The recipient entity's physical address:
           2600 Johnston Street
Lafayette, LA 70503

The recipient entity's mailing address (if different):
           2600 Johnston Street
Lafayette, LA 70503

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

If the entity is a corporation, list the names of the incorporators:
          Carleen Castille, John Indest, Neil Morein, Michael Blanchard, Jim Bob Crawford, Flo Jones, Adrien Stewart, Ted Hoyt

The last four digits of the entity's taxpayer ID number:  6610

What is the dollar amount of the request?  $250,000

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:
           Joseph C. Giglio, Jr., President
308 Keeney Dr.
Lafayette, LA 70501

Laura Ann Edwards, Secretary
124 Acacia Dr.
Lafayette, LA 70508

Angela Morrison, Treasurer
621 Webb St.
Lafayette, LA 70501

Nancy Mounce
106 Annunciation Dr.
Lafayette, LA 70508

Paul J. Hebert
P.O. Drawer 52606
Lafayette, LA 70503

Cathi Pavy
500 E. University Ave.
Lafayette, LA 70503

Joseph C. Moss
329 W. Farrel Rd.
Lafayette, LA 70508

Durwood Conque
203 Louis Dr.
Lafayette, LA 70503

Renee Revett Marty
210 Beringer Dr.
Duson, LA 70539

Kacee S. Thompson, Executive Director
111 Western Lane
Lafayette, LA 70507

Provide a summary of the project or program:
           Hospice of Acadiana Foundation, Inc. is building a 12-bed inpatient hospice house, the Calcutta House. As the only nonprofit hospice in Acadiana, the nonprofit hospice house will care for those terminal patients whose symptoms can no longer be managed in a home setting; for those terminal patients who don't have anyone to care for them; or for those who don't have a home conducive to a dignified death (i.e. homeless, unsafe home due to drugs, violence, unsanitary, etc.). The 9,000 square foot facility will include 12 private patient suites, with a private bath, consultation room, chapel, family living area, family kitchen, etc. The Calcutta House will care for approximately 800 patients on an annual basis. Any medically eligible patient will receive all of the care they need for as long as they need it, regardless of their ability to pay.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $125,000
          Major Repairs . . . . . . . $125,000
          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?
          The primary purpose of the inpatient hospice facility is to ensure everyone has access to a safe, comfortable and dignified death - especially those most vulnerable. As the only nonprofit inpatient hospice house in Region 4, the project help mitigate social determinant insecurities as it relates to end-of-life care, which includes caregiver insecurity, food insecurity, and shelter insecurity. The project will serve a 9-parish area, with a service population of 685,490, providing care and support to dying patients with only a few days or weeks to live. Medical care will be available 24 hours a day, 7 days a week, 365 days a year in a homelike setting, thereby reducing unnecessary burden on our community hospitals. The funding requested will serve all of the citizens of Region 4, but particularly those in rural areas, those disadvantaged, and those at high-risk for no care or insufficient care.

What are the goals and objectives for achieving such purpose?
          As a community, we have an obligation - and an opportunity - to ensure everyone receives quality end-of-life care. This project ensures care is available 24 hours a day ,7 days a week in a peaceful, home-like setting designed for, and that is conducive to the end-of-life transition. This includes General Inpatient Care (GIP) in which symptoms cannot be managed in a home setting; Routine Home Care for those patients who do not have a home or a caregiver; and Respite Care for those patients who have caregivers suffering from caregiver fatigue either physically, socially or emotionally.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           6 months

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:
                 NA
    
     (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:
                 NA

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

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

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: 
               NA

(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:
               NA

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

          What is the nature of the relationship?  NA

(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:
                 NA

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


Contact Information
name:  Kacee Thompson 
                                       address:  2600 JOHNSTON ST
                                       phone:  3372321234
                                       fax: 
                                       e-mail:  kacee@hospiceacadiana.com
                                       relationship to entity:  Executive Director