NGO Funding Request


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

The recipient entity's physical address:
           500 Main Street, Room 303 Courthouse
Franklin, Louisiana 70538


The recipient entity's mailing address (if different):
           500 Main Street, Room 303 Courthouse
Franklin, Louisiana 70538


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

If the entity is a corporation, list the names of the incorporators:
          Mrs. Jane Powers; Mrs. Cora Lunny; Mrs. Anthony Ibert;
Mrs. Laure Belle Porche; Rev. C. R. McCammon; Mrs. Ann Ford;Mrs. Albert Loustalat; Miss Eunice Oliver; Mrs. Mary Millet; Mrs. Nancy Jolivet; Mrs. Marguerite Bell; Miss Lydia Phillips; Mr. B. S. Defils; Mrs. Mazel Ball; Mr. Wilbur Lawrence


The last four digits of the entity's taxpayer ID number:  8665

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

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:
           John Benge, P. O. Box 1584; Patterson, Louisiana 70392
Cathy Broussard, 412 Jacobs Street, Berwick, Louisiana 70342
Emma Dell Broussard, 2116 Hebert Street, Franklin, Louisiana 70538
Della Carson Bellard, 1502 Pine Street, Franklin, Louisiana 70538, Secretary/Treasurer
Jeanette Clements, 1309 Cayce Street, Franklin, Louisiana 70538
Chairman
Linda Darce, P. O. Box 451, Baldwin, Louisiana 70514
Verline Keenze, P. O. Box 226, Franklin, Louisiana 70538
Troy LeRive, 106 Callahan, Patterson, Louisiana 70392
Floyd LeBlanc, 819 Guidros Street, Franklin Louisiana 70538 Vice Chairman
John Renthrop, P. O. Box 950; Patterson, Louisiana 70392
Denise Romero, P. O. Box 2328, Patterson, Louisiana 70392
Beverly Domengeaux, 800 Second Street, Franklin, Louisiana 70538
Executive Director


Provide a summary of the project or program:
           To establish a Senior Wellness Center, we will utilize the historical Crowell Gym which has been vacate for several years.
Proper documents have been completed entitling the St. Mary Council
on Aging to utilize said building but there are repairs needed, i.e. roofing; ceiling repairs; floor repairs prior to complete
useage. THERE IS NOTHING FOR SENIOR'S RECREATIONAL NEEDS and/or
socialization. The St. Mary Senior Wellness Activity Center will
be a first.


What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $100,000
          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?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To get our Seniors out of their houses and staying active,
therefore, decreasing $ for nursing home care. Our Senior
Center is limited but useful and with the additional spaces;
more activities can be scheduled, including community type
activities.


What are the goals and objectives for achieving such purpose?
          To assist our Seniors to age in the manner of their own chose;
to keep the history of this great Parish current and in place;
and to be sure that all Seniors have a hand to hold; an ear to
listen and are served by an agency with a heart that cares.


What is the proposed length of time estimated by the entity to accomplish the purpose?
           2 years

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:
                 N/A

     (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:
                 N/A

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


Contact Information
name:  Beverly Domengeaux 
                                       address:  St. Mary Council on Aging
Room 303 Courthouse, 500 Main Street
Franklin, Louisiana 70538

                                       phone:  `337-828-4100-321
                                       fax:  337-828-7557
                                       e-mail:  stmarycoa@teche.net
                                       relationship to entity:  Executive Director