NGO Funding Request


The recipient entity's full legal name:  St Helena Council on Aging, Inc.

The recipient entity's physical address:
           48Kendrick St
Greensburg, LA 70441


The recipient entity's mailing address (if different):
           P O Box 324
Greensburg ,LA 7041


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

If the entity is a corporation, list the names of the incorporators:
          

The last four digits of the entity's taxpayer ID number:  2867

What is the dollar amount of the request?  $100,000

What type of request is this?  Both

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:
           Joe L. Lee Vice-President James Fraizer
219 Dennis Lee Rd. 1301 Hwy 38
Denham Springs LA, 70706 Kentwood, LA 70444
225-777-4475 Home 985-229-6306
Cell # 225-362-4493 Cell 985-514-7694
Dist. #4 District #6

Sarah M. Kent Daisy Callihan
19328 Hwy 43 Sect/ Treasure 4231 Hwy 1043
Greensburg, LA 70441 Greensburg, LA 70441
225-222-4225 225-222-4459
Cell # 985-517-8384 Cell # 225-933-3717
Dist. #2 Dist. #1

Sally Freiler Myrtie N. Wofford
62 Freiler Rd 3770 Newman Rd
Greensburg, LA 7044l Kentwood, LA 70444
P.O. Box 942 985-229-8215
Greensburg, LA 70441 Dist. #6
225-222-6843
Cell # 225-425-0506 Paul Harper
Dist. #2 5157 HWY 38
Kentwood, LA 70444
Earl Ray Marler Vice-President 985-229-6182
46 Industral Park Rd President 225-439-1621 cell
Greensburg, LA 70441 Dist. # 6
225-222-3972
Cell # 225-954-7405 Rev. Peter Donald
Dist. #2 P.O. Box 722
Pine Grove, LA 70453
Bettie Womack Home 225-777-4386
560 Pistol Womack LN Cell 225-278-7110
Greensburg, LA 70441 District # 4
225-222-3724 home
985-974-0885 cell John W. Stewart
Dist # 1 9895 HWY 1042
Box Box 269
Greensburg, LA 70441
225-222-6189
Dist. # 2
Revised 9/2015 cell # 225-610-5681


Provide a summary of the project or program:
           Land purchase and to do engineering design for construction of senior community center.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $18,000
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $82,000
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $0

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?
          Not Applicable

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To provide support and services to adult seniors to keep them in their homea and in the community as long as possible.

What are the goals and objectives for achieving such purpose?
          Providing additional in home service and expanding Meals on Wheels, congregate meals, transportation , homemaker and caregiverf services. developing a community based ecucation services at a senior center.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           2 years for completing the building of senior center.

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:
                 NO
    
     (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:
                 NOL

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                 NONE

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                  NONE

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: 
               NONE

(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:
               NONE

          Provide the name, address, and office of the official to whom the person is related:
                NONE

          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:
                 GOEA has contract with COA for services. Capital Aea Area Agency on Aging has contract with COA. DOTA has contract with COA for Rural transportation services.

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               Service to keep seniord in the local community as long as possibel. DOTA is to provide transportatiopn for rural clients to necessary service.


Contact Information
name:  Jim Robb 
                                       address:  498 Kendrick St
P O Box 324
Greensburg, LA 7041

                                       phone:  225-222-6070
                                       fax:  225-222-4924
                                       e-mail:  jhrobb3rd@yahoo.com
                                       relationship to entity:  Executive Director