworkers are impacted as well. While substance abuse is widely accepted as a problem, the
 full scope and cost of the problem has often been difficult to quantify. Recent studies by the Robert Woods
 Johnson Foundation and the Federal Government's Center for Substance Abuse Treatment provide data related
 to the extent of the problem and the cost when left untreated.

 PEER Services has been providing substance abuse prevention and treatment services to residents of Skokie
 for more than 35 years. We offer outpatient treatment for teens and adults, Intensive Outpatient Programs (lOP)
 for teens and adults, a specialized medically supervised treatment for adults addicted to heroin and other opiate
 drugs of abuse, gender-specific programming for women, DUI risk education and treatment, services for families
 whose substance abuse has brought them to the attention of the child welfare system, and an HIV risk-reduction
 program which provides HIV education, testing, and counseling to one of the populations which is at greatest risk
 for contracting and spreading the virus. We have been successful at engaging Skokie residents in treatment and
 providing the individualized treatment they need. However, our services have generally been limited to those
 clients who are referred by another agency or organization, or who simply find us on their own.



 Skokie CDBG 2013-14 Application- KH
 Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 With the CDBG funding , we will deploy a half-time counselor to provide substance abuse outreach, assessment,
 and treatment services to teens and adults in the Village of Skokie. Our outreach component will help make
 services more accessible to clients and assist Skokie residents in identifying substance problems and access
 services earlier in the progression of the problem.




 Skokie CDBG 2013-14 Application- KH
 Page 7
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


12, Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How manv people are Skokie residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 We keep an unduplicated count of clients. Clients are only counted one time per year. While a few clients
 may come only for an assessment, typically, most clients are seen many times during the course of a
 treatment episode. We have many clients who remain in treatment for more than a year.

 B. What do you consider to be a unit of service? (Please select only one.)

 ~ One client, many times
 D One client, one time
 D Multiple clients, one time
 D Other (Please describe.)
 C. What types of service(s) are included? (Please select all that apply.)

 ~ Phone counseling
 ~ In-office counseling
 D Nights of service
 ~ Home visits
 D Other (Please describe.)
 D. What types of tangible services are provided? (Please select all that apply.)

 D Food
 D Housing/shelter
 D Clothing
 D Emergency Funds
 ~ Other (Please describe.) We do not provide any tangible services directly. Clearly, with the
 population we serve, a large percentage of our clients need tangible
 services. In order to avoid the duplication of services, we strive to
 meet our clients' tangible needs through referral to other non-profits
 and units of goverruuent that are designed to meet these needs.




 Skokie CDBG 2013-14 Application- KH
 Page 8
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 12] Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by low//moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, literacy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opportunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 12] Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 D Affordability
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Affordability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the afford ability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 low/moderate-income microenterprise businesses at 1% interest, which is far below the market rate. This program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income persons/families at lower cost than unsubsidized day
 care.

 D Sustainability
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




 Skokie CDBG 2013-14 Application- KH
 Page 9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed time line identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of 02, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 01 May:
 June:
 July:
 02 August:
 September:
 October:
 03 November:
 December:
 January:
 04 February:
 March:
 April:


16. Other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 Our board of directors has committed to raising funds to the additional $11,600 to support the client
 engagemenUretention specialist position.


17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 We have had previous funding to provide these services to low-income residents of Skokie. We are requesting
 an increase to cover the costs of responding to the increasing demand for services for low-income Skokie
 residents.




 Skokie CDBG 2013-14 Application - KH
 Page 10
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 [8] Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 [8] Budget (including REVENUE and EXPENSE line items for the proposal)
 [8] Latest Agency Budget
 [8] Latest Agency Independent Financial Audit
 [8] Blank Income Verification Form
 0 Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 [8] Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 [8] Activity Programs Brochure with Fee Schedule (scholarship. public service activities only)
 0 Other (Please describe.)




CDBG_FY13_Application
Page 11
 EXTENSION ATIACHED
 Form AG990-IL
rF~o"-ro"'tt""ic,_e""us"'-e"""on"'IY_ __, Illinois Charitable Organization Annual Report ~evlsed ~105 lD: 2BN
 Attorney General Lisa Madigan State of Illinois
 PMT # - - - - - - 1 Charitable Trust Bureau, 100 West Randolph
 11th Floor, Chicago, Illinois 60601 CO# 01008570
 AMT Check all items attached:




 ~
 Report for the Fiscal Period: Copy of IRS Return
 INIT Beginning 7/01/10 Audited Financial Statements
 Milke Checks
 & Ending 6/30/11 P•ya/#efo
 theOJinals
 Copy of Form IFC
 MO DAY YR C/wily $15.00 Annual Report filing Fee
 Bureau F'und
 $100.011 Late Report filing fee
FederaiiD # 36-2848969 MO DAY YR
 to the No
 LEGAL
 NAME PEER SERVICES, INC.
 MAIL
 ADDRESS 9 06 DAVIS STREET
 CITY, STATE
 ZIP COOE EVANSTON, IL 60201

 I SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:
 D PUBLIC SUPPORT, CONTRIBUTIONS AND PROGRAM SERVICE REVENUE
 (GROSS AMOUNTS).. .. .. . .. ........... .
 E GOVERNMENT GRANTS AND MEMBERSHIP DUES
 F OTHER REVENUES .......... . ... SEE . STATEMENT. 1 .
 G TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, AND F) ..
  II SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
 H OPERATING CHARITABLE PROGRAM EXPENSE ........... .
 I EDUCATION PROGRAM SERVICE I':XPENSE ..... , ..
 J TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H AND I) .
 J1 JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J)..... $---,------P"""
 K GRANTS TO OTHER CHARITABLE ORGANIZATIONS ..
 L TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J AND K) ...
 M MANAGEMENT AND GENERAL EXPENSE ...
 N FUNDRAISING EXPENSE ..
 0 TOTAL EXPENDITURES THIS PERIOD (ADD L, M, AND N).. . , ........ .
Ill SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
 (Attach Attorney Genera! Report of Individual Fundraising Campa'1gn- Form lfC. Ona for each PFR.)
 PROFESSIONAL FUNDRAISERS:
 P TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS..
 Q TOTAL FUNDRAISERS FEES AND EXPENSES ..
 R NET RECEIVED BY THE CHARITY (P MINUS Q=R)..
 PROFESSIONAL FUNDRAISING CONSULTANTS:
 S TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS .................... .
IV COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:



 · V
 U NAME, TITLE:

 T NAME, TITLE: TITLE:~~~~~~~~ii~~~~~~~~~~~;~===~~~~~~~~
V CHARITABLE PROGRAM DESCRIPTION: CHARITABLE PROGRAM (3 HIGHEST BY$
 EXPEND£0) CODE CATEGORIES


 W
 X DESCRIPTION: ~~:~~~~~~~~~~~:~~§Q~======~t==~t=j
 _!

 !LVA0212l 12/29/08
 3
 IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:

  1 WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENAL1Y OR JUDGMENT?.
  2 HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE OFFICER OR EMPLOYEE THEREOF, EVER BEEN
 CONVICTED BY ANY COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS
 OR ANY FELONY?. .. . . . . . ..... , . . . . ........... .
  3 DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH
 ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PAR1Y TO ANY
 TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL
 INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED
 AS OOMPENSATION? ...
  4 HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR
 TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES?.
  5 IS ANY PROPER1Y OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPER1Y OF
 ANY OTHER PERSON OR ORGANIZATION?........ . . . . . . .. .. . . ....... , . . . ............... .
  6 DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC)
  7a DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR
 LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? ..................•..
  7b IF 'YES', ENTER 0) THE AGGREGA'TEAMOUNT OF THESE JOINTOOSTS $ ; (ii) THE
 AMOUNT ALLOCATED TO PROGRAM SERVICES$ ; (ii) THE AMOUNT ALLOCATED TO
 MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO
 FUNDRAISING $ _ _ _ _ __
  8 DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN
 RESTRICTED PURPOSES? ..... , , .. . . ......... , . , .....
  9 HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION
 SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY?....................... . ............ ..
 10 WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEfT, DEFALCATION
 MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?.,...  . .................. .
 11 LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE
 LARGEST ACCOUNTS:




ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT- SEE INSTRUCTIONS




BE SURE TO INCLUDE ALL FEES DUE:
 1 REPORTS ARE DUE WITHIN SIX
 MONTHS OF YOUR FISCAL YEAR END.
 2 FOR FEES DUE SEE INSTRUCTIONS.

 3 REPORTS THAT ARE LATE OR
 INCOMPLETE ARE SUBJECT TO A ARTHUR S. GUNN MST CPA
 $100.00 PENAL1Y. PREPARER (PRINT NAME)
 ARTHUR S. GUNN LTD
 910 SKOKIE BLVD STE 115
 NORTHBROOK, IL 60062-4032




 !LVA02l2L 12129/08
2010 ILLINOIS STATEMENTS PAGE 1
 PEER SERVICES, INC. 36-2848969


 STATEMENT1
 FORM AG990-IL, PAGE 1, LINE F
 OTHER REVENUES

 MISCELLANEOUS. . . .. . . . . . ...... $ 1,925.
 INVESTMENT INCOME .. ........ . TOTAL F$---;2;-,i:~~E?~i-'-:


 STATEMENT2
 FORM AG990·1L, PAGE 2, QUESTION 11
 NAME AND ACCOUNT NUMBER OF INSTITUTIONS HOLDING THREE LARGEST ACCOUNTS

 CHARTER ONE A/C4508665690
 SKOKIE, IL
 FIRST BANK & TRUST A/C4053134
 EVANSTON, IL
 FIRST BANK & TRUST A/C50152750
 EVANSTON, IL
 Project Budget

Revenue
Skokie CDBG Request 12,000
PEER Services Fundraising 11,600
 $23,600

Expenses
Salary 16,000
FICA/Worker's Comp/Unemployment 1,600
Health Benefits 4 000
 $23,600
 PEER Services
 Fiscal Year 2013 Annual Budget

Revenue
Illinois Department of Human Services 926,600
Illinois Department of Children & Family Services 3,400
SAMHSA 125,000
Evanston Township/Evanston Mental Heatth Board 98,000
New Trier Township 75,000
Village of Skokie 11,000
Maine Township 5,000
Northfield Township 6,000
Wilmette Youth Commission 1,000
United Way 52,000
Medicaid 115,000
Third Party Payments 40,000
Foundations/Corporations 70,000
Client Fees 140,000
Fund raising 68,000
Miscellaneous 5,000
Total $1,741,000


Expenses
Salaries 996,000
Payroll Taxes 75,000
Benefits 180,000
Consultants 80,000
Supplies 90,000
Utilities 16,000
Facility Repair & Maintenance 30,000
General Operating 132,000
Occupancy 118,000
Travel 4,000
Equipment 15,000
Miscellaneous 5,000
Total $1,741,000
 Client Engagement and Retention Specialist

 Job Description

• Co- facilitate group therapy for adolescents and adults struggling with substance abuse

• Facilitate phone intakes, crisis intervention for new clients and the advanced drug and alcohol
 education program
  • Serve as agency liaison to community and professional networking groups including but not
 limited to Child & Adolescent LAN, DASA/DCFS workgroup and Skokie Youth Outreach Program
 for the purpose of coordinating services, helping community residents access PEER Services'
 early intervention and treatment services and meeting client's case management needs.
• Work with primary counselors to identify community resources to address unmet client needs.
 • Assist uninsured adolescents and their families in accessing health benefits. This includes
 helping people to apply for public aid, verifying coverage through private insurance companies
 and helping to resolve billing issues with private insurance companies.
• Coordinate agency's community drug testing program for DCFS involved families, corporations
 and individuals not currently enrolled in treatment. Coordination includes marketing the
 services in the community, managing all required documentation, serving as a liaison with the
 agency's externally contracted laboratory, managing the agency's inventory of drug testing
 supplies.
 • When program census is at capacity, provide interim services for clients waiting to be
 assigned a primary counselor.
 Compensation/Benefits/Position Duration




The annual salary for this position is $32,000/FTE.

In addition to paying the required FICA, unemployment and worker's compensation insurance, staff
benefits include health insurance, dental insurance and life insurance.

The position is currently filled using CDBG funding along with money raised by our Board of Directors.
To insure continuity of care for Skokie residents, we plan for this to be an ongoing position.
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014) !




CDBG PROPOSAL- APPLICATION SUMMARY SI'IEE'(
 ' .



 <'· . .i \
Project Title: Child Abuse Services I" '••.,


 , '. r·:;·.:··._ . _,. ·...,...
Project Description (150 words maximum): The Children's Advocacy Center assists Ghil~ Victims of
 sexual abuse and/or severe physical abuse, and their
 non-offending familly members during the investigation
 of the alleged abuse through expert child interviews,
 medical evaluations and crisis intervention services.
 Following the completion of the investigation, the Center
 provides on-going advocacy, court support and trauma-
 focused counseling and other follow-up services to help
 the child and her/his family heal from their abuse
 experiences. Services are available 24 hours a day and
 are offered to children and families free of charge.

Project Address: 255 Revere Drive, Northbrook, IL 60062


 Construction/Rehabilitation Projects:
 Total Sponsor Organization Match (25% minimum of Total Estimated Project Cost): $
 Total CDBG Funding Request (75% maximum of Total Estimated Project Cost): $

 Total Estimated Project Cost: $


 Public Services:
 Total CDBG Funding Request: $ 3,500




 Contact Information
 Organization Name: Children's Advocacy Center of North and Northwest Cook County
 Contact Name, Title: Mark Parr, Executive Director


 Signature:


 Mailing Address 1: 640 Illinois Boulevard, Hoffman Estates, IL 60169
 Mailing Address 2: 255 Revere Drive, Suite 200
 City, State, Zip: Northbrook, IL 60062

CDBG_FY13_Application.DOC
Page 1
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 Telephone Number: (847) 885-0100
 Fax Number: (847) 885-0187
 Email Address: mparrcac@sbcglobal.net




CDBG_FY13_Application. DOC
Page 2
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)



CDBG PROPOSAL- APPLICATION
All items must be addressed to receive any consideration for funding.

1. National Objective
 All CDBG projects must meet one of the following national objectives listed below. (Please select only one.)

 Benefit to Low-Income Persons
 D (A) Benefits Specific Low-Income Geographic Areas (go to #3)
 [8J (B) Benefits Specific and Limited Low-Income Clientele (go to #4)
 D (C) Benefits Housing (go to #5)
 D (D) Benefits Jobs (go to #6)

 Prevent or Eliminate Blight
 D Prevents or Eliminates Blight on an Area Basis (go to #7)
 0 Prevents or Eliminates Blight on a Spot Basis (go to #7)


2. Data to Justify the Benefit to Low-Income Persons
 If you identified the national objective of "Benefit to Low-Income Persons", please use the following income limits
 chart in computing the numbers of low-income clients for the tables below. Agencies or organizations seeking
 operational and administrative funding should complete Item 4 on the next page.

 2012
 Income Limits Household Size
 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
 Extremely Low (0-30%): $15,950 18,200 20,500 22,750 24,600 26.400 28,250 30,050
 Very Low (31-50%): $26,550 30,350 34,150 37,900 40,950 44,000 47,000 50,050
 Low (51-80%): $42,500 48,550 54,600 60,650 65,550 70,400 75,250 80,100

 NOTE: Household income is the total income of all household members 18 years old or older that contribute to the household. The
 extremely low, vef)f low, and low income limits are based on Median Family Income, in which a householder has one or more
 other persons living in the same household who are related to the householder by birlh, marriage, or adoption.



3. Benefits Specific Low-Income Areas
 This item must be completed if (A) is checked in Item 1. This benefit is generally limited to public sector capital
 improvement projects. (Please list all Census Tracts and Block Groups benefiting from this project.)




CDBG_FY13_Application.DOC
Page 3
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April 30, 2014)


4. Benefits Specific and Limited Low-Income Clientele
 The following chart must be completed if (B) is checked in Item 1. The numbers to be listed below are the numbers of_ individuals benefiting from
 the project or program for which you are requesting funding. The totals in the !'1!~§11,1 must match. The totals in the!"± must match.

 Female-
 Headed
 Households



 207 150 85 220 337 212 54 0 22 220 229
 5 12 6 7 10 20 7 3 0 6 10 : 12


5. Benefits Housing
 The following chart must be completed if (C) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. The totals in the i11B1
 must match.

 Female-
 Headed
 Households
 American Alaskan
 Native




6. Benefits Jobs
 The following chart must be completed if (D) is checked in Item 1. The numbers to be listed below are the numbers of unduplicated individuals benefiting
 from the project or program for which you are requesting funding. Expected low-income hires are those people from households that are low-income at the
 time of hire, not after the time of hire.
 Total Full~Time Total Part~Time Talai Part-Time Expected Low- Expected Low-
 Jobs Jobs Weekly Hours Income Full-Time Income Part-Time
 Hires Hires




CDBG_FY 13_Application.DOC
Page4
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 20t3 Application (Term: May 1, 2013, through April30, 2014)


7. Priority Needs
 Check the highest priority need to be addressed by the project. (Please select only one.)

 Anti-Crime Programs Senior Programs
 D Crime Awareness D Senior Centers
 D Senior Services
 Economic Development
 D Commercial Rehabilitation Youth
 D Micro-Enterprise Assistance D Youth Centers
 D Child Care Centers
 Non-Homeless Housing D Youth Services
 D Renter- Elderly 0 Child Care Services
 D Renter- Small Family
 D Renter- Large Family Homeless Individuals
 D Other Housing D Emergency Shelter
 D Owner-Occupied D Transitional Housing
 D Job Training
 Infrastructure D Case Management
 D Street Improvements D Mental Health Care
 D Sidewalks D Housing Placement
 D Tree Planting D Life Skills Training
 Public Facilities Homeless Person in Families with Children
 (Physical improvement Projects) D Emergency Shelter
 D General Public Facilities D Transitional Housing
 D Handicapped Centers D Job Training
 D Parks/Recreational Facilities D Case Management
 D Parking Facilities D Child Care
 D Health Facilities D Substance Abuse Treatment
 D Mental Health Care
 Public Setvices D Housing Placement
 (Administrative Support Activities) D Life Skills Training
 D General Public Services
 D Handicapped Services
 0 Transportation Services
 D Employment Training
 D Health Services
 ~ Mental Health Services
 D Screening for Lead-Based Paint




CDBG_FY 13_Application. DOC
Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


8. Special Needs
 Check below if the proposed programming is serving any of these Special Needs Populations:
 (Please select all that apply.)

 D Elderly
 0 Frail Elderly
 0 Severe Mental Illness
 D Developmentally Disabled
 D Physically Disabled
 D Substance Abusers
 D Persons with HIV/AIDS
 ~ Victims of Domestic Violence

 Comments: Victims of child abuse and their non-offending family members.


9. Agency Description
 Please provide the mission statement for your agency. (150 words maximum)

 The Children's Advocacy Center was established in 1989 as a grassroots effort of local professionals and
 concerned community members to serve child victims of abuse and their family members. The mission of the
 Children's Advocacy Center is to reduce trauma and provide support and healing for child victims of sexual
 abuse, severe physical abuse, and other forms of family violence. The Center also serves the non-offending
 parent(s) and the siblings of the victim of abuse. The Children's Advocacy Center serves as a community
 resource to facilitate the identification, intervention and prevention of child abuse.


10. Project Description
 Please provide a detailed description of the specific activities you expect to undertake with CDBG funding during
 the upcoming program year. If the project has several components, please prioritize the key elements of the
 proposal. (500 words maximum)

 The Children's Advocacy Center provides a comprehensive and coordinated response to reports of suspected
 child abuse. The Center helped develop the Cook County Protocol for the Investigation of Child and Adolescent
 Sexual Abuse reports and interagency agreements with local police departments, the Cook County State's
 Attorney's Office and the Illinois Department of Children and Family Services to promote this coordianted and
 timely response. Services include coordination of the professionals involved in the multidisciplinary investigation
 of child abuse, expert child interviews and medical evaluations, court preparation and advocacy, crisis
 intervention and on-going support for the child victim and her/his family, trauma-focused indvidual and family
 counseling, support groups for survivors of abuse and for parents or caregivers, and linkages to community
 services. All services are provided free of charge to the child and family. CDBG funds will support services
 provided for residents of Skokie through the Center's Coordination, Advocacy and Sensitive Interviewing
 Program (CAS I) and the Family Support Services Program (FSS). CASI Program services are available 24
 hours a day, 365 days a year, in order to respond to emergencies involving the safety of child victims of abuse.
 Services are offered in English, Spanish and Polish.


11. Justification
 Describe how this project meets the CDBG Program national objectives of benefiting low/moderate-income
 persons or eliminating/preventing blight, and discuss the nature and extent of the problem the objective is

 CDBG_FY13_Application.DOC
 Page 5
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


 addressing and any previous efforts to remedy it. (150 words maximum)

 The Child Abuse Services project enhances public services for residents of Skokie by addressing the safety and
 mental health needs of child victims of sexual abuse, severe physical abuse and other forms of family violence.
 Child abuse, and specifically sexual abuse, can be a painful, frightening and confusing experience for the child
 victim and her/his family. Abuse may result in reactions that interfere with normal growth and development, and
 may increase the child's risk for developing problems that may continue into adolescence and adulthood.
 Studies have shown that a range of psychological, behavioral, health and interpersonal problems are more
 frequently found among survivors of childhood abuse and trauma than in non-abused groups. For this reason, it
 is important that child victims of abuse are identified as early as possible and provided access to on-going
 support and trauma-focused counseling services. The services offered by the Children's Advocacy Center
 provide opportunities for healing for the child and non-offending parents and siblings, who may also be
 experiencing distress related to the abuse. Each year, more than 300 children in the north and northwest
 suburbs of Cook County are referred to the Center due to reports of sexual or physical abuse.




CDBG_FY13_Application.DOC
Page 6
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


12. Documentation of Low/Moderate-Income Benefit
 Identify the target population expected to benefit from the project. How many people are Skokie residents? How
 does the agency determine the low/moderate-income status of its clientele?

 A. How will statistics be compiled for service delivery? Does it typically involve multiple sessions?
 (150 words maximum)

 The project will benefit children, ages 3-17, who are alleged to be victims of sexual abuse, severe physical
 abuse, or other crimes, and their non-offending parent(s) and siblings. The Center serves children and
 families living in the north or northwest suburbs of Cook County, including the Village of Skokie. Child
 victims of abuse and their non-offending family members are presumed to be low-income by CDBG
 gudelines. The Center documents income levels and family size for all clients referred for services and last
 year 454 of the 516 clients receivng CASI or FSS Program services had income levels in the Extremely
 Low, Very Low or Low Income categories.

 During FY12, thirty (30) residents of Skokie, and their families, received services through the Children's
 Advocacy Center due to allegations of child abuse. In this period, 77% of Skokie residents served had
 income levels in the Extremely Low (5), Very Low (12), or Low Income (6) categories. Clients referred to the
 Children's Advocacy Center typically receive 20-25 hours of service over a period of several months.

 B. What do you consider to be a unit of service? (Please select only one.)

 [8] One client, many times
 D One client, one time
 D Multiple clients, one time
 D Other (Please describe.)
 C. What types of service(s) are included? (Please select all that apply.)

 [8] Phone counseling
 [8] In-office counseling
 D Nights of service
 D Home visits
 [8] Other (Please describe.) Other services include face-to-face contacts including child sensitive
 interviews; medical evaluations; crisis intervention, both in-person and by
 telephone; court preparation and advocacy; individual, family and group
 counseling and telephone counseling and case management services.

 D. What types of tangible services are provided? (Please select all that apply.)

 D Food
 D Housing/shelter
 D Clothing
 D Emergency Funds
 D Other (Please describe.)




CDBG_FY13_Application .DOC
Page 7
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


13. Project Objectives
 Which of the following primary objectives of the CDBG program will be addressed by the activities for which
 funding is being requested? (Please select only one.)

 When selecting an objective, ask: What is the purpose of the activity?
 What is the larger community need that I am seeking to address?

 [2<J Creating a Suitable Living Environment
 This objective relates to activities that are intended to address a wide range of issues faced by Jowl/moderate-income persons, from
 physical problems with their environment, such as poor quality infrastructure, to social issues such as crime prevention, llteracy, or
 elderly health services. Includes activities that are designed to benefit communities, families, or individuals, by addressing issues in
 their living environment.

 D Providing Decent Housing
 This objective focuses on housing activities whose purpose is to meet individual family or community housing needs. It does not
 include programs where housing is an element of a larger effort to make community-wide improvements, since such programs
 would be more appropriately reported under Suitable Living Environments.

 D Creating Economic Opporlunities
 This objective applies to activities related to economic development, commercial revitalization, or job creation.



14. Project Outcomes
 How will the project objectives be measured and performance be documented? (Please select only one.)

 When selecting an outcome, ask: What type of change or result am I seeking?


 [2<J Availability/Accessibility
 This outcome applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or
 accessible to low/moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to
 physical barriers, but also to making the basics of daily living available and accessible to low/moderate-income people where they
 live.

 D Affordabifity
 This outcome applies to activities that provide affordability in a variety of ways to low/moderate-income people. It can include the
 creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.
 Affordability is an appropriate objective whenever an activity is lowering the cost, improving the quality, or increasing the affordability
 of a product or service to benefit a low-income household. Example #1: A low interest loan program might make loans available to
 low/moderatec~ncome m'1croenterprise businesses at 1% '~nterest, which is far below the market rate. Th'ls program lowers the cost
 of the loan, enabling entrepreneurs to start businesses. As a result, the program makes financing more affordable. Example #2: A
 subsidized day care program that provides services to low/moderate-income personsflamilies at lower cost than unsubsidized day
 care.

 D Sustainabi/ity
 This outcome applies to activities that are aimed at improving communities or neighborhoods, helping to make them livable or viable
 by providing benefit to persons of low/moderate-income or by removing or eliminating slums or blighted areas, through multiple
 activities or services that sustain communities or neighborhoods.




 CDBGJY13_Application.DOC
 Page 8
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


15. Proposed Timeline
 If the proposed activity is a construction/rehabilitation project, please provide a proposed timeline identifying the
 start and completion dates, and any other interim target dates for key elements of the project. (Please note that
 weather-sensitive construction/rehabilitation projects should be completed by the end of Q2, if possible. Funding
 availability will not be extended beyond April30, 2014.)

 Q1 May:
 June:
 July:
 Q2 August:
 September:
 October:
 Q3 November:
 December:
 January:
 Q4 February:
 March:
 April:


16. Other Funding Sources
 Has funding for this project been requested from any other funding sources (i.e. foundations, other government
 grants, private donations)? What are the matching funds that have been identified for this project? If CDBG
 funds are not granted for this project, what will happen? (150 words maximum)

 Additional funding for Child Abuse Services offered by the Children's Advocacy Center has been requested from
 governmental sources, including the Office of the Attorney General (VCVA), the Illinois Department of Children
 and Family Services, the Illinois Criminal Justice Information Authority (VOCA), local townships and other
 municipalities. The agency also requests support from private sources, including the United Way, family and
 corporate foundations, local community and philanthropic groups, and individual and corporate donors. Since all
 programs and services are provided for children and families free of charge, any reduction or elimination of
 funding for Child Abuse Services will effect the agency's ability to provide the level of service that child victims of
 abuse, and their families, need and deserve.


17. Previous CDBG Funding
 Briefly describe the status of the last three projects funded by Village of Skokie CDBG program, including if any
 of these projects are still ongoing, and what efforts are being made to complete the projects. If this is a public
 service request and you are currently receiving CDBG funding, please explain how your new request represents
 an increase or change in service from the present year. (150 words maximum)

 The Children's Advocacy Center is currently receiving CDBG funding for Child Abuse Services. During the first
 four months of the CDBG reporting period, seven (7) residents of Skokie, and their families, have received Child
 Abuse Services from the Center. This level of service is less than that of last year during the same time period.




CDBG_FY13_Application.DOC
Page9
Village of Skokie
Community Development Block Grant (CDBG) Program
Program Year 2013 Application (Term: May 1, 2013, through April30, 2014)


18. Attachments

 Construction/rehabilitation projects must document the source (architect, contractor, and/or facility manager) and
 basis of all cost and design assistance estimates. Construction/rehabilitation projects are subject to Federal
 Labor Standards and Davis-Bacon Act prevailing wages, which should be taken into account in budgeting for the
 projects.

 Public service activities must provide a breakdown of salaries, benefits, supplies, utilities, etc. (for non-
 scholarship activities) or an activity programs brochure with fee schedule (for scholarship activities) pertinent to
 the funding request. Proposals for staff positions must include a complete job description, compensation,
 benefits, and duration of the position.

 ~ Copy of your organization's submitted 2011 Illinois Charitable Organization Annual Report Form AG990-IL
 ~ Budget (including REVENUE and EXPENSE line items for the proposal)
 ~ Latest Agency Budget
 ~ Latest Agency Independent Financial Audit
 D Blank Income Verification Fonm
 D Cost and Design Assistance Estimates (construction/rehabilitation projects only)
 ~ Job Description, Compensation, Benefits, and Position Duration (non-scholarship, public service activities only)
 D Activity Programs Brochure with Fee Schedule (scholarship, public service activities only)
 D Other (Please describe.)




CDBGJY13_Application.DOC
Page 10
10684000 11127/2012 2:27 PM



r'F-"'"-"o'"""""''""""'-'o"""'''----------iiLLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT Form AG990-IL
  PMT# Attorney General LISA MADIGAN State of Illinois Revised 3/05
 Charitable Trust Bureau, 100 West Randolph
 11th Floor, Chicago, Illinois 60601 CO #._ _,0"-=1'-'0'-'2'-'0'-'8'-'8"-=9"----------
 AMT Check all items attached:
 Report for the Fiscal Period:




 ~
 Copy of IRS Retum
 Make Checks Audited Financial Statements
 Beginning 07/01/2011 Payable to
 Copy of Form !FC
 INIT the Illinois
 Charity $15.00 Annual Report Filing Fee
 & Ending 06/30/2012 Bureau Fund $100.00 Late Report Filing Fee
  FederaiiD# 36-3711203 MD DAY YR
 DAY

  Are contributions to the organization tax deductible? No Date
 Year-end
 LEGAL CHILDRENS ADVOCACY CTR OF amounts
 NAME NORTH & NORTHWEST COOK COUNTY
 A) ASSETS
 MAIL
 ADDRESS 640 ILLINOIS BOULEVARD B) LIABILITIES
 CITY, STATE HOFFMAN ESTATES IL
 ZIP CODE 60169

 I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:

 D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.)

 E) GOVERNMENT GRANTS & MEMBERSHIP DUES

 F) OTHER REVENUES

 G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E. & F)
 II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:

 H) OPERATING CHARITABLE PROGRAM EXPENSE

 I) EDUCATION PROGRAM SERVICE EXPENSE
 J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)

 J') JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J):
 K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS

 L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)

 M) MANAGEMENT AND GENERAL EXPENSE

 N) FUNDRAISING EXPENSE

 0) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)
 Ill. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
 (AIIach Allomey Gereral Report of lndWdual FurdraiSng Campaign- Fol!ll IFC. Ore for each PFR.)
 PROFESSIONAL FUNDRAISERS:
 P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS 100%

 Q) TOTAL FUNDRAISERS FEES AND EXPENSES %

 R) NET RECEIVED BY THE CHARITY (P MINUS Q=R) %
 PROFESSIONAL FUNDRAISING CONSULTANTS:

 S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS
 IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:




 V. CHARITABLE PROGRAM DESCRIPTION: CHARITABLE PROGRAM (3 HGI-ESTBY$ EXPEI'VID) CODECA'IEGORES




 111
10684000 1112712012 2:27 PM



 OF 36-3711203
 IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:


 1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? 1.

 2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF,
 EVER BEEN CONVICTED BY ANY COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR
 MISAPPROPRIATION OF FUNDS OR ANY FELONY? 2.

 3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH
 ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION
 IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID
 ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3.


 4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR
 TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? 4.


 5. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE
 PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? 5.

 6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC) ..


 ?a. DID THE OF~GANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR
 LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?


 ?b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS$ ;(ii) THE AMOUNT
 ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT
 AND GENERAL$,___ _ _ _ _ _ _ _ ,; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ _ _ _ _ _ _ _ __


 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED
 PURPOSES? 8.

 9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION
 SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9.

 10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION
 MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10.


 11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
 THREE LARGEST ACCOUNTS:
 UNITED



 12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: MARK PARR

 ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT- SEE INSTRUCTIONS

  UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I 0f/E) HAVE EXAMINED THIS ANNUAL REPORT
  AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE
  TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE
  STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT
  HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.




  13E:: S!!BE: IQ I~QL !lOE All EEES Rl!E·
 PRESIDENT or TRUSTEE (PRINT NAME) SIGNATURE DATE
 1.) REPORTS ARE DUE WITHIN SIX
 MONTHS OF YOUR FISCAL YFAR END.
  2.} FOR FEES DUE SEE INSTRUCTIONS
 TREASURER or TRUSTEE (PRINT NAME) SIGNATURE DATE
  3.} REPORTS THAT ARE LATE OF~
 INCOMPLETE ARE: SUBJECT TO A
 $100.00 PENALTY WILLIAM A. FATES
 PREPARER (PRINT NAME) SIGNATURE DATE
 CHILDREN'S ADVOCACY CENTER
 2013-2014 CASI AND FAMILY SUPPORT SERVICES OPERATING BUDGET

Expenses Revenue
Salary $329,743 DCFS $208,576
Fringe Benefits $ 67,217 United Way $ 45,000
Consultants $ 2,000 Township $ 61,600
Conferences/Training $ 2,000 Foundations $ 12,500
Employee Travel $ 5,943 Ill. CJIA $ 92,207
Occupancy $ 52,604 Municipal $ 17,500
Insurance $ 5,250 National Children's $ 10,000
Program Supplies $ 3,450 Alliance
Operating Expenses: Community Service $ 5,000
Web Site $ 250 Groups
Attorney/Legal $ 2,100 Donations/Fundraising $ 39,729
Maintenance $ 2,995 Request to Skokie CDBG $ 3,500
Memberships/Dues $ 2,075
Office Supplies $ 3,190
Payroll $ 1,995
Telephone/Paging $ 7,200
Postage $ 925
Printing $ 800
Publications $ 250
Public Relations $ 4,625
Volunteer Services $ 1,000

Total $495,612 Total $495,612
 CHILDREN'S ADVOCACY CENTER
 OF NORTH AND NORTHWEST COOK COUNTY
 OPERATING BUDGET FY2013

 Income Expenses
State
DCFS $208,576 Salaries $676,280
lVPA $121,500 Benefits $144,274
lCJlA $ 92,207 Occupancy/Rent $ 65,095
State $422,283 Telephone/Paging $ 13,795
 Supplies $ 7,025
Foundations Local Travel $ 10,505
Christopher Foundation $ 10,000 Consultant/Contract $ 6,200
Hedge Funds Care $ 40,000 Conferences/Training $ 3,500
Tribune Charities $ 25,000 Insurance $ 7,555
Blowitz-Ridgeway Found. $ 15,000 Fund Raising Costs $ 12,000
Topfer Family Foundation $ 7,500 Accounting/Audit $ 5,800
Village Treasure House $ 6,000 Maintenance $ 4,380
BELC Foundation $ 500 Printing $ 1,200
Foundations $104,000 Payroll $ 3,478
 Volunteer Services $ 1,550
Fundraising $ 65,000 Dues/Memberships $ 1,265
 Legal Fees $ 2,500
Township $ 80,350 Postage $ 1,320
 Publications $ 557
United Way $ 65,000 Public Relations $ 7,330
 Recruitment/Adver. $ 1,500
Donations $ 68,490 Web Site $ 360
 Computer Expense $ 1,850
Municipal $ 31,000 Miscellaneous $ 2,375

Fees and Fines $110,000

Community Organizations $ 5,600

NCA/CACI $ 10,000

Other $ 20,000




Total $981,723 Total $981,723
 CHILDREN'S ADVOCACY CENTER
 OF NORTH AND NORTHWEST COOK COUNTY

 Job Description


Title: Advocate
Reports to: Program Supervisor
Minimum Requirements: BA/BS with two or more years experience in the field of
child welfare, services for victims of sexual assault/abuse or domestic violence or other
related work experience; MAIMSW preferred.

Responsibilities include, but are not limited to:

 • Crisis Intervention for child victims of sexual abuse and/or severe physical abuse,
 and their non-offending family members.

 • On-going support and case management services.

 • Court Advocacy, including court preparation; notifying children and families of
 court hearings; attending trials and court appearances with client families;
 advocating with the criminal justice system on behalf of clients, as needed.

 • Completing family assessments in order to identify family resources and areas of
 need.

 • Providing client families with information and linkage services to therapeutic,
 educational, housing, employment or other services available in the community.

 • Maintain case and agency advocacy statistics.

 • Participate in staff meetings, supervision and training, as requested.

 • Other duties, as assigned.
 CHILDREN'S ADVOCACY CENTER
 OF NORTH AND NORTHWEST COOK COUNTY

 VILLAGE OF SKOKIE
 COMMUNITY DEVELOPMENT BLOCK GRANT
 LINE-ITEM BUDGET


Expenses
Salary for Margaret Zangrilli, LCSW, Child and Family Advocate/Counselor $3,500



Total $3,500


The Advocate position is a permanent, full-time position at the Children's Advocacy
Center. The Advocate dedicates 100% of her/his time to Child Abuse Services
(Coordination, Advocacy and Sensitive Interviewing Program and Family Support
Services Program). The starting salary for the position ranges from $30,000-$35,000
depending on level of education and years of relevant work experience. Ms. Zangrilli' s
current salary is $42,100. Benefits for the position total $9,789 and include FICA,
unemployment insurance, and worker's compensation (total of $4,380); health, dental
and life insurance (total of $5,409 per year).

12681
MINUTES of a regular meeting of the Mayor and the Board of Trustees of the Village of
Skokie, Cook County, Illinois held in the Council Chambers at 5127 Oakton Street at 8
p.m. on Monday, January 7, 2013

Pledge of Allegiance led by Cub Scout Pack #85 from Middleton School.

The Mayor called the meeting to order.
The Clerk called the Roll. Those present were Trustee Perille, Roberts, Sutker, Bromberg
Shah, Gray-Keeler and Mayor Van Dusen. .
Motion to approve the Consent Agenda.
Moved: Trustee Shah Seconded: Trustee Sutker
Ayes: Perille, Roberts, Sutker, Bromberg, Shah, Gray-Keeler and Mayor Van Dusen
Nays: None.
Absent: None.
MOTION CARRIED

* Approve, as submitted, minutes of regular meeting held December 17, 2012.
Omnibus vote.

* Approve Voucher List #16-FY13 of January 7, 2013.
Omnibus vote.

*Proclamations and Resolutions.
A. Proclamation:
Martin Luther King Day – January 21, 2013
Omnibus


* Appointments, Reappointments and Resignations.
A. Appointments:
Fire Pension Board: George Van Geem, Director of Finance (Voting), Michael M. Lorge,
Corporation Counsel (Non-Voting)
Human Relations Commission (Three-Year Term): Dr. David Y. Ko
B. Resignation:
Sustainable Environmental Advisory Commission: Ben Harris
Omnibus vote.

Report of the Village Manager.
A. Request for Executive Session.
Motion to approve the request of the Village Manager for an Executive Session
pertaining to land acquisition pursuant to Section 2, Paragraph C.5 of the State of Illinois
Open Meetings Act at the end of the regular meeting and to adjourn therefrom.
Moved: Trustee Roberts Seconded: Trustee Sutker
Ayes: Perille, Roberts, Sutker, Bromberg, Shah, Gray-Keeler and Mayor Van Dusen
Nays: None.
Absent: None.
MOTION CARRIED

Report of the Corporation Counsel.
 CONSENT:
*A. Ordinance 13-1-C-3961
Motion to adopt an ordinance amending Chapter 2, Article VII, of the Skokie Village Code
pertaining to the creation of the Economic Development Commission. This item is on the
consent agenda for second reading and adoption.
Omnibus vote.

*B. Ordinance 13-1-C-3962
Motion to adopt an ordinance amending Chapter 2, Article VII, Sections 2-896 and 2-902 of
the Skokie Village Code pertaining to the Cable Television Advisory Commission. This item
is on the consent agenda for second reading and adoption.
Omnibus vote.

 1
12682
Meeting of the Mayor and Board of Trustees
Monday, January 7, 2013 Page Two

2013-14 Community Development Block Grant Public Hearing #2.
Planner/CDBG Administrator Carrie J. Haberstich presented the Public Hearing.

Trustee Sutker read a prepared statement “I am employed by a social service agency that is an
applicant for a CDBG grant. I do not believe this creates a conflict, however, I believe it is
important to avoid the appearance of partiality. Therefore, I will recuse myself from
participating in the discussions relating to the applications and from voting on the grants. My
recusal from participating in the discussion should not be construed as indifference to the
valuable services that the applicants provide to people in need. I commend and admire all of
the agencies for their efforts.”

2013-2014 CDBG Funding Proposals

The Village's entitlement grant for 2013-2014 is not known yet. We are estimating $425,000
at this point based on hearing reports that CDBG funding is expected to decrease once again.
In addition to the new entitlement, we will reprogram approximately $36,446 in unallocated
funds from FY12 and $2,240 in program income from FY13, resulting in an estimated 2013-
2014 budget of $463,686. Proposals from both Village staff and outside agencies total
$501,020, so reductions will be necessary. A reduction of approximately $37,334 will be
necessary for the public service funding requests. The program cap of 20% for administrative
funding is applied against the new entitlement only, while the 15% for public service funding
(non-capital/non-construction expenditures) is applied against the new entitlement plus the
program income from the current program year.

Staff recommendations will be presented at the final public hearing on Monday, February 4.
The Board will determine at that time the exact funding award for each project or activity.
 STAFF PROPOSALS

Program Administration $85,000
Home Improvement Program 95,000
Street and Alley Resurfacing 150,000
Sidewalk Replacement Program 3,000
Social Worker 37,920

TOTAL VILLAGE PROPOSALS $370,920

Overview of CDBG Proposals for FY14
Village of Skokie Community Development Block Grant (CDBG) Program

Public Services

Metropolitan Family Services Metropolitan Family Services
(MFS) is seeking funding to cover a portion of a counselor and intake worker/program
supervisor who provides information and referral services.
 5,000
Center for Enriched Living The Center for Enriched Living
(CEL) is seeking funding to provide scholarships to enable low-income Skokie residents with
developmental disabilities to be fully included in the community, achieve personal success, and
enjoy a good quality of life. 5,000

Maine-Niles Association of Special Recreation (MNASR)
M-NASR is seeking funding to provide financial aid to enable extremely low- to low-income
children and adult Skokie residents with developmental disabilities the opportunity to
participate in therapeutic recreation activities and providing their caregivers much needed
respite. 3,000




 2
 12683

Meeting of the Mayor and Board of Trustees
Monday, January 7, 2013 Page Three

Access to Care
The Access to Care Program, sponsored by the Suburban Primary Health Care Council located
in Westchester, Illinois, is seeking funding to provide primary medical services to low-income
residents of suburban Cook County and northwest Chicago. The requested funding would
enable Access to Care to enroll 10 Skokie residents in the program. 7,000

PEER Services
PEER Services is seeking funding to offset the costs associated with employing a half-time
treatment engagement and retention specialist. 12,000

Children's Advocacy Center
The Children's Advocacy Center is seeking funding to support child victims of abuse, and their
non-offending family members, through expert child interviews, medical evaluations and
crisis intervention services during the investigation of the alleged abuse. Focused counseling
services are provided to help children and families heal from the abuse. 3,500

The Harbour
The Harbour, Inc. is seeking funding to serve the needs of homeless youth (including locked-
out, runaway, and abandoned) ages 12-21 in the north and northwest Chicago suburbs. 8,000

North Shore Senior Center (NSSC)
The NSSC is seeking funding to offset the staffing costs associated with providing long-term
case management and counseling services to Skokie’s homebound, low-income elderly and
their families. 10,000

JCFS Jewish Child and Family Services
 (JCFS) is seeking funding to support a Financial Assistance Case Manager position. The
overall goal of the financial assistance program is to empower low-income Skokie residents to
create more stable environments. 10,000

Public Facilities
Connections for the Homeless
Connections for the Homeless is seeking funding to replace a damaged sidewalk and install a
fence at 4840 Hull Street property, one of the locations for the organization’s Family Housing
program 3,559

CJE SeniorLife
CJE is seeking funding to expand emergency generator coverage for extended power outages
that impact the Lieberman Center for Health and Rehabilitation at 9700 Gross Point Road.
15,000

Turning Point
Turning Point is seeking funding to construct a green space therapeutic playground for family
and children's therapy for physically and mentally disabled children 0-8 years old.
 9,750

SHORE
SHORE is seeking funding to replace deteriorating carpeting/padding and vinyl sheet flooring
with a commercial-grade tile at the Karger House CILA at 4324 Church Street. 13,541


Search
Search is seeking funding to replace windows and doors in a group home for women with
developmental disabilities located at 7807 Keeler. 24,750

TOTAL COMMUNITY ORGANIZATION PROPOSALS $130,100


 3
 12684
Meeting of the Mayor and Board of Trustees
Monday, January 7, 2013 Page Four


Representatives from each of the organizations explained their requests and answered
questions from the Trustees. Staff recommendations will be presented at the final public
hearing on Monday, February 4th.

Mayor Van Dusen thanked everyone for providing services to the Village of Skokie.

Citizen Comments.


Adjournment
Motion to adjourn at 9:20 p.m.
Moved: Trustee Perille Seconded: Trustee Sutker
Ayes: Perille, Roberts, Sutker, Bromberg , Shah, Gray-Keeler and Mayor Van Dusen
Nays: None.
Absent: None.
MOTION CARRIED




 __________________________

 Marlene Williams, Village Clerk



.
Approved:
______________________
George Van Dusen, Mayor




Executive Session
A Closed Session was held in the main floor conference room at 9:26 p.m. Those present were
Mayor Van Dusen, Clerk Williams and Trustees Sutker, Roberts, Perille, Shah, Gray-Keeler
and Bromberg. Also present were Village Manager Rigoni, Assistant Village Manager
Lockerby, Corporation Counsel Lorge, and Economic Development Director Thompson. The
meeting adjourned at 9:36 p.m.




 4
5