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NAME AND ADDRESS Home and Community Care Block Grant for Older Adults DOA-732(Rev.2/04) <br />COMMUNITY SERVICE PROVIDER County Funding Pla County Oran e <br />h Ju <br />ou <br />2005 th <br />200 <br />ne 30 <br />Senior Care of Orange County, Inc. g <br />r <br />July 1, , <br />515 Meadowland Drive, Suite 400 provider Services Sum mary Revision # ,Date: <br />Hillsborough, NC 27278 <br /> Projected Projected Projected Projected <br />Serv. Delivery <br />Required <br />Net" USDA <br />Total <br />HCCBG <br />Reimburse. <br />HCCBG <br />ota <br />{Check One} Block Grant Funding <br />Other Total Local Match Serv Cost Subsidy Funding Units Rate Clients Units <br />Services Direct Purch Access In-Home <br />193 10,193 <br />10 1,133 11,326 291 $ 35.00 5 291 <br /> <br />, <br />Adult Day Health Care x <br />193 - 10,193 <br />10 1,133 <br />11,326 <br />291 <br />$ 35.00 <br />5 <br />291 <br />, <br />Total \\\\\\\\\\ \\\\\\\\\\\ - <br />* Adult Day Care and Adult ' <br />Day Health Care Net Service Cost •.,' <br />ADC ADHC Certlfcation of required minimum local match availability. qutFwr¢ed Signet , Ttt a Date <br />Daily Care 94,020 Required bcal match will be expended simultaneously Com ervice Provider <br />Transportation 12,000 wnn Bloai< ~ t Funa+ng. <br />Administrative 83,625 <br />New Ser. Cost Total 189,645 <br />Finance Offer Date <br />t <br />C Signature,chalmian D e <br /> y <br />oun <br />Signature, Board of Commissioners <br /> <br />