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:
          Arkeshia Chocklin
Edgar Lancaster
Bill Buckner


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?  Both

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:
           President Donald Butler 100 Leslie Drive, Tallulah, LA 71282
Vice President-Lacey Williams-Johnson 129 Chicago St. Tallulah, LA
Secretary - Mary Kathryn Book - 305 N. Lincoln St. Tallulah, LA
Treasurer - Marilyn Wyche-415 Bailey St. Tallulah, LA 71282
Joseph Candler - 101 Travis St. Tallulah, LA 71282
Carlos Ford - 708 W. Washington St. Tallulah, LA 71282
Rita Hargrave - 95 Marianna St Tallulah, LA 71282
Louise Magoun - 113 Marianna Drive, Tallulah, LA 71282
Anthony Moore - 103 Fuqua St., Tallulah, LA 71282
Suzanne Paxton - 502 Old Hwy 65 South, Tallulah, LA 71282
Geraldine Shears - 212 Tige St. Tallulah, LA 71282
Andrew Sims - 209 McCall St. Tallulah, LA 71282
Flora Tucker - 304 Rheagan Drive, Tallulah, LA 71282
Executive Director - Mike Rome, 509 Montrose Rd. Tallulah, LA


Provide a summary of the project or program:
           The funds will be used to purchase a vehicle to use for at home assessments and travel to meetings. At present the vehicles we have are being utilized to deliver home bound meals and to carrier participants to medical appointments and to run errands or go to work. The balance will be used to reroof our activity shed which has a deteriorating medal roof badly in need of replacement. This large shed is used for outdoor activities, it is a large covered area that seniors enjoy for games and activities and is used for our annual Senior Olympic Fun Day. All funds remaining will be used to update roofs and paint exteriors of buildings.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $40,000
          Major Repairs . . . . . . . $60
          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 provide an activity area for the seniors of rural Madison Parish to allow them to congregate and participate in activities that will improve their lives and increase their mobility and activity. The vehicle will be used to travel to out of town meetings and to reach those possible participants in the far reaches of the parish. The out buildings will be utilized for ceramics, art, exercise and any other activity that will increase the activity and aid the seniors in preventing dementia.

What are the goals and objectives for achieving such purpose?
          The goals are to reach every senior in Madison Parish to assess their needs and provide any services that will allow them to live independently in the manor of their choice. Also to encourage seniors to increase activity and exercise to improve health and balance, falls are a major source of permanent injury to our Seniors and we are trying to reduce the injuries to allow for a better quality of life.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           The process is ongiong, The number and percentage of seniors reaching our service age in increasing each year and seniors are living longer. So facilities have to be maintained and kept safe for senior use. Transportation is needed for employees to ourtreach to the rural seniors.

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:
                 Rita Hargrave- Director - 95 Marianna Drive, Tallulah, LA 71282 Elected parish school board member-
    
     (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:
                 None

     (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:
                  0

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: 
               none

(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:
               none

          Provide the name, address, and office of the official to whom the person is related:
                none

          What is the nature of the relationship?  none

(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
500 Florida Blvd.
Baton Rouge, LA 70802


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