FY16 SRC CAPE FEAR MEMORIAL PRESCRIPTION ASST GRANT CONTRACTOrganization:
Amount of Grant:
Date of Payment:
Term of Grant:
Project Title:
Grant ID:
(7,`-a-'P'
ear
MORIAL FOUNDATION
GRANT CONTRACT
New Hanover County Senior Resource Center
$10,000.00
4/15/2016
12 Months
Prescription Assistance Counseling (PAC) Program
1722
The following terms are agreed upon as conditions for this grant:
The tax- exempt status verified in the proposal is still valid; any changes in the organization that could
lead to a change in the status will be reported to Cape Fear Memorial Foundation immediately.
2. The funds will be used by the above -named organization solely for the purposes described in the project
title above. No funds will be utilized for the purpose of promotion or advancement of political causes
3. The organization will keep and maintain records of expenditures adequate to verify the use of grant funds.
Progress reports concerning budget, personnel and program developments will be timely completed and
returned to Cape Fear Memorial Foundation. Misappropriation of grants funds or unsatisfactory progress
(as determined by the Foundation) may result in a demand that the grantee repay grant funds to the
Foundation.
4. The organization will repay, upon demand, to Cape Fear Memorial Foundation the amount of the grant if
any condition of the contract is not upheld. Additionally, the organization will repay Cape Fear Memorial
Foundation an amount equal to the book value of any assets acquired through a capital grant from Cape
Fear Memorial Foundation if and when your organization is sold, or loses its tax- exempt status or no
longer provides services consistent with those supported by this grant.
The organization will send to the Foundation copies of any printed publicity regarding the awarding of the
grant or the program supported by the grant; the organization may, if it chooses, refer to Cape Fear
Memorial Foundation's support in any such publicity.
6. Future payments under multi -year grants will be subject to availability of funds and to satisfactory review
of progress reports which document meaningful progress toward the goal.
The following special terms will be observed: None
The to is contract are accepted by:
Cape F r Memori Fo on New Hanover Countyy Senior Resource Center
By: By:
nna Erwin, CPA, President Printed or Typed Name of Board Chairman
Date: April 6, 2016 By: CN
Si atture of Board Chairman
Date:ot� J
�P
2508 INDEPENDENCE BLVD, STE 200
WILMINGTON, NC 28412
BOARD OF DIRECTORS:
AGNES R. BEANE
WILLIAM H. CAMERON
GARRY GARRS, C1.1 .
JAMES D. HUNDLEr, M.D.
W. CARTER MEBANE, III
JANELLE A. RHYNE, M.D., M.A.C.P
RONALD SINCLAIR
ROBERT F. WARWICK, CPA
RICHARD L. WOODBURY
ANNA ERWIN, CPA, PRESIDENT
�Ga���-\Je Fear
I MEMORIAL FOUNDATION
(910) 452 -0611 PHONE
(910) 452 -5879 FAX
www.cfmfdn.org
April 7, 2016
Ms. Amber Smith
New Hanover County Senior Resource Center
2222 South College Road
Wilmington, NC 28403
Re: Grant ID: 1722
Prescription Assistance Counseling (PAC) Program
Dear Ms. Smith:
At its meeting on April 6, 2016, the Board of Directors of Cape Fear
Memorial Foundation approved a grant of $10,000.00 for your organization.
This grant is to help fund the above- referenced project. To accept this grant,
please have your Board Chair sign and date both copies of the enclosed Grant
Contract. Retain one original for your records and return an original to us for
our file. Please do not send any mailing to the Foundation requiring a
recipient's signature. If confirmation of receipt is required, organizations are
encouraged to follow up with an email or telephone call. The grant check
will be mailed by April 15, 2016 provided a signed contract has been
received.
With your acceptance of this grant you agree to use these funds only
for the purpose shown above and to provide progress reports as requested by
us. Misappropriation of grant funds or failure to timely and accurately
complete and return progress reports may result in our demand for a
repayment of monies to the Foundation.
Please feel free to publicize your receiving these funds. However, we
would appreciate a copy of any release you make.
The Directors of Cape Fear Memorial Foundation are pleased to
support you as you serve our community and wish you continued success.
Since
Anna Erwin, CPA ` )
President
Enclosures
DEDICATED TO ADVANCING GOD'S DESIRE FOR OUR HEALING AND HEALTH
Grant Document Routing
107
Start date: 4/19/16
From: Teresa Hewett, Finance Department (7408)
Signatures r uired:
Beth Dawson, Board of Commissioners Chairman
Return to Teresa Hewett, Finance Department (7408)
Type (s) of document(s) attached:
2 originals — SRC Cape Fear Memorial Foundation Prescription Assistance Counseling
Explanation of document(s):
Attached are two originals requiring the Chairman's signature to accept a $10,000 grant to be
used for the Senior Resource Center's Prescription Assistance Counseling program. This grant
was approved by the Board as part of the Adopted FYI 5-16 Budget, therefore no Board action is
required at this time. Please let me know if you have any questions. Thank you
----------------------- -- for finance department use---------------------------- `----------- - - - - --
DATE ADDED TO LASERFICHE
PICKED UP BY:
Print Name & Date
Signature
NEW HANOVER COUNTY
Lisa Wurtzbacher, CPA
FINANCE DEPARTMENT
Chief Financial Officer
230 Government Center Drive
G0VNTY. `p
Suite 165
�` R,
Barbara D. McClure, CPA
Wilmington, NC 28403
? F
Deputy Chief Financial Officer
Telephone: (910) 798 -7187
- o
i
Jennifer R. Maready, CPA
Fax: (910) 798 -7806
Deputy Chief Financial Officer
April 26, 2016
Ms. Anna Erwin
Cape Fear Memorial Foundation
2508 Independence Blvd, Suite 200
Wilmington, NC 28412
Dear Ms. Erwin,
Enclosed is one executed original of Grant ID 1722 for the Senior Resource Center's Prescription
Assistance Counseling Program. The County has retain one original for our records.
New Hanover County sincerely appreciates Cape Fear Memorial Foundation's continued support of this
important program.
Sincerely,
Teresa R. Hewett
thewett(a) nhcaov.com
910 - 798 -7408
Website: w .nhceov.wm
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