The recipient entity's physical address:
           210 S State St
Jennings, La 70546

The recipient entity's mailing address (if different):
           P.O. Box 734
Jennings, La 70546

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

If the entity is a corporation, list the names of the incorporators:
          501 c3

The last four digits of the entity's taxpayer ID number:  4711

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

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:
           Jason Bouley-President; 314 Maple St Roanoke, La 70581
Donnie Daigle-Vice President; 1506 Johnson St Jennings 70546
Gerald Larousse-Secretary; 714 Comfort Lane Jennings, La 70546
Marilla Lafleur-Treasurer; 903 Florence St Jennings, La 70546
Faye Gradney; 20453 Peterson Welsh, La 70591
Connie Deville; 507 E Nezpique Jennings, La 70546
Donna Deshotel; 21108 Highway 102 Jennings, La 70546
Early Gotreaux; 13681 Touchet Rd Jennings, La 70546
Chris Lehman; 1010 Isabella Jennings, La 70546
Majorie Broussard; 527 Broussard Lane Jennings, La 70546
Sylvia Abbott; 427 3rd St Jennings, La 70546
Kay Prudhomme; 9165 Highway 101 Iowa, La 70647
Helen Vital; 9169 Highway 101 Iowa, La 70647

Provide a summary of the project or program:
           Equipment and supplies for the betterment of our aging community.

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

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To innovate and deliver services that meet the changing needs of the aging population and their caregivers within our parish.

What are the goals and objectives for achieving such purpose?
          We strive to locate individuals and their caregiver in our parish, assess their needs, coordinate a plan to help in any available areas we have access to.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           Within our fiscal years end

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: 
               

(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:
              

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

          What is the nature of the relationship? 

(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:
                

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               Equipment


Contact Information
name:  Helen Langley 
                                       address:  P.O. Box 734
Jennings, La 70546
                                       phone:  337-824-5504
                                       fax:  337-616-8622
                                       e-mail:  hlangleyjdcoa@yahoo.com
                                       relationship to entity:  Executive Director