2019 Samaritan HouseMontana HOME Annual Rental Certification Checklist
In order to complete the Annual Rental Certification, please complete and attach the following
documents/documentation:
IN Annual Certification for Rental Housing form
IN Rent and Occupancy Report
0 Operating Budget for the current year for the project
®' Income Statement and Balance Sheet for the project
❑ If you have changed your Lease in the last 12 months, please attach a copy highlighting the
differences
❑ If you have changed your Affirmative Fair Housing Marketing Plan in the last 12 months, please
attach a copy highlighting the differences
❑ If you have changed your Tenant Selection Policy in the last 12 months, please attach a copy
highlighting the differences
Send all of documents via the Transfer Service (httPs:Htransfer.mt.gov) to DOCCDD@mt.gov.
Please title the transfer:
"Annual Rental Recertification/ (Grantee Name)/ (Project Name)".
If you have any questions, please contact the Community Development Division at DOCCDD(a@mt.eov.
or 406-841-2770.
Montana HOME Investment Partnerships Program
Annual Certification for Rental Housing
Certification Period
January 1, 2018 — December 31, 2018
Project Name
Samaritan House
Project Address
124 9th Avenue West
City, Zip Code
Kalispell, 59901
Owner Information
Original Contract #
M9756300117
Original Grantee
City of Kalispell
Current Owner
Samaritan House, Inc.
Owner Contact Person
Chris Krager, Director
Street Address
124 9th Avenue West
City, State, Zip Code
Kalispell, MT 59901
Phone
257-5801
Email
Chris.Krager@vahoo.com
Date Entity Commenced Ownership of Project
1998
CH DO (Yes or No)
Yes
Non -Profit Organization (Yes or No)
Yes
Management Information (If different from Owner Information)
Management Company Name
Same
Management Contact Person
Kent McLellan
Professional Title
Associate Director
Street Address
124 9th Avenue West
City, State, Zip Code
Kalispell, MT 59901
Phone
257-5801
Email
The Samaritanhouse@vahoo.com
Date Company Commenced Management of Project
1998
On -Site Contact Person
Kent McLellan
On -Site Phone
257-5801
On -Site Contact Email
Samhouse124(a@yahoo.com
Montana Department of Commerce 1 Annual HOME Rental Certification
Community Development Division Revised 01/22/2019
Annual Tenant Income Certification/Establishing Tenant Eligibility
Establishing Tenant Eligibility [24 CFR 92.203 and 92.252(h)]
1. The owner/management has conducted initial income verification for each HOME household and has
the supporting documentation available, including full third -party documentation of all income and
assets.
XYes.
❑No. If no, explain:
2. The owner/management has performed an annual re-examination of HOME -assisted household income.
The annual re-examination was conducted within twelve (12) months of the previous verification. This
information is indicated on the attached Rental Occupancy Report.
WYes.
[]No. If "No", please explain:
3. For each household occupying a unit designated as HOME, the owner/management agent has
conducted an annual recertification all income and assets.
E�Yes
❑No. If "No", please explain:
Rent Restrictions [24 CFR 92.2521
4. Each HOME -assisted unit was rent -restricted as prescribed by the HOME Contract and Period of
Affordability Agreement.
gVes.
❑No. If "No", please explain:
5. No fee(s), other than rent, were charged to any HOME tenant for non -optional services or provisions
(i.e., water -billing service fees, parking fees, non-refundable security deposit fees, payments for meals,
etc.).
JoNone were charged.
❑Additional fees were charged. Explain:
Utility Allowances [24 CFR 92.252(d) and HOME Final Rule]
6. Are tenants responsible for paying their own utilities?
23 Yes U-V\-JS A+ i�, s g �z �; u,,,{s of 14!S4 `' 4vi i,)
®' No (If "No", skip Question 7) unt45 0 ia-{ y'�` Aue.0
7. The Owner certifies that the utility allowance is reviewed annually and is calculated by using either the
Section 8 Utility Allowance Schedule or the HUD Utility Schedule Model (as applicable). NOTE: All
projects awarded after August 23, 2013 are required to use the HUD Utility Schedule Model.
15Yes
ONO. If "No", please explain:
Montana Department of Commerce 2 Annual HOME Rental Certification
Community Development Division Revised 01/22/2019
Over -Income Units and 'Next Available Unit' Rule [24 CFR 92.252(i)]
8. Have any HOME -assisted tenants become over -income during the last year?
❑ Yes (If "Yes", please answer the following questions)
[�No (If "No", skip questions 9 and 10) /
r
9. If a HOME -assisted tenant became over income, the next available comparable unit in the project was
rented to a qualified household.
YLYes
No. If "No", please explain:
10. If a HOME -assisted tenant's income exceeded 80% of the Area Median Income (AMI) at recertification,
the household's rent was adjusted to 30% of the household adjusted income (unless other federal
program rules apply to the unit) or the Fair Market Rent of a comparable unit, whichever is less.
❑Yes
❑No. If "No", please explain:
Vacant Units [24 CFR 92.2520)]
11. If a floating HOME -assisted unit in the project became vacant during the past year, reasonable attempts
were made to restore compliance with the HOME unit mix requirements by renting the next comparable
unit to an income -qualified household.
lAYes
❑No. If "No", please explain:
12. If a fixed HOME -assisted unit in the project became vacant during the past year, reasonable attempts
were made to restore compliance with the HOME unit mix requirements by renting the unit to an
income -qualified household.
Myes
❑No. If "No", please explain:
Physical Condition [24 CFR 92.251 and 92.504(d)]
13. Each HOME -assisted unit and building in the project is suitable for occupancy according to State and
local codes, ordinances, requirements, and either HUD's Uniform Physical Condition Standards (UPCS) or
Housing Quality Standards (HQS) (as applicable), and were inspected accordingly, within the past year.
[Yes
❑No. (If "No", state nature of violation and describe any corrective action that has been taken or is
planned.)
Montana Department of Commerce 3 Annual HOME Rental Certification
Community Development Division Revised 01/22/2019
Lead -Based Paint [24 CFR 35 and 36]
14. Each tenant has signed the "Lead Based Paint" form and has been given a copy of the signed form.
❑Yes
KNo, due to one of the following exemption(s):
19 None of the buildings or portions of the buildings in the development were constructed prior to
January 1, 1978 (See 35.86 "Target Housing".)
❑ All buildings on the property have been certified Lead -based paint free and appropriate test
reports and certifications have been or will be provided to Commerce.
❑ All units are 0-bedroom units (See 35.86 "Target Housing" and 0-bedroom dwelling.)
❑ This is a HUD Elderly development and no child of less than 6 years of age resides or is expected
to reside in any unit.
❑ The development is designated exclusively for persons with disabilities and no child less than 6
years of age resides or is expected to reside in any unit.
❑ Other reason as follows:
15. The property owner has incorporated ongoing lead -based paint maintenance activities into regular
building operations, such as visual inspection of lead -based paint annually and at unit turnover; repair of
all unstable paint; and repair of encapsulated or enclosed areas that are changed.
g Not Applicable
❑ Yes
❑ No. If "No", please explain:
Comparable Basis —Tenant Facilities [24 CFR 92.251]
16. The Owner certifies that all tenant facilities (such as recreational facilities, parking areas, washer/dryer
hookups, and other appliances) of any building in the project are provided on a comparable basis to all
tenants (including HOME -assisted) in the development.
ZYes
❑No. If "No", please explain:
Lease Agreement [24 CFR 92.253(b)]
17. The lease term for all HOME -assisted units is at least one year and each lease contains all the provisions
required by the HOME Program, and does not include any prohibited provisions.
Eyes
❑No. If "No", please explain:
18. Has the lease been updated during the last year?
[]Yes; if "Yes" please attach and highlight any changes.
[PNo.
Montana Department of Commerce
Community Development Division
4
f
Annual HOME Rental Certification
Revised 01/22/2019
Tenant Selection Criteria [24 CFR 92.253(d)]
19. The owner/management has adopted and utilizes written tenant selection policies that:
a. are consistent with the purpose of providing housing for very low-income and low-income
families;
b. are reasonably related to program eligibility and the applicants' ability to perform the
obligations of the lease;
c. provide for the selection of tenants from a written waiting list in the chronological order of their
application, insofar as is practicable; and,
d. requires prompt written notification to any rejected applicant of the grounds for any rejections.
Wes
❑No. If no, explain:
20. Has the Tenant Selection Criteria been updated in the last year?
❑Yes; please attach and highlight updates.
(&No.
Termination of Tenancy [24 CFR 92.253(c)]
21. The undersigned certifies that tenants have neither been evicted nor had leases fail to be renewed,
except for serious or repeated violations of the terms and conditions of the lease; for violation of
applicable Federal, State, or local law; for completion of the tenancy period for transitional housing, or
for other good cause.
ISIYes
❑No. If no, explain:
22. In the event of a lease termination, is a 30-day notice provided to tenants as required by the HOME
Program?
IgYes
[]No. If no, explain:
Discrimination Against Section 8/Housing Choice Vouchers [24 CFR 92.253(d)(4)]
23. All HOME -restricted units were leased to residents regardless of their status as holders of rental
vouchers or certificates that are available under 24 CFR 882, 887, or 92.211(ex. Section 8, Tenant -Based
Rental Voucher, etc.).
L(Yes
❑No. If no, explain:
Affirmative Fair Housing Marketing Plan [24 CFR 92.351]
24. Is a Fair Housing poster on display at the project location?
Yes.
[]No. If no, explain:
25. Where is the Fair Housing poster displayed?
tJIA/sc i�� ti t*7
Montana Department of Commerce 5 Annual HOME Rental Certification
Community Development Division Revised 01/22/2019
26. Does the property have five or more HOME -assisted units?
If Yes
❑ No (If No, please skip questions 27-30).
27. For projects with five or more HOME -assisted units, an up-to-date Affirmative Fair Housing Marketing
Plan (AFHMP) is on file (and available for viewing by interested parties) at the development.
WYes. Indicate the date of the last update:
❑No. If no, explain:
28. The AFHMP has been reviewed by the Owner and has been found to be effective in soliciting tenants.
0Yes
❑No. If no, explain:
29. If the affirmative marketing requirements were not met, the Owner has attached a plan of corrective
actions to be taken to implement the AFHMP.
Yes
No. If no, explain:
30. Has the AFHMP been updated as required every five (5) years?
9Yes; please attach copy if updated during the last year and not yet submitted to HOME for approval.
❑No.
Fair Housing and Reasonable Accommodations/Accessibility
31. The owner has and is complying with all federal, state, and local laws relating to fair housing and equal
opportunity, including but not limited to the following:
e. The Federal Fair Housing Act and the Montana Fair Housing Act;
f. Age Discrimination Act of 1975;
g. Section 504 of the Rehabilitation Act of 1973;
h. Americans With Disabilities Act of 1990 (ADA);
i. Title VI Civil Rights Act —1964; and
j. Section 3 of the Housing and Urban Development Act of 1968
WYes
❑No. If "No", please explain:
Change in Management/Ownership
32. The management of the project has changed since the last annual certification.
❑Yes, there has been a change. If "Yes", the HOME Program must be or has been notified in writing
within 30 days of the change.
I?No (there has been no change).
Montana Department of Commerce 6 Annual HOME Rental Certification
Community Development Division Revised 01/22/2019
Record Keeping
33. The Owner will maintain required records for five years after the end of the affordability period, and has
policies in place to keep these records accordingly. (Required records include documentation related to
tenant income verifications, unit rents, affirmative marketing, and property standards.)
ffYes
❑No. If no, explain:
34. All resident data for the project has been completed on the Rental Occupancy Report, a copy of which is
attached to this form.
YYes
[]No. If no, explain:
35. Please fill out the following table indicating the 2018 Rent Schedule
Net Rent Schedule (if applicable) — Tenant Pays Utilities
0-Bed f
l-Bed "04
2-Bed
3-Bed
4-Bed
5-Bed
Low HOME Rent
38S
1WS
Utilities
00
114
Total Low HOME Rent
6i 6
High HOME Rent
Utilities
Total High HOME Rent
Gross Rent Structure (if applicable) —Tenant Does NOT Pay Utilities
0-Bed
1-Bed
2-Bed
3-Bed
4-Bed
5-Bed
Low HOME Rent
5�'0
["A6-
High HOME Rent
6 E 4
tG•k,8
Other Compliance Requirements
36. Other than Montana HOME funds, does the project have any other government funding and/or income,
rent or leasing restrictions?
qgNo.
❑Yes. Please check all that apply:
❑ Housing Tax Credits
❑ Project -Based Section 8
❑ USDA Rural Development
❑ Housing Trust Fund
❑ Other:
Montana Department of Commerce
Community Development Division
Annual HOME Rental Certification
Revised 01/22/2019
The undersigned, having entered into a loan or grant agreement pursuant to the applicable provisions of the
"HOME Investment Partnership Act" ("HOME"), do hereby certify that the housing project is in continuing
compliance with the requirements of the HOME Program and any other applicable compliance requirement.
This Certification and any attachments are made UNDER PENALTY OF PERJURY.
Responsible Entity: Gra
Signature
Printed Name
Title
Date
Owner or Mai
Signature
Printed Name
Title
Date
Housing Development Program
Signature
Printed Name
Title
Date
Montana Department of Commerce
Community Development Division
EQUAL HOUSING
OPPORTUNITY
8
Annual HOME Rental Certification
Revised 01/22/2019
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Samaritan House
Balance Sheet
As of December 31, 2018
ASSETS
Current Assets
Checking/Savings
105 • Cash in Bank - Checking
Total Checking/Savings
Other Current Assets
112 • Grants Receivable
113 • Cookbook Inventory
115 • Board Restricted Funds
115.3 • Rural Development Reserve A...
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 126 • Investments
149 • Prepaid insurance
Total Other Current Assets
Total Current Assets
Fixed Assets
162 • Land
162.2 • Land - Armory
162 • Land - Other
Total 162 • Land
164 • Buildings
164.1 • Building - Residence
164.2 • Building -Armory
164 • Buildings - Other
Total 164 • Buildings
165 • Equipment
165.1 • Equipment - Residence
165.2 • Equipment - Armory
165 • Equipment - Other
Total 165 • Equipment
167 • Vehicles
172 • Accumulated Depreciation
172.1 • Accumulated Depr. Bldg -Reside...
172.2 • Accumulated Depr.- Bldg Armory
172.3 • Accumulated Depr. Equip. Res
172 • Accumulated Depreciation - Other
Total 172 • Accumulated Depreciation
Total Fixed Assets
TOTAL ASSETS
Dec 31, 18
159,459.92
159,459.92
7,272.00
3,124.04
16,960.72
91,186.46
316,036.90
947.99
52,375.97
555,547.32
649.65
583,553.73
743,013.65
404,695.00
448,371.87
36,278.79
1,096,771.00
608,112.28
1,741,162.07
8,307.99
2,774.91
89,290.73
3,500.00
-371, 529.94
-181,133.64
-57,575.68
-231,869.39
-842,108.65
1,440,216.02
2,183,229.67
Page 1
Samaritan House
Balance Sheet
As of December 31, 2018
LIABILITIES & EQUITY
Liabilities
Current Liabilities
Accounts Payable
2000 • Accounts Payable
230 • Property Tax Payable
Total Accounts Payable
Other Current Liabilities
210 • Wages Payable
213 • P/R Tax payable - FWT & FICA
214 • P/R Tax payable - SWT
216 • P/R Tax payable - SUI
217 • Payroll taxes payable
222 • Garnishments
225 • Damage Deposits Payable
226 • Prepaid Rents
Total Other Current Liabilities
Total Current Liabilities
Long Term Liabilities
243 • Note Payable - RHS-USDA
Total Long Term Liabilities
Total Liabilities
Equity
270 • Retained Earnings
3000 • Opening Bal Equity
Net Income
Total Equity
TOTAL LIABILITIES & EQUITY
Dec 31, 18
15,159.47
5,011.24
20,170.71
15,951.40
-307.47
982.00
661.51
1,207.39
206.31
15,365.00
1,360.00
35,426.14
55,596.85
161,370.34
161,370.34
216,967.19
2,007,565.82
1.29
-41,304.63
1,966,262.48
2,183,229.67
f
Page 2