2016 Application Package
United Way of Horry County
Name of Organization:
_______________________ __
Check mark each section below to confirm that it is completed and included in the
package. Please keep in the order listed, with exhibits in sequence at the end.
Include eight complete copies, due April 1, 2015.
Check mark___
Contents
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Statement of Admissions Policies (information only)
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Agency Application
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Exhibits A-G
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A. Case Studies
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B. Beneficiaries Form
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C. Nondiscrimination Form
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D. Leadership and Contact Information
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E. Community Partner Agreement
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F. Budget Forms
G. Attachments:
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1. Charter, constitution & bylaws
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2. IRS tax letter
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3. Admission policies
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4. Financial Report
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5. Annual Report
STATEMENT OF ADMISSIONS POLICIES
OF UNITED WAY OF HORRY COUNTY, INC
General Policy
United Way of Horry County, Inc. supports an “Open Door” policy of participation in
federated fund raising, taking into account the factors of community need, standards
of performance of the agency, stage of readiness of the community to accept certain
types of enterprises for federated fund raising, and potential financial resources at
any given time for adequate support of present and proposed appeals.
United Way will consider applications from agencies with local autonomy and service
programs in Horry County or from agencies with state or national affiliations with
local service programs or work which Horry County might want to support. All
applicants must be incorporated, non-profit organizations, contributions to which are
deductible, under appropriate sections of the Internal Revenue Service, meeting a
demonstrated need in the field of Education, Self Sufficiency, Health or Basic Needs.
Eligibility for Participation in United Way of Horry
To be eligible for participation, United Way of Horry County must be satisfied on the
following points:
1) That the agency renders a needed service in a manner and in a field of work
which justifies inclusion in a broad financial federation. This will involve
such study reports as the Community Investment Committee may wish to
make or cause to be made.
2) That the services are or will be open to all persons in need regardless of
religion, race, gender, sexual orientation or national origin. If there are
limitations to this effect, the Board of Directors must approve these
limitations before participation in United Way is granted.
3) That the organization of the agency is such as to assure effective control by
a managing board selected in a satisfactory manner. The organization must
also be such as to assure efficient management, effective service and a
reasonable prospect of continuity.
4) The agency must (a) have a demonstrated fund raising ability or (B) be of
such importance to the community as to have potential fund raising
capacity, (c) perform a service which in the opinion of the Board of the
United Way is essential to Education, Self Sufficiency, Health or Basic
Needs.
5) The agency must agree to establish and maintain sound financial practices
as required by United Way (such as an annual audit) and must give United
Way of Horry County and its designated committee’s full access to its
financial records and procedures.
6) The agency must include annually with its proposed budget, a signed,
audited financial report which lists real properties, capital, trust and
endowment funds, and all other holdings which make up the total financial
structure of the agency. Exceptions to the requirement for an audited
financial report may be made by the Board of Directors of United Way of
Horry County when the cost of such audit is a prohibitively large portion of
the agency’s annual budget.
7) The agency must sign the United Way of Horry County Community Partner
Agreement. Agencies approved for United Way of Horry County funding
become Community Partners.
Applying
All applications for participation in the United Way of Horry County will be sent to
United Way of Horry County office (P. O. Box 673, Conway, S. C. 29528) for the
Chairman of the Community Investment Committee. The chairman will then arrange
for and conduct the annual community investment committee review process.
Timing
1) Applications are due by April 1, preceding the campaign in which the
community partner would hope to participate.
2) Review of applications will take place during April and May. Review date and
time will be assigned to each applying agency. Staff and board representation
of the applying agency is expected for the review appointment.
3) Agencies that are approved for funding will become United Way of Horry
County Community Partners. Funding will be for the full calendar year
following the application process.
Agency Application
Agency Scope, Plans, Programs, Budgets
United Way of Horry County, Inc.
P.O. Box 673
Conway, SC 29528
www.unitedwayhcsc.org
Date: _______________________
1. Legal name of organization:
2. Incorporated under laws of South Carolina?
3. Address of Organization:
4. Date Organized:
5. Brief History of organization.
6. Purpose of organization.
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What does your agency do or provide?
Enclose two case studies (success stories) about clients that your agency has served.
(Two examples attached. Please write the case studies as a story that depicts your
agency and the difference it has made in an individual’s life not as clinical history)
Label these Exhibit A, and insert as such in order.
How does it help individuals, groups or your community?
What are the specific objectives (in quantative terms, where possible) to be attained
in 2014?
How and why did the agency decide on the above objective?
How does your agency plan to measure progress toward objectives at year’s end?
7. If affiliated with a national or state organization, state details of affiliation. (Control of
administration, appointment of executive funds contributed or received, etc.)
8. List the number of beneficiaries served during the past calendar year by geographic area of
the county and program. Also describe the nature of assistance provided. (Use Exhibit B
Beneficiaries form.) The geographic information is mandatory for use in the United Way drive.
9. Are you under religious auspices? If so, describe.
10. Are beneficiaries limited to neighborhood, religion, settlement, military status, race
nationality, creed or political affiliation?
If so, state limitations.
11. Please complete and sign the Nondiscrimination Form, which is Exhibit C.
12. If new programs or major expansion of existing programs are being planned for next year,
please explain them.
13. Describe the priority your agency will give this new program in relation to other programs
and why.
14. Which other community agencies did you consult or cooperate within planning the new
program or programs described in Question # 11?
15. How does your new program vary from other programs in the community? Will you be
duplicating services of another agency?
16. Please list on separate sheet the following and mark it Exhibit D:
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Principal Officers
Board of Directors with addresses and phone numbers.
Executive Committee
Executive Director or equivalent and email address
Term the officers serve: __________ # of years
Phone Number
Office Hours
Physical and Mailing Address
Contact Name with Title and email
Website
17. How often did your Executive Committee or Committee of Management meet last year?
Average Attendance:
18. How often did your directors or trustees meet last year? Dates of Meetings:
19. By whom are expenditures authorized?
20. Are bills paid by check?
Number of check signatures required?
21. Does your agency charge membership fees?
If so, what are the charges?
22. Do you charge recipients for services? Please explain.
23. Who prepares your yearly audit?
24. (A) Capital and Liquid Assets:
Date of last audit:
Endowment Fund
Building Fund
$
Other Funds
$
Property Held
$
Checking Account
$
(B) How are funds invested?
25. Fiscal year end date: _____________
26. What indebtedness does your organization have for:
(A) Capital?
(B) Improvements?
$
(C) Operating Expense?
(D) Other (describe)?
27. How would you modify your overall operational plan if the United Way cannot supply all
the funding requested for next year? What would the community lose?
28. Do you know of any critical unmet need that your agency could meet if United Way funds
in excess of your request were ever available? Explain the need, program components,
resources required, etc.
29. Review and sign a copy of Community Partner Agreement Exhibit E.
STATEMENT OF ADMISSION POLICIES
30. Complete Budget Forms #1, #2, #3, #4 A and #4B in Exhibit F.
31. Please attach copies of the following as Exhibit G.
(A)
Charter of articles incorporation, constitution and bylaws.
(B)
Copy of letter from Internal Revenue Service in regards to tax status.
(C)
Statement of policies regarding admission to services of agency.
(D)
Financial report for the last fiscal year or the latest report.
(E)
Annual Report for the last fiscal year.
PLEASE SUBMIT EIGHT (8) COPIES OF THE APPLICATION INCLUDING EXHIBITS A, B, C, D, E,
F, and G.
Exhibit A: Case Studies:
Beneficiaries for 2014
Regions
Exhibit B
Organization
Name
(list programs
separately)
North
Strand
South
Strand
West of
Myrtle
Beach
Myrtle
Beach
Conway
Loris
Aynor
(Wampee, Fremont,
Cherry Grove, Little
River, North Myrtle
Beach, Longs, Atlantic
Beach)
(Socastee, Surfside
Beach, Murrells Inlet,
Garden City, Burgess)
(Carolina Forest,
Forestbrook)
(Myrtle Beach
Area)
(Conway,
Bucksport)
(Loris, Green Seas
Floyds, Mt. Vernon,
Nichols)
(Aynor,
Galivants Ferry)
Total
Exhibit C
At a meeting of the governing board of ________________________________ held on
_____________________, the board:
 adopted a policy of nondiscrimination
Out of
Area
Total
Impact
 affirmed its policy of nondiscrimination
as follows:
1. No person is excluded from service because of race, color, religion, gender, sexual
orientation or national origin.
2. There is no segregation of persons served on the basis of race, color, religion, gender,
sexual orientation or national origin.
3. There is no discrimination on the basis of race, color, religion, gender, sexual
orientation or national origin with regard to hiring, assignment, promotion or other
conditions of staff employment.
4. The agency has a written plan for positive action to achieve equal employment
opportunity for all persons in the filling of its staff positions including elements such as
contacts with various organizations in the community, including minority group
organizations, regarding the agency’s employment needs; recruitment advertisements
in minority group news media where advertising in the general media is used to fill
jobs; identifying the agency as an equal employment opportunity employer in
recruitment advertisements; and the use for job referral purposes of only those
employment agencies which do not discriminate on the basis of race, color, religion,
gender, sexual orientation or national origin.
5. There is no discrimination on the basis of race, color, religion, gender, sexual
orientation or national origin in membership on the agency’s governing body.
I certify that the practices of this organization conform to the policy of nondiscrimination
stated above.
_________________
Date
_________________________________________
Signature of Board Chair/Chief Volunteer Officer
EXHIBIT D:
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Principal Officers
Board of Directors with addresses and phone numbers
Executive Committee
Executive Director or equivalent and email address
Term the officers serve: _______ # of years
Phone Number
Office hours
Physical and mailing address
Contact name with Title and email
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Website
EXHIBIT E
United Way of Horry County
Community Partner Agreement
with
____________________________________________________
Please read in its entirety and sign below when finished.
United Way of Horry County, Inc.
By: _________________________________
Board Chair, United Way of Horry County
Attest: _________________________________
United Way Executive
I.
_______________________________
Name of Community Partner
_______________________________
Community Partner Board Chair
Attest: _______________________________
Community Partner Executive
Preamble
This Agreement sets forth the understanding of United Way and its Community
Partners as to how they will work together.
The information provides the Partners with policies pertaining to United Way of
Horry County’s fiscal support. It also provides requirements with respect to
Partners seeking support from other sources.
United Way encourages its Partners to acquire revenue, as needed, from all
acceptable sources available to them. However, the methods used by Partners to
approach these sources should be in harmony with United Way. It is essential that
Partner fundraising activities be conducted in a manner which would not adversely
affect the annual United Way campaign.
II.
Fundraising Responsibilities of the United Way
A. United Way is responsible for planning, organizing and conducting its annual
campaign and the distribution of funds resulting thereafter.
B. United Way will keep the community and its Partners informed on the campaign
progress and final results.
C. United Way funds support the Partners and also augment the fundraising efforts
carried out by its Partners.
III.
Responsibilities of United Way Community Partners
A. Partners will subscribe to and abide by this Agreement.
B. Each Partner must conduct an active annual United Way of Horry County
workplace campaign. Community Partners shall complete and return their
United Way employee campaign paperwork on or before December 15. The
exceptions will be 1) Partners located outside of Horry County, or 2) Partners
operating exclusively on a volunteer basis. All partners will be expected to
notify board members and other volunteers of the annual United Way of Horry
County campaign and urge their participation.
If Partners not included in the above exclusions fail to conduct a
viable
Campaign in a given year, they may not be ineligible for funds from United
Way of Horry County for that year.
C. Partners will actively participate and cooperate with the annual United Way
campaign.
D. Partners may generate additional support for their programs from outside
sources and special fundraising activities, provided such support is consistent
with this Agreement.
E. Partners will present each year by April 1 to the Chairman of the Community
Investment Committee, a brief explanation of each planned program and an
estimated budget of income and expenses for the succeeding fiscal year. Such
information will be submitted on the forms provided by United Way of Horry
County. All requested information must be included. Such submissions must be
approved by the board of the participating organization and signed by the
organization Board President and Senior Staff official. One or more volunteer
officers of the organization will review the proposed annual program and
budget with United Way volunteers each year in a meeting or meetings
scheduled by United Way.
F. Partners will accept United Way apportionment of funds for operations only,
excluding capital expenditures to carry out the programs specified in the
annual program and budget review. In the event of dissatisfaction with the
stated apportionment, the Partner may request a review by United Way on or
before July 15 of each year.
G. Any substantial change in the scope or cost of programs submitted during the
annual Partner review must receive clearance by United Way.
H. Responsible management of Partners will be maintained under an active Board
of Directors and active officers who meet regularly. Such Directors and officers
will be chosen in a fair and generally acceptable manner.
I. Regular books of account will be maintained which shall be audited each fiscal
year. A copy of the audit is to be forwarded to United Way of Horry County
within 12 months of the closing preceding fiscal year. An audit is required by
all United Way Community Partners unless an exception is made by the United
Way Board of Directors.
J. Quarterly detailed financial statements and brief reports on progress with
programs will be prepared and submitted to United Way by the 15 of the
month following each calendar quarter in a format endorsed by United Way.
Allocations may be withheld for failure to comply with the terms of this
agreement or failure to file required quarterly reports. After a report is three
months late, the United Way Board of Directors will review the matter and may
recommend a possible forfeiture of the remaining annual allocations of the
partner.
K. Partners will cooperate with other community service organizations in
preventing duplication of effort.
L. The Partner agrees to continuously display United Way of Horry County
designated signage at each Partner location.
In addition, each Partner must display where practical on all letterhead,
literature, brochures, etc. produced by the local agency, the United Way logo
and/or an approved phrase. Finally, wherever possible, the Partner must
include in all public service announcements, news releases, articles,
advertisements, etc. wording to the effect that the organization is a “United
Way Community Partner.”
M. All officers and employees directly responsible for the fiscal operation of
Partners will be bonded unless an exception is made by the United Way Board
of Directors.
N. Partners providing agency services outside of Horry County should develop
other revenue sources from those areas. United Way funds are for Horry County
only.
O. All fundraising activities conducted by community organizations on behalf of a
Partner shall be considered activities of the Partner.
IV.
Fundraising Activities
Generation of certain operating revenues must be reflected in the Partners annual
operating budget. These include:
A. Program Service Fees – Fees charged to individuals for participating in the
organization’s programs and services.
B. Rental – Fees charged to outsiders for the use of the organization’s facilities.
C. Grants – Private and public foundations, churches, individuals, government
agencies and civic organizations that make grants or donations.
D. Bequests and Memorials – Endowments, trusts, honor gifts, scholarships, real
property and other forms of gifts.
V.
Capital Campaigns
A. Capital Campaign is any direct or indirect effort by the Partner to raise funds
for other than operating expenses. The Partner agrees to notify United Way of
Horry County at least 30 days before the first solicitation is made and to
provide United Way the dates and purpose of the proposed capital campaign
and any other information as requested.
VI.
Prohibited Fundraising Activities
A. Solicitation of any employee group except on behalf of United Way of Horry
County.
B. Mailing of Unordered Items with a request for money in return.
VII.
Effective Date and Termination Provision
This Partner Agreement shall be binding until December 31, 2016 unless the
Partner gives notice of its withdrawal of participation in the joint campaign before
July 1 of any year or unless United Way gives notice to the Partner before July 1
that it intends to terminate their Partner Agreement.
United Way of Horry County reserves the right, at any time during the term of this
agreement, to reduce or withhold the Partner’s funding, place the Partner on
probationary status, or terminate this agreement in the event of Partner
noncompliance.
Exhibit F
Exhibit G (Attachments)
1. Charter of articles incorporation, constitution and bylaws
2. Copy of letter from Internal Revenue Service in regards to tax status
3. Statement of policies regarding admission to services of agency
4. Financial report for the last fiscal year or the latest report
5. Annual Report for the last fiscal year