NGO Funding Request


The recipient entity's full legal name:  The Madison Voluntary Council On Aging, Inc.

The recipient entity's physical address:
           203 S Elm Street
Tallulah, LA 71282


The recipient entity's mailing address (if different):
           203 S Elm Street
Tallulah, LA 71282


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

If the entity is a corporation, list the names of the incorporators:
          Edgar Lancaster
Arkisha Chocklin


The last four digits of the entity's taxpayer ID number:  4167

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

What type of request is this?  General 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:
           Atchra Beckwith- PO Box 71282, Tallulah, LA 71282
Mary Kathryn Book -305 N. Lincoln, Tallulah, LA 71282
Donald Butler, President - 100 Leslie St. Tallulah, LA 71282
Joseph Candler - 101 Travis Street, Tallulah, LA 71282
Carlos Ford - 708 W. Washington Street, Tallulah, LA 71282
Lloyd Erwin - 712 Hwy 80, Tallulah, LA 71282
Rita Hargrave - 95 Marianna Drive, Tallulah, LA 71282
Joy Stewart Jackson - 150 Jackson-Yerger Road, Tallulah, LA 71282
Louise Magoun - 113 Marianna St. Tallulah, LA 71282
Geraldine Shears - 212 Tige Street, Tallulah, LA 71282
Andrew Lee Simms - 209 McCall Street, Tallulah, LA 71282
Tiki Shivers - 242 Old Hwy 65 South, Tallulah, LA 71282
Lacey Williams Johnson - 129 Chicago Street, Tallulah, LA 71282
Mike Rome, Executive Director - 203 S Elm Street, Tallulah, LA 71282


Provide a summary of the project or program:
           The funds would be used to assist in the conducting of the parish activities and services for the seniors of Madison Parish. There are areas of rural Madison Parish that are not being served, the current budget amounts do not allow for the expenses that would be incurred in reaching all portions and regions of the parish. Funds are needed to supplement the funds that are used to conduct these programs. The populations of Madison Parish is elderly and most of the families educate their children then they have to go to urban areas for employment, leaving elderly parents and grand parents without family caretakers. The council programs offer services to these large number of poor families allowing them to age at home in the manner of their choice.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $30,000
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $70,000
          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?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          Provide services to the elder and homebound seniors of the parish. Allowing them to live out their lives at home by providing meals, homemaker services, caregiver services, transportation, nutritional information, legal services, assistance in applications for state programs and anything else that they need to maintain their dignity and remain in their homes in a healthy fashion.

What are the goals and objectives for achieving such purpose?
          To allow the seniors of Madison Parish to age gracefully in the manor of their choice. Our services keep these seniors who many do not have family caretakers to remain independent and our of the nursing homes which are a much greater cost to the state and federal government.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           This is an ongoing program. there are currently over 800, 000 seniors in the state and that number is growing as baby boomers reach 60.

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:
                 n/a
    
     (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:
                 n/a

     (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: 
               Contracts are with The Governor's Office of Elder Affairs involving the Older American Act funds, and state appropriated funds.

(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?  none

(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:
                 Governor's Office of Elderly Affairs
500 Florida Street
Baton Rouge, LA


(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               Homebound meals, homemaker services, transportation, caregiver services, nutritional education, wellness.


Contact Information
name:  Mike Rome 
                                       address:  203 S Elm Street
Tallulah, LA
71282

                                       phone:  318-574-3666
                                       fax:  318-574-3668
                                       e-mail:  mvcoa@att.net
                                       relationship to entity:  Executive Director