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2016 Samaritan Housek Before you send the completed Rental Certification - check for the following to ensure the form is complete: ®Did you use the most current form? (Dated January 2014) ®Did you attach the current rent schedule? You can use ExNW..m7L to provide a rent schedule ❑If you have 5 or more HOME -assisted units, did you include the date your Affirmative Fair Housing Marketing Plan was reviewed? []If you have changed your Lease in the last 12 months, did you attach a copy? ❑ If you have changed your Tenant Selection Policy in the last 12 months did you attach a copy? ODid you attach the following: Statement of Financial Position for the project C3 Statement of Activities for the project 0 Statement of Cash Flows for the project 12 Operating Budget for the current year for the project Ells the Tenant Information Section complete? ❑ Is the form signed? (The authorized signature must be the Executive Director/CEO/Chief Elected Official of the original -grantee.) HOME Investment Partnerships Program HOME Administration Manual Montana Department of Commerce 1013.3-5 January 2014 Tenant Income must be re-examined annually. Owners/property managers must review full source documentation for al tenants every sixth year of the affordability period of the project. Other years, each tenant's income may be verifie4 through self -certification by the tenant (signed and dated). HOME rent/income limits are at: h // ud® ov/o ices/c d/a ordablehoc�sin / ro rarr�s/ha a/li its/ HOME Use Only 1. How many units are occupied by tenants whose incomes are: Are Income targeting 0 to 30% of AMI? 31 to 50% of AMI? 51 to 60% of AMI? 61 to 80% of AMI? levels being met? ❑ Yes ❑ No 2. Do re .��...._..a �_. nts meet the selected rent standard? ❑ Yes ❑ No 3. For projects with 5 or more HOME units, do 20% of the tenants have incomes at or below ❑ Yes ❑ No 50% of AMI and rents not greater than the Low HOME Rent or 30% of monthly income? Call (406) 841-2820 with any questions regarding the referenced HOME requirements. Grantee: 01 i5Pe Project Year: rcly7 Project Name: SA►'nA P_ I-ra0,f4xts.:,P- I certify that the information included in this report represents a true and complete statement of the facts. SIGNAT E of Pe Completing Report Print/Type Name '"nd Titl#�'of the Executive Director / CEO A Chief Elected Official SIGNATURE Director / CEO / Chief Elected Official Form reviewed by HOME Program Officer: Date: Return completed, signed forms to: HOUSING DIVISION — HOME PROGRAM MT DEPARTMENT OF COMMERCE P.O. BOX 200546 HELENA, MT 59620-0545 HOME Investment Partnerships Program HOME Administration Manua Montana Department of Commerce 106.3-6 January 201,e EXHIBIT 10-13.3a HOME Program Annual Certification for Rental Housing as of 1/1/2014 Grantee: Project Name and Address: Name of GRANTEE: Name of OWNER (if not the Grantee) Name, Address, & Phone Number of Property Management Company, if applicable: Name Phon N b & E -5am4C ,r 14cLA- H &AS 0, f n C 64,1 ©�- k 0d's Pe. I l C hr+s krcy - (4d1,-) 357- 5801 Check box if Property Management Company changed since last Annual Certification e um er -mail of CA ri S K r-c �-e r t�tl oG,� Person Completing Form: Lhrl S , j�rQ 2r @ c� hoo . Ccrm FACILITY INFORMATION 1. Rent Schedule: Attach rent schedu/e(s) in effect during the time period covered by certification a. Check the Rent Standard(s) used for the project. Attach the applicable rent schedule(s), if other than HOME rents are used. 0 HOME Rents HOME/LIHTC Blended Rents Project Based Section 8 Rents El Rural Development 515 Rural Development 538 Other (specify) NOTE: MDOC must approve all vent schedules. Exhibit 7-L must be submitted to MDOC at least 30-45 days before expected tenant notification date. Rent schedules may only be changed once a year. 2. Unit Mix 0 BR 1 BR 2 BR 3 BR 4 BR 5 or more BR a. # of HOME -assisted Units 1 + b. # of Non -HOME -assisted units c. For projects that are not 100% HOME -assisted, are the HOME units1-1 Fixed or Floating C 3. Utility Allowances: a. Does tenant pay any utilities? 5�] No Yes b. If YES, identify the source of the utility allowance used (e.g., Section 8, Rural Development, etc.) 1) If other than Section 8, ATTACH copy(ies) of applicable utility allowance schedule used HOME Use Onli Onsite ❑ Yes ❑ No Aches Onsite Fili ❑ Yes ❑ No HOME Investment Partnerships Program HOME Administration Manual Montana Department of Commerce 10B.3-1 January2014 2) If Section 8 utility allowance used, circle the applicable Section 8 region and check the utilities the tenant pays for __ below and identify fuel type for each utility tenant pays for Item ISpecify Fuel Type Section 8 Regions Circle One ❑ Heating ..............❑ Natural Gas ❑ Bottled Gas ❑ Electric ❑ Oil ❑ Coal/Other ❑ Cooking .............❑ Natural Gas ElBottled Gas ❑ Electric ❑ Oil ❑ Coal/Other Region 1 Region 2 Region 2 ❑ Water Heating ... ❑ Natural Gas ❑ Bottled Gas ElElectric ❑ Oil ❑ Coal/Other Region 4 Region S Region 6 ❑ Other Electric Date(s) of Section 8 Utility Schedule Used: Region 7 Region 8 Region 9 ❑ Water %� % I % () I3� f / r Region 10 Region 11 Region 12 / / ❑ Sewer Region 13 Region 14 Region 16 ❑ Trash Collection Region 16 Region 17 Region 18 ❑ Air Conditioning 4. Lease/Rental Agreements (REQUIRED for ALL HOME -assisted units a. Describe the term of the lease/rental j � 4k agreement b. When (date) was your lease or rental agreement last updated? If lease/rental agreement has changed during the last year, attach a current copy to this annual certification. NOTE: If the property management company has changed since the last certification, attach a copy of the current lease/rental agreement HOME Use Only Does termination of tenancy by owner stipulate a 30-day written notice be given? ❑ Yes ❑ No Are there any prohibited lease terms? (See HOME Admin Manual, Chapter 7) ❑ Yes ❑ No 5. Identify where the Fair Housing posters are displayed. Requirements met i ElLb (i c, V) u- 1 le .+ 1 0 rA 1 n Yyc, I I w 0. ❑ Yes ❑ No 6. Have you updated your tenant selection criteria in the last 12 months? Yes 0 No Requirements mete If yes, attach the updated selection criteria / policy ❑ Yes ❑ No NOTE: If the property management company has changed since the last certification, attach a copy of the current tenant selection criteria 7. How many: Requirements met? a. Section 8 tenants are currently residing in the project? ® ❑ Yes ❑ No b. Section 8 clients have applied for tenancy at the project in the last 12 months? 8. Projects with 5 or more HOME -assisted units are required to have an Affirmative Fair Housing Requirements met? Marketing Plan (AFHMP) in place. r a. If have an AFHMP, what date it last 0$,o 11/15 ❑ Yes ❑ No you was reviewed? b. Are you maintaining a file that documents your Affirmative Fair Housing Marketing activities throughout the year? Yes u No NOTE: If the property management company has changed since the last certification, attach a copy of the new Affirmative Fair Housing Marketing Plan 9. Attach copies of the Project's Requirements met? a. Financial statements for the past year, including a Statement of Financial Position, ❑ Yes ❑ Yes Statement of Activities, and Statement of Cash Flows b. Operating budget for the current year HOME Investment Partnerships Program Montana Department of Commerce 10B.3-2 HOME Administration Manua January 2014 (NIA) i!un Peses Peroid- ------ - - - ------- --■ - -4 Uj-9AOVY 10 918 1 uolloedsul 83dn joSOH Ise-1 10 9180 — ---- — --------- --- ---- swooipee jo jgqwn (s9lj!j!jn ped -ivauai (Aue j!) junowV Ap!sqnS uoileog!:Peoe qw0oul 4sr3-1 10 ele — -------- -- — ------------ uo!leo!j! 9 ewooul legful 10 le(a — ------- - ----- (only ewooul (ssojE)) lenu -- --------- (N/A) (jueuej Aq pepue j! 'ploqesnOH palqesi ploqesnOH 10 941 ---------- uolieuftea i!un we 3VYOH (H) ON JO (1) mo — ---------- - ------- - -- — ----- - (N/A) munP9leu6'sGP-3VYOC jeqwnN Pfi� � � L EXHIBIT 10-B.3a HOME Program Annual Certification for Rental Housing as of 1/1/2014 Grantee: Project Name and Address: 5 C� YV� Gu C- 1 CLL� House I -::rnL . 5 q*1t �� W i l -!- S-q 9 01 Name of GRANTEE: Ci�-cJ. 6F I-&Iispe,1tI —1 Name of OWNER (if not the Grantee) �1 Name, Address, & Phone Number of Property Management Company, if applicable: Check box if Property Management Company changed since last Annual Certification Name, Phone Number & E-mail of Person Completing Form: (,Kris V rcLQr C4cO a 57- 58 o I 9 C h r• 1` 5, lL r- a 5,e r g akoo , L&-rvL FACILITY INFORMATION HOME Use Only 1. Rent Schedule: Attach rent schedule(s) in effect during the time period covered by certiflication Matches Onsite File? a. Check the Rent Standard(s) used for the project. Attach the applicable rent schedule(s), if other than HOME rents are used. ❑ Yes ❑ No HOME Rents HOME/LIHTC Blended Rents FlProject Based Section 8 Rents Rural Development 515 Rural Development 538 Other (specify) NOTE. MDOC must approve all rent schedules. Exhibit 7-L must be submitted to MDOC at least 30-45 days before expected tenant notification date. Rent schedules may only be changed once a year. 2. Unit Mix 0 BR 1 BR 2 BR 3 BR 4 BR 5 or more BR Matches Onsite File a. # of HOME -assisted Units i ❑ Yes ❑ No b. # of Non -HOME -assisted units c. For projects that are not 100% HOME -assisted, are the HOME units Fixed or Floating 3. Utility Allowances: a. Does tenant pay any utilities? No EXI Yes b. If YES, identify the source of the utility allowance used (e.g., Section 8, Rural Development, etc.) 1) If other than Section 8, ATTACH copy(ies) of applicable utility allowance schedule used HOME Investment Partnerships Program HOME Administration Manual Montana Department of Commerce 10B.3-1 January 2014 2) If Section 8 utility allowance used, circle the applicable Section 8 region and check the utilities the tenant pays for below and identify fuel type for each utility tenant pays for Item I Specify Fuel Type Section 8 Regions Circle One 19 Heating ..............❑ Natural Gas ❑ Bottled Gas ❑ Electric ❑ Oil ❑ Coal/Other ® Cooking .............❑ Natural Gas ❑ Bottled Gas ❑ Electric ❑ Oil ❑ Coal/Other Region 1 Region 2 Region 2 ® Water Heating ... ❑ Natural Gas ❑ Bottled Gas ❑ Electric ❑ Oil ElCoal/Other Region 4 Region 5 Region 6 Other Electric Date(s) of Section 8 Utility Schedule Used: Region 7 Region 8 Region 9 ® Water / / l i / / L _ Q 3 / J / T egion 10 Region 11 Region 12 / ® $ewer / Region 13 Region 14 Region 15 ❑ Trash Collection Region 16 Region 17 Region 18 ❑ Air Conditioning 4. Lease/Rental Agreements (REQUIRED for ALL HOME -assisted units a. Describe the term of the lease/rental agreement b. When (date) was your lease or rental agreement last updated? S krA be- rQ t 0 If lease/rental agreement has changed during the last year, attach a current copy to this annual certification. NOTE: If the property management company has changed since the last certification, attach a copy of the current lease/rental agreement HOME Use Only Does termination of tenancy by owner stipulate a 30-day written notice be given? ❑ Yes ❑ No Are there any prohibited lease terms? (See HOME Admin Manual, Chapter 7) ❑ Yes ❑ No 5. Identify where the Fair Housing posters are displayed. Requirements met? wb 1 l61 KOA LiCL ❑ Yes ❑ No 6. Have you updated your tenant selection criteria in the last 12 months? Yes 0 No Requirements met? If yes, attach the updated selection criteria / policy ❑ Yes ❑ No NOTE: If the property management company has changed since the last certification, attach a copy of the current tenant selection criteria 7. How many: Requirements met? a. Section 8 tenants are currently residing in the project? ® ❑ Yes ❑ No b. Section 8 clients have applied for tenancy at the project in the last 12 months? 8. Projects with 5 or more HOME -assisted units are required to have an Affirmative Fair Housing Requirements met? Marketing Plan (AFHMP) in place. a. If you have an AFHMP, what date was it last reviewed? II(S ❑ Yes ❑ No b. Are you maintaining a file that documents your Affirmative Fair Housing Marketing activities throughout the year? ® Yes No NOTE: If the property management company has changed since the last certification, attach a copy of the new Affirmative Fair Housing Marketing Plan 9. Attach copies of the Project's Requirements met? a. Financial statements for the past year, including a Statement of Financial Position, ❑ Yes ❑ Yes Statement of Activities, and Statement of Cash Flows b. Operating budget for the current year HOME Investment Partnerships Program Montana Department of Commerce 10B.3-2 HOME Administration Manua January 201 (N/A) ;!un pase8 ;oalad (algeogdde p);no-anolN }o a;ea ul-anolni }o 81e(3 uoljoadsul p SOdn Jo SOH;sel }o a;ea Ncv swoojpa9 jo jagwnN WON 1e101 ca a) (sal;!l!;n pled U xj cm -;ueua; joj) aouemoliv �3!mn a� a (Aue;!);unowy Ap!sgnS m c 0 =o m i!� m ;uau ;ueuel Q N CA D ro m v 0 uogeo!;!iaoaa awooul ;sea 10 a;eQ 1 y i r r o z g uol;eo! j!:Peo awooul lei;!ul }o ajec] �R p m a` lit z apoO awooul ue!paryl e9Jy10;u90Jad- z z 1` N _ v c7� � w, ewooul (ssaOlenuuy �` -") 'a CC) .r n (N/A) (;ueua; Aq pa!;!;uep! `ployasnoH ;! palges!Q ployasnoH 10 az!S N — A- aweN;se-I;ueual uo!;eu6!s9a ;!un ;ueN 3WOH (H) 461H Jo (-I) mO-1 (N/A) ;!un p91eu6!sap-3WOH aagwnN;!un _ . EXHIBIT 10-13.3a HOME Program Annual Certification for Rental Housing as of 1/1/2014 Grantee: Project Name SCXW\'\ar-t+aA(', 6U-'Se r)e and Address: r if 5' 9*k Ave, LUC 5 4-1 9ai1,5pe0 z qqC I Name of GRANTEE: Name of OWNER (if not the Grantee) Name, Address, & Phone Number of Property Management Company, if applicable: Name, Phone Number & E-mail of Person Completing Form: C4�j of kcdispei t Check box if Property Management Company changed since last Annual Certification C-Kr15 kr-CL39r- 58'cl Ch-r15 . 1-�r-ajer c tAa.hoa . CCWL FACILITY INFORMATION 1. Rent Schedule: Attach rent schedule(s) in effect during the time period covered by certification a. Check the Rent Standard(s) used for the project. Attach the applicable rent schedule(s), if other than HOME rents are used. =OME Rents HOME/LIHTC Blended Rents Project Based Section 8 Rents Rural Development 515 Rural Development 538 Other (specify) NOTE. MDOC must approve all rent schedules. Exhibit 7-L must be submitted to MDOC at least 30-45 days before expected tenant notification date. Rent schedules may only be changed once a year. 2. Unit Mix 0 BR 1 BR 2 BR 3 BR 4 BR 5 or more BR a. # of HOME -assisted Units b. # of Non -HOME -assisted units c. For projects that are not 100% HOME -assisted, are the HOME units F1 Fixed or Floating C 3. Utility Allowances: a. Does tenant pay any utilities? No [Y] Yes b. If YES, identify the source of the utility allowance F��� used (e.g., Section 8, Rural Development, etc.) 1) If other than Section 8, ATTACH copy(ies) of applicable utility allowance schedule used HOME Use Onl Onsite File? ❑ Yes ❑ No itches Onsite Fil, ❑ Yes ❑ No HOME Investment Partnerships Program HOME Administration Manual Montana Department of Commerce 1013.3-1 January 2014 2) If Section 8 utility allowance used, circle the applicable Section 8 region and check the utilities the tenant pays for __ below and identify fuel type for each utility tenant pays for Item Ispecify Fuel Type Section 8 Regions Circle One ® Heating..............M Natural Gas ❑ Bottled Gas ❑ Electric ❑ Oil ❑ Coal/Other l9 Cooking .............❑ Natural Gas ElBottled Gas ® Electric ❑ Oil ❑ Coal/Other Region 1 Region 2 Region 2 Water Heating ... ❑ Natural Gas ❑ Bottled Gas aElectric ❑ Oil ❑ Coal/Other Region 4 Region 5 Region 6 Other Electric Date(s) of Section 8 Utility Schedule Used: Region 7 Region 8 Region 9 Water 5 Region 10 Region 11 Region 12 19Sewer ` Region 13 Region 14 Region 15 ❑ Trash Collection Region 16 Region 17 Region 18 ❑ Air Conditioning 4. Lease/Rental Agreements (REQUIRED for ALL HOME -assisted units a. Describe the term of the lease/rental f 4-A— agreement b. When (date) was your lease or rental agreement last updated? n r r�Q 10 If lease/rental agreement has changed during the last year, attach a current copy to this annual certification. NOTE: If the property management company has changed since the last certification, attach a copy of the current lease/rental agreement HOME Use Only Does termination of tenancy by owner stipulate a 30-day written notice be given? ❑ Yes ❑ No Are there any prohibited lease terms? (See HOME Admin Manual, Chapter 7) ❑ Yes ❑ No 5. Identify where the Fair Housing posters are displayed. Requirements met? ® /C ,.(J%2 ► -7 n r in Aar!/1,u ❑ Yes ❑ No 6. Have you updated your tenant selection criteria in the last 12 months? Yes No Requirements met? If yes, attach the updated selection criteria / policy ❑ Yes ❑ No NOTE: If the property management company has changed since the last certification, attach a copy of the current tenant selection criteria 7. How many: Requirements met? a. Section 8 tenants are currently residing in the project? ❑ Yes ❑ No b. Section 8 clients have applied for tenancy at the project in the last 12 months? 8. Projects with 5 or more HOME -assisted units are required to have an Affirmative Fair Housing Requirements met? - Marketing Plan (AFHMP) in place. b a. If you have an AFHMP, what date was it last reviewed? '�lol 1?11 ❑ Yes ❑ No b. Are you maintaining a file that documents your Affirmative Fair Housing Marketing activities throughout the year? Yes No NOTE: If the property management company has changed since the last certification, attach a copy of the new Affirmative Fair Housing Marketing Plan 9. Attach copies of the Project's Requirements met? a. Financial statements for the past year, including a Statement of Financial Position, e� ❑ Yes ❑ Yes Statement of Activities, and Statement of Cash Flows b. Operating budget for the current year HOME Investment Partnerships Program Montana Department of Commerce 10B.3-2 HOME Administration Manual January 2014 (N/A) ijun pase8 }OafOJd (elgeolldde p) Ino-anoVy jo ale(] N o .. ul-enOVy /o elea v � O uogoedsul �y q SOdfl JO SOH Isel JO 91e0 1 'V swoape8 jo jegwnN _ c•1 N t�1 .-. Well 1e101 0 3 ca�- U) m(sailygn p!ed v -lueual joi) eouemonv A!I!i,ncu m m _ rn a W (Rue }!) }unowy Ap!sgnS m c 0 ;ua'l ;ueuel ¢ N N N u011eogpigoe-d rJ 60 0 ewooul 499-I jo ale(] — z O _ H uo!;eog!:paO 4 awooul lel;lul 10 alea - O � u. z F apoO�- awooul ue!payy eaay jo lusOJad r z z w } J awooul (sswO) lenuuy o m o (N/A) (}ueua} Aq pepuep! p `ployesnoH pelges!Q ployesnoH }o az!S p� L aweN Isel jueual x * uol;eu6!sed ;!un }ueZl 3WOH (H) 461H Jo (-0 mOl (N/A) i!un peleu61s9p-31NOH �- aagwnN }!un 11:38 AM Samaritan House 07/29/16 2016 Annual Budget Accrual Basis January through December 2016 Jan - Dec 16 YTD Budget Annual Budget Ordinary Income/Expense Income 301 - Room Rentals 30101 - Room Rentals - B7 89,500.00 89,500.00 89,500.00 30102 - Room Rentals - B2 32,000.00 32,000.00 32,000.00 30103 - Room Rentals - B3 15,000.00 15,000.00 15,000.00 30104 - Room Rentals - B4 17,100.00 17,100.00 17,100.00 Total 301 - Room Rentals 153,600.00 153,600.00 153,600.00 303 - Laundry Machine Income 4,950.00 4,950.00 4,950.00 311 - Donations 311.1 - Donations from Newsletter 12,850.00 12,850.00 12,850.00 311 - Donations - Other 187,150.00 187,150.00 187,150.00 Total 311 - Donations 200,000.00 200,000.00 200,000.00 313 - Fundraising event income 70,000.00 70,000.00 70,000.00 320 - Investment income 6,000.00 6,000.00 6,000.00 322 - Interest income - bank 10.00 10.00 10.00 323 • Dividend Income - Endowment 1,700.00 1,700.00 1,700.00 325 • Grant income 77,005.00 77,005.00 77,005.00 326 - Veteran's Program 91,250.00 91,250.00 91,250.00 330 • United Way Income 6,780.00 6,780.00 6,780.00 399 - Miscellaneous income 500.00 500.00 500.00 Total Income 611,795.00 611,795.00 611,795.00 Expense 401 - Telephone 40101 - Staff Phones 6,935.00 6,935.00 6,935.00 40102 - Client Services 2,610.00 2,610.00 2,610.00 40103 - Armory Telephones 2,955.00 2,955.00 2,955.00 Total 401 - Telephone 12,500.00 12,500.00 12,500.00 402 - Utilities 40201 - Utilities - Building 1 12,000.00 12,000.00 12,000.00 40202 • Utilities - Building 2 24,500.00 24,500.00 24,500.00 40203 • Utilities - Building 3 500.00 500.00 500.00 40204 • Utilities - Building 4A-D 2,200.00 2,200.00 2,200.00 40205 • Utilities - Armory 13,800.00 .............. 13,800.00 13,800.00 Total 402 • Utilities 53,000.00 53,000.00 53,000.00 409 • Depreciation 56,640.00 56,640.00 56,640.00 411 - Insurance 23,800.00 23,800.00 23,800.00 412 • Custodial supplies 1,500.00 1,500.00 1,500.00 414 - Property Fees 414.1 - Property Fees - Residential 7,688.00 7,688.00 7,688.00 414.2 - Property Fees - Armory 1-812.00 1,812.00 1,812.00 Total 414 • Property Fees 9,500.00 9,500.00 9,500.00 416 - Miscellaneous expense 3,750.00 3,750.00 3,750.00 420 - Supplies 750.00 750.00 750.00 421 - Maintenance/Repairs 421.1 • Maint. / Repairs - Residence 30,000.00 30,000.00 30,000.00 421.2 - Maint./Repairs - Armory 8,600.00 ............................ _ ......................... .. _............... 8„600.00 .................................. ..................... ........ ................................... -. 8,600.00 Total 421 - Maintenance/Repairs 38,600.00 38,600.00 38,600.00 Page 1 11:38 AM Samaritan House 07/29/16 2016 Annual Budget Accrual Basis January through December 2016 Jan - Dec 16 YTD Budget Annual Budget 430 • Professional services 6,500.00 6,500.00 6,500.00 461 • Food 6,000.00 6,000.00 6,000.00 462 • Lunchroom supplies 1,500.00 1,500.00 1,500.00 471 • Laundry supplies 100.00 100.00 100.00 601 • Vehicle expenses 8,000.00 8,000.00 8,000.00 673 - Payroll taxes 28,000.00 28,000.00 28,000.00 581 • Insurance - workers compensatio 6,750.00 6,750.00 6,750.00 600 • Administrator salary 59,000.00 59,000.00 59,000.00 602 Staff Salaries 246,250.00 246,250.00 246,250.00 603 Health Insurance Expense 6,000.00 6,000.00 6,000.00 605 • Staff Training 400.00 400.00 400.00 607 • Public relations 2,800.00 2,800.00 2,800.00 609.Office supplies 12,000.00 12,000.00 12,000.00 612 • Dues & subscriptions 1,200.00 1,200.00 1,200.00 614 - Bank charges 55.00 55.00 55.00 618 - Rent refunds 500.00 500.00 500.00 620 • Meals 500.00 500.00 500.00 622 • Travel & Lodging 1,500.00 1,500.00 1,500.00 641 Interest expense 8,700.00 8,700.00 8,700.00 680 Fundraising expense 16,000.00 16,000.00 16,000.00 Total Expense 611,795.00 611,795.00 611,795.00 Net Ordinary Income 0.00 0.00 0.00 Net Income 0.00 0.00 0.00 Page 2 Samaritan House Balance Sheet As of December 31, 2015 ASSETS Current Assets Checking/Savings 105 - Cash in Bank - Checking 105.5 - PayPal 105 - Cash In Bank - Checking - Other Total 105 - Cash in Bank - Checking Total Checking/Savings Accounts Receivable 110 - Accounts receivable Total Accounts Receivable Other Current Assets 112 - Grants Receivable 113 - Cookbook Inventory 115 • Board Restricted Funds 115.3 - Rural Development Reserve Acct. Total 115 - Board Restricted Funds 125 - Investments 125.1 - Endowment Fund 125.2 - Board Directed Investments 125.27 • WFCU 125.29 - Park Side Credit Union 125 - Investments - Other Total 125 - Investments 149 • Prepaid insurance Total Other Current Assets Dec 31, 15 6,685.83 72,719.05 79,404.88 79,404.88 300.00 300.00 65,999.00 3,839.04 16,925.13 16,925.13 74,480.18 248,788.70 38,755.26 50,959.45 95,000.00 507,983.59 372.00 595,118.76 Total Current Assets 674,823.64 Fixed Assets 162 - Land 162.2 - Land - Armory 404,695.00 162 - Land - Other 43,676.87 Total 162 - Land 448,371.87 164 - Buildings 164.1 - Building - Residence 30,212.82 164.2 - Building -Armory 1,096,771.00 164 • Buildings - Other 608,112.28 Total 164 • Buildings 1,735,096.10 165 - Equipment 165.1 • Equipment - Residence 8,427.98 166.2 - Equipment - Armory 1,419.66 166 - Equipment - Other 78,207.83 _. _.. _. _.......... _.... _................................. Total 165 - Equipment 88,055.47 167 • Vehicles 500.00 172 - Accumulated Depreciation 172.1 - Accumulated Depr. Bldg-Residenc -323,050.03 172.2 - Accumulated Depr.- Bldg Armory -71,715.96 172.3 • Accumulated Depr. Equip. Res -45,187.43 172 • Accumulated Depreciation - Other -232,334.85 Total 172 - Accumulated Depreciation -672,288.27 Total Fixed Assets 1,599,735.17 TOTAL ASSETS 2,274,568.81 Page 1 Samaritan House Balance Sheet As of December 31, 2015 Dec 31,16 ..---................................................................................................ LIABILITIES & EQUITY Liabilities Current Liabilities Accounts Payable 2000 - Accounts Payable 14,031.57 230 - Property Tax Payable 4,444.72 Total Accounts Payable 18,476.29 Other Current Liabilities 210- Wages Payable 12,411.58 213 - P/R Tax payable - FWT & FICA 25.88 214 - P/R Tax payable - SWT 881.00 215 - P/R Tax payable - SUI 901.12 217 - Payroll taxes payable 949.49 225 - Damage Deposits Payable 15,484.00 226 - Prepaid Rents 2,449.00 Total Other Current Liabilities 33,102.07 Total Current Liabilities 51,578.36 Long Term Liabilities 243 - Note Payable - RHS-USDA 186,798.12 Total Long Term Liabilities 186,798.12 Total Liabilities 238,376.48 Equity 270 - Retained Earnings 2,071,543.72 3000 • Opening Bal Equity 0.79 Net Income -35,362.18 Total Equity 2,036,182.33 TOTAL LIABILITIES & EQUITY 2,274,668.81 Page 2 11:30 AM Samaritan House 07/29/16 Statement of Cash Flows January through December 2015 Jan - Dec 15 OPERATING ACTIVITIES Net Income -35,362.18 Adjustments to reconcile Net Income to net cash provided by operations: 115.3 - Rural Development Reserve Acct. -21.84 126.1 - Endowment Fund 886.82 126.2 - Board Directed Investments 4,087.68 125.27 - WFCU -262.20 126.29 - Park Side Credit Union -405.84 230 - Property Tax Payable -51.97 213 - P/R Tax payable - FWT & FICA 25.88 214 - P/R Tax payable - SWT -4.00 215 - P/R Tax payable - SUI -218.60 225 - Damage Deposits Payable 2,424.00 Net cash provided by Operating Activities -28,902.25 INVESTING ACTIVITIES 165.1 - Equipment - Residence -1,364.65 165.2 - Equipment - Armory -1,419.66 172.1 • Accumulated Depr. Bldg-Residenc 16,045.32 172.2 - Accumulated Depr.- Bldg Armory 36,472.56 172.3 - Accumulated Depr. Equip. Res 4,127.40 Net cash provided by Investing Activities 53,860.97 FINANCING ACTIVITIES 243 - Note Payable - RHS-USDA -7,703.45 3000.Opening Bal Equity 0.60 Net cash provided by Financing Activities-7,702.85 Net cash increase for period 17,255.87 Cash at beginning of period 62,149.01 Cash at end of period 79,404.88 Page 1 11:25 AM Samaritan House 07/29/16 Income & Loss Performance Accrual Basis January through December 2016 Jan - Dec 15 Budget Jan - Dec 16 Ordinary Income/Expense Income 301 • Room Rentals 30101 • Room Rentals - B1 30102 • Room Rentals - B2 30103 • Room Rentals - B3 30104 • Room Rentals - S4 Total 301 • Room Rentals 303 • Laundry Machine Income 311 • Donations 311.1 • Donations from Newsletter 311.2 • Donations - Advertising 311 • Donations - Other Total 311 • Donations 313 • Fundraising event Income 320 • Investment Income 322 • Interest Income - bank 323 • Dividend Income - Endowment 325 • Grant Income 326 • Veteran's Program 330 • United Way Income 399 • Miscellaneous Income Total Income Expense 401 • Telephone 40101 • Staff Phones 40102 • Client Services 40103 • Armory Telephones Total 401 • Telephone 402 • Utilities 40201 • Utilities - Building 1 40202 • Utilities - Building 2 40203 • Utilities - Building 3 40204 • Utilities - Building 4A-D 40205 • Utilities - Armory Total 402 • Utilities 409 • Depreciation 411•Insurance 412 • Custodial supplies 414 • Property Fees 414.1 • Property Fees - Residential 414.2 • Property Fees - Armory Total 414 • Property Fees 416 • Miscellaneous expense 420 • Supplies 421 • Maintenance/Repairs 421.1 • Maint / Repairs - Residence 421.2 • Maint/Repairs -Armory Total 421 • Maintenance/Repairs 430 • Professional services 461 • Food 462 • Lunchroom supplies 471 • Laundry supplies 501 • Vehicle expenses 573 • Payroll taxes 581 • Insurance - workers compensatio 600 • Administrator salary 602 • Staff Salaries 603 • Health Insurance Expense 605 • Staff Training 607 • Public relations 609. Office supplies 612 • Dues & subscriptions 614 • Bank charges 618 • Rent refunds 620 • Meals 622 • Travel & Lodging 641 • Interest expense 680 • Fundraising expense Total Expense Net Ordinary Income 83,985.27 29,773.43 14,325.00 16,775.00 144,858.70 2,384.50 11,370.00 889.10 185,380.61 197,639.71 47,328.00 12,049.78 11.84 3,841.75 113,180.00 50,750.00 7,386.00 5,816.96 2,268.18 2.557.76 10,642.90 11,891.82 26,928.33 470.78 1,875.94 11,222.51 52,389.38 56,645.28 24,063.00 1,310.99 7,427.87 1,576.57 9,004.44 3,285.81 376.89 34,046.39 1 � c1c nc 45,723.24 6,000.00 5,456.12 761.77 100.50 7,212.43 27,843.84 6,140.19 59,826.19 239, 756.76 0.00 633.90 3,782.04 10,191.45 1.215.00 80.00 0.00 157.99 167.15 9,072.55 -15,164.19 89,500.00 32,000.00 15,000.00 17,100.00 153,600.00 4,150.00 12,850.00 167,252.00 180,102.00 70,000.00 6,000.00 10.00 1,700.00 69,324.00 90,000.00 6,780.00 6,525.00 2,400.00 2,645.00 11,570.00 12.000.00 23,750.00 500.00 2,200.00 13,000.00 51,450.00 21,461.00 23,300.00 1,500.00 12,000.00 1 GMM 14,500.00 3,750.00 750.00 25,000.00 5.000.00 30,000.00 6.500.00 13,000.00 1,500.00 100.00 5,000.00 26,500.00 6,750.00 59,000.00 233,636.00 36,000.00 400.00 2,000.00 8.500.00 1.200.00 55.00 500.00 500.00 1,500.00 10,000.00 16,000.00 -4,756.00 83,985.27 29,773.43 14,325.00 16,775.00 144,858.70 2,384.50 11,370.00 889.10 185,380.61 197,639.71 47,328.00 12,049.78 11.84 3,841.75 113,180.00 50,750.00 7.386.00 5,816.96 2,268.18 2.557.76 10,642.90 11,891.82 26,928.33 470.78 1,875.94 11,222.51 52.389.38 56,645.28 24.063.00 1,310.99 7,427.87 9,004.44 3,285, 81 376.89 34,046.39 45,723.24 6,000.00 5,456.12 761.77 100.50 7,212.43 27,843.84 6,140.19 59,826,19 239.756.76 0.00 633.90 3,782.04 10,191.45 1,215.00 80.00 0.00 157.99 167.15 9,072.55 13,566.24 595,406.05 -15,164.19 89.500.00 32,000.00 15.000.00 17,100.00 153,600.00 4,150.00 12,850.00 167,252.00 180,102.00 70,000.00 6,000.00 10.00 1.700.00 69,324.00 90,000.00 6,780.00 6,525.00 2,400.00 2,645.00 11,570.00 12,000.00 23,750.00 500.00 2,200.00 13.000.00 51,450.00 21,461.00 23,300.00 1,500.00 12,000.00 14,500.00 3,750.00 750.00 25,000.00 5,000.00 30,000.00 6,500.00 13,000.00 1,500.00 100.00 5,000.00 26,500.00 6,750.00 59,000.00 233,636.00 36,000.00 400.00 2,000.00 8,50000 1,200.00 55.00 500.00 500.00 1,500.00 10,000.00 16,000.00 586,922.00 -4, 756.00 Annual Budget 89,500.00 32,000.00 15,000.00 17,100.00 153,600.00 4,150.00 12,850.00 167,252.00 180,102.00 70,000.00 6,000.00 10.00 1,700.00 69,324.00 90,000.00 6,780.00 6,525.00 2,400.00 2,645.00 11,570.00 12,000.00 23,750.00 500.00 2.200.00 13.000.00 51.450.00 21.461.00 23,300.00 1.500.00 12,000.00 2,500.00 14,500.00 3,750.00 750.00 25,000.00 5,000.00 30,000.00 6,500.00 13,000.00 1,500.00 100.00 5,000.00 26,500.00 6,750.00 59,000.00 233,636.00 36,000.00 400.00 2,000.00 8,500.00 1,200.00 55.00 500.00 500.00 1,500.00 10,000.00 -4,756.00 Page 1 11:25 AM 07/29116 Accrual Basis Otherincome/Expense Other Income 720 • Unrealized Gain or Loss on Inve Total Other Income Net Other Income Net Income Samaritan House Income & Loss Performance January through December 2015 Jan - Dec 15 Budget Jan -floc 15 YTD Budget Annual Budget -20,197.99 -20,197.99 -20,197.99 0.00-20,197.99 -M,362.18 4,766.00-35,362.18 0.00 0.00 A766.00-4,766.00 Page 2 124-9`h Ave. W. Kalispell, MT 59901 406-257-5801 Thank you for your interest in renting an apartment at The Samaritan House, INC. Enclosed you will find a rental application and price list. All apartments require a security deposit equal to the amount charged for rent. The deposit is payable at move -in. rental prices are as follows: 124 9"' Ave. west: Studio transitional apartments $190month (Without bathroom) Studio transitional apartments $210month (With bathroom) 135 9"' Ave. west: 1 bedroom loft apartment $325month (Utilities not included in rent) Has electric heat 140 9"' Ave. west: 1 bedroom apartment $360month Studio apartment $305month (Utilities included) 145 9' Ave. west: 1 bedroom loft apartment $325month (Utilities not included) Has gas heat All apartments are non-smoking! All rentals are required to sign a rental agreement. Please attach proof of income, identification (picture ID and social security cards). We cannot process any application without these items.1 EQUAL SING OPPORTUNITY