FY18 SRC Prescription Asst CFMF Grant application('C,a e Fear
MEMORIAL FOUNDATION
Grant Application Instructions*
Please submit one (1) copy of the Application to the Foundation office. Applications with
original signatures (copies of signatures will NOT be accepted) must be RECEIVED in the
Foundation office by 5:00 p.m. on July 17'h, 2017, to be considered for a grant.
Please submit Applications via LISPS Mall or hand deliver to: (CAPE FEAR MEMORIAL FOUNDATION
DOES NOT ACCEPT APPLICATIONS REQUIRING A SIGNATURE OF RECEIPT):
Ms. Anna Erwin, President
Cape Fear Memorial Foundation
2508 Independence Boulevard
Suite 200
Wilmington, NC 28412
Please call (910) 452 -0611 if you have any questions. - Thank you for submitting your grant
application to Cape Fear Memorial Foundation.
* This Application for Funding will only be accepted if a Letter of Inquiry has been received and
approved for an Application by Cape Fear Memorial Foundation.
Cape Fear Memorial Foundation - Grant Application Form Page 1 of 12
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MORIAL FOUNDATION
Grant Application Form
Organization Information
Name: New Hanover County Senior Resource Center
Physical
Address: 2222 South College Road Wilmington, NC 28403
Mailing Address: 2222 South College Road Wilmington, NC 28403
Telephone #: 910 - 798 -6400 Fax #: 910 - 798 -6411
Contact Information
Primary Contact: Andrew Zeldin
Telephone #: 910 - 798 -6445
E -mail Address: azeldin @nhcgov.com
CEO /Executive Director Information
Name: Amber Smith
Telephone #: 910 - 798 -6410
E -mail Address:
Title: Social Work Supervisor
Fax # : 910 - 798 -6411
Title: Director
Fax # : 910 - 798 -6411
1. Summarize the organization's history and current operations. (Please limit response to
500 words)
Mission Statement: To act as the focal point for aging services in New Hanover County
by providing services which promote wellness, encourage independence, and enhance
quality of life for all older persons.
SERVICES:
BLOOD PRESSURE CHECK: Blood pressure health screenings are offered on the 3 d
Wednesday of each month from 10AM to 12 Noon.
CONGREGATE MEALS: Individuals 60 years of age and older may participate in the
Congregate Meal Service, Monday- Friday from 9:30 AM to 1:00 PM. Meal is served 11:30
to 12:00. A voluntary donation of $1.50 is recommended.
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FAMILY SUPPORT GROUPS: Support Groups for Blind & Visually Impaired, Deaf & Hard
of Hearing, Family Caregiver, Parkinson's, Essential Tremor, Lewy Body Dementia.
FITNESS AND HEALTH PROMOTION: A listing of exercise classes and other health
promotion opportunities is available at the Information Desk and is published in our
newsletter. The Hugh MacRae nature Trail is located adjacent to the Senior Center with a
0.3 and 0.6 mile trail for nature walks.
FRAN'S FANS PROGRAM: Provides fans for individuals with no means of cooling their
home.
FOSTER GRANDPARENT PROGRAM: Individuals 55+ who meet an income requirement
volunteer to nurture and mentor at -risk babies and children in pre - school, elementary,
and after - school programs.
HOME DELIVERED MEALS: Participants must be 60 years of age and older, live alone,
and unable to prepare his /her own meal adequately.
INSURANCE (MEDICARE) COUNSELING: The Senior Health Insurance Information
Program ( SHIIP) has volunteer insurance counselors trained by the SHIIP program and
the NC Department of Insurance.
PHONE PALS FOR FRIENDSHIP: designed to provide companionship for isolated and
home -bound elderly by matching them with an RSVP volunteer caller.
PRESCRIPTION DRUG ASSISTANCE: Counseling and education provided for the
Medicare Prescription Drug Plan. This includes enrollment assistance, Part D reviews,
extra help assistance, and problem resolution. Also includes assistance with obtaining
prescriptions at a lower cost.
RETIRED AND SENIOR VOLUNTEER PROGRAM: Matches the varied interests and skills
of volunteers age 55 and older with community needs by offering a diversity of volunteer
service opportunities through a wide range of placements.
SPECIAL NEEDS REGISTRY: The Registry is a database of individuals with special
needs and maintained by trained RSVP volunteers in support of the New Hanover County
Special Needs Task Force which evaluates and allocates available resources to meet
determined needs.
Family Caregiver Support program: Support groups, respite grant, information and
assistance, incontinence supplies and nutritional supplements.
TAX PREPARATION: The Volunteer Income Tax Assistance (VITA) Program is available
each year from February through April 15. VITA volunteers prepare basic State and
Federal Taxes for individuals free of charge.
TRANSPORTATION: Provided for medical appointments, to nutrition site, and group
grocery shopping. There is a waiting list.
INFORMATION AND REFERRAL: a Social Worker collaborates with community agencies
to assist clients locate resources that meet their needs.
2. Please attach an organizational chart or summarize the organization's
management /personnel structure. (Please limit response to 500 words)
SENIOR RESOURCE CENTER ORGANIZATIONAL CHART (2014 -15)
AMBER SMITH, SRC Manager
TINA HEATH: Administrative Specialist
RICHARD LOESER: Administrative Specialist
CHRIS DODSON: SRC Transportation Program Coordinator
HAROLD NORRIS: Transportation Program Assistant
GREG KENNEDY: Activities Program Manager
SHANTEL DAVIS: Activities Program Assistant
MARION Johnson - McIntyre: Part-time Switchboard Operator
2 SENIOR COMMUNITY SERVICE EMPLOYMENT TITLE V WORKERS: Part -Time
Switchboard Operator (not County employee)
ANDREW ZELDIN: Social Work Supervisor Life Enrichment Program (LEP)
REBECCA "BECKY" HAYES: Social Worker
JEFF LEE: Social Worker
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BART CANNY: Social Worker
VALORIE HATTEN: Econ. Case Worker
PAM WALL: Prescription Assistance Counselor
ELLEN CONNOR: Nutrition Program Manager
KELLY GILL: Nutrition Program Coordinator - Volunteer Drivers
KARLA BRIDGERS: Nutrition Program Assistant- Packer
MARGARET BRYANT: Nutrition Program Assistant - Congregate Site Manager
JARED HOLMES: Nutrition Program Assistant - Meal Delivery Truck Driver
MAYA DAVIS: Retired & Senior Volunteer Program (RSVP) and Foster Grandparent Program (FGP)
Manager
VALERIE SMITH: RSVP Program Coordinator
JEANETTE BELL: RSVP Program Assistant (Part-Time)
VACANT: FGP Program Coordinator
Summarize the background of organization's key personnel in the form of name, title,
and few sentences. (Please limit response to 500 words)
The NHC Senior Resource Center (SRC) is responsible to the New Hanover County Board
of Commissioners. The manager of the Department reports directly to Avril Pinder, one
of the Assistant County Managers. The Senior Resource Center works with two advisory
boards: VOCAL, Inc (Volunteer Older Citizen Action League, Inc) and the Home and
Community Care Block Grant Committee (HCCBG). Both of these advisory committees
provide advice and direction as well as recommendations to the NH County Board of
Commissioners for distribution of Home and Community Block Grant federal and state
funds. Key personnel include:
Amber Smith: Amber began her career in public service in 2001 as a part -time employee at the
New Hanover County Senior Resource Center. In 2003, Amber became fulltime as the retired
senior volunteer program (RSVP) coordinator and later as social worker for the Life Enrichment
Program. In 2012, Amber transferred to the New Hanover County Department of Social
Services as an adult protective services social worker, where she assisted disabled adults who
were in need of protective service from alleged abuse, neglect, and /or exploitation. After
transferring back to the Senior Resource Center in 2014, she served as the social work
supervisor. In 2015, she was promoted to director.
Pam Wall- Pam has an Associate Degree in Business Administration from Cape Fear
Community College, was a Licensed Insurance Agent for NC Property & Casualty, Life &
Health, worked as a physicians' office Claims and Billing clerk and came to the SRC from
Onslow County DSS Medicaid case worker. Pam has been instrumental in establishing the SRC
prescription assistance program as the primary referral source to assist seniors with prescription
assistance in New Hanover County. Referrals come from DSS, doctor offices, Social Security
Administration, Health Department, social workers, churches, and pharmacists.
Andrew Zeldin- Andrew is the social worker supervisor, managing the Life Enrichment Program.
Since 2011 Andrew has worked tirelessly as an aging life care professional while also teaching
at UNCW as a lecturer in the Gerontology program. Andrew received his master's degree in
Gerontology from UNCW and completed the University of Florida's Geriatric Care Management
Graduate Certificate Program. In partnership with Alzheimer's North Carolina, Andrew also
facilitates The Forget- Me -Nots, an early -stage support group for people recently diagnosed with
Alzheimer's and other related dementias, as well as their caregiver
Is the organization accredited by any agency or are any accreditations planned? If yes,
please provide details. (Please limit response to 300 words)
We are certified a "Center of Excellence" by the North Carolina Division of Aging and Adult Services.
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Briefly discuss the organization's board and staff development policies. Additionally,
discuss the organization's participation in the offerings for development offered by
QENO. (Please limit response to 500 words)
The Senior Resource Center works with two advisory boards: VOCAL, Inc (Volunteer Older Citizen
Action League, Inc) composed of active senior community leaders attuned to senior issues, and the
Home and Community Care Block Grant Committee (HCCBG) whose appointment is approved by
County Commissioners. Both of these advisory committees provide advice and direction as well as
recommendations to the New Hanover County Board of Commissioners for distribution of Home and
Community Block Grant federal and state funds. VOCAL board requires initial orientation from SRC
Management and monthly updates. The HCCBG Advisory Committee receives additional training from
the Cape Fear Council of Governments Area Agency on Aging
New Hanover County has a variety of training and development programs to support a culture of
continuous learning by providing a comprehensive offering of training and professional development
opportunities for our employees. NHC is committed to developing the most knowledgeable,
experienced and dedicated staff of professionals in local government. NHC does this by providing
organizational and employee development opportunities that support the County's mission and
strategic goals, effectively and efficiently serving the public as the Model of Good Governance.
S.E.R.V.E. NHC (SERVE is an acronym for: Succession, Evolution, Retention, Viability, and Engagement)
is the all- encompassing umbrella under which we deliver, as an enterprise, our training and
professional development for county employees to deliver the best service to our citizens and to one
another! In keeping with our efforts to align all of what we do to train and create better avenues, to
deliver our model of good governance, and in keeping with our commitment to public service; SERVE
is the platform to help us be our best -- to do our best. SERVE training and development includes point
and click university, customer service training, department specific training, and professional
development curriculum (SERVE Supervisor Impact Training, SERVE NHC /UNCW Professional
Development Academy, and SERVE Project Management Academy). The Core Curriculum identifies
courses of general application to all employees; examples include Customer Service, technology
proficiency (MS Outlook, MS Word, MS Excel ...), Diversity Awareness, and Interpersonal Relations.
Customer Service Certification Curriculum — Elevated customer focus is an organization -wide standard
by which all customers come away from contact with us feeling they have been served professionally
and respectfully, and that they were our priority. Another new program, NHC internal coach, is
available to all management level employees to assist them in their professional growth.
While NHC values QENO, NHC does not currently participate in QENO trainings. NHC does access all
other aspects of UNCW training in particular the Swain Center's Professional and Continuing
Education. We are committed to staff development and see UNCW as a valuable resource for our
department and for New Hanover County.
Does the organization have any affiliations with national organizations to which dues or
fees are paid? (Please limit response to 300 words)
Not applicable
Does your organization now, or does it plan, to engage in the promotion of political
causes or in affecting any state or federal legislation? If yes, please explain. (Please limit
response to 300 words)
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The SRC collaborates with the INC Senior Tarheel Legislature (STHL) program established by the NC
General Assembly on July 24, 1993. Each County has one representative and an alternate who reports
and makes recommendation to the INC General Assembly. They provide information and education to
senior adults on the legislative process and matters being considered by the INC General Assembly.
They promote citizen involvement and advocacy concerning aging issues, and assess the legislative
needs of older adults by convening a forum modeled after the NC General Assembly
1. What is the purpose of this request? (Please limit response to one sentence)
The Senior Resource Center (SRC) is requesting funding consideration for the Prescription Drug
Assistance Program (PDAP), which provides education and guidance on the complex Medicare
prescription drug plans and assists needy seniors in obtaining medications at no cost from
pharmaceutical companies, subsidy programs, physician samples, and other resources that may be
identified.
What is the geographic area and target population to be affected? (Please limit
response to 500 words)
The area serviced will be New Hanover County and the target population is residents who are 60+
years of age in New Hanover County.
Is this a new or an existing program /project? (Please limit response to one sentence)
This is an existing program.
4. Summarize the program /project. (Please limit response to 1,000 words)
The Senior Resource Center (SRC) is requesting funding consideration for the Prescription Drug
Assistance Program (PDAP), which provides education and guidance on the complex Medicare
prescription drug plans and assists needy seniors in obtaining medications at no cost from
pharmaceutical companies, subsidy programs, physician samples, and other resources that may be
identified.
The SRC and New Hanover County have made a commitment to have the PDAP continue as the need
for prescription drug assistance rises due to the significant increasing aging population, the continued
rise in prescription costs, and uncertain climate for health care insurance. The program continues to
increase the number of seniors served and provides a central location where seniors can get answers
to their Medicare prescription questions. Furthermore, collaboration with outside agencies and
service providers is at an all -time high. In 2016 -17, more than 671 seniors were counseled with a total
savings of $402,297.41 of direct prescription assistance savings. The requested funds would be used
to support the salary expense of the Prescription Assistance Counselor who currently works 40 hours
per week, up 15 hours from the previous fiscal year. With the increase in hours, when compared to
last year, the program had a 42% increase in the number of seniors that were served and assisted in
locating resources to reduce, and even eliminate, their prescription drug cost.
Below is a list of services offered by the PDAP:
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• PDAP assists seniors one -on -one in obtaining named brand medications at no cost. The source
may be through a pharmaceutical company, subsidy programs, physician samples, and other
sources that may be identified.
• The PDAP counselor assists with the completion of pharmaceutical applications and
communicating with the physician's office; to ensure everything is completed in a timely
manner.
• The PDAP counselor helps complete Low Income Subsidy Applications, if client feels they meet
the criteria and want to apply, which saves the client time from being referred to Social
Security office, when counselor can help client complete the application online.
• PDAP Outreach has become a top priority as the cost of medications continue to rise and our
senior population increases, especially in New Hanover County. Presentations to low income
housing facilities, churches, medical groups, retirees, and association meetings are just some
of the organizations where education is being provided on an annual basis.
• PDAP counselor works very closely with the Senior Health Insurance Information Program
(SHIIP), collaborating on a daily basis to best serve the SRC participants. The SHIIP volunteers
have been instructed to notify their clients of the PDAP and possible savings that may be
provided.
• PDAP counselor provides client referrals to the Department of Social Service for possible
Medicaid Assistance and /or Food and Nutrition Services.
• The PDAP encourages each client to be their own advocate. The counselor provides education
to insure the client has a clear understanding of their Part D plan, the monthly billing
statements, and the coverage gap, which many Medicare recipients encounter.
• PDAP counselor assists the client with the recertification of applications by serving as a liaison
between the client and pharmaceutical companies. The company guidelines are constantly
changing and clients depend on the program's counselor for guidance and assistance.
The seniors in our community are frustrated and confused by the variety of Medicare prescription
drug plans. At the end of each calendar year, they have a limited period to make changes to existing
plans and are faced with new rules, increased cost, and greater options. Making the correct choice is
not easy and they need a trained professional to provide guidance. We are hoping to secure another
grant for next year, with the possibility of a grant dollar increase, to support the growth in the
position hours and to serve more seniors in need of this important service.
Is this an evidence based intervention (Cite previous use /success and sources)? "Not
applicable" is an acceptable answer to this question. (Please limit response to 500
words)
Not applicable
Define the roles of the program /project's key personnel (please specify the personnel as
new or existing in the organization) and other partner agencies (Please include letters of
agreement from any collaborative partner). (Please limit response to 500 words)
Pam wall, the Prescription Assistance Coordinator's Job Responsibilities include:
• Assist seniors (60+) who are unable to afford costly prescription medication needs by
obtaining low /no cost prescription medications from pharmaceutical companies,
subsidy programs, physician samples, and other identified resources.
• Assist seniors with Medicare donut hole counseling, medical billing including
explanation of statement, and low income subsidy applications.
• Referrals and explanation of Senior Health Insurance and Information (SHIIP).
• Outreach: to reach beneficiaries with limited income and resources and assist them
with applications for the Low Income Subsidy program. Education: gives
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presentations to low income housing facilities, churches, health groups, civic
organizations, retiree association meetings, etc.
• Maintain a computer database of all clients served and prepare monthly reports to
analyze cost savings to program participants.
The Prescription Assistance Coordinator reports directly to the Senior Resource Center Social Work
Supervisor, Andrew Zeldin. Andrew Zeldin has worked with the older adult population since 2011.
Andrew's care management background and Pam's knowledge of the ins and outs of the prescription
plans, local resources, and drug companies, provide a high level of service to our senior citizens.
Amber Smith will provide all reports to the Foundation regarding this grant.
LIST the program /project's quantitative measures (number served, success rate)?
(Please limit response to 500 words)
From April 15, 2016 -April 14, 2017 661 seniors were assisted under the Prescription Assistance
Program. Within the 671 seniors served, 1410 services were offered to lower their prescription drug
cost. During this reporting period, there has been a confirmed $402,297.41 of direct prescription
assistance savings to the seniors served by this program. Many of the seniors who were assisted
would not have been able to afford their medication without the help of the Prescription Assistance
Program and would have otherwise made tough choices such as not taking the medication or cutting
their medication in half. As result, this program not only is a financial help to many, but also helps
seniors stay healthy and enhances quality of life.
1. Identify /Define results of the program /project. (Please limit response to 500 words)
The Prescription Drug Assistance program serves as a one -stop location where seniors on New
Hanover County can go to for information, one on one counseling, and special assistance with
navigating the complicated Medicare and prescription drug plan system.
Copay savings to NHC citizens below demonstrate the success and growth of the PDAP over the last
three years:
8/20/2013 — 6/30/2014 - $ 38,643.88
7/01/2014 - 6/30/2015 - $173,979.20
7/01/2015 — 6/30/2016 - $266,556.59
7/01/2016 — 6/30/2017 - $402,297.41
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2. List the program /project critical steps and timeline for completion. (Please limit response
to 500 words)
The most critical step for this program is securing additional funding. Since the program is already in
existence, the relationships with referring agencies and pharmacies are very strong. Many
pharmacists, physicians, nurses, and caseworkers call Pam Wall for her help in guiding their customers
to the right plan.
Timeline- ongoing. We are researching grants and private funding sources to support this vital
program.
This is a crucial time for older adults, with an average of ten thousand seniors turning 65 every day.
Health Care Reform is very uncertain at the present moment and as more and more baby boomers
reach Medicare age, the need for assistance will only increase. It is imperative that the Coordinator
be well versed in Health Care Reform and its impact on seniors. Timeline- ongoing
3. List the milestones the organization will recognize as steps toward success in the timeline?
(Please limit response to 500 words)
The most critical milestone is obtaining funding for this vital program. Almost all of the other services
provided by the Senior Resource Center are grant funded, mandated or generate revenue. This
program is vital, yet falls into the category of non - mandated, does not generate revenue because we
do not charge for the services, making it vulnerable when County budgets tighten.
4. List the expected benefits to the community as a whole upon success of this
program /project. (Please limit response to 500 words)
There continues to be an increase of older adults in our community as well as in the nation. Currently
40% of New Hanover County's population is 60+ years old. It is projected by 2035; NHC's population
will increase by of 59% of citizens 60 years old and older. Many older adults are faced with challenges
such as declining health and increased medical costs. There continues to be a rising "out of pocket"
expense to individuals regarding the cost of prescription drugs, both generic and brand name. Seniors
are faced with having to choose between purchasing life sustaining medications or buying groceries,
paying rent, utilities, and other basic needs expenses. This program allows for us to assess seniors for
local and state subsidies or patient assistance programs that can provide some relief to their
struggles. This program is valuable on many levels, but being able to assist one's health care needs is
at the top.
We have learned through seeing and listening that there are many seniors in our community that
have real struggles with affording basic needs such as medications. There are countless stories of
seniors who were assisted that stated a weight had been lifted off of them after receiving this service.
They are able to live a healthier life just by being able to obtain their prescribed medication (many
that are life sustaining medications).
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1. State the amount and term for which funding is requested. If funds are being requested
for multiple years, please state the amount requested for each term in addition to the full
amount requested. $10,000 Fy 2017 -18
2. Attach financial statements (audits, compilations, or forms 990) for the most recent 2 fiscal
years. If deficits were incurred, how were they covered? n/a
3. In the table below, please list the organization's Sources of Funding and amounts over the
previous 2 years by category (private, grants, fee for service, etc.)?
PREVIOUS SOURCES OF FUNDING (PAST 2 FISCAL YEARS)
From: 4/15/2017 To:4/14/2018
FY 2015
Income (By Sources)
FY 2016
33,715
Home Community Care Block G
977,353 Home Community Care Block G
977,310
NC DOT Transportation Grant
80,354 NC DOT Transportation Grant
170,743
Family Caregiver Respite Grant
23,000 Family Caregiver Respite
24,000
Cape Fear Memorial Foundation
9,500 Cape Fear Memorial Foundation
10,000
Foster Grandparent Grant
153,693 Foster Grandparent
153,693
RSVP Grant
111,097 RSVP
111,097
Health Promotion
11,793 Health Promotion
12,512
Sr. Center General Purpose
11,397 Sr. Center General Purpose
10,875
Senior Health Insurance Info
5,521 Senior Health Insurance Info
6,790
4. In the table below, please provide the complete Program /Project Budget including
expenses and income for the period the funds are requested.
Project Budget:
From: 4/15/2017 To:4/14/2018
Expenses (By Category)
Income (By Sources)
Salary
33,715
Cape Fear Memorial Foundation
10,000
FICA
2,365
New Hanover County
27,174
Supplies
75
VOCAL
7,000
Benefits
8,019
Total Expenses: $1
44,1741
Total Income: $
44,174
5. In the table below, please itemize the Sources of Funding for this Request. Include public,
private, fee for service, fundraising and other sources in addition to the status (budgeted,
pending, approved, or declined) of the projection.
Cape Fear Memorial Foundation - Grant Application Form Page 10 of 1.
Last Revised: 06/07/2017 (1GD)
Funds Requested for this Project
From:4 /15/2017 To:4/14/2018
Organization
Status
Amount
Cape Fear Memorial Foundation
requested
10,000
VOCAL
approved
7,000
N FIC
approved
27,174
SHIIP & MIPPA (Dept of Insurance)
0
6. In the table below, please provide a complete Organization Operating Budget including
expenses and income for the period the funds are requested.
Expenses (By Category)
Income (By Sources)
Home and Community Care Block
1,927,638
HCCBG services (8 programs)
977,310
ROAP Transportation
170,743
ROAP
170,743
Family Caregiver Support Program
23,000
Family Caregiver Support Program
23,000
SHIIP & MIPPA (Dept of Insurance)
13,444
SHIIP & MIPPA
13,444
General Purpose (state)
14,607
General Purpose (state)
10,875
Prescription Assistance
44,174
NHC general fund, CFMF, VOCAL
44,174
RSVP
160,857
RSVP (Corp for National Comm Sen
111,097
Title III D
20,307
Title III D
12,512
FGP
174,036
FGP (Corp For National Comm Sery
153,693
Total Expenses: $1
2,548,806
Total Income: $
1,516,848
7. In the table below, please itemize the Sources of Funding for the Organization as a whole.
Include public, private, fee for service, fundraising and other sources in addition to the
status (budgeted, pending, approved, or declined) of the projection.
VOCAL
approved
Home and Community Care Block Grant
approved
DOT 5310 Transportation Grant
approved
Family Caregiver Respite Grant
approved
Foster Grandparent Grant
approved
Retired and Senior Volunteer Program Grant (RSVP)
approved
WAVE -ROAP Transportation Grant
approved
Sr. Center General Purpose grant
approved
Senior Health Insurance Information Program Grant
approved
8. If the funds requested are to be used for capital acquisition, please attach quotes or
estimates. N/A
9. If the program /project increases operating costs, how will these increases be funded after
this grant period? (Please limit response to 300 words)
Cape Fear Memorial Foundation - Grant Application Form Page 11 of 1
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We will seek grant funding from other sources and will ask New Hanover County for
support. The public is not charged a fee for the service. VOCAL utilizes part of fund
raising funds to support the program. A full time position to provide this service to the
citizens would not be possible without the support of Cape Fear Memorial Foundation,
VOCAL, and NHC general funds.
10. How will this program /project increase the sustainability of the organization as a whole?
(Please limit response to 300 words)
This program allows the New Hanover County Senior Resource to continue to focus on
its mission "To act as the Focal Point for Aging Service in NHC by providing services
which promote wellness, encourage independence and enhance quality of life for all
older persons ". We are the primary organization in New Hanover County providing this
valuable service to seniors.
11. Does the organization have any endowment funds? What are the restrictions on these
funds? (Please limit response to 500 words). N/A
PLEASE NOTE - Cape Fear Memorial Foundation requires periodic progress reports to be
completed informing the Foundation of the progress made by the organization's program /project
and its associated expenses. Grant payments are contingent upon receipt and review of these
reports. Preliminary Progress Report forms for current grants will be mailed in the beginning of
July and due no later than August 15, 2017.
Auv,� i\ - Pi42r
Typed or Printed Name of CEO /Executive
Director
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Signature of CEO /Executive Director
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Title
Date
Woody White, NHC BOCC
Chairman
Typed or Printed Name
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Date
Cape Fear Memorial Foundation - Grant Application Form Page 12 of 1
Last Revised: 06/07/2017 (1GD)
Hewett, Teresa
From:
Smith, Amber
Sent:
Tuesday, July 11, 2017 1:24 PM
To:
Hewett, Teresa
Cc:
Zeldin, Andrew
Subject:
CFMF application FY18
Attachments:
CFMF application FY18.docx
Importance: High
Teresa,
Can you route the Cape Fear Memorial Foundation grant application for signatures? This is to help continue support the
prescription assistance position and was included in the adopted budget. We have to turn in the signed application to
CFMF by Monday, 7/17/17. Thanks.
-Amber
Amber Smith I Director
Senior Resource Center
New Hanover County
2222 S. College Road
Wilmington, NC 28403
(910) 798 -6410 p 1 (910) 798 -6411 f
www.nhcqov.com
07/11/2017 15:17 INEW HANOVER COUNTY - LIVE P 1
9811thewett NEXT YEAR BUDGET DETAIL REPORT Ibgnyrpta
PROJECTION: 2018 FY17 -18 BUDGET PROJECTION
ACCOUNTS FOR:
GENERAL FUND VENDOR QUANTITY UNIT COST 2018 ADOPTED
302850 GRANT- LOCAL -OTHER REVENUE -GRAN
11068713 302850 - G0215 GRANT- LOCAL -OTHER REVENUE -GRAN 10,000.00
Projected revenue from Cape 1.00 10,000.00 - 10,000.00
Fear Memorial Foundat
610000 SALARIES AND WAGES
11068710 610000 - G0215 SALARIES AND WAGES 33,176.00 *
PROGRAM ASSISTANT (11203) 1.00 .00 33,176.00
621000 SOCIAL SECURITY TAXES
11068710 621000 - G0215 SOCIAL SECURITY TAXES 2,538.00
FICA
00 .00 2,057.00
MEDICARE
00 .00 481.00
622000 RETIREMENT -LOCAL GOVT EMPLOYEE
11068710 622000 - G0215 RETIREMENT -LOCAL GOVT EMPLOYEE 2,515.00
LOCAL GOVERNMENT RETIREMENT 00 .00 2,515.00
625000 MEDICAL INSURANCE EXPENSE
11068710 625000 - G0215 MEDICAL INSURANCE EXPENSE 9,131.00
00 .00 9,131.00
BUD_MEDICAL /DENTAL
07/11/2017 15:17 NEW HANOVER COUNTY - LIVE
9811thewett NEXT YEAR BUDGET DETAIL REPORT
PROJECTION: 2018 FY17 -18 BUDGET PROJECTION
ACCOUNTS FOR:
GENERAL FUND VENDOR QUANTITY
626000 LONG TERM DISABILITY INSURANCE
11068710 626000 - G0215 LONG TERM DISABILITY INSURANCE
.00
BUD—LTD
f�
( b k F
=L i
P 2
bgnyrpts
UNIT COST 2018 ADOPTED
66.00
00 66.00
TOTAL GENERAL FUND 57,426.00
TOTAL REVENUE 10,000.00
TOTAL EXPENSE 47,426.00
GRAND TOTAL 57,426.00
** END OF REPORT - Generated by TERESA HEWETT **
07/11/2017 15:17 NEW HANOVER COUNTY - LIVE
9811thewett NEXT YEAR BUDGET DETAIL REPORT
PROJECTION: 2018 FY17 -18 BUDGET PROJECTION
ACCOUNTS FOR:
GENERAL FUND
Field # Total Page Break
Sequence 1 1 Y Y
Sequence 2 11 N N
Sequence 3 0 N N
Sequence 4 0 N N
Report title:
07/11/2017 15:17 NEW HANOVER COUNTY - LIVE
9811thewett NEXT YEAR BUDGET DETAIL REPORT
PROJECTION: 2018 FY17 -18 BUDGET PROJECTION
Report type: 3
Include employee with benefit detail: N
Budget level:
Percentage change calculation method: 1
Print detail lines: B
Print first or second year of budget requests: F
Print revenue as credit: N
Include cfwd in rev bud: N
Include cfwd in actuals: N
Print totals only: N
Include segment code: N
Include report grand totals by account type: Y
Print full GL account: N
Double space: N
Suppress zero bdgt accts: Y
Print as worksheet: N
Print percent change or comment: C
Print text: Y
Amounts /totals exceed 999 million dollars: N
Print five budget levels: N
Report view: D
3
VENDOR QUANTITY
UNIT COST 2018 ADOPTED
bgnyrpts
P 3
bgnyrpts
FOR PERIOD 99
y
UNIT COST 2018 ADOPTED
bgnyrpts
P 3
bgnyrpts
FOR PERIOD 99
Grant Document Routing
136
Start date: 7/11/17
From: Teresa Hewett, Finance Department (7408)
Signatures required:
✓ Avril Pinder, Deputy County Manager
/Woody White, Chairman
Return to Teresa Hewett, Finance Department (7408)
Type(s) of document(s) attached:
1 original — Senior Resource Center Prescription Assistance Program grant application
Explanation of document(s):
Attached is a grant application for the SRC Prescription Assistance Program with the Cape Fear
Memorial Foundation. This grant was included in the FYI Adopted Budget. 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
0
Signature