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:
          Artesia Chocklin
Edgar Lancaster


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:
           To purchase a vehicle to use for travel to training meetings, do outreach, home visits, and in-home assessments. The vehicle would also be used to back up current homebound meal delivery vehicles. The remainder would be used to do outreach to underserved areas of the parish to ensure that all eligible seniors are provided services. The funds would also be used to make repairs to buildings on property of the Senior Center.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $30,000
          Major Repairs . . . . . . . $70,000
          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 services to all eligible seniors in Madison Parish and to allow them to age gracefully in the manner of their choice. Madison has a large percentage of the population which have reached the age of 60 or over. They are usually parents who have worked all their lives and raised and educated their children. The children have had to move away to find employment. The seniors need services to maintain independence in b the absence of local family members.

What are the goals and objectives for achieving such purpose?
          To provide the services needed to the senior population of Madison Parish to allow those seniors to live out their lives in the manner of their choice and to reduce the need and expense of maintaining them in long care facilities for as long as they are safe in their homes. This will be accomplished by providing homebound meals, homemaker services, caregiver services, transportation and assistance with enrollment in other programs providing for their needs.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           This will be an ongoing project as more 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:
                 501(c)3 organization, no individual ownership.
    
     (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:
                 not applicable

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                 0

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

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:
                 Governor's Office of Elderly Affairs
Federal Older American Act Funding


(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               Contractor for Older American Act Funds and State Appropriated Funds.


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