The recipient entity's physical address:
           13 Wisteria Lane
Covington, LA 70433

The recipient entity's mailing address (if different):
           PO Box 2141
Mandeville, LA 70470

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

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

The last four digits of the entity's taxpayer ID number:  3020

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

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:
           Kelly Gibson (Chairman)-13 Wisteria Lane, Covington, LA 70433
Jimmy Hingle (President)-15 Wisteria Lane, Covington, LA 70433
Steve Sawyer (Vice President)-11 East Woodlawn Dr, Destrehan, LA 70047
Elizabeth Gibson (Secretary/Treasurer)-13 Wisteria Lane, Covington, LA 70433
Patrick Cawthorne (Director)-990 Hwy 287 N, Suite 106-274, Mansfield, TX 76063
Stacey Serro (Director)-5539 Hurst St, New Orleans, LA 70115
Ken Friend (Director)-11 Rosa Park, New Orleans, LA 70115
Chris Patrizi (Director)-27108 Founders Place, Spicewood, TX 78669
Jim Grady (Director)-1326 Joseph St, New Orleans, LA 70115
Giles Kibbe (Director)-2124 Tangley St, Houston, TX 77005
Patrick McMath (Director)-78 Riverdale Dr, Covington, LA 70433
Michael Loup (Director)-159 Cordillera Springs, Boerne, TX 78006
Taylor Capouch (Executive Director) 110 W Ruelle Dr, Mandeville, LA 70471

Provide a summary of the project or program:
           Funds will be used to expand our mission and its footprint, impacting military initiatives, first responders and youth athletic programming with a focus on programming development and staff expansion.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $100,000
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $75,000
          Other Charges. . . . . . . $75,000

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?
          We are a community driven 501c3 non-profit organizaton, committed to impacting first responders, military initiatives and youth athletic programming.

What are the goals and objectives for achieving such purpose?
          The goals are to positively impact our community through our mission statement and to develop children through good character development programs.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           1-2 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:
                 Patrick McMath (Louisiana State Senator)
78 Riverdale Dr
Covington, LA 70433
    
     (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:
                 0%

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

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:
               

          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:
                 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:  Taylor Capouch 
                                       address:  110 W Ruelle Dr
Mandeville, LA 70471
                                       phone:  504-400-8013
                                       fax: 
                                       e-mail:  taylor@thekellygibsonfoundation.org
                                       relationship to entity:  Executive Director