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?  $100,000

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:
           Mike Rome, Executive Director, 509 Montrose Road, Tallulah, LA 71282
Sara Finlayson. Board President, 811 Lillian Street, Tallulah, LA 71282
Joyce Williams, Board Vice President, 131 Chicago St., Tallulah, LA 41282
Beverly Cooper-Whitney, Secretary, 808 Mississippi St. Tallulah, LA 71282
Calvin Washington, Treasurer, 113 West Oghbourne St., Tallulah, LA 41282

Provide a summary of the project or program:
           The requested funding is to help cover the expenses of the Senior Center Addition which over ran the Capital Outlay Grant. TMVCOA is feeding 200 Homebound Seniors a hot meal each day and the rising cost of the meals and expenses to provide Senior the services they need increasing the burden on the funding sources available. If additional funding is not secured THMVCOA will have to reduce services. As the only transportation available, funding is needed to maintain required insurance levels.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $100,000
          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?
          Not Applicable

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To provide for the seniors of Madison Parish services needed. This includes homebound meals, transportation to medical appointments, homemaker services. These services are not available in this rural parish except through this agency.

What are the goals and objectives for achieving such purpose?
          he goals of TMVCOA is to allow the seniors of Madison Parish to age in the manner of their choice. Providing the services for the seniors to live independently in their homes. This includes educational information to prevent being scammed, and nutrition trainings, exercise programs and mental stimulation activities.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           This is an ongoing process,

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:
                 No Elected officials.
    
     (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:
                  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: 
               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?  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:
                 The Madison Voluntary Council On Aging is not a political subdivision.

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               The contract will be used to fund the extra services that are given to the seniors of Madison Parish. This funding is necessary because of the extra cost incurred in the building remodeling and the increased cost in supplies.


Contact Information
name:  Mike Rome 
                                       address:  203 S Elm Street
Tallulah, LA 71282
                                       phone:  318-341-0532
                                       fax:  318-574-3668
                                       e-mail:  mvcoa@att.net
                                       relationship to entity:  Executive Director