rotary international district 5580 district grant...

RI District 5580 District Grant Proposal-Application: of 13Revision: August 15, 2013

Rotary International District 5580District Grant Application

Grant # _15.1.15_Note: Rotarians completing this District Grant Application should submit this form to the appropriate Rotary InternationalDistrict 5580 Grants Committee Mentor (GCM) and D5580 Grants Committee Chair (GCC). Contact information isavailable at www.clubrunner.ca/5580 Forms to be submitted typed, not hand written.

NOTE: Select a box, double click on it. Then, from the sub-menu select checked or not checked, then click on Okay.Application [document must be completed in its entirety, including signatures]

DG Project Title:Active Living Center Project at the YMCA

Primary Contact’sName: Kristi Kane

Rotary Club:Grand Rapids Centennial Rotary Club

Phone:(B): 218-999-9233 ©:

(H): 218-244-9639 (F): 218-999-7543

Email:[email protected]

Mentor’s Name: Roly TurnerPhone:Email:

(807) 683 [email protected]

Date Submitted 3/28/2014EstimatedTimeline Start August 1, 2014

Finish April 1, 2015

SECTION 1: PROJECT DESCRIPTIONExplanation: District Grants support the humanitarian service projects of Rotary clubs and districts. In this section,describe in detail the humanitarian need your project will address, the intent of the project, how the project will beimplemented, and how Rotarians will be directly involved in the project. Rotarian involvement is required and a oneyear timeline is requested (start to finish).

Please provide the name of the project site, the city or village, state or province, and country. List multiple locations, ifapplicable.Project site: Itasca County Family YMCA

City / Village: Grand Rapids

State / Province: MN

Country: United States of America

Describe how the benefiting community will maintain this project after grant funding has been fully expended.

This is a collaborative project with the City of Grand Rapids, the Itasca County Family YMCA andElderCircle. The city of Grand Rapids has pledged annual support of $25,000 per year (with a twoyear out because they cannot bind future city councils). The YMCA receives supportive funding onan annual basis from the Blandin Foundation and through fundraising and programming for seniorinitiatives. ElderCircle receives supportive funding from Itasca County and the Blandin Foundationas well as earned revenue from its Adult Day Services program and cost share from the SeniorWheels and Respite programs.


Describe specific activities of the benefiting community partners in implementing the project. How will the Rotarianswho are members of the partner clubs be involved the project? Please note that financial support is not consideredactive involvement. (See the District Grant application instructions for suggestions.)

Rotarians from both clubs were involved in the planning of this project from it’s inception, ShawnGillen and Kristi Kane both of the Centennial Club were part of the initial work with the consultantduring the visioning stage. Rotarians were involved with the feasibility study, representation on theRepresentative Body Committee which developed the original governance structure and as teamcaptains in the community fundraising drive. Presentations on this project were given to bothRotary Clubs and several Rotarians volunteered for the benefiting agencies by providing volunteerservices to one or both partnering non-profits. In addition, Rotarians from both clubs worked toplan the reverse lottery to benefit this project. Rotarians sold tickets, collected raffle items, andworked on the logistics the day of the event. In addition five Interact students also participated theday of the reverse lottery to help benefit this project. Overall it is estimated that 51 Rotarians fromboth clubs have contributed approximately 910 hours in the planning, publicizing, fundraising, andexecution of this project.

SECTION 2: PROJECT BUDGETExplanation: For detailed information on what TRF will fund, please see The Guide to Matching Grants (144-EN). Official RI exchangerates can be found at www.rotary.org/en/AboutUs/SiteTools/DownloadLibrary/Pages/ridefault.aspx . Please use the most recent rate.Your estimated costs below must include quotes from a bona-fide vendor if costs for items exceed $100.

Budget Item Name of Supplier AmountVOIP telephone system connecting ElderCircle,the clinic and the YMCA to optimizeprogramming and maximize promotion of healthand wellness

Paul Bunyan - attached 17,447.00

Bathroom Remodeling to include tub fixtures andassistive devices for individuals attending AdultDay Stay and Handicap accessibility in clinic andcommon area bathrooms –both men and women

Norson - bid attached 6558.00

Brochures Promoting Aging Service Programs forall collaborative partners to be offered at theActive Living Center

White Ivy Design bid attached 2156.00

Projection Equipment for the Active LivingCenter Classroom to promote communityoutreach events and community education/ tackboards/chalk

Will get bids and take best bid option –Initial estimate from Norson - attached

2130.00

48-72 Chairs non skid with and without armrestfor easy transfer – 2 lift chairs - for Active LivingCenter area -and up to 6 tables for communityclassrooms.

Will get three bids from local retailers andtake best option.

3709.00


Subtotal 32,000.00

Exchange rate used US $1=

Total in U.S. dollars 32,000.00

You must substantiate your project with actual receipts when completing the Final Report or the Final Report willbe returned as incomplete.


SECTION 3: PROJECT PLANNING

Explanation: Before an application is submitted to Rotary International District 5580 GC, project partners should discuss variousplanning details. The questions below are a guide to aid project planning. Note that a Rotary club/district or Rotarian may not own orbenefit from anything purchased with grant funds.

Identify who will own equipment and maintain, operate, and secure items purchased with grant funds. (A Rotary clubor Rotarian cannot own equipment.)

The Itasca County Family YMCA will own and maintain the equipment. The YMCA, ElderCircle andthe City of Grand Rapids will have the ability to operate the equipment as part of the collaborativeagreement. A Governance agreement has been formed with representation from each board andthe community at large to govern the collaborative space.

Will training in use and maintenance of technical equipment be provided? If so, who will provide training?

Yes. Manufacturer’s Representative will provide training for the phone system.

Is software necessary to operate any items? If so, has software been provided?

No

Indicate what arrangements have been made for customs clearance if items will be purchased and shipped fromoutside the project country.

N/A

Have the sponsor clubs/districts planned and agreed to fund plumbing or electrification for equipment and appliancesin existing buildings (hospitals, schools, libraries, orphanages, etc.)?

No this will include purchase of equipment and installation of the phone system.

The mission of The Rotary Foundation is to enable Rotarians to advance world understanding, goodwill, and peacethrough the improvement of health, the support of education, and the alleviation of poverty.

How will this project meet the mission of Rotary Foundation?

The new Active Living Center will be a “one stop shop” that will offer continuing education classes forour aging community members, opportunities for socializing and fitness, connections with otherservices for older adults and their families and lively interaction among diverse age groups. Thecommitted partners have a strong commitment to the education and promotion of wellness as well as a


commitment to empower people to expand their social connections and become engaged with theircommunity to lead a more fulfilling life.

This project primarily meets the Rotary Foundation mission by creating a community atmosphere ofgoodwill and peace through the improvement of community health. By creating an Active Living Centerfree and open to all community members, the partnering organizations will provide a resource forwellness and socialization activities that is accessible to all Itasca County community members. Inaddition, all partnering organizations have a commitment to serving low income individuals living in oron the cusp of poverty. In 2013 the YMCA provided $129,923.00 in financial assistance and subsidies for1469 children, youth and families to participate in Y programs and membership. Nine of ElderCircle’sprograms focus on serving individuals 55+ who are living at or below poverty level. In 2013 over 4000individuals were provided assistance to keep them independent, healthy and in their own home. Someof these services included snow removal, lawn mowing, delivery of frozen meals, grocery shopping,rides to medical appointments, employment placement and skill building, respite for caregivers, AdultDay Services and minor home repairs.

Education and outreach is a large piece of the programming that will happen out of this center and theopportunity for intergenerational programming is an exciting step in building good will and peaceamong generations and different social economic groups.

Describe the project and the problem or need it will address, including the intended beneficiaries and how the project will benefit thecommunity in need. Provide the estimated length of time needed to complete the project including a START and END DATE.

The primary objective of these funds would be to purchase and install the equipment that will enablethis facility to provide better community healthcare through education, outreach, wellness & healthprogramming and clinic facilities. This includes a VOIP phone system connecting the clinic, ElderCircleand the YMCA to optimize programming and efficiency and educational technology such as a projectorand assistive devices. Funding would also be used to remodel existing space to make it moreaccessible, primarily the bathrooms in the Adult Day Stay and public restroom space as well as awheelchair accessible gate to the fitness area.

Itasca County’s aging residents and their caregivers have a far greater need for home- and community-based services than are currently provided. The percentage of Itasca County residents who are over 65will rise from 18% today to 34% by 2030. Because of the projected dramatic age wave, it’s essential todevelop strategies to strengthen community support of such services now. To help Itasca County’s vitalaging population and their dedicated caregivers integrate into the larger community as well as topromote their independence and overall quality of life, a broad-based area partnership has launched abold joint venture. The city of Grand Rapids, Itasca County Family YMCA, Grand Itasca Clinic andHospital, and ElderCircle are expanding the local YMCA and enhancing it with an active living center thatwill cater to retirees, the aging population, and caregivers. The goal of the proposed project is tomaximize the capacity of this broad community initiative to deliver tangible outcomes. The objectivesare: 1) Use technology to centralize and deliver services, improve quality, manage data, reduce costs,and remove impediments that prevent seniors from living independent, active lives; 2) Collaborate withhealth care and community organizations to centralize and enhance service delivery; 3) Expandessential home-based support services to improve outcomes for at-risk seniors and their caregivers andeducate them about community-based services; and 4) Support at-risk families and informal caregivers


by helping them address barriers.

With the City of Grand Rapids and ElderCircle partners in place, the time is right to create a newresource that will serve older adults and the entire community. As older adults have the tools they needto remain active and live independently, the quality of life in our community will improve and the costsof health care and care giving will be reduced.

The YMCA has 1200 people per day that walk through its doors. Membership covers allsocial/economic backgrounds and people from birth to well into their 90’s. ElderCircle and the Citybelieve this to be the perfect location to educate individual’s early on healthy living and healthy aging.The Active Living Center will be free and open to the community at large, it will contain classrooms forcommunity education, a recreation area, a large sitting area and coffee bar for socialization among thecommunity and an information kiosk with information on programs and services throughout the countythat contribute to healthy aging. ElderCircle office and program will be located on site as well as a 1000sq foot clinic.


SECTION 4: ROTARY INTERNATIONAL DISTRICT 5580 - PRIMARY CLUB

Explanation: The Rotary International District 5580 primary club is the club sponsoring the project. A committee of at least threeRotarians from this club must be established to oversee the project. The primary project contact must be a member of the primary clubidentified below. The project committee must be composed of members of the sponsor Rotary club for club-sponsored projects or districtfor district-sponsored projects. The committee members must be committed for the duration of the grant process. Please provide theprimary address for all committee members, as all Rotary information will be sent to this address. It is highly recommended that theprimary contact (who receives all information from the District Grants Subcommittee) have an e-mail address to expedite communication.

Primary ClubClub Grand Rapids Rotary Club Club ID number 1401District 5580 Country USA

Primary Contact:Name: Chris Deadrick Member ID: 8615862Club: Grand Rapids Rotary ClubRotary position: Grant Committee ChairAddress: 1111 Isleview RdCity: Grand RapidsState/Province: MN Postal code: 55744 Country: USAE-mail: [email protected] Cell phone: 218-343-9284Home phone: Office phone: 218-322-2800 Fax: 218-327-0812

Project Contact #2:Name: Eric Northard Member ID: 2521899Club: Grand Rapids Rotary ClubRotary position: Current PresidentAddress: 1032 NW 3rd AveCity: Grand RapidsState/Province: MN Postal code: 55744 Country: USAE-mail: [email protected] Cell phone:Home phone: 218-301-6738 Office phone: Fax:

Project Contact #3:Name: Kristi Kane Member ID: 8163054Club: Centennial Rotary ClubRotary position: Grant Committee/Youth Exchange OfficerAddress: 4542 E Hwy 169City: BoveyState/Province: MN Postal code: 55709 Country: USAE-mail: [email protected] Cell phone: 218-999-9639Home phone: 218-245-3822 Office phone: 218-999-9233 Fax: 218-999-7543


SECTION 5: ROTARY INTERNATIONAL DISTRICT 5580ADDITONAL CONTRIBUTING ROTARY CLUB / DISTRICT PARTNERSExplanation: An additional contributing partner is a Rotary club or district who is not the sponsoring club or the host club. The additionalcontributing partner primary project contact must be a member of the additional contributing Rotary club identified below and must becommitted for the duration of the grant process from application through implementation and final reporting. Please provide the primaryaddress for all additional contributing Rotary club and district partners, as all Rotary information will be sent to this/these address (es). Itis highly recommended that the primary contact(s) (who receives all information from the D5580 Grants Committee) have an e-mailaddress to expedite communication.

Additional Contributing Club #1Club Centennial Rotary Club Club ID number: 27971District 5580 Country: USA

Additional Contributing Club #1 Primary Contact:Name: Keith Polister Member ID: 6664755

Club: Centennial Rotary Club

Rotary position: President Elect

Address: 519 NW 5th St

City: Grand Rapids

State/Province: MN Postal code: 55744 Country: USA

E-mail: [email protected] Cell phone: 1-218-256-0702Home phone: Office phone: 218-326-1133 Fax:

Additional Contributing Club #2Club: Club ID number:District: 5580 Country: USA

Additional Contributing Club #2 Primary Contact:Name: Member ID:Club:Rotary position:Address:City:State/Province: Postal code: Country: USAE-mail: Cell phone:Home phone: Office phone: Fax:

Additional Contributing Club #3Club Club ID numberDistrict 5580 Country USA

Contributing Club #3 Primary Contact:Name: Member ID:Club:Rotary position:Address:City:State/Province: Postal code: Country: USAE-mail: Cell phone:Home phone: Office phone: Fax:

RI District 5580 District Grant Proposal-Application: Page 10 of 13Revision: August 15, 2013

SECTION 6: PROJECT FINANCINGExplanation: Clearly list all financing in U.S. dollars noting which funds will be contributed in cash and which will be contributed from DistrictGrant Funds (DGF). The district Rotary Foundation Committee Chair must authorize use of District Grant Funds.

Project finances must match projected project budget.

NOTE: No funds should be spent and no work should be started on this specific project prior to official Rotary International District 5580 GrantsCommittee approval. Upon approval, a notice will be sent to the sponsors informing them of approval and providing detailed instructions on howand where to submit their contributions and reports.

RI District 5580Rotary clubs

Cash(US$) DGF (US$)

DRFC ChairD-5580

DRFC ChairAuthorization

Dist. GovernorD-5580

Dist. GovernorAuthorization

Grand Rapids Rotary 12000.00 5000.00Centennial Rotary Club 10000.00 5000.00

Total D-5580 Club &DG Funds 22000.00 10000.00

RolyTurner

DavidSmette

Subtotals, Cash and DGF22,000.00 10,000.00

TOTAL Cosponsorcontributions 0Additional non-Rotarianoutside funding(not matched by or forwarded toRI District 5580) 0

Total project financing(Must equal Project Budget pageTotal)

32,000.00

RI District 5580 District Grant Proposal-Application: Page 11 of 13Revision: August 15, 2013

SECTION 7: AUTHORIZATIONSExplanation: Authorizations ensure that all partners are aware of, and interested in, pursuing the described project. Bysigning below, the current club presidents for club-sponsored projects and current district grants subcommittee chair fordistrict-sponsored projects, as well as the committee members, agree to the criteria listed and affirm their support of theproject.

All Rotary clubs, districts, and Rotarians involved in this project are responsible to The Rotary Foundation(TRF) for the implementation of the project and its subsequent reporting. The signatures of all involvedparties confirm that they understand and accept responsibility for the project. Parties may either sign thispage or submit a separate letter of commitment.By signing the next page below, we agree to the following:

All information contained in this application is, to the best of our knowledge, true and accurate, andwe intend to implement the project as presented in this application. Any alterations or changes inscope must have the expressed approval of the D5580 Grants Committee Chair.

The club/district agrees to undertake this project as an activity of the club/district. We ensure all cash contributions (as detailed in Project Financing) will be forwarded directly to the

project account after RI D-5580 Grants Committee approval of the grant. RI D-5580, RI and TRF may use information contained in this application to promote the project by

various means such as district publications, The Rotarian, the RI international convention, RVM: TheRotarian Video Magazine, etc.

The partners agree to share information on best practices when asked, and RI D-5580 and TRF mayprovide partners’ contact information to other Rotarians who may wish advice on implementingsimilar projects.

To the best of my knowledge and belief, except as disclosed herewith, neither I nor any person withwhom I have or had a personal or business relationship is engaged, or intends to engage, inbenefiting from TRF grant funds or has any interest that may represent a potential competing orconflicting interest. A conflict of interest is defined as a situation in which a Rotarian, in relationshipto an outside organization, is in a position to influence the spending of TRF grant funds, or influencedecisions in ways that could lead directly or indirectly to financial gain for the Rotarian, a businesscolleague, or his or her family, or give improper advantage to others to the detriment of TRF. (NOTE:Any and all exceptions must be explained in an attached statement.)

The club agrees to comply with all applicable terms and conditions of “The Rotary FoundationMemorandum of Understanding” and “The Rotary Foundation Future Vision RI District 5580Addendum to The Rotary Foundation Club Memorandum of Understanding”. The Rotary Foundation,RI D-5580 Audit Committee and/or the RI D-5580 District Foundation Compliance Officer have theauthorization to audit the project at any time.

Grand Rapids Rotary ClubsGrand Rapids Rotary Club #1401 Centennial Club #27971PO Box 364 PO Box 5113Grand Rapids, MN 55744 Grand Rapids, MN 55744________________________________________________________________________

District Grant Review Committee,

Thank you for considering the Active Living Center project as a possible recipient of theDistrict 5580 matching funds. This request is a smaller but vital piece of a $5,000,000initiative that has been actively working with the community since 2010. Our projectwill be to provide infrastructure to optimize programming between the collaborativepartners to better meet the needs of Itasca County residents. By supporting this initiative,Rotary will assist the partners in equipping program space with optimal communication,accessibility to all community members and provide an outlet for increased communityeducation within a centralized location in the county.

Rotarians have taken an active role in exploring the feasibility and planning thegovernance of this collaborative effort with the Itasca County Family YMCA, the City ofGrand Rapids, and ElderCircle. It is the community’s belief that by working together andcombining resources these entities will be able to have a larger impact on our aging,youth, families and those living in poverty in Itasca County as well as a more sustainablebudget. Recently Grand Itasca Clinic and Hospital has signed an MOU to build a 1000square foot clinic on site as well. It is their intention to provide clinic services andwellness education from this site during the daytime hours and possible donate the use ofthe facility to the Grand Rapids Free Clinic – a non-profit that serves low incomenoninsured individuals in the area.

The YMCA serves over 1200 people per day of all social economic backgrounds and allage levels. It is a wonderful site for this new center allowing ElderCircle to reach morepeople at an earlier age to educate them on healthy aging program, caregiver support andservices for veterans and low income individuals over the age of 60. The YMCA has onsite childcare as well as an afterschool youth center. Both provide wonderfulopportunities for intergenerational programming and mentoring. The city has pledgedongoing support to the future programming of this facility as well as many in kindcontributions during the planning of this project.

Overall, we are very excited for this opportunity to apply for matching grants. The GrandRapids Rotary Club sent three individuals to the Grant Management Seminar. TheCentennial Club had one person signed up, who was not able to attend, but will sendsomeone to the seminar at the District Conference.

Again, thank you for this opportunity. Please do not hesitate to call with any questions orconcerns.

Sincerely,

Kristi Kane, Grand Rapids Centennial Rotary Club

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