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:
          

The last four digits of the entity's taxpayer ID number:  4167

What is the dollar amount of the request?  $150,000

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:
           Executive Director:
John Michael Rome
509 Montrose Road
Tallulah, LA 71282

Board of Directors:
Saraj Finlayson President 811 Lillian Street, Tallulah
Joyce Williams- Vice President -131 Chicago Street, Tallulah
Calvin Washington - Treasurer - 113 W. Oghbourne, Tallulah
Beverly Cooper- Whitney - 808 Mississippi ST. Tallulah, LA
Robert Butler - 100 Leslie Street, Tallulah, LA
Charlyn Paxton - 502 Old Hwy 65 S, Tallulah, LA
Thomas Mitchell - 701 S Walnut Street, Tallulah, LA
Birtdock Crosby P O Box 1673 Tallulah, LA
Lamar Walters - 125 Burnside Drive, Tallulah, LA
Sarah Sims - 902 LaSalle Street, Tallulah, LA
Luci Thornton - 1501 Mississippi Street, Tallulah, LA
Robert Ray Thornton,Sr. 313 McClure Street, Tallulah, LA
Michael Washington - 124 N. Madison Street, Tallulah, LA

Provide a summary of the project or program:
           The funds will be used to finish the unfunded portion of the Capital Outlay project that was funded last year. A portion will be used to improve the delivery vehicles used to deliver hot home bound meals.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $50,000
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $100,000

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?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To finish up building expansion for the Senior Center. Capital Outlay project funding was insufficient to complete the project. Funds that are used to provide meals and services to Seniors of Madison Parish were used and funds are needed to continue these projects at current levels. Madison Parish is a poor parish and there are no outside resources to fund these projects.

What are the goals and objectives for achieving such purpose?
          To serve the underserved community of Madison Parish. The seniors lack opportunities that are available in more urban areas. The Senior center needs to be designed and large enough to allow the senior activities. Meals and wellness programs are conducted here. There are no local groups or organizations that provide a location or services to the seniors of Madison.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           the next calendar year.

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:
                 None
    
     (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:
                  none

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:
                 none

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               none


Contact Information
name:  Mike Rome 
                                       address:  203 S Elm Street
Tallulah, LA 71282
                                       phone:  3183410532
                                       fax: 
                                       e-mail:  mvcoa@att.net
                                       relationship to entity:  Executive Director