NGO Funding Request


The recipient entity's full legal name:  Caldwell Council on Aging, Inc

The recipient entity's physical address:
           307 Main Street
Columbia, LA 71418


The recipient entity's mailing address (if different):
           P.O. Box 1498
Columbia, LA 71418


Type of Entity (for instance, a nonprofit corporation):  Non-Profit Corporation

If the entity is a corporation, list the names of the incorporators:
          See Board of Directors List

The last four digits of the entity's taxpayer ID number:  9370

What is the dollar amount of the request?  $50,000

What type of request is this?  Capital Outlay Appropriation

Is this entity in good standing with the Secretary of State?  Yes

Provide the name of each member of the recipient entity's governing board and officers:
           Monty Adams, Jr., Tommy Basco, James Carroll, Louis Champagne, Beckie Crain, Faye Copeland, Ronnie Darden, Barbara Davis, Ms. Joy Etier, Mr. Kevin Martin, Ms. Lora Ann May, Richard Meredith, Valda Parker, Doris Roberts, Betty Robinson, Ms. Laura Roquemore, Mr. Calvin Wooten,

Provide a summary of the project or program:
           We need to replace our 2005 Home-delivered Meals Mini-Van. It is in poor condition with over 100,000 miles on it. This is a vehicle that is used to serve home-bound Senior Citizens. We presently serve 45 Home-delivered meals of which 35 are served a hot meal Monday through Friday (hot) and 10 are served Frozen. We also need to replace the 2005 Homemaker vehicle which is also in very poor condition.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $50,000

Does your organization have any outstanding audit issues or findings?  No

If 'Yes' is your organization working with the appropriate governmental agencies to resolve those issues or findings?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To serve Hot Meals, Monday through Friday to 45 Senior Citizens in Caldwell Parish.

What are the goals and objectives for achieving such purpose?
          To have a vehicle to fit the purpose such as a mini van.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           1 month

If any elected or appointed state official or an immediate family member of such an official is an officer, director, trustee, or employee of the recipient entity who receives compensation or holds any ownership interest therein:
     (a) If an elected or appointed state official, the name and address of the official and the office held by such person:
                
    
     (b) If an immediate family member of an elected or appointed state official, the name and address of such person; the name, address, and office of the official to whom the person is related; and the nature of the relationship:
                

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                 

If the recipient entity has a contract with any elected or appointed state official or an immediate family member of such an official or with the state or any political subdivision of the state:
(a) If the contract is with an elected or appointed state official, provide the name and address of the official and the office held by such person: 
               N/A

(b) If the contract is with an immediate family member of an elected or appointed state official:
          Provide the name and address of such person:
               N/A

          Provide the name, address, and office of the official to whom the person is related:
                N/A

          What is the nature of the relationship?  N/A

(c) If the contract is with the state or a political subdivision of the state, provide the name and address of the state entity or political subdivision of the state:
                 Receive funding through Governor's Office of Elderly Affairs

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               Social Services - We deliver services to elderly (60 plus) individuals such as transportation, congregate meals, home-delivered meals, material aid, information & assistance, homemaker services (cleaning houses), etc.


Contact Information
name:  Dottie Etheridge 
                                       address:  P.O. Box 1498
Columbia, LA 71418

                                       phone:  318-649-0107
                                       fax:  318-649-7600
                                       e-mail:  dottie@caldwellcoa.org
                                       relationship to entity:  Executive Director