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FY16 HCCBG Elderhaus revised funding planNAME AND ADDRESS Home and Community Care Block Grant for Older Adults COMMIINITY SERVICE PROVIDER DOA -732 (Rev. 2/15) Elderhaus, Inc. County Funding Plan County_New Hanover 1950 Amphitheater Drive July 11 2015 through June 30, 2016 Wilmington, NC 28401 Provider Services Summary REVISION # F DATE : 6/1/2015 A B C D E F G H 1 Ser. deli —) Check one) Black Grant Funding Required Local Matc Net` Sery Cost NSIP Subsidy Total Funding Projected HCCBG Units Projected eimburse Rate Projected HCCBG Clients Projected Total Units Direct P—h. Access - In -Home Other Total 72714 \ \ \ \ \ \ \ \ \ \ \ \ \1 \ \ \\ 8079 80793 80793 1263 63.9691 th AHealdt 25474 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 2830 28304 28304 404 70.0594 ADC 946 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 105 1051 1051 701 1.5 -ADH 160 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 18 178 178 119 1.5 \ \ \ \ \ \ \ \ \ \ \ \ \ \1 \ \\ 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \1 \\ 0 0 0 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \\ \ \ \ \\ 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0 0 Total \ \ \ \ \ \\ \ \ \ \ \ \\ 0 0 99294 99294 11032 110326 0 110326 2487 \ \ \ \U \ \ \ \ \ \ \\ 0 0 'Adult Day Care & Adult Day Health Care Net Service Cost ADC ADHC Daily Care # # ## 40.00 Certification of required minimum local match availability. Transportation Required local match will be expended simultaneously orized Signature, Title Date Administrative ## ## 30.02 with lock Grant Funding. Community Service Provider Net Sec Cost Total ## ## 70.02 , , \ ( SS — ignature, County Finance Officer Date Signature, Chairman, Board of Commissioners Date �i5 r \