AGREEMENT TO PROVIDE FUNDING FOR MENTAL HEALTH SERVICESAGREEMENT
This Funds Agreement is made and entered into between the City of Clearwater, hereinafter
referred to as the City, and Directions for Mental Health, Inc., hereinafter referred to as the
Agency.
WHEREAS, it has been determined to be highly desirable and socially responsible to provide
mental health services to those who would not otherwise have a means to fill these needs; and
WHEREAS, the City desires to help those in need by providing funding for the above services;
and
WHEREAS, the Agency provides such services and operates in the City;
NOW, THERFORE, the parties agree as follows:
ARTICLE I. TERM
The term of this agreement shall be for a period of 12 months commencing on the 1st day of
October, 2000 and continuing through the 30th day of September, 2001 (the Termination Date)
unless earlier terminated under the terms of this agreement.
ARTICLE II. RESPONSIBILITIES OF THE AGENCY
1. Services to be Provided: The Agency shall provide the above stated service in
accordance with the proposal submitted by the Agency and approved by the City, which
is attached and incorporated herein by reference.
2. Area to be Served: Services rendered through this agreement shall be provided within
the corporate limits of the City as it now exists and as its boundaries may be changed
during he term of this agreement.
3. Scheduled Reports of Agency Activities: The Agency shall furnish the City Human
Relations Department, Grants Coordinator, with an annual report of activities conducted
under the provisions of this agreement by October 31, 2001. Each report is to identify the
number of clients served, the costs of such service, and commentary on the viability,
effectiveness, results of measurable goals and objectives as set out in the agency's
proposal, and trends affecting the program. The agency will also provide a copy of its
most recent independent financial audit.
4. Use and Disposition of Funds Received: Funds received by the Agency from the City
shall be used to pay for the above services as further described in the grant proposal
submitted by the Agency to the City. Funds existing and not used for this purpose at the
end of this agreement term shall be deemed excess to the intended purpose and shall be
returned to the City.
5. Creation, Use, and Maintenance of Financial Records:
a) Creation of Records: Agency shall create and maintain financial and accounting
records, books, documents, policies, practices, procedures and any information
necessary to reflect fully the financial activities of the Agency. Such records shall
be available and accessible at all times for inspection, review, or audit by
authorized City representatives.
b) Use of Records: Agency shall produce such reports and analyses that may be
required by the City and other duly authorized agencies to document the proper
and prudent stewardship and use of the monies received through this agreement.
c) Maintenance of Records: All records created hereby are to be retained and
maintained for a period not less than five (5) years from the termination of this
agreement.
6. Non- discrimination: Notwithstanding any other provisions of this agreement during the
term of this agreement, the Agency for itself, agents and representatives, as part of the
consideration for this agreement, does covenant and agree that:
a) No Exclusion from Use: No person shall be excluded from participation in,
denied the benefits of, or otherwise be subjected to discrimination in the operation
of this program on the grounds of race, color, religion, sex, age, national origin, or
disability.
b) No Exclusion from Hire: In the management, operation, or provision of the
program activities authorized and enabled by this agreement, no person shall be
excluded from participation in or denied the benefits of or otherwise be subject to
discrimination on the grounds of or otherwise be subjected to discrimination on
the grounds of race, color, religion, sex, age, national origin, or disability.
c) Inclusion in Subcontracts: The Agency agrees to include the requirement to
adhere to Title VI and Title VII of the Civil Rights Act of 1964 in all approved
sub - contracts.
d) Breach of Nondiscrimination Covenants: In the event of conclusive evidenced
of a breach of any of the above non - discrimination covenants, the City shall have
the right to terminate this agreement.
7. Liability and Indemnification: The Agency shall act as an independent contractor and
agrees to assume all risks of providing the program activities and services herein agreed
and all liability therefore, and shall defend, indemnify, and hold harmless the City, its
officers, agents, and employees from and against any and all claims of loss, liability, and
damages of whatever nature, to persons and property, including, without limiting the
generality of the foregoing, death of any person and loss of the use of any property, except
claims arising from the negligence or willful misconduct of the City or City's agents or
employees. This includes, but is not limited to matters arising out of or claimed to have
been caused by or in any manner related to the Agency's activities or those of any
approved or unapproved invitee, contractor, subcontractor, or other person approved,
authorized, or permitted by the Agency in or about its premises whether or not based on
negligence
ARTICLE III. RESPONSIBILITIES OF THE CITY
1. Grant of Funds: The City agrees to provide a total grant of $2529.00 to fund the
program in accordance with this agreement and subject to City Commission budget
approval.
2. Payments: The total amount requested will be paid by the City to the Agency within 30
days after execution of this agreement by the City and the Agency but no earlier than
October 1 of the budget year for which the funds are authorized.
ARTICLE IV. DISCLAIMER OF WARRANTIES
This Agreement constitutes the entire Agreement of the parties on the subject hereof and may not
be changed, modified, or discharged except by written Amendment duly executed by both
parties. No representations or warranties by either party shall be binding unless expressed herein
or in a duly executed Amendment hereof.
ARTICLE V. TERMINATION
1. For Cause: Failure to adhere to any of the provisions of this agreement as determined by
the City shall constitute cause for termination. This agreement may by terminated with 5
days notice without any further obligation by City.
2. Disposition of Fund Monies: In the event of termination for any reason, monies made
available to the Agency but not expended in accordance with this agreement shall be
returned to the City.
ARTICLE VI. NOTICE
Any notice required or permitted to be given by the provisions of this agreement shall be
conclusively deemed to have been received by a party hereto on the date it is hand - delivered to
such party at the address indicated below (or at such other address as such party shall specify to
the other party in writing), or if sent by registered or certified mail (postage prepaid), on the fifth
(5th) business day after the day on which such notice is mailed and properly addressed.
1. If to City, addressed to Grants Coordinator, Human Relations Department, P.O Box 4748,
Clearwater, FL 33758
iXJ
2. If to Agency, addressed to Clinical Director, Directions for Mental Health, Inc., 1437 S.
Belcher Road, Clearwater, FL 33764.
ARTICLE VII. EFFECTIVE DATE
The effective date of this agreement shall be as of the first day of October, 2000.
.IN WITNESS WHEREOF, the parties hereto have set their hands and seals this
x1.- day of Lt�c4 , 2001.
Countersigned:
Brian J. Aungst, ,r.yor- Commiss
Approved as to form:
Pamela K. Akin, City Attorney
Witnesses as to Agency:
1� orr evw% vc1t- Gam► N �.
}SAY l CrU, &13-11-I
rn
CITY OF CLEARWATER, FLORIDA
c.,66.1113 :
Willi. B
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InterimC; anager
CITY OF CLEARWATER
SOCIAL SERVICES GRANT
PROJECT APPLICATION FORM
Phone: (727) 562 -4060 for assistance Due: January 26, 2001
A. Application Information
Applicant:
(Sponsor /Developer)
Organization Name:
(If different)
Address:
City; State; Zip
Telephone Number:
Contact Person:
Title:
Telephone Number:
Period for which funds
are being requested:
Signature
Date (- ;25---24o/
NOTE:
Directions for Mental Health, Inc,
1437 South Belcher Road
Clearwater, Florida 33764
(727) 524 -4464
Ann H. Kelley, Ph.D.
Clinical Director
(727) 524 -4464 Oct. 1702
10/01/2000 - 09/30/2001
Jerry Dickman
Board of Directors Chairperson
The City of Clearwater reserves the right to fund applicants at a
level lower than requested.
2
B. Activity (Check One)
Adult Crime
Child Abuse
Elderly
Hunger
Juvenile Crime
Physical Illness
Parenting
Adolescents
Substance Abuse
Unsupervised
Children
Youth Development
Other
(Describe Below)
X
3
C. AMOUNT OF FUNDING CURRENTLY REQUESTED:
(Not to exceed $10,000)
$ 2,529.00
SPECIFICALLY FOR WHAT WILL THIS MONEY BE USED.
(Line : item budget for this amount)
Dell Computer for use with clients, program supervisor, coordinator $1100
Modem line /intemet (12 months) $ 600
$ 430
Materials and refreshments for group activities $ 300
Software — BigShot Magnifier by Ai Squared $ 99
Printer .
E BRIEF DESCRIPTION OF PROJECT YOII WISH TO FUND UTILIZING THIS
GRANT. The present proposal seeks to enhance our services to seniors by acquiring a
computer dedicated to the program. A personal computer, which would be shared by the
pro ram supervisor and volunteer coordinator, would improve efficiency in collecting data and
creating reports. is wou ere y increase the amount of time they can allocate to
providing clients with services. The PC would also be used as the foundation for an
introductory computer class. (We would also borrow computers purchased for other
programs). The seniors served are low income. They tend to be isolated, depressed and
vulnerable. We are proposing to implement bi- monthly groups that would teach these seniors
some ve basic information re • ardin • com • uter technolo • and the intemet. Most research
has shown that older persons are less likely to seek out opportunities to leam about
- nd that the tend to be fearful of new id - - • echnolo • . We ho • e to dispel
some of the seniors' unease and encourage their use of computers through these groups.
her serve to incr- - - s ' • • 1 -ft d introduce a leisure
• 11 •
•
u
activity that could enhance their independence.
F. BRIEF DESCRIPTION OF YOUR OVERALL ORGANIZATION.
Directions for Mental Health, Inc., a community mental health center, has been incorporated
as a not - for - profit Florida Corporation since 1982. Our mission is to ameliorate
• ical difficulties and • revent future • roblems b • rovidin • a broad ran • e of hi • h
quality, accessible psychological and behavioral health services to residents of our
community in need.
Last year Directions served 5,082 persons (unduplicated count). 88.5% of the families
serusc were low income with annual incomes of less than $23.000. With 20 different
programs, Directions staff are generally able to serve clients with diverse needs. In line with
Dire i . ns'
programs are outpatient -based and community- focused. Our service area is upper Pinellas
County, specifically north of 62nd Avenue North to 1 -275, Seminole, .Bay Pines and the
Beaches north of John's Pass.
1..•
• _
Of • • • • •
4
• 1 11 - 1
C G. NUMBER OF CLIENTS SERVED BY THIS PROGRAM.
80
H. PERCENTAGE OF THESE CLIENTS WHO ARE CITIZENS OF CLEARWATER.
32%
I. CURRENT OVERALL ORGANIZATION BUDGET (PLEASE ATTACH).
J. IF THIS IS START UP OR MATCHING MONEY, SPECIFY THE DETAILS
i.e.:
WHICH AGENCY OR ORGANIZATION WILL PROVIDE THE MATCH, THE
REQUIREMENTS AND THE AMOUNT OF THE MATCH.
The volunteer conent of our current program for seniors is funded
by Area Agency on Aging and The United Way. These funding sources
will pay for the staff time required for this project.
R. IS YOUR AGENCY A REGISTERED 501(C)(3) NON - PROFIT AGENCY OR IN
THE PROCESS OF BECOMING ONE.
Yes
L. DOES YOUR FACILITY HAVE OR IS IT IN THE PROCESS OF ACQUIRING
THE APPROPRIATE LICENSURE FOR THE DELIVERY OF THE SERVICES
• DESCRIBED IN THIS APPLICATION.
We have a coordination agreement and contract with Area Agency on Aging_
and Neighborly Senior Services to provide services to the elderly in
compliance with the Department of Elder Affairs.
5
Measurable Objective(s):
Clients, aged 60 years and older, will increase participation in socialization activities as
measured by their attendance and self report as recorded in client logs and individual
case files.
Clients, aged 60 years and older, will indicate an increased comfort level and
understanding of computers and the Internet as a result of group participation as
measured by a brief survey administered at the end of each Introduction to Computers
group.
BUDTOMO2.WK1
DIRECTIONS FOR MENTAL HEALTH, INC.
2000 -01 ANNUAL BUDGET
ti ?•: ?::,J,:::•i}.4'i sir :v>:,
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tiV }'ti
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State ADM Funding:
Community Mental Health & General $1,324,417
Indigent Drug Program $88,384
Contingency & Support Funds $36,190
{•::Stete...#t31yl:..n In ............ »:: »::: >:: ><: >:.
`99V
Other Governmental Funding:
Juvenile Welfare Board of Pinellas County $734,289
Family Continuity $91,487
Area Agency on Aging $85,019
Foundation for Mental Health in Pinellas $128,494
Other Local Governmental Funding $825,734
,OT,At.:�?ther;�iovernmentaFFiiii
i3
Fee Revenues:
MEDICAID
MEDICARE
Third.Party Fees
Client Fees
Reallocated Fee Revenues
$2,682,447
$187,058
$31,779
$106,067
$0
}}}}}:.}:.>:.:.::- :;.:;.:.;�:.:;; { :.:::.:....... ........... a ..e....npes:.. .......
>a0T�351':
Other Funding & Revenues:
Donations
Other Revenues
In-Kind Contributions
aTAL.0 #her:;F::unding &....0 0
TOTAL Revenues
$10,000
$10,000
$448,799
$6,790,164
Personnel Expense:
Salaries & Wages
Fringe Benefits
Operating Expenses:
Building Occupancy
Professional Services
Travel Expense
Equipment Expenses
Medical & Pharmacy
Insurance
Interest, Amortization, & Taxes
Operating Supplies & Expenses
In -Kind Expense Items
TOTAL Operating Expenses
TOTAL Expenses
$4,459 „627
$758.841
$168,900
$101,000
$151,707
$115,400
$166,114
$83,095
$81,600
$271,206
$448.799
51,587,821:
$6,806,289
16 ;125)
Net Operating .Profit;]; (Loss)
Non - Operating Income / (Expense):
Gain / (Loss) on Disposal of Assets
Other Non•0- eratin: Income / Expense
TOTAL Non - Operating Income / (Expense)
$0
$0
$0
Net<Oftange in Font! .Balance
($16;125).
8/25/00
M. HAS YOUR ORGANIZATION RECEIVED OR IS IT EXPECTING TO RECEIVE
FUNDING (WHETHER CASH OR IN -KIND CONTRIBUTIONS) FROM THE CITY
OF CLEARWATER DURING THE FISCAL YEAR FROM OCTOBER 1, 2000
THROUGH SEPTEMBER 30, 2001?
YES NO X
IF YES, PLEASE EXPLAIN:
6
f
UNIFIED FUNDING APPLICATION •
To: (fender): City of Clearwater
Applicant Information (print or (ype):
Directions for Mental Health, Inc.
.Legal Name of Organization:
•
-. •
Complete Address:
For time period of:
l0 /oi /00 - 09/30/01
1437 South Belcher Road
Clearwater, FL 3376(
Phone (7) 524 -4464
Fax F)524-4474 - E-Mail an.ke»R i* tia t.oro .
• :Federal Tax Identification Number
59- 2092715
Contact Person: Ann H. Kelley, Ph.D.
Title: Clinical Director
Organization Type: Public Private x Non -profit Other
Seivice Area: x County City of
Other
Agency currently funded by ( check all that apply):
St Petersburg x Florida Dept. of Children & Families
Clearwater x Florida Dept of Justice
Largo x Pinellas County Foundation
x Pinellas County Allegany Franciscan Foundation
-' Area Agency on Aging Eckerd Family Foundation
x Juvenile Welfare Bd. x Other: HUD, Florida Coalition for the Homeless,
x United Way Family Continuity, Pinellas County School Bd.
Certifications: (1) If required to register for solicitation of funds, is the Agency currently
registered with the State? X Yes _ No The County? X Yes _ No
(2) If incorporated, has the Agency Annual Report been filed with the Florida
Secretary of State? X Yes _ No
Name and Title of Agency Representative submitting this funding request:
Ann H. Kelley, Ph.D. Clinical Director
Signature of Agency Director (se or s « i member) or Board Chair:
Date:
January 25, 2001
Received in funder's office by: Date:
UFA1
BOARD OF DIRECTORS -# required in By Laws = 9 to 20
NAMEJOFFICER
Dan Andriso
Brian Annis
L'foya'Ba i1 %
Eleanor Breland
Mary Devine
Jerry Dickman/Pres.
Nevis Herrington
Robert Hilsky
Krista Hinrichs
Bill Home
Robert Jackson/Treas.
Don Kirby
Sarah Macario
Carl Meisner /Sec.
Craig Phillips
arren Sturgis
uck SullivanN.P.
Ave VanNahmen
UFA2
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Banking
HR Director
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Financial Consultant
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Health Care Director
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Acting City Manager
CPA
Marketing Consultant
Chief Operations Officer
Psychologist
Financial Planner
Charter Boat Captain
Attorney
Public Relations
Consultant
Human Resources
•-Corp. Benefits Mgr
Finance -
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Marketing
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Finance
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Psychology
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