501(c)(2) X 501(c)(3) 501(c)(4) 502(c)(3)

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Caroline Weaver
5 years ago
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1 II. APPLICANT INFORMATION 1. Organization: Addiction Relief & Supported Recovery. Inc. 2. Contact Person: David Beatty Title: Executive Director 3. Organization's Address: P.O. Box Lansing. MI Phone Number: (517) Fax Number: ( WEB: vavw.arsr.org and 6. Proposal Title: ARSR Support Services Amount Requested: $ Federal Tax Identification Number: Ingham County communications regarding community agency funds shall be sent to address: 10. Please indicate the names and titles of persons who are authorized to execute agreements on behalf of your organization: Name: David Beattv Name: Erica Shifflet Title: Executive Director Title: President 11. Nonprofit Organization: Please Check One - 501(c)(2) X 501(c)(3) 501(c)(4) 502(c)(3) QOther (specify) 12. Business organization (profit): 13. Unit of government including schools (specify): 14. Not incorporated (specify legal and/or professional status of the requesting individual): 15. How long has the applicant's organization been in business? Since October What is the number of full-time equivalent positions currently employed? one 17. How many volunteers are currently involved? two 18. a. How does your proposal involve coordination or collaboration with County services, other local governments, or other agencies? ARSR collaborates with a number of agencies in the Ingham County region, including CEI-CHM. Sparrow Health System. Ingham County Probation/Parole. Ingham County Department of Human Services, local homeless shelters and the 12-Step Recovery community.

2 b. What other programs similar to your program are operating in the County? There are no other existing projects that provide immediate assistance to homeless addicts and alcoholics in the county. Many individuals released from treatment, jail or prison are without sober housing, clothing, food, transportation, counseling, etc.. especially in the first hours. davs or weeks of recovery. It is significant to note that in the past six months, four male % way houses have closed in Lansing. 19. Is this your first request for funds from Ingham County? Q yes Xflno 20. a. Have you sought funds for this proposal or concept from any other entity? Please identify who and the response. Q yes XQ no not yet for the 2014 FY b. Does the proposal anticipate utilizing funds from other sources? xq yes Q no c. To what extent is the other funding assured? There are no guaranteed funds. We anticipate donations and other possible grants.

3 III. nftattfd SCOPE OF WORK The Scope of Work should be one page or less and contain: 1. A statement regarding the general nature of the services and population with which your agency concerns itself. 2. A statement explaining how the proposal will address the County's long-term objective of Meeting Basic Needs. (See the attached Resolution # Resolution Approving Criteria for Ranking 2014 Applications for Community Agency Funding. Priority consideration will be given to applicants that meet the objective of Meeting Basic Needs; however, if there are funds available, secondary consideration will be given to agencies serving vulnerable populations. 3. A statement detailing the specific services which will be provided by Ingham County's appropriation. A statement of the specific target group for these areas. 4. A statement describing the eligibility criteria for these services. (See the attached Resolution # Resolution Approving Criteria for Ranking 2014 Applications for Community Agency Funding and must serve residents of Ingham County to be eligible.) 5. A statement describing the time for the performance of these services. Substance dependent individuals who are homeless within Ingham County continue to be without adequate and effective resources, in order to increase this population's chances of getting and remaining clean and/or sober and obtaining employment they need access to sober, transitional housing. Addiction Relief & Supported Recovery. Inc. (ARSR) provides this type of housing through Joe & Shirley's Place- In addition. ARSR provides other services which include but are not limited to: counseling, education, emergency medical and/or dental care, food, clothing, and transportation. Over fifty percent of homeless adults surveyed in our community report substance abuse as the reason for being homeless. Obviously, this number does not reflect people who do not know or who will not say that substance abuse is a problem for them. Seventy to eighty percent of individuals incarcerated in the Ingham County Jail are there as a result, directly or indirectly, of drug and/or alcohol dependency related offenses. A homeless person can usually be admitted to a detoxification facility within one to three days at the present time. Many of these individuals go to a residential treatment center for a few days, weeks or even months. However, the problem remains where do homeless, substance dependent individuals go after release from detoxification, sobering centers, residential treatment, jail or prison in this county? They are still homeless and need immediate case management and supportive services as well as a safe and sober place to live. There are approximately sixteen other three-quarter beds available in the tricountv region (only eight female beds). This is simply not enough sober housing for homeless individuals in the area. It takes days, weeks and months for people to get established. This is extremely difficult if one if penniless and homeless. Staying clean and sober is difficult enough if one has a home, a job, a support svstem. etc. It takes case management services and sober housing for the possibility of o

4 successful recovery and this is the number one priority of ARSR. Due to the nature of the services that ARSR provides a timetable is not possible to establish. Funds will be used on an as-needed basis, $ of these funds will be used for general operating expenses and $ will be used to pav property taxes.

5 IV. PROJECT BUDGET The Proposed Line Item Budget should be structured to address four major areas: Personnel Services, Professional and Contractual Services, Operating Expenses, and Direct Services to Ingham County Residents. Please be advised that for 2014 emphasis will be placed on provision of direct services to county residents and use of Community Agency funds for personnel related expenditures is strongly discouraged. COUNTY REQUESTED OTHER SOURCES AMOUNT 1 Personnel Services a. Salaries & Wages b. FICA c. Unemployment d. Fringe Benefits (may be further subdivided) e. Overtime f. Temporary g. Work Study Wages 2 Professional and Contractual a. Medical Services (for recipient population) b. Accounting Services c. Membership/Subscriptions d. Federal or State grant match e. Office Equipment Leases f. Maintenance Agreements 3 Operating Expenses a. Telephone b. Rent c. Utilities d. Postage e. Office Supplies f. Travel g. Insurance h. Property Taxes $6, $ Direct Services to Ingham County $5, $0.00 Residents a. Food b. Utilities c. Shelter/Housing d. Other Direct Assistance TOTAL $11, $0.00

6 ADDICTION RELIEF & SUPPORTED RECOVERY INC Proposed Operating Budget Operating Income Donations 14,100 Fundraisers 5,000 Grants 200,000 (100,000 Construction Repairs/Renovations) + (100,000 General Operating Funds) JSP Properties (Resident Program fees) 40,000 Probation, Community Service (Refundable Cans/Bottles) 5,000 Texas Holdem Tournaments 12,000 Freedom Clinics, SUBOXONE Treatment 96,000 Total Income 372,100 Expenses Advertising/Promotional 2,500 Bank Charges 700 Board Meeting 500 Bus Passes 2,000 Commissions & Fees 500 Computer Expense & Office Equipment 4,000 Drug Test Kits 3,000 Entertainment 1,000 Education 2,500 Food 2,500 Fundraising Expense 2,500 Health Care - Medical/Dental (Urgent Care, Psychiatric Evaluations, Therapy, Medications,) 8,000 Household Supplies 5,000 Insurance 7,500 Interest 1,400 Legal & Professional Fees 6,000 Licenses & Permits 1,500 Meals 2,500 Office Expense: Freedom Clinics Contrart Physicians & Rent or Lease) 58,000 Personal Needs Joe & Shirley's Place Residents 2,500 Repairs/Renovations/Construction & Maintenance 100,000 Motels 1,500 Taxes-Payroll 15,000 Taxes - Property 7,000 Telephone/internet/cell phones 9,500 Transportation/Travel (Fuel, Vehicle Expenses & Maintenance) 34,000 Utilities/Trash/Cable TV/Internet/Land Lines (JSP) 25,000 Wages & Benefits 66,000 Total Expenses 372,100

7 INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH DEPARTMENT OF T: Date: JUL ? Employer Identification Number: DLN: ADDICTION RELIEF & SUPPORTED RECOVERY INC 2600 FOREST RD LANSING, MI Contact Person: GINGER L JONES ID# 31S46 Contact Telephone Number: (877) B Public Charity Status: 170 (b) (1) (A) (vi) Dear Applicant: Our letter dated September 3, 2003, stated you would be exempt from Federal income tax under section 501{c) (3) of the Internal Revenue Code, and you would be treated as a public charity, rather than as a private foundation, during an advance ruling period. Based on the information you submitted, you are classified as a public charity under the Code section listed in the heading of this letter. Since your exempt status was not under consideration, you continue to be classified as an organization exempt from Federal income tax under section 501 (c) E3) of the Code. Publication 557, Tax-Exempt Status for Your Organization, provides detailed information about your rights and responsibilities as an exempt organization. You may request a copy by calling the toll-free number for forms, {800) Information is also available on our Internet Web Site at If you have general questions about exempt organizations, please call our toll-free number shown in the heading. Please keep this letter in your permanent records. We have sent a copy of this letter to your representative as indicated in your power of.attorney. Sincerely yours, Robert Choi Director, Exempt Organizations Rulings and Agreements Letter 1050 (DO/CG) 7

8 ADDICTION RELIEF & SUPPORTED RECOVERY BOARD MEMBER INFORMATION Dennis Barrett (Executive Board, ARSR) barrettlaw2(5)sbcalobal.net 4205 Charlar Drive, Suite 3,Holt, MI David Beatty (Executive Director, ARSR) dpbeattv 1 (Slhotmai l.com 2727 E. Kalamazoo St., Lansing, MI BS. CAC-M Becky Weyers (Executive Board, ARSR) (517) Windbreak Ln., Lansins, MI Beckvkav84(2),2m ail.com Marianne Barger (Secretary, ARSR) mariannebarserfaivahoo.com 2515 S.MLK Blvd., Lansing, MI Erica Shifflet, LMSW (President, ARSR) ericads78(a),vahoo.com 9054 Cook Rd., Games, MI Rob Flanders (Treasurer, ARSR) robf^judvbascs.com 3419W. Michigan., Lansing, MI Jason Beatty (Executive Board, ARSR) Medical Director beattvia(s>msu.edu 8607 US Hwy 23 South, Ossineke, MI Eric Shifflet (Executive Board, ARSR) Ericdsl946(a)vahoo.com 8336 Peninsular Dr., Fenton, MI Howard (Jack) Weyers Jr. (Executive Board, ARSR) (517) jack. wvfs),hotmaii. com 2508 Windbreak Lane, Lansing, MI Janice Hardman (Executive Board. ARSR) (517) lardmif^icc.edu 4600 Alpha, Lansing, MI BoardMemberList.rtf (revised 03/27/2013)

9 ADDICTION RELIEF & SUPPORTED RECOVERY BOARD MEMBER INFORMATION Dennis Barrett (Executive Board, ARSR) barrettlaw2(a)sbcqloba!.net 4205 Charlar Drive, Suite 3,Holt, MI Rob Flanders (Treasurer, ARSR) robf5irudvbaees.com 3419 W.Michigan., Lansing, MI David Beatty (Executive Director, ARSR) Jason Beatty (Executive Board, ARSR) Medical Director dpbeattvl (Slhotmail.com 2727 E. Kalamazoo St., Lansing, MT BS, CAC-M Becky Weyers (Executive Board, ARSR) (517) Windbreak Ln., Lansina. MI Beckvkav84(a),2mail.com Marianne Barger (Secretary, ARSR) mariannebaraeri vahoo.com 2515 S. MLK Blvd., Lansing, MI Erica Shi filet, LMSW (President, ARSR) ericads78f&>vahoo.com 9054 Cook Rd., Gaines, MI beattvja(a!msu.edu 8607 US Hwy 23 South, Ossineke, MI Eric Shifflet (Executive Board, ARSR) Ericdsl946fo),vahoo.com 8336 Peninsular Dr., Fenton, MI Howard (Jack) Weyers Jr. (Executive Board, ARSR) (517) jack, wvfaihotmail. com 2508 Windbreak Lane, Lansing. MI Janice Hardman (Executive Board, ARSR) (517) hardmi(^)jcc.edu 4600 Alpha, Lansing, MI B oardmemberl ist.rtf (revised 03/27/2013)

GLHRN Grant Application

GLHRN Grant Application (One project per application) FUNDING2016 HUD NOFA GRANT PERIOD 2017-18 Application due to coordinator@glhrn.org by 6 pm on Friday, August 12 th PART I: Program Information Renewal